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What universal health care means during a pandemic

Our series on universal health care, The Best Health Care? America and the World, was filmed before the novel coronavirus pandemic exploded. How have the three countries we explored -- the United Kingdom, Switzerland and Australia -- responded to this global crisis? And what lessons might they offer the United States? William Brangham reports and talks to Dr. Ashish Jha, our series collaborator.

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  • Judy Woodruff:

    We turn now to our series on universal health care in three different nations, and concerns in our own country.

    William Brangham filmed this series before the pandemic exploded. Tonight, he looks at how those countries have responded to COVID since then, and what lessons they may provide.

  • William Brangham:

    We started this series in Houston, Texas, looking at the U.S. health care system.

    And then we visited the United Kingdom, Switzerland and Australia, asking: How is it they have managed to do what we haven't, achieve universal health care?

    But one thing we didn't address is how those nations dealt with this novel coronavirus. Does a universal health system give inherent advantages when a pandemic occurs?

    To answer that, I spoke again recently with our collaborator on this series, Dr. Ashish Jha. He's the newly appointed dean of Brown University's School of Public Health.

    Ashish, very, very good to see you again.

    I wonder, could you start off by just giving us a quick synopsis of how these three countries, Australia, Switzerland and the U.K., how did they handle the pandemic?

  • Ashish Jha:

    Yes.

    So, William, the bottom line is, I think all three of those countries have done a much better job than we have. There's a lot of variation. They're not all the same.

    U.K. probably has handled it the worst of the three. They had quite a bad outbreak in the beginning, and a lot of people got sick and a lot of people died. But they're in much better shape now than we are. And the other two countries, both Switzerland and Australia, I think, have really been exemplars of how you handle this pandemic.

    We saw in Switzerland not just really good messaging that led to a pretty substantial lockdown, but then also government engagement in buying protective equipment that helped protect doctors and nurses.

    Australia, I think, has been terrific at building up their testing infrastructure. They are testing widely with very, very low percentage of positive tests.

    So, the strategies look different in each country, but each of them did different things really well.

  • William Brangham:

    And how much of the actual structure of their health care systems contributed to that response?

  • Ashish Jha:

    So I would say, a little.

    There's no doubt about it that there are features of their health care system that gave them certain advantages over us and over ours. But, overall, the big difference is really about the public health response, which has been very different in each of those three countries compared to the U.S.

  • William Brangham:

    You touched on this, but how much does a nation's political leadership rely on how well they respond?

    I'm thinking, in particular, of people who've talked about the fact that the U.K. has Boris Johnson. And his Cabinet was as influential in the U.K.'s response, as compared to having their National Health System.

  • Ashish Jha:

    I would say leadership's been pretty central across the world.

    When I look at countries across the world, how seriously leaders have taken the virus, how effectively they have mobilized forces has had a — has had a very dramatic effect. And so even Boris Johnson, who I think initially did not take the virus as seriously, really struggled with what the U.K.'s response should be, eventually got on board with a much more science-driven process.

    Of course, he himself ended up getting infected and quite sick, and I suspect that probably helped shape some of his thinking about the seriousness of this virus.

    But, certainly, both in Switzerland and Australia, we saw very different types of leadership, much more engagement, much less misinformation coming from political leaders.

  • William Brangham:

    When you look at the U.S. response, are there aspects of our health care system and the way we structure health care in America that impacted our ability to respond?

  • Ashish Jha:

    You know, there are.

    I mean, there are obviously a lot of strengths of our health care system, fabulous doctors and nurses, really good hospitals. But some of the payment issues, I think, have really hindered us.

    There are examples, like, in nursing homes, when we wanted to start testing health care workers, we couldn't figure out who was going to pay for it.

    The bigger issue, in my mind, has been, even though the policy response has been, we will pay for COVID care, the truth is, Americans, especially with high-deductible health plans, or people who don't have insurance, are deeply worried about costs, and rightly so.

    And that has really prevented them from seeking care. And, you know, that kind of fear in the middle of a pandemic really makes it hard for people to do what is necessary.

    And so I think, as we emerge from this pandemic, we're going to really have to look at our payment system and ask, do we really want people to act like consumers in the middle of a pandemic? Do we really need people to feel that extra set of stress, or can we find a better way?

  • William Brangham:

    At the risk of sounding a little too general, is there something about the way those three nations have responded to the pandemic that you think we could learn if, God forbid, we have to go through this again?

  • Ashish Jha:

    Yes, absolutely.

    So, those three countries have all done it a little differently, right? There's a lot of variation among them. But when you look at the consistent themes, there are two or three things that I think really stand out.

    One is consistent public health messaging. You did not hear their leaders undermine scientific guidance. I think that's been really critical.

    Second is, all of them have had much more substantial investments in public health. The U.K. has built up this fabulous testing and tracing infrastructure. They don't think it's as fabulous as it could be, and maybe it's not, but it's certainly much better than ours.

    What you saw with Switzerland was this incredible investment in making sure that the health care workers were protected through PPEs, again, the government getting much more engaged.

    So, it strikes me that messaging is really important, investing in the things that are outside of the health care system is important, and then a central role for government to coordinate all of this, because this is not something the private sector can figure out on its own. This is not something a fragmented system can figure out on its own.

    It's a pandemic. It requires that kind of concerted response.

  • William Brangham:

    Dr. Ashish Jha, dean of the Brown School of Public Health, as always, thank you so much for your time, and thank you for all your help on this series.

  • Ashish Jha:

    It was my pleasure. Thank you for including me and for being part of this.

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