JUDY WOODRUFF: We continue with our series
on universal health care.
As the United States struggles with the most
expensive health care system in the world,
some have started looking to Australia.
William Brangham and producer Jason Kane report
on how that nation has achieved universal
coverage at a lower cost.
Their story was filmed before the pandemic
began.
WOMAN: Hello.
(LAUGHTER)
WILLIAM BRANGHAM: Don't be fooled by this
happy scene. This is a family divided.
OK, it's not quite that serious, but the division
is stark when it comes to, of all things,
health insurance. On one side, Felofani Elisara and her husband Paul Dunn rely on Australia's
public health care system. It's known as Medicare.
It's paid for by taxes, and it's available
to all Australians and permanent residents.
That public system has gotten them through
some pretty traumatic stuff, IVF treatment
and a hysterectomy for Felofani, and, for
Paul, brain surgery to remove a malignant
tumor.
At first, they panicked over what they feared
would be a huge price tag.
PAUL DUNN, Australia: I was really scared.
I was like, what am I going to do? Do I need
to start a GoFundMe? Which my friends did
for me and my family did for me anyway.
WILLIAM BRANGHAM: But then you found out that
the public system was going to cover a majority
of that?
PAUL DUNN: A majority of that, yes.
FELOFANI ELISARA, Australia: Well, it covered
all of it.
PAUL DUNN: It covered all of it, actually.
WILLIAM BRANGHAM: On the other side:, Paul's
parents, Carole and Ross, are evangelists
of the private sort.
They skip over the public system and buy their
own private insurance coverage. About half
the country does this. Carole recently had
her knee replaced and said she got great care
and terrific perks.
She says, if she'd been in the public system,
she'd be in agony, on a waiting list.
WOMAN: Well, I'd be crippled, really, in one
leg.
WILLIAM BRANGHAM: This hybrid system, with
the public Medicare system as a base, but
then layered with private insurance on top,
is by design.
They're meant to work together, with the private
system taking pressure off the busier public
one. This unique setup meets two basic values,
says health economist Rosalie Viney.
ROSALIE VINEY, University of Technology Sydney:
Just as one of the tenets of Australians'
beliefs is that they should have access to
public care, there's also an element that
choice is part of what a lot of Australians
seem to value.
WILLIAM BRANGHAM: Help me understand. If you
have a system where any person, any Australian
can go and get free care from their G.P. or
at a public hospital, what is the rationale
for private insurance?
Why would I, as an Australian, ever want to
pay extra, if I can get it for free?
ROSALIE VINEY: So, some of it is about access
to elective care at the time when they want
it. Some of it is about access to the amenities
that a private hospital might offer. Some
of it...
WILLIAM BRANGHAM: Amenities like?
ROSALIE VINEY: Private room, better food,
those sorts of things. You have a choice of
menu. Some of it is about choice of your own
doctor.
But some of it is actually about getting quicker
access. So, waiting lists can be long. And
particularly for elective surgery, waiting
lists in the public system tend to be long.
SARAH KOZICKI, Nurse in Training: The whole
sense of waiting for me, like, with endometriosis,
you could be in bed, like, chronic pain. So,
that could mean a year without working, two
years without working. And it's just -- that's
not feasible either.
WILLIAM BRANGHAM: A private health plan makes
sense for Sarah Kozicki. She's training to
become a nurse, and every couple of years,
she needs a costly surgery for endometriosis,
which is a painful disorder involving the
uterus.
SARAH KOZICKI: So, for that, I choose to have
private health insurance, that I can go and
have surgery when I need to have surgery.
I can do it in a private hospital, or do it
in a public hospital as a private patient,
and I get to choose my specialist.
WILLIAM BRANGHAM: The outcomes for both systems
have been quite good. Australians live longer
than Americans, they're healthier and they
see their doctors more.
They don't die of preventable diseases nearly
as often as we do. And they get these results
for less money, spending about half what we
do per person.
Costs are kept low partially because the government
sets prices for drugs, treatments and other
expenses. But there's one major problem. Increasing
numbers of Australians are choosing not to
buy private insurance, people like Emily Maguire.
She's a teacher, she's healthy, and she says
the rising cost of living makes it hard to
justify paying for a private plan.
EMILY MAGUIRE, Teacher: And, like, the public
health system is so great. Like, they do a
great job.
So, I'm just like, no, I think I will trust
them. And if I need something, then I will
pay for it myself. I'm not too worried. It's
a little bit about, I think, my values as
well. Like, I don't want to be paying for
something that I'm not really getting anything
from, if you know what I mean.
WILLIAM BRANGHAM: An estimated 64,000 Australians
dropped their private health insurance in
2018, and this creates what's called a death
spiral for the system.
Younger people, who tend to be healthier,
have been leaving the private market, while
older people, who tend to be sicker, have
been joining it.
Rosalie Viney says that cycle then perpetuates
itself.
ROSALIE VINEY: Private insurance holders tend
to be those who are more likely to use private
insurance, and so we see premiums start to
creep up, associated with use of the care.
WILLIAM BRANGHAM: Remember, the private system
is meant to relieve pressure on the public
one. So, now the government is spending over
$4 billion a year in subsidies to encourage
people to buy private care. And that cost
keeps going up.
JANINE MOHAMED, CEO, Lowitja Institute: So,
what would be better is if we actually took
a reinvestment of those private health care
dollars, and put it into our primary health
care system.
WILLIAM BRANGHAM: Janine Mohamed has a very
different idea of where those billions ought
to go. She runs the Lowitja Institute, a research
organization that advocates for better health
care for Australia's Aboriginal and Torres
Strait Islander populations, people who've
suffered decades of racism and discrimination.
On average, people from indigenous groups,
like Kylie Battese, suffer higher rates
of chronic diseases than their peers. Mohamed
says they die 11 years earlier, on average,
than non-indigenous Australians
JANINE MOHAMED: It just seems ridiculous that
those funds can't be redirected to Aboriginal,
Torres Strait Islander health, when we know
that we have the poorest health outcomes in
Australia.
So, for us, it's, you know, giving the most
privileged more funding.
WILLIAM BRANGHAM: Dr. Ashish Jha, dean of
the Brown School of Public Health and a collaborator
with us on this series, says, yes, there are
significant problems here.
But every nation's health system is a work
in progress, and Australia has made important
strides that the U.S. hasn't.
DR. ASHISH JHA, Director, Harvard Global Health
Institute: When we look across the world,
we see lots of different systems that seem
to work. They get universal coverage, good
outcomes, reasonable costs.
They don't all look like each other. And there's
a lot we can learn from Australia, from the
U.K., from Switzerland, all of which have
very different systems from each other. But
each of them can teach us specific things
about how we can improve coverage and lower
costs and improve outcomes for our own country.
That's the key here, is to learn those lessons
without worrying about importing any of these
systems wholesale and trying to transplant
them into the United States.
WILLIAM BRANGHAM: The members of the Dunn
family have given up trying to convince each
other that their health care choices are best.
WOMAN: Cheers, guys.
MAN: Cheers.
WILLIAM BRANGHAM: They're OK with the division.
WOMAN: And I was going to say, vive la difference.
WOMAN: Vive la difference!
WILLIAM BRANGHAM: For the "PBS NewsHour,"
I'm William Brangham outside Sydney, Australia.
