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JOHN WHYTE: You’re watching


Coronavirus in Context.


I’m Dr. John Whyte,


chief medical officer at WebMD.


How do you feel


about your health care?


Is it good?


Is it bad?


A lot of people


will say we have the best health


care in the world,


if you have insurance.


And what has COVID taught us


about the realities of how we


deliver care in the United


States?


To help provide some insight,


I’ve asked William Brangham.


He’s the host of a new series


at PBS NewsHour called The Best


Health: America and the World.


William, thanks for joining me.




WILLIAM BRANGHAM: Doctor, very


nice to see you.


Happy to be here.




JOHN WHYTE: Now, you started


filming this series pre-COVID


to really provide insight–


you–


you have this great line where


you talk about we have


tremendous innovation


in the United States,


yet we also have


these significant disparities


in who receives health.


So tell us the status of health


care in the United States.




WILLIAM BRANGHAM: Well, just


as you say,


we set out to do this


before the pandemic disrupted


everything about our jobs


and our lives


and all of– all of those things


that we have been living


through the past six months


or so.


The– the whole idea


for the series


was to look at American health


care, and it’s the best parts


of it and the worst parts of it,


and then go to three


other nations that are


able to do certain things better


than we can do, principally,


are able to find a way


to provide universal health


care for all their citizens.




And so the idea was this


was going to be a big debate


going on


in the Democratic primaries.


Remember, this was back


in January and February


when we started filming this.


And so we thought let’s do


a– a portrait


of American health care.


We went to Houston, Texas


for that.


And in some ways,


I think Houston,


and Texas, uh, more broadly,


is emblematic of American health


care.


Houston, Texas is home


to the Texas Medical Center,


which is one


of the great medical hubs


in America.


And just a few miles away


from the Texas Medical Center


are census tracts,


are neighborhoods, largely poor,


in this case largely


Black neighborhoods, where


people in those neighborhoods


die 20 years earlier,


on average,


than people just a few miles


away.




JOHN WHYTE: But we don’t have


to go to Houston


to see that, William.


We see that in Boston,


where you can’t spit and not hit


a teaching hospital.


We see that in Philadelphia.


We see it–




WILLIAM BRANGHAM: Right.




JOHN WHYTE: –in– here


in the nation’s capital, where


you and I are.


Um–




WILLIAM BRANGHAM: Right.




JOHN WHYTE: –how does that


compare to, say, the UK


or Australia or Switzerland,


some of those countries


that you visited?




WILLIAM BRANGHAM: Well, that’s


the interesting thing,


is that we thought, OK, let’s


pick countries that are


similarly developed– again,


they’re not nearly as big as we


are, they’re not,


generally speaking,


as wealthy as we are,


but how is it that they do what


we can’t do?


So we went to the UK, as you


say,


and Switzerland and Australia,


all three nations that


do achieve universal health


care.


They do it without bankrupting


their countries, and they do it


in a way that provides a system


that, generally speaking,


is overwhelmingly


beloved by the people


in those countries.




They also get better outcomes


than we do.


This is the incredible thing,


is that they spend less


per person


in each of those three countries


and they get better health


outcomes in general, like people


live longer or they don’t suffer


from chronic diseases as much,


they die at much lower rates


than we do from things that are


preventable.


So we tried to look at a sort


of a comparison of, well, what


do we do great


and what do we fall down on,


and how did these three


other nations do it.




The interesting thing


is those three nations–


and we chose them very


specifically– they get


to universal health care


through very different means.


Everyone knows the UK,


the famous National Health


Service.


It’s a single payer system.


You get taxed fairly heavily,


and the government then pays all


the doctors and all


the hospitals.


Switzerland does it


in the exact opposite way.


It’s very similar to the US


instance.


It’s 100% private insurance.


There is no governmental role


in providing health care or any


of that.


It’s all private insurers.


Australia is a bit of a hybrid.


They have a public system that


is paid for by taxes,


but overlaid with that,


almost half the country uses


private insurance.




So we sort of looked


at the mechanics of each


of those nations


to say, OK, they’re achieving


these results that we all say


we want.


We want everyone to have


good access to health care.


How did they do it?


Let’s look what we might learn


from them.




JOHN WHYTE: What surprised you?




WILLIAM BRANGHAM:


I have listened


for many, many years


to the health care debate


in this country, and it’s always


presented as if, well, if you


want to cover everyone, or go


to Canada or go to America–


go to the UK,


you’re going to be waiting


in line forever.


People are going to be


agonizing, waiting for surgery,


and people are going to be


fleeing the nation trying to get


better health care elsewhere.




That’s not necessarily the case.


There are some examples


of longer wait lists in the UK


and in Canada, but the myths


that we have been told


that there is a trade-off


between America’s innovation


and caring for everybody


is really not true.


That was the biggest revelation


to me,


is that these other nations


that share our values


and share our sense of culture


and all of those things,


they can do it, and they can do


it successfully.


So what might we learn?




JOHN WHYTE: Well, I also want


to bring into context,


uh, the elephant in the room,


coronavirus, and–


and see how what you’ve learned


perhaps


is influencing what the response


has been, you know, particularly


in these different countries.


You’ve talked about how people


view health and the role


of prevention.


Um, the role of prevention


and the focus on prevention is–


is very


different in these countries


than it is in the United States.


Is that correct?




WILLIAM BRANGHAM: Yeah, that’s


exactly right.


And each of those three nations,


if you simply look at the number


of cases, the number of people


who are dying per capita,


they’re doing much better


than we are with regards


to coronavirus.


It’s– it’s pretty clear.


The UK suffered really


the worst.


They had the hardest outbreak.


And they’ve since rebounded


and have done better.


But none of their responses


guarantee that the virus has


gone away.


They’re still wrestling


with the same virus, and they’re


doing better than we are not


with better medicines


or smarter doctors or–


they just simply mounted, uh,


a more consistent public health


response.




JOHN WHYTE: Was it


through testing?


Was it through messaging?


What– what did Australia do,


in your mind, that was, you


know, so different that it


resulted in a better outcome?


You know, what– what can


we learn from, you know, their–


their interventions?




WILLIAM BRANGHAM: Australia


in particular, they did a very


good job on testing.


They really ramped up testing


early and got it out


to the public, so they could


really keep their eye


on the spread of the virus.


And when cases broke out,


they were able to zoom in


on that, isolate those people,


and try to put out those smaller


fires


before they became more


widespread.




Scientists were


the principal drivers


of their policy.


They were the people who were


speaking to the public about why


they are doing these things, why


they’re asking people to wear


masks, why they’re asking people


to not go to work,


why they’re asking people


to take these,


again, uh, understandably hard


economic pain initially to put


this fire out.


They did that, and they got


great compliance.


I think consistent messaging


across the board


was something all three


of these nations shared,


a science-driven approach.




Um, there’s also– and I think


this is interesting, especially


in Switzerland–


you touched on this before,


John– the–


the view that people


in these nations


have towards their government,


especially their public health


officials,


it’s not a politicized thing.


I mean, Switzerland did not


enact a terribly aggressive


lockdown measure,


but if you look


at the compliance


as it was tracked by,


you know, cell phone data of how


far people were driving away


from their homes, the government


sort of said, we need you


to stay home,


please try to do this, the Swiss


did it unbelievably well.


They just said, the government


is saying we need to do this


to control the virus,


we will do this.


Now–




JOHN WHYTE: So why is it


different here?




WILLIAM BRANGHAM: We are


a big, fractious nation.


We have


different political opinions.


We have vigorous debates


about these things.


I mean, also we have conspiracy


theories.


We have people who are– are


telling others to not believe,


that Anthony Fauci is somehow


out to undo this country, not


to try to help heal


this country.




So we have the– we run


the spectrum of healthy


skepticism towards institutions


and questioning and a vigorous


debate, but we also tend


towards–


I think many would look


at our response and say


we’ve– we’ve– we’ve taken that


skepticism a little bit too far,


that– that–


I– I don’t think there is


any evidence that public health


officials are trying to control


us by asking us to wear a mask


or trying to control


our lives by asking us to stay


home and keep


our distance from people.


And so I think that has been,


in some ways, our undoing.


It’s one of the great things


that makes America America,


this rigorous, vigorous debate


that we have.


It– it sometimes has gone too


far, I would argue.




JOHN WHYTE: You’ve touched


upon in this show


about this issue of whether, you


know, health care is


a human right.


And you also address this issue


of disparity.


We’re seeing it front and center


with the impact of COVID


on minority populations,


marginalized populations,


sometimes six times


the death rate.


It’s not just access


to the health care system.


We all know that.


It’s those social determinants


of health– access


to fresh fruits and vegetables,


walking paths, um, you know,


other aspects


of– of their total health.


How fair is it, people could


say, you know, to– to make


these comparisons [INAUDIBLE]


amongst the different countries?




WILLIAM BRANGHAM: Well, we set


out initially–


again, all pre-pandemic–


to simply look at this issue


of universal health care.


How is it that they do that


which we cannot seem to do?


Why do we have 30 million


Americans, nearly 10%


of our population,


uninsured and–


and reluctant to get care


because it costs too much?


How did those nations tackle


that?




With regards to COVID, I think


as you’re– as you’re pointing


out, there’s a lot of other


factors that make


the disparities we have with


regards to coronavirus, things


that you exactly touched on.


The people who tend to be


uninsured in this country,


poorer, minority Americans


principally, are also the people


who are putting themselves


professionally in the jobs that


make them most likely to get


sick.


They don’t have the luxury


of working like we do


in our homes.




And so again– that’s,


in some ways,


apart from our health care


system more broadly.


I do think there is a way


in which our health care system


has complicated our–


our coronavirus response.


And it’s simply that I–


I think the recent polling shows


that a third of Americans


have said that they avoided


some medical treatment


because they were worried


about the cost.




If that is in your mind


and you come down with a fever,


you start having a dry cough,


you’ve seen on the news


that these might be symptoms


of the coronavirus,


if you are concerned


about getting hit


with a bill, especially


when you’re not sure


if your job is going to stick


around till next week, that


fear, that reluctance to go


and get care, which


is crucial for our public health


response, that directly affects


our ability to respond if people


are afraid to go to the doctor,


are afraid to go to get


to a test,


because they don’t know


if they’re going to get knocked


with a big bill.


And that, I think,


is one of the central ways


in which our inability to cover


everyone


has complicated our response.


I would say there’s no doubt


about that.




JOHN WHYTE: But in fairness,


that was also very much


pre-COVID, you know, during this


COVID pandemic, health


institutions, systems also told


patients, don’t come


into the emergency room, you


know, don’t just come


to the doctor’s office–




WILLIAM BRANGHAM: Right.




JOHN WHYTE: –be sure to call.


So they were fearful also,


you know, of catching COVID-19,


as well.




WILLIAM BRANGHAM: Right.




JOHN WHYTE: I mean, now we’re


trying to tell people to come


back because we know, you know,


preventive services are– are


way down, in terms


of colonoscopies and mammograms.


How is COVID-19 permanently


changing the way we deliver


health or view health here


in the United States


compared to the rest


of the world?




WILLIAM BRANGHAM: Compared


to the rest of the world,


I’m not sure.


I– I would say that the–




JOHN WHYTE: Are they changing?


Do you think it changed there,


as well?




WILLIAM BRANGHAM: I think–




JOHN WHYTE: [INAUDIBLE]




WILLIAM BRANGHAM: –well,


the things that I would point


to that I think will change


in American medicine–


and again, this is simply from


talking to a lot of doctors


and practitioners through


the course of my reporting–


I think we have suddenly put


telehealth on warp speed.


And people are recognizing


that you can get–


I mean, I’ve had now


several doctors visits purely


the way you and I are talking


right here.


As soon as we can develop


the technology for, you know,


better diagnostics, blood


pressure, whatever– whatever


my doctor needs to know from me


that they can’t get this way,


as long as we can start


to transmit that, I think


that will be a big leap forward.




I would hope that


the– the focus on hygiene,


the basics of handwashing,


distancing when you’re sick,


that–


there’s– there’s the belief


that some of the things that we


are putting in place for COVID


might, in fact, help us avoid


a more severe flu season.


Those types of things


would be great.


If people become more cognizant


of the fact


that, you know what, I’m feeling


these symptoms, I’m not sure


if it’s a cold, I’m not sure


if it’s the flu, but maybe


there’s something I ought


to do– again,


it requires the luxury of not


getting fired from your job


if you need to take a day off,


but I think those things will


change.




JOHN WHYTE: Where can viewers


learn more about your series?


They can find many


of the episodes that have


already been done?




WILLIAM BRANGHAM: Yeah,


the whole series is now


at pbs.org/newshour.


That’s the PBS NewsHour website.


And at the very top, they’ll


see a little banner, a little


green and red, uh, uh, uh,


medical sign at the top.


And the name of the series


is right there, The Best Health


Care.


And you can click on that,


and you can see all the stories


we did, a lot


of interactive features, polls.


But all the stories are listed


right there at the top


of the NewsHour’s website.




JOHN WHYTE: Thank you for taking


the time to do this type


of reporting to help shed, you


know,


some light in– in terms


of where the system is doing


well


and– and where it is failing,


uh, many of our citizens.




WILLIAM BRANGHAM: Dr. Whyte,


very nice to meet you.


Thank you so much for having me


on.




JOHN WHYTE: And thank you


for watching Coronavirus


in Context.