Is U.S. health care the best or ‘least effective’ system in the modern world?

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• Judy Woodruff:

  This global pandemic has again driven home the crucial role that our health care system plays in our health and our well-being.

  And, tonight, we begin a special series about how we provide health care in America, compared with how it is done elsewhere in the world.

  William Brangham and producer Jason Kane filmed this series in the weeks before the pandemic broke out.

  And William joins me now to explain a bit more about the series.

  So, hi, William.

  I know you two worked very hard on this. Tell us a little about what the series covers.

• William Brangham:

  Well, as you said, Judy, we started this before the pandemic broke out.

  And the idea was to look at the state of American health care, how it is today. And, as you know, this is a country with remarkable innovation in that field, remarkable innovation. And yet this is also a country with incredibly stark disparities.

  There's over 30 million people who have no health care insurance whatsoever. And so we thought, 'Can we learn something about — can we learn something from other nations that do a better job of covering everybody?'

  And there is obviously a political side to this. We saw a big debate going on in the Democratic primary. We know this is going to be a big issue in the presidential campaign. Vice President Biden wants to expand the Affordable Care Act and get us closer to universal coverage. President Trump says he wants to get rid of the ACA and replace it with something better and to lower costs.

  But we thought, 'Since there are so many nations that are already doing a very good job of this, let's go there and see how they're doing it.'

• Judy Woodruff:

  So, inevitably, as you say, it is going to be a part of the campaign.

  Where did you go to make these comparisons?

• William Brangham:

  Well, we went to three countries that provide good, inexpensive, universal health care to their people.

  And there's been this debate happening in this country about: Is health care actually a right? These are nations that are not having that debate. They're just doing it for their citizens.

  And the key metrics that we looked at here are access, quality, cost, and how they take care of the disadvantaged in their societies. And the U.S., frankly, doesn't do that well on a lot of those metrics.

  So we went to several nations, three in particular, the United Kingdom, Switzerland, and Australia, all of which measure better. And we wanted to see, how do they do it? Let's look at exactly the mechanics of how they get there.

• Judy Woodruff:

  And, as you say, you started filming — you were filming before the pandemic broke out. But, of course, since then, it's become a huge public health concern.

  How did you look at how these countries are dealing with that?

• William Brangham:

  Well, initially, we are not looking at that.

  We really wanted to stay focused on this issue of universal care, in part also because the way these countries responded to the coronavirus pandemic is only partly influenced by the structure of their health care systems.

  I should say, at the end of this series, we will have a conversation very specifically about how they responded to COVID. But we really wanted to stay focused on: How is it that these countries are able to cover everyone at seemingly a reasonable cost, and what might we learn from that experience?

  And so, for that, we begin our story here in the U.S., in Houston, Texas.

  This is a boy saved by American innovation. A bouncing, rocking, joyful testament to the miracles of modern American medicine.

  His life was transformed here, in what's called the largest medical city in the world, the Texas Medical Center in Houston. Here, doctors test artificial organs built from scratch. Technicians design robots to speed efficiency.

  Surgeons use virtual reality reconstruction to see tumors inside the body before ever making an incision. And kids like 6-year-old Cason Cox come back from near death.

  Cason was born with only half his heart functioning normally, the hints of blue in his skin a sign of a little body hungry for oxygen. Most kids with this condition don't live very long.

• Savannah Cox:

  I can remember it perfectly. It was pouring rain outside, of course, and I was by myself. And my doctor told me that she sees that Cason's heart is underdeveloped. It was a very few dark days for me.

• William Brangham:

  But in 2017, using a new and highly complex surgical technique at the Texas Medical Center's Children's Memorial Hermann Hospital, Dr. Jorge Salazar changed the course of Cason's life.

• Jorge Salazar:

  Cason was going to die. And had we done what we have always done, he would have had a transplant already, or — it's a hard thing to say, but he would have passed away already. But now we have a normal child in front of us.

• Savannah Cox:

  Dr. Salazar came out with the biggest smile on his face, and he said, "I did it. You did it. He did it. And it works."

  So, I mean, I think we all started crying.

• William Brangham:

  Cason Cox is one story.

  The Texas Medical Center performs 180,000 surgeries every year. And it, like other gold standard medical centers across the U.S., draw hundreds of thousands of patients from around the world. The technologies and innovations created in the U.S. also get exported globally.

  Elena Marks, President and CEO, Episcopal Health Foundation: You see what your options are around here…

• William Brangham:

  But just a few miles away, it's a world apart. In North Houston, the mostly low-income residents here experience a very different health care story.

• Elena Marks:

  I want you to see that, within just a few miles, you have the very best and the very worst.

• William Brangham:

  Elena Marks: is the president and CEO of the Episcopal Health Foundation. They analyzed CDC data that revealed incredibly stark inequalities here.

• Woman:

  They don't know a discharge date right now.

• William Brangham:

  The mostly Black residents here are disproportionately uninsured, and they often don't get care until it's too late. They die, on average, 20 years earlier than residents in other parts of Houston.

• Elena Marks:

  You know, the deck is stacked against you. If you could get to the medical center, that would be great, but you would probably be really sick, because of the neighborhood you live in, by the time you get there.

• William Brangham:

  The U.S. spends more than $3.5 trillion on health care every year. It's nearly a fifth of our economy. As a percentage of GDP, that's almost twice what most developed nations spend. We spend more than all these nations combined.

  And yet Americans still die of preventable and treatable diseases at higher rates than in other high-income countries. Ours has been called the most expensive, least effective health care system in the modern world.

  Lack of health insurance, or the high cost of health care, is a huge barrier for millions. In one recent poll, more than one in three people said they skipped medical treatment because of money. That includes people with health insurance.

  And, last year, more than 30 million Americans, about 9 percent of the country, had no health insurance at all. Since the pandemic, an estimated three million more joined their ranks.

  For many years, Houston resident LaKeisha Parker was among the uninsured. She was a certified nursing assistant.

• Lakeshia Parker:

  I was proud of that work. I enjoyed doing it, because I love to be able to help people.

  So, what I would do is go into people's homes after their surgeries or illnesses, and assist them with getting back to life, daily activities of living, bathing, fixing them a small meal, going to get their…

• William Brangham:

  That's very intimate work with — right.

• Lakeshia Parker:

  It is, very intimate work.

• William Brangham:

  But Parker says the pay wasn't great. She says the most she ever earned was about $13 an hour. And it never came with health insurance she could afford.

• Lakeshia Parker:

  I'm actually working in health care, and can't afford to pay it. That's not right.

• William Brangham:

  Texas has the highest uninsured rate in the nation. Roughly 18 percent of Texans, five million people, don't have insurance. And the state didn't expand Medicaid, which would insure more low-income Texans, under the Affordable Care Act.

  So, like many, Parker went for years without checkups or seeing a regular doctor. Too expensive, she said. But then she discovered a lump the size of a tangerine in her breast. It was malignant cancer.

• Woman:

  Relax your arm for me.

• William Brangham:

  Parker found this Houston clinic that would treat her on a sliding scale, based on her income. Only after the cancer diagnosis did she qualify for a special Medicaid program.

  So, the tumor, along with 33 lymph nodes, were removed. While surgery was a success, it, along with the chemotherapy and radiation, left her unable to use one of her arms like before.

• Woman:

  OK. Not bad. OK, let me feel underneath your arm.

• Lakeshia Parker:

  Sure.

• William Brangham:

  Do you think, if you had had health insurance, you would have found this sooner, you would have been going to the doctor sooner?

• Lakeshia Parker:

  If I would have had insurance for me at that time, health care that I would have been able to afford, I would have easily accepted it.

  But, again, it comes the question of having somewhere to live, having something to eat, gas to get back and forth to work. So…

• William Brangham:

  Those were the choices you were wrestling with?

• Lakeshia Parker:

  Of course. You know, those are everyday life choices that a lot of people have to make based on their income.

• William Brangham:

  The weakness in her arm cost her her job. With no money, she lost her apartment.

• Lakeshia Parker:

  And you become homeless if you cannot pay rent.

• William Brangham:

  Parker is now homeless, unemployed, and at the time of our interview, living in a shelter.

• Dr. Ashish Jha:

  Houston represents both what is the best of American health care and really what is the worst of American health care.

  You have parts of Harris County, which is where Houston is, where life expectancy is lower than what you see in many Third World countries.

• William Brangham:

  Dr. Ashish Jha, who's now the dean of Brown University's School of Public Health, traveled with us for this series. He says that the seeming choice between medical innovation and universal coverage is a false one.

• Dr. Ashish Jha:

  I reject that dichotomy as, somehow, we have to have 20, 25 percent of people uninsured if we're going to have a really highly innovative health care system.

  There are many reasons to reject that. So, take a state like Massachusetts, where I live. It's also very dynamic, incredible new innovations happening. And yet pretty much everybody in Massachusetts is covered.

• William Brangham:

  How do we wrestle with this idea that we're in a place with this incredible level of innovation, and technological advancement, and yet we are seeing these disparities in health care? What is causing those horrible end of the numbers?

• Dr. Ashish Jha:

  So, the disparities we see are driven — it's some by high costs. Of course, if health care spending was cheaper, it would allow us to cover more people.

  But there's also a bunch of political choices we have made. We have just decided, as a society — not everyone has decided this, but many political leaders have — that it's OK to have people die from totally preventable, totally treatable diseases because we're not going to cover them. That's a political choice.

  Of course, I think that's a terrible political choice. We can cover everybody in America without bankrupting the country, without creating long wait times. But we have to decide that we're going to do that.

• William Brangham:

  For our next three programs, we travel to the United Kingdom, to Switzerland and to Australia to look at how they get to universal coverage, and what the U.S. might learn. So that America can both embrace its innovation…

• Savannah Cox:

  It just makes me feel good just to know that he is getting this life that he deserves.

• William Brangham:

  … and address its disparities.

• Lakeshia Parker:

  We are still citizens. We pay taxes. It makes me feel that we don't matter.

• William Brangham:

  So those two worlds don't remain so far apart.

  For the "PBS NewsHour," I'm William Brangham in Houston, Texas.

• Judy Woodruff:

  And a quick postscript to William's report.

  LaKeisha Parker has a new job at Amazon. It has benefits, and she will soon be moving into her own apartment.