Health Care Systems Around the World

just say, speaking for Molly and I thank god? Yeah, you're not speaking for me to Do you think I like this? Chuck? Are you ready to move on? Yeah? Okay, okay. So we've talked about healthcare reform. First of all, Molly, what was that statistic that that you mentioned, um a long time ago in a in a podcast far far away, where you said, like only one in a Americans think that the health care system in the US needs reforming.

Are happy with their healthcare as it is. So. Um, what we've kind of deconstructed is why healthcare form is even on the table. We've talked about the uninsured. Right. We've talked about the fact that UM that America has UM really really terrible like mortality rates or UM disease rates, chronic disease rates, that kind of stuff. UM. So that in and of itself makes the health care system worth fixing. Right.

But one thing that hasn't been brought up, and I haven't seen it brought up in coverage too much, is the fact that our health care system is actually keeping us from competing as well as we could on a global scale, right, which is why we would compare ourselves to other health care systems around the world. You know. The thing is that no one in this country wants

to become like any other system in the world. But I don't know if you could find anyone who lives in another country who wants to trade place with an American that comes to their health care. We'll put We'll put let's talk about competitiveness and the health care reform system via Dr Michael Royson, who you guys might remember, right, Yes, what is he? Dr Roysen is the chief Wellness officer of the Cleveland Clinic and my hero and the co author of UM The You the Owner's Manual book series.

Right with Dr Oz here is what he had to say, because healthcare is a expensive thing in America, and that we need reform for the economy to function, for jobs to be created, and for us to be competitive with Europe and Asia four jobs, and for us to not worry about a following standard of living, and for people to not worry, not have the stress of worrying about will there be health care for me when I need

it that I can afford? Okay, So, if we're going to keep up with Europe and Asia, like Dr Reason suggested, we could by reforming our health care system. Um, maybe we should kind of peek in on what other countries around the world are doing, whether for better or for worse. Um, Malla, you wrote this article ten health care systems around the world, right, which is up on the site. Yeah, it's sort of I think, a virtual hot air balloon ride through the

world of health care. It was. It was a delightful one too. It was beautiful, like so many bloody bandages. Um, so, where was there any particular health care system that struck you as arguably better than the US or better than all the other ones? Actually we wait, wait, let's talk about France. France transition. Oh gotcha get it? Yeah, I do. Now we mean yes, it's like, okay, France, Uh, they apparently have the best health care in the world, I

mean World Health Organization. Right. Yeah, it's hard to argue with who. Moving on then, no, that's actually um, I think just because it's become a relic in the healthcare reform debate in the United States that who um two thousand report of a hundred countries healthcare system rankings is controversial. I think we should say that. Everybody's like, oh, well who said that? So okay, it must be true. Um.

But again, you can pick apart anything. But so let's just stick to the fact that France was rated number one in the year two thousand by the World Health Organizations rankings of a countries. Right, right, So all French citizens will put in money based on their income, you can't opt out of it, and then in return they'll get about seventy of their healthcare paid for by the government. Um, you can get same day appointments, you can choose any

healthcare provider you'd like. Um. But okay, so we said, s how do they pay for the other thirty percent? They all have supplemental insurance with either a public or a private plan, and that is more similar to how we have in the U S where that supplemental plan might come mere employer. So there there are a couple of problems with the French system, and it's not flawless. There is no flawless plan. We should go ahead and say that, you lie. Um. I saw one guy that said,

I said it like this. He said, it's sort of like medicare for everybody with the French system. Yeah, I got it, and he was he was a pro. So they make up the other thirty with private plans, right, private or republic. And that's the problem is if you have money, then you would probably opt for a private plan. So some critics would say that the French plan is too divided by class. People who want really good care and can pay for it, get it. Those who can

don't write. But they do that in England too. You can get also get your private insurance, right yeah, and we should say for a kind of a comprehensive rundown of England. Molly gave one in the third podcast. Right, so we're not gonna talk about this, We're okay. I mean it was a nice step on the balloon ride. But here's how France got it's awesome writing. Okay, it spends personal healthcare while that you spins over twice that, UM,

so already they're using money pretty well. And if you get really sick, like you have just the worst form of cancer in the world, everything is paid for. Yeah, that's what I saw that your article. In some other stuff I read is that if the sicker you are in France, the better off you've got it, or the easier and quicker your claims will get paid as well. Exactly. But it's not just the really sick who benefit. Because UM, I think what's cool about Frances they have the lowest

rate of deaths that could have been prevented. The US has the highest number of these preventable deaths that they say, or you know, if you had had an early diagnosis or if you'd had an early treatment in condition right, I did see also in another article I read that UM. One of the criticisms criticisms is that there's not great coordination between the GPS and the specialist in France. But if you're talking about problems, that's not the worst thing

in the world. That's better than being denied for a pre existing condition. I think, wouldn't you say, I wouldn't say, yeah, Um, you guys done with France, because I'd like to get back in the balloon, okay, and just head on over a few kilometers a few clicks, if you will, to Germany, which is um out of the out of the healthcare systems in the in the article, this one's my favorite,

and I'm not embarrassed to say that. One of the reasons why is because of the ample access to spa days and even the public health insurance plans, right and there's two hundred of them, correct, and their employer and employee funded, right. Yeah. And you know where that comes from is actually in three old Otto. Von Bismarck was like the spies. He was like, I want some healthcare

like they had back in the days of guilds. And so he is basing all of this off the fact that when you were in your medieval guild for being, you know, the podcasters guild, the you know clothmaker's guild, you know with Germany, that was how they named them. Um, they all pay for each other sick time. They all got together, and it would be like us saying podcasters, let's have to pay for Josh's care when he has a stroke from smoking. I we can't even get podcasters

to unite under this roof. I doubt if we can get it all around the world. So model, this is a pretty old system, and um, it's been around for hundreds of years. But if because they're always willing to keep reforming it. Yeah, I noticed that in another article UM from Berlin University. Actually, um, it was kind of a rundown of the German healthcare system. All these different years kept coming up, like they try new things like every year or two. Uh, and it seems like that's

probably what you'd have to do. I think the impression that a lot of people in America have, whether supporters or opponents, is that this healthcare reform is going to happen and that's it. Yeah, And I think you're I think you make a very bad the point that it has to keep evolving and changing as problems come up or as things prove very effective, you know, you put more money into this or take funding away from that. Right.

Some of their cool new initiatives are these disease management programs UM, where if the patient gets more counseling from a doctor, like if a nurse calls them up at home to make sure they're taking their meds, you know, sticking with their diet. These people have much um lower rates of hospital emissions and much lower rates of deaths from people than people who have the exact same conditions who aren't getting that counseling. So I think that's a

pretty cool way to approach disease. I don't know, I could see like half the people in the United States thinking it's really nice thing to get a call, and half the people be like, stay out of my business, nurse, how did you get this number? Right? Well, and you know it's not like the nurses and the doctors love the system. I would say that you read a lot

of articles about how the German doctors feel underpaid. To protests the most often right German doctors says they're paid about two thirds what American doctors um make, and but they pay less for malpractice insurance and some of them go to school for free med school. And you know one cool factor that I did not manage to squeeze into this article. But um, those plans, those two in our plans that we were talking about those plans get

incentives if they get sicker people on their rosters. So instead of a system like in the US where people where we tend to deny people, they get benefits for doing that. In Germany it's pretty cool. Also, saw where you can in Germany you can go straight to a specialist, like you don't have to go through your gatekeeper GP, which's kind of cool. Also, there is a private insurance market for UM people who make over forty eight thousand

euros a year. It's not compulsory for those people. Actually, long term health insurance is compulsory for everybody, but basic health care coverage isn't compulsory for people who make over forty eight thousand euros a year UM. So there's another uh I guess accompanying private insurance market, but that's still regulated by the government. UH. There's like you can't deny for pre existing condition and UM. And apparently your rates are assessed when you enter that private system UM based

on your risk. But that's it. There's like a one time risk assessment and that sticks with you for the rest of your life. I missed the DEUT. I'm just gonna go ahead and say that you missed the Deutsche Mark. Yeah, I missed the deutsch Mark. Miss I missed the frank I miss this whole euro business. Yeah, but I hate to change money from country to country, so I thought it was kind of thrilling. But then you're left with

your leftover coins. Yeah, but then you take them and you give them to your cousins and nephews and nieces. I actually haven't been to Europe since the introduce the Euros, I'd probably love it. Speaking of redistributing money. Oh, I know we're going next. This is gonna be kind of a long balloon ride. So it's just fly forward to when we when we land in Cuba. So Cuba, let's talk they have healthcare for well, you'd give the skinny

because I have. I just read some articles where they say it wouldn't so for well, you know the famous example, I think Cuba. If you're a Michael Moore fans, when he took people to Cuba so they could get better care than they could in the United States, and you know it was meant to embarrass the U s health care system. There are obviously a lot of critics, as with anything Michael Moore does, of how it was portrayed

in the movie. And some people say that there is um sort of one level for the people they're going to impress and then one level for everyone else, Right, But I do think that even those people who are in maybe that lower um echelon get an immense amount of preventative care. That's pretty pretty cool. Well that's it sounds like they do, uh do a pretty good job with preventative care because they kind of have to. Well, you guys were talking about Germany and doctors or nurses

calling you up to going how you doing. Um, If you had a problem with that, you probably really have a problem with Cuba because any any person is subject to a surprise visit from their physician once a year. Yeah, they are going to stop at your door, see what you're doing, What are you eating? They're like, while we're here,

what's under your mattress and what's in your closet? Well, see, that's sort of the problem is that, you know, because they have the preventative care, because they may not have let's say, a fridge or access to really fatty food or a really great car. Um. So it's almost like the you know what we would see as the deficiencies in Cuba have created a culture whereby they walk a lot,

they don't have fast food. I mean it's coming. They say that that might be sort of the next wave of obesity, as Cuba is getting some fast food really well. As a result, Cuba they have I think they spend two hundred and sixty bucks of person on healthcare a year A year, Yeah, right, because they're they're really good with preventative wellness. But I do want to point out, you know, sometimes I believe you brought it up, Josh, there's the thought that if we spend a lot less

on healthcare, will really skimp on our innovation. But Cuba surprisingly is known for its um innovation of medical break facs. I have heard that they the medical sector is their sixth largest in exports, obviously not to the US, but they really got to put themselves on the map with some vaccines they've come up with first meningitis B and then hepatitis B and UM. So they're really making a name for themselves in terms of their pharmaceutical and mechanical

medical equipment exports. Chuck, you reference some articles that you've read that the Cuban um I think this is one of the systems where it all depends on who which side you're reading, because I read a bunch of articles that said and a lot of these people interviewed Cuban refugees that were now living in America, and they said things like there's two health care systems, one for health tourists, which apparently Michael Moore is a health tourist, and that's

a big deal, kind of camera coup filling yourself around that, right, you're gonna get treated differently. But there's health tourism is a big deal there, and you can go and pay cash. And so there's one system for Communist Party officials and health tourists and then one for the rest of Cuba, and they maintain that, you know, if you're the rest of Cuba, you can't get things like aspirin, you can't get any biotics unless it's on the black market, and you don't have access to a lot of like basic

medical care. Uh, you have to bring your own cheets to the hospital. Stuff like that. Well, I think there's also a concern that they get these really great statistics by fudging their numbers a little bit, Like Cuba has really good rates of mortality. I thought that was interesting. But in the United States, you know, if if a baby is born only lives a very short period of time, we count that, whereas if it was in the same if it was a lie for the same period of time,

in Cuba, they may count that is dead on arrival. Right, And didn't you also say that some doctors allegedly will suggest abortions in the world the government UM suggests they abort a fetus that could be developmentally disabled or something. Right, Right, you know, there's just concerned that UM they have great numbers, but because you know, we don't really know much felt what goes on inside the country, we don't know exactly know how to get them right. It was really nice

to visit it. Can it can be hard to separate your opinions on the Cuban health system from your opinions just on Cuba the country, right, So I don't want to oversell Cuba, Okay, but I'm glad I got to visit the balloon. I don't have any opinions on Cuba other than what I've heard from a couple of friends have traveled there and said it was really awesome, the men, that people were lovely, and the country is beautiful when politics aside the country itself. The love it's illegal, it's illegal,

actually not true. Um, so you guys, let's head on over to China. Okay, Well, here we are in China, and this place is kind of screwed up all. I mean, I don't know if i'd want to get sick here. It used to be pretty good from what I understand in your article that there was cooperative healthcare system right right, and they dismantled it and that just didn't go very well because, uh, you know, no one knew were to send the bill, and the places they were sending the

bill didn't pay up. And what the huge effect of this was that there's a giant divide between healthcare and cities and healthcare in the rural areas. Yeah. One of the I guess ideas for Chinese healthcare reform was that all farmers pay a dollar for healthcare, and they bought in a year, and they balked at that as being too expensive. Are the rural Chinese that poor really well just not really taken seriously over there. One Well, I think they're also saying that yes, a dollar was high,

especially for the care they got. I was reading one article it was in the New York Times about how you got us in these world clinics and stray dogs are walking the halls of the clinics. But it's not worth a dollar a year. Straight dogs in your hospital. They bring dogs into American hospitals to perk up cancer patients and nice, healthy ones, not one that looks like they're going to die. You don't know whether they're straight or not. You're talking about the uh like they have

different names at every hospital, I guess. But Love on four Paws, that kind of programs dogs love to not enough hospitals. Well, okay, so China is in addition to it's ridding the hospitals of stray dogs initiatives. Um, they're planning on building seven hundred thousand I guess probably pet unfriendly clinics in rural areas. I mean, maybe they'll bring

the nice dogs into those clinics. But yes, they are in the middle of funneling just a ton of money into their healthcare system and hopes that they cannot eradicate this divide between ten years or so, ten or eleven years, but by the population will have health insurance. They're hoping the billion on it. Yes, e yen you want. I don't really know how to pronounce anything in China. Want. That doesn't sound like very much money to me. It

does to build seven thousand clinics. Yeah, and well. The other problem is Molly points out that um of that money UH is supposed to come from the central government, which means provincial governments are gonna have to make up the rest. And right now, no one knows if they're going to pay up right, sort of the problem they had when they first dismantled them. No one wants to pay for healthcare. That's true everywhere, but you know one place where they do pay. There we going back to

a bloom. Now, do we have enough game it's run on unicorn tiers? Excellent? Okay? Do we have enough unicorn tiers to make it to tai wall on? You think? Oh? I hope so, because Taiwan's got a pretty nifty system. I don't think it would work in this country. But dude, the smart card. The smart card sounds so convenient, although kind of mirror bracking for someone like me who has the tendency to lose things. Wait, wait, you guys can get to Taiwan. Okay, I wanted to do. I wanted

to brief check before we got there. They're chatting along the way. Let's just all sit silently in a balloons. Alright. So we're in Taiwan. Now this is lovely. So back to the smart card before we were exactly Um, okay, So you get a smart card. It's got your entire medical history on it, right, and you can just show up to a doctor and give them your card and they can pull up your entire medical history. And that

is how they will also build a government. So it's like your healthcare credit card that you never have to see the bill for and it's your entire medical history. Now, of course, I people who say that's a way too much information for any government to have about a person.

I like the idea of the smart card. I wouldn't mind all my medical information being on one car because I'm a little distressed every time I go to the doctor and I see them pull out a paper file in the midst of thousands of paper files, it seems very archaic to me. Well, I've I've moved quite a bit and I just hate having to kind of start over every time with every doctor. And what do you do. I actually haven't changed doctor as much. You get them

to send everything to your new doctor. I think you're supposed to. Really, maybe I shouldn't reveal how poorly I manage my health switchovers. So I am a health writer. The smart card sounds word well, yeah, medical medical billing, medical information. It's a huge, huge problem in the US,

just an administrative costs and time. Yeah. And that's the thing that was cool about what Taiwan did is that in expanding coverage to cover so much more the population, that they cut all those costs because now they have no administrative costs essentially. But the fact matters is that now Taiwan doesn't spend enough on healthcare to cover their costs, and the Taiwanese have gotten used to these really low healthcare costs, and people of our frager RaSE the taxes

the age old story. Yeah, saw, we're a family and average family premium it's six d and fifty dollars a year in Taiwan. So I can't even think about car insurance for that. So are we done with Taiwan? Is that smart card? This place is really clean, by the way, have you noticed the food is good? Yeah, let's go to Russia. Okay, guys, thank you again for nuts speaking during the balloon ride. So we're in Russia now, and unfortunately this is not a good place to get six.

So no one drink the water here. Okay, okay, right, but you can't drink the water in Russia. No, okay? Really, wow, I didn't know that. You think they would have had that worked out? So they not in a place that has one of the four worst healthcare systems in the world. Right, is there another one we may have heard of that's in that list? According to Foreign Policy, the United States also makes that list. It was a foreign policy article,

so it's it's not stellar. The World Health Organization that we mentioned earlier ranks them out, so, you know, and they've got a fair bit of money. It seems like they should be doing doing a little bit better. And this is another system sort of like China, where they dismantled their old Soviet system which was pretty well admired around the world, and tried to create a public private combo system. And basically this system works well in theory

but sucks in practice. Financially, it doesn't work out, right, I don't even think of I mean financially personally you got to show up with a pretty hefty bribe to see a doctor in Russia. Yeah, I thought that was really interesting that the on paper or you know, um spoken, it's um the populations covered, but the government doesn't really pay up and so to keep operating hospitals and doctors go, um, yeah, I need you to give me a donation, buddy, or

else I'm not going to you. It's extortion for healthcare, which is nuts. Can we just be careful because I don't want Vladimir Putin to listen to this podcast listen to the word extortion, So let's make stop your brief. I think. I think what's good to know is that the World Health Organization, Love It or Leave It, recommends the countries spend about five percent of their total spending on healthcare, and Russia spends three. Okay, I don't want

to alarm anybody. Some guys just pointed at us and are starting to come over, So we should probably get back to our balloon. Okay, a pretty happy place. Canada. Okay, yeah, we had a lot of Canadians right in, So what about us? We have a lot of Canadian fans, and so we're gonna we're gonna talk about you all now up there in the Great White North. Okay, I'm gonna let that one slide. Uh. We're here in Canada now. Um, thank you Molly for not speaking during the journey. I

couldn't be quilled any longer. I was writing a personals ad for AMOUNTEE, So let's see if we can find you one here. But first, let's talk about the healthcare system in Canada. This is the one that the US is often compared to. If we're if we go to socialized men or something this this Canada. I always feel bad for him because they serve as like some sort

of cautionary tale for what we don't want. But from what I hear that it's not nearly as bad as as we've been told by some quar right, people are trying to treat Canada like the worst case scenario, and I think that, um, this is due to a lot of commercials and from what I can understand, I mean, I haven't talked to these people myself, but it seems like people are very good about going and finding the people who did have just staggering long wait times and

put them in the commercial. Right. I have some Canadian friends who I keep up with on the blog and they've they've written me before and said, you know, it's not perfect over here. Wait times aren't nearly as bad as you're depicted, though, and we'll take it any day. And I think wait times were really bad back in the eighties and early nineties, and then in the nineties

Canada invested billions of dollars to improve the statistics. And so now if you want to head over to a clinic, before you go over, you type in which clinic you want and they will tell you what the weight time is. So I mean that's sort of transparency. I think it's pretty hard to find in this country. And then the wait times aren't it's it's not for like basic care right and usually for like special elective surgeries and the right the weights are longest for you know, like knee

replacements sort of elective things. And I think that one of the ways that Canada does keep their costs low and comparison to the United States is they don't buy every single new fangled machine that comes out. In the United States, we have a tendency to buy every single cool gadget, and that's and that really can make our health care systems seem like it's working really well. It really does provide us a great level of care. But it doesn't mean that the old machines were necessarily in

bad shape. Right, But there appears to be something of an equally American sentiment among Canadians that they do like they're pretty machines like an m R I and new r m R I. Because there you mentioned in the article there's a I guess, a subculture of rogue doctors who offer UM unlicensed illegal medicine for people who don't want to wait and can pay up. I assume, right, right, mean, I think that that's sort of the message you can take from any of these systems is the people who

have money will use it. UM. We should also say that if you're going to compare country with socialized medicine to what the US, what the fear of what the US might become, you shouldn't you shouldn't point to Canada. You'd be much better off pointing to Britain, because while Canada does have a single payer government system of healthcare UM, the hospitals and doctors are private entities, their private enterprises. Right in Britain, they run the hospitals and pay their doctors.

But in Canada it's just single payer. And let's talk about that means, because single payer seems like such a dirty word to people. UM. Here's how Canada pays for their health insurance. The citizens fund you know, their their healthcare by paying income taxes and sales taxes and then UM, all that money is sort of funneled through to the provinces and the territory. So it's not even like Canada as an entity is pushing out the money. Gotcha you clear on that, Josh, I am. Do you want a

fun fact? Yeah? Please? Did you know that open heart surgery cost less in Toronto than it does in Chicago? Really? Yes, that's crazy. Also, prescription drugs tend to cost a lot less in Canada, UM, from what I understand from Roison during that phone interview, because UM Canada promotes far more competition among UM pharmaceutical companies. The same pharmaceutical companies that might be based in the US are doing business here in the US or bass why their costs are lower

for pharmaceuticals. And also doctors and nurses make a fair bit less. So I don't know if I don't know if doctors want to go to Canadian system. Okay, kids, one last stop on our whistle stop tour, taking a good one. I feel like doing some skiing. Um, let's go to Switzerland, a little good chessolate. Okay, here we are in our last stop. It's beautiful. You see the red crosses everywhere in the Alps and the nice smiling rib apple cheep face. I'm going to stay neutral and

not give you an opinion on this. That's their Their health care system is really expensive, really really expensive. And yet um, Americans who are looking for alternatives abroad, seemed to love it. Both Democrats are Republicans because it's a pretty good system. But it's just expensive. Right. Well, you know they have free choice, but they pay for that, they do. What do you mean by that? Well, I will tell you you know how everyone here is all

freaked out about public health option. Um, it's all private plans in Switzerland. It's not tied to your employment at all. You just can go into a marketplace, let's say, for lack of better word, pick your private plan and um, you know, making fancily want and it can cost a lot. You can just seven fifty dollars per family per month.

Not Yeah, so pretty steep. So generally Republicans like the choice you can have a private plan, and Democrats like the fact that even though that's expensive, everyone's covered because those who can't afford it receives sus tous from the government. But I don't know if you want to go from being a first expensive most expensive healthcare sites from the

world's second most expensive healthcare in the world. One of the things I found significant in your article about Switzerland was that, um, your healthcare providers aren't allowed to make a profit off of basic healthcare. They make their profit off of like elective surgeries. Um up tom and trade things like that. I'll turn the medicine. Just the right to get a private room in a hospital, that's a little bit extra. Um. So yeah, every everyone's private plan

is essentially the same, and everyone pays the same. That's the key thing. It's not tied to how much money you make. Regressive not progressive. Wow, I got a little efect for you to one of the largest insurance companies in Switzerland pays out claims in five business days. That's awesome and people love it, they said, I'm sure clearly you guys want to go back to the studio. You get your kind of like here in Switzerland. I'm going to go back to the studio and wrap this up,

all right, good knowing you. So I'm here with Josh. I couldn't let him go alone. Thanks. We left Molly and her mounty in Switzerland. Let's say those two are a handsome couple. They are. They're going to live out the rest of their days in the alps Um, she promises postcards, Yes, and chocolates. Yes, we have finished the fourth installment of our podcast Sweet, which means it's the end of our special healthcare podcast Suite. I have hot

air balloon lag. I know you do, buddy. We'll get you the bed with some warm milk and a beer in a second. Okay, yeah, um, chuck, let's wrap this this puppy up all right. And Molly, she's really here. We've really Oh yeah she is. She's sitting right there just daydreaming about the mount here. I like the life you pulled for us. Yes, um, thank you very much Molly for joining us. I don't know that we could have done this without you. It wouldn't have been the same.

Definitely agreed, no problem. Thanks for having me, guys, and thank you, of course, the Dr Roison who gave us like an hour of his time quite generously and for free, like you didn't have lives to say. I was expecting him to be like a Russian physician, be like I demand a donation, right, but no he didn't. Um and thank you for tuning in to listen to our four part series on healthcare reform. It's an important issue, which is why we tackled it and hopefully you learn something

from it. Had some of your questions answered. If you have more questions, you can visit Molly's wonderful articles on the site. At how stuff works dot com. You can just type healthcare reform in the handy search bar, and if you have any questions that you want to direct towards me and Chuck, you can send those in an email to stuff Podcast at how stuff works dot com. For more on this and thousands of other topics, is

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