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, Mother of Cason: 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.
DR. JORGE SALAZAR, Children's Memorial Hermann
Hospital: 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.
LAKEISHA PARKER, Former Certified Nursing
Assistant: 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.
LAKEISHA 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.
LAKEISHA 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 feel underneath
your arm.
LAKEISHA 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?
LAKEISHA 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?
LAKEISHA 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.
LAKEISHA 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, Director, Harvard Global Health
Institute: 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.
LAKEISHA 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.
