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Is U.S. health care the best or ‘least effective’ system in the modern world?
The U.S. has the world's most expensive health care system, but it leaves roughly 30 million people uninsured. As policymakers consider making changes, some are looking to Australia as a model. That nation has achieved universal health coverage at a lower cost, using a successful mix of public and private systems. William Brangham reports for our series "The Best Health Care? America & the World."
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.
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, Fealofani 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 Fealofani, and, for Paul, brain surgery to remove a malignant tumor.
At first, they panicked over what they feared would be a huge price tag.
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.
But then you found out that the public system was going to cover a majority of that?
A majority of that, yes.
Well, it covered all of it.
It covered all of it, actually.
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.
Well, I'd be crippled, really, in one leg.
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.
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.
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?
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…
Private room, better food, those sorts of things. You know, 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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:
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.
The members of the Dunn family have given up trying to convince each other that their health care choices are best.
They're OK with the division.
And I was going to say, vive la difference.
Vive la difference!
For the "PBS NewsHour," I'm William Brangham outside Sydney, Australia.
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William Brangham is a correspondent and producer for PBS NewsHour in Washington, D.C. He joined the flagship PBS program in 2015, after spending two years with PBS NewsHour Weekend in New York City.
Jason Kane is a PBS NewsHour producer, focusing on health care and national affairs.
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