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Health Care Systems Around the World · Stuff You Should Know

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Speaker 1: Brought to you by the reinvented two thousand twelve camera.
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Speaker 1: It's ready. Are you welcome to stuff you should know
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Speaker 1: from house Stuff Works dot com? Hey, and welcome to
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Speaker 1: the podcast. I'm Josh Clark. With me as always this
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Speaker 1: Charles W. Chuck Bryant sliding into my seat and with
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Speaker 1: us is Dr Molly Edmonds, m D esquire PhD LLC. Right, Yes,
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Speaker 1: that get all of those. Molly. Uh. This is uh
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Speaker 1: the final installment of our four part healthcare reform suite.
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Speaker 1: We've reached the end of the final countdown. Can I
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Speaker 1: just say, speaking for Molly and I thank god? Yeah,
0:42
Speaker 1: you're not speaking for me to Do you think I
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Speaker 1: like this? Chuck? Are you ready to move on? Yeah? Okay, okay.
0:47
Speaker 1: So we've talked about healthcare reform. First of all, Molly,
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Speaker 1: what was that statistic that that you mentioned, um a
0:54
Speaker 1: long time ago in a in a podcast far far away,
0:57
Speaker 1: where you said, like only one in a Americans think
1:01
Speaker 1: that the health care system in the US needs reforming.
1:05
Speaker 1: Are happy with their healthcare as it is. So. Um,
1:09
Speaker 1: what we've kind of deconstructed is why healthcare form is
1:12
Speaker 1: even on the table. We've talked about the uninsured. Right.
1:16
Speaker 1: We've talked about the fact that UM that America has
1:20
Speaker 1: UM really really terrible like mortality rates or UM disease rates,
1:28
Speaker 1: chronic disease rates, that kind of stuff. UM. So that
1:31
Speaker 1: in and of itself makes the health care system worth fixing. Right.
1:34
Speaker 1: But one thing that hasn't been brought up, and I
1:37
Speaker 1: haven't seen it brought up in coverage too much, is
1:39
Speaker 1: the fact that our health care system is actually keeping
1:41
Speaker 1: us from competing as well as we could on a
1:44
Speaker 1: global scale, right, which is why we would compare ourselves
1:49
Speaker 1: to other health care systems around the world. You know.
1:51
Speaker 1: The thing is that no one in this country wants
1:54
Speaker 1: to become like any other system in the world. But
1:56
Speaker 1: I don't know if you could find anyone who lives
1:57
Speaker 1: in another country who wants to trade place with an
1:59
Speaker 1: American that comes to their health care. We'll put We'll
2:02
Speaker 1: put let's talk about competitiveness and the health care reform
2:06
Speaker 1: system via Dr Michael Royson, who you guys might remember, right, Yes,
2:10
Speaker 1: what is he? Dr Roysen is the chief Wellness officer
2:14
Speaker 1: of the Cleveland Clinic and my hero and the co
2:18
Speaker 1: author of UM The You the Owner's Manual book series.
2:21
Speaker 1: Right with Dr Oz here is what he had to say,
2:25
Speaker 1: because healthcare is a expensive thing in America, and that
2:32
Speaker 1: we need reform for the economy to function, for jobs
2:37
Speaker 1: to be created, and for us to be competitive with
2:41
Speaker 1: Europe and Asia four jobs, and for us to not
2:44
Speaker 1: worry about a following standard of living, and for people
2:47
Speaker 1: to not worry, not have the stress of worrying about
2:50
Speaker 1: will there be health care for me when I need
2:53
Speaker 1: it that I can afford? Okay, So, if we're going
2:57
Speaker 1: to keep up with Europe and Asia, like Dr Reason suggested,
3:00
Speaker 1: we could by reforming our health care system. Um, maybe
3:04
Speaker 1: we should kind of peek in on what other countries
3:07
Speaker 1: around the world are doing, whether for better or for worse. Um, Malla,
3:11
Speaker 1: you wrote this article ten health care systems around the world, right,
3:13
Speaker 1: which is up on the site. Yeah, it's sort of
3:15
Speaker 1: I think, a virtual hot air balloon ride through the
3:17
Speaker 1: world of health care. It was. It was a delightful
3:19
Speaker 1: one too. It was beautiful, like so many bloody bandages. Um, so,
3:25
Speaker 1: where was there any particular health care system that struck
3:28
Speaker 1: you as arguably better than the US or better than
3:34
Speaker 1: all the other ones? Actually we wait, wait, let's talk
3:37
Speaker 1: about France. France transition. Oh gotcha get it? Yeah, I do.
3:44
Speaker 1: Now we mean yes, it's like, okay, France, Uh, they
3:51
Speaker 1: apparently have the best health care in the world, I
3:53
Speaker 1: mean World Health Organization. Right. Yeah, it's hard to argue
3:56
Speaker 1: with who. Moving on then, no, that's actually um, I
4:00
Speaker 1: think just because it's become a relic in the healthcare
4:04
Speaker 1: reform debate in the United States that who um two
4:08
Speaker 1: thousand report of a hundred countries healthcare system rankings is controversial.
4:13
Speaker 1: I think we should say that. Everybody's like, oh, well
4:16
Speaker 1: who said that? So okay, it must be true. Um.
4:19
Speaker 1: But again, you can pick apart anything. But so let's
4:22
Speaker 1: just stick to the fact that France was rated number
4:25
Speaker 1: one in the year two thousand by the World Health
4:28
Speaker 1: Organizations rankings of a countries. Right, right, So all French
4:32
Speaker 1: citizens will put in money based on their income, you
4:36
Speaker 1: can't opt out of it, and then in return they'll
4:39
Speaker 1: get about seventy of their healthcare paid for by the government. Um,
4:42
Speaker 1: you can get same day appointments, you can choose any
4:45
Speaker 1: healthcare provider you'd like. Um. But okay, so we said,
4:48
Speaker 1: s how do they pay for the other thirty percent?
4:51
Speaker 1: They all have supplemental insurance with either a public or
4:53
Speaker 1: a private plan, and that is more similar to how
4:56
Speaker 1: we have in the U S where that supplemental plan
4:59
Speaker 1: might come mere employer. So there there are a couple
5:02
Speaker 1: of problems with the French system, and it's not flawless.
5:06
Speaker 1: There is no flawless plan. We should go ahead and
5:07
Speaker 1: say that, you lie. Um. I saw one guy that said,
5:12
Speaker 1: I said it like this. He said, it's sort of
5:13
Speaker 1: like medicare for everybody with the French system. Yeah, I
5:17
Speaker 1: got it, and he was he was a pro. So
5:19
Speaker 1: they make up the other thirty with private plans, right,
5:23
Speaker 1: private or republic. And that's the problem is if you
5:25
Speaker 1: have money, then you would probably opt for a private plan.
5:28
Speaker 1: So some critics would say that the French plan is
5:31
Speaker 1: too divided by class. People who want really good care
5:34
Speaker 1: and can pay for it, get it. Those who can
5:36
Speaker 1: don't write. But they do that in England too. You
5:38
Speaker 1: can get also get your private insurance, right yeah, and
5:41
Speaker 1: we should say for a kind of a comprehensive rundown
5:44
Speaker 1: of England. Molly gave one in the third podcast. Right,
5:47
Speaker 1: so we're not gonna talk about this, We're okay. I
5:51
Speaker 1: mean it was a nice step on the balloon ride.
5:53
Speaker 1: But here's how France got it's awesome writing. Okay, it
5:57
Speaker 1: spends personal healthcare while that you spins over twice that, UM,
6:02
Speaker 1: so already they're using money pretty well. And if you
6:05
Speaker 1: get really sick, like you have just the worst form
6:07
Speaker 1: of cancer in the world, everything is paid for. Yeah,
6:10
Speaker 1: that's what I saw that your article. In some other
6:13
Speaker 1: stuff I read is that if the sicker you are
6:15
Speaker 1: in France, the better off you've got it, or the
6:16
Speaker 1: easier and quicker your claims will get paid as well. Exactly.
6:19
Speaker 1: But it's not just the really sick who benefit. Because UM,
6:22
Speaker 1: I think what's cool about Frances they have the lowest
6:24
Speaker 1: rate of deaths that could have been prevented. The US
6:27
Speaker 1: has the highest number of these preventable deaths that they say,
6:30
Speaker 1: or you know, if you had had an early diagnosis
6:33
Speaker 1: or if you'd had an early treatment in condition right,
6:35
Speaker 1: I did see also in another article I read that UM.
6:38
Speaker 1: One of the criticisms criticisms is that there's not great
6:41
Speaker 1: coordination between the GPS and the specialist in France. But
6:45
Speaker 1: if you're talking about problems, that's not the worst thing
6:48
Speaker 1: in the world. That's better than being denied for a
6:50
Speaker 1: pre existing condition. I think, wouldn't you say, I wouldn't say, yeah, Um,
6:56
Speaker 1: you guys done with France, because I'd like to get
6:58
Speaker 1: back in the balloon, okay, and just head on over
7:03
Speaker 1: a few kilometers a few clicks, if you will, to Germany,
7:11
Speaker 1: which is um out of the out of the healthcare
7:14
Speaker 1: systems in the in the article, this one's my favorite,
7:16
Speaker 1: and I'm not embarrassed to say that. One of the
7:19
Speaker 1: reasons why is because of the ample access to spa
7:23
Speaker 1: days and even the public health insurance plans, right and
7:29
Speaker 1: there's two hundred of them, correct, and their employer and
7:33
Speaker 1: employee funded, right. Yeah. And you know where that comes
7:37
Speaker 1: from is actually in three old Otto. Von Bismarck was
7:42
Speaker 1: like the spies. He was like, I want some healthcare
7:47
Speaker 1: like they had back in the days of guilds. And
7:49
Speaker 1: so he is basing all of this off the fact
7:52
Speaker 1: that when you were in your medieval guild for being,
7:54
Speaker 1: you know, the podcasters guild, the you know clothmaker's guild,
7:59
Speaker 1: you know with Germany, that was how they named them. Um,
8:03
Speaker 1: they all pay for each other sick time. They all
8:06
Speaker 1: got together, and it would be like us saying podcasters,
8:09
Speaker 1: let's have to pay for Josh's care when he has
8:12
Speaker 1: a stroke from smoking. I we can't even get podcasters
8:16
Speaker 1: to unite under this roof. I doubt if we can
8:17
Speaker 1: get it all around the world. So model, this is
8:23
Speaker 1: a pretty old system, and um, it's been around for
8:25
Speaker 1: hundreds of years. But if because they're always willing to
8:27
Speaker 1: keep reforming it. Yeah, I noticed that in another article
8:31
Speaker 1: UM from Berlin University. Actually, um, it was kind of
8:37
Speaker 1: a rundown of the German healthcare system. All these different
8:41
Speaker 1: years kept coming up, like they try new things like
8:43
Speaker 1: every year or two. Uh, and it seems like that's
8:46
Speaker 1: probably what you'd have to do. I think the impression
8:49
Speaker 1: that a lot of people in America have, whether supporters
8:52
Speaker 1: or opponents, is that this healthcare reform is going to
8:56
Speaker 1: happen and that's it. Yeah, And I think you're I
8:58
Speaker 1: think you make a very bad the point that it
9:01
Speaker 1: has to keep evolving and changing as problems come up
9:04
Speaker 1: or as things prove very effective, you know, you put
9:06
Speaker 1: more money into this or take funding away from that. Right.
9:10
Speaker 1: Some of their cool new initiatives are these disease management
9:13
Speaker 1: programs UM, where if the patient gets more counseling from
9:16
Speaker 1: a doctor, like if a nurse calls them up at
9:18
Speaker 1: home to make sure they're taking their meds, you know,
9:20
Speaker 1: sticking with their diet. These people have much um lower
9:24
Speaker 1: rates of hospital emissions and much lower rates of deaths
9:27
Speaker 1: from people than people who have the exact same conditions
9:29
Speaker 1: who aren't getting that counseling. So I think that's a
9:32
Speaker 1: pretty cool way to approach disease. I don't know, I
9:34
Speaker 1: could see like half the people in the United States
9:36
Speaker 1: thinking it's really nice thing to get a call, and
9:38
Speaker 1: half the people be like, stay out of my business, nurse,
9:40
Speaker 1: how did you get this number? Right? Well, and you
9:43
Speaker 1: know it's not like the nurses and the doctors love
9:44
Speaker 1: the system. I would say that you read a lot
9:46
Speaker 1: of articles about how the German doctors feel underpaid. To
9:50
Speaker 1: protests the most often right German doctors says they're paid
9:53
Speaker 1: about two thirds what American doctors um make, and but
9:57
Speaker 1: they pay less for malpractice insurance and some of them
10:00
Speaker 1: go to school for free med school. And you know
10:02
Speaker 1: one cool factor that I did not manage to squeeze
10:05
Speaker 1: into this article. But um, those plans, those two in
10:08
Speaker 1: our plans that we were talking about those plans get
10:11
Speaker 1: incentives if they get sicker people on their rosters. So
10:14
Speaker 1: instead of a system like in the US where people
10:17
Speaker 1: where we tend to deny people, they get benefits for
10:20
Speaker 1: doing that. In Germany it's pretty cool. Also, saw where
10:23
Speaker 1: you can in Germany you can go straight to a specialist,
10:25
Speaker 1: like you don't have to go through your gatekeeper GP,
10:28
Speaker 1: which's kind of cool. Also, there is a private insurance
10:30
Speaker 1: market for UM people who make over forty eight thousand
10:35
Speaker 1: euros a year. It's not compulsory for those people. Actually,
10:39
Speaker 1: long term health insurance is compulsory for everybody, but basic
10:43
Speaker 1: health care coverage isn't compulsory for people who make over
10:46
Speaker 1: forty eight thousand euros a year UM. So there's another
10:50
Speaker 1: uh I guess accompanying private insurance market, but that's still
10:54
Speaker 1: regulated by the government. UH. There's like you can't deny
10:58
Speaker 1: for pre existing condition and UM. And apparently your rates
11:02
Speaker 1: are assessed when you enter that private system UM based
11:06
Speaker 1: on your risk. But that's it. There's like a one
11:08
Speaker 1: time risk assessment and that sticks with you for the
11:10
Speaker 1: rest of your life. I missed the DEUT. I'm just
11:13
Speaker 1: gonna go ahead and say that you missed the Deutsche Mark. Yeah,
11:16
Speaker 1: I missed the deutsch Mark. Miss I missed the frank
11:18
Speaker 1: I miss this whole euro business. Yeah, but I hate
11:21
Speaker 1: to change money from country to country, so I thought
11:24
Speaker 1: it was kind of thrilling. But then you're left with
11:26
Speaker 1: your leftover coins. Yeah, but then you take them and
11:28
Speaker 1: you give them to your cousins and nephews and nieces.
11:32
Speaker 1: I actually haven't been to Europe since the introduce the Euros,
11:34
Speaker 1: I'd probably love it. Speaking of redistributing money. Oh, I
11:38
Speaker 1: know we're going next. This is gonna be kind of
11:40
Speaker 1: a long balloon ride. So it's just fly forward to
11:43
Speaker 1: when we when we land in Cuba. So Cuba, let's
11:53
Speaker 1: talk they have healthcare for well, you'd give the skinny
11:57
Speaker 1: because I have. I just read some articles where they
11:59
Speaker 1: say it wouldn't so for well, you know the famous example,
12:02
Speaker 1: I think Cuba. If you're a Michael Moore fans, when
12:04
Speaker 1: he took people to Cuba so they could get better
12:07
Speaker 1: care than they could in the United States, and you
12:09
Speaker 1: know it was meant to embarrass the U s health
12:11
Speaker 1: care system. There are obviously a lot of critics, as
12:14
Speaker 1: with anything Michael Moore does, of how it was portrayed
12:16
Speaker 1: in the movie. And some people say that there is
12:19
Speaker 1: um sort of one level for the people they're going
12:21
Speaker 1: to impress and then one level for everyone else, Right,
12:25
Speaker 1: But I do think that even those people who are
12:27
Speaker 1: in maybe that lower um echelon get an immense amount
12:31
Speaker 1: of preventative care. That's pretty pretty cool. Well that's it
12:34
Speaker 1: sounds like they do, uh do a pretty good job
12:36
Speaker 1: with preventative care because they kind of have to. Well,
12:38
Speaker 1: you guys were talking about Germany and doctors or nurses
12:41
Speaker 1: calling you up to going how you doing. Um, If
12:44
Speaker 1: you had a problem with that, you probably really have
12:46
Speaker 1: a problem with Cuba because any any person is subject
12:50
Speaker 1: to a surprise visit from their physician once a year. Yeah,
12:54
Speaker 1: they are going to stop at your door, see what
12:56
Speaker 1: you're doing, What are you eating? They're like, while we're here,
12:59
Speaker 1: what's under your mattress and what's in your closet? Well, see,
13:02
Speaker 1: that's sort of the problem is that, you know, because
13:04
Speaker 1: they have the preventative care, because they may not have
13:07
Speaker 1: let's say, a fridge or access to really fatty food
13:09
Speaker 1: or a really great car. Um. So it's almost like
13:13
Speaker 1: the you know what we would see as the deficiencies
13:15
Speaker 1: in Cuba have created a culture whereby they walk a lot,
13:19
Speaker 1: they don't have fast food. I mean it's coming. They
13:22
Speaker 1: say that that might be sort of the next wave
13:23
Speaker 1: of obesity, as Cuba is getting some fast food really well.
13:27
Speaker 1: As a result, Cuba they have I think they spend
13:31
Speaker 1: two hundred and sixty bucks of person on healthcare a
13:34
Speaker 1: year A year, Yeah, right, because they're they're really good
13:37
Speaker 1: with preventative wellness. But I do want to point out,
13:40
Speaker 1: you know, sometimes I believe you brought it up, Josh,
13:42
Speaker 1: there's the thought that if we spend a lot less
13:43
Speaker 1: on healthcare, will really skimp on our innovation. But Cuba
13:48
Speaker 1: surprisingly is known for its um innovation of medical break facs.
13:52
Speaker 1: I have heard that they the medical sector is their
13:57
Speaker 1: sixth largest in exports, obviously not to the US, but
14:01
Speaker 1: they really got to put themselves on the map with
14:02
Speaker 1: some vaccines they've come up with first meningitis B and
14:05
Speaker 1: then hepatitis B and UM. So they're really making a
14:08
Speaker 1: name for themselves in terms of their pharmaceutical and mechanical
14:11
Speaker 1: medical equipment exports. Chuck, you reference some articles that you've
14:15
Speaker 1: read that the Cuban um I think this is one
14:18
Speaker 1: of the systems where it all depends on who which
14:21
Speaker 1: side you're reading, because I read a bunch of articles
14:23
Speaker 1: that said and a lot of these people interviewed Cuban
14:26
Speaker 1: refugees that were now living in America, and they said
14:29
Speaker 1: things like there's two health care systems, one for health tourists,
14:33
Speaker 1: which apparently Michael Moore is a health tourist, and that's
14:36
Speaker 1: a big deal, kind of camera coup filling yourself around that, right,
14:39
Speaker 1: you're gonna get treated differently. But there's health tourism is
14:41
Speaker 1: a big deal there, and you can go and pay cash.
14:44
Speaker 1: And so there's one system for Communist Party officials and
14:46
Speaker 1: health tourists and then one for the rest of Cuba,
14:49
Speaker 1: and they maintain that, you know, if you're the rest
14:52
Speaker 1: of Cuba, you can't get things like aspirin, you can't
14:54
Speaker 1: get any biotics unless it's on the black market, and
14:57
Speaker 1: you don't have access to a lot of like basic
14:59
Speaker 1: medical care. Uh, you have to bring your own cheets
15:01
Speaker 1: to the hospital. Stuff like that. Well, I think there's
15:04
Speaker 1: also a concern that they get these really great statistics
15:06
Speaker 1: by fudging their numbers a little bit, Like Cuba has
15:09
Speaker 1: really good rates of mortality. I thought that was interesting.
15:12
Speaker 1: But in the United States, you know, if if a
15:14
Speaker 1: baby is born only lives a very short period of time,
15:16
Speaker 1: we count that, whereas if it was in the same
15:19
Speaker 1: if it was a lie for the same period of time,
15:21
Speaker 1: in Cuba, they may count that is dead on arrival. Right,
15:23
Speaker 1: And didn't you also say that some doctors allegedly will
15:27
Speaker 1: suggest abortions in the world the government UM suggests they
15:31
Speaker 1: abort a fetus that could be developmentally disabled or something. Right, Right,
15:35
Speaker 1: you know, there's just concerned that UM they have great numbers,
15:39
Speaker 1: but because you know, we don't really know much felt
15:41
Speaker 1: what goes on inside the country, we don't know exactly
15:43
Speaker 1: know how to get them right. It was really nice
15:46
Speaker 1: to visit it. Can it can be hard to separate
15:48
Speaker 1: your opinions on the Cuban health system from your opinions
15:50
Speaker 1: just on Cuba the country, right, So I don't want
15:52
Speaker 1: to oversell Cuba, Okay, but I'm glad I got to
15:54
Speaker 1: visit the balloon. I don't have any opinions on Cuba
15:57
Speaker 1: other than what I've heard from a couple of friends
15:58
Speaker 1: have traveled there and said it was really awesome, the men,
16:00
Speaker 1: that people were lovely, and the country is beautiful when
16:03
Speaker 1: politics aside the country itself. The love it's illegal, it's illegal,
16:08
Speaker 1: actually not true. Um, so you guys, let's head on
16:11
Speaker 1: over to China. Okay, Well, here we are in China,
16:18
Speaker 1: and this place is kind of screwed up all. I mean,
16:21
Speaker 1: I don't know if i'd want to get sick here.
16:23
Speaker 1: It used to be pretty good from what I understand
16:25
Speaker 1: in your article that there was cooperative healthcare system right right,
16:29
Speaker 1: and they dismantled it and that just didn't go very
16:31
Speaker 1: well because, uh, you know, no one knew were to
16:33
Speaker 1: send the bill, and the places they were sending the
16:35
Speaker 1: bill didn't pay up. And what the huge effect of
16:39
Speaker 1: this was that there's a giant divide between healthcare and
16:42
Speaker 1: cities and healthcare in the rural areas. Yeah. One of
16:45
Speaker 1: the I guess ideas for Chinese healthcare reform was that
16:49
Speaker 1: all farmers pay a dollar for healthcare, and they bought
16:53
Speaker 1: in a year, and they balked at that as being
16:55
Speaker 1: too expensive. Are the rural Chinese that poor really well
17:01
Speaker 1: just not really taken seriously over there. One Well, I
17:03
Speaker 1: think they're also saying that yes, a dollar was high,
17:05
Speaker 1: especially for the care they got. I was reading one
17:07
Speaker 1: article it was in the New York Times about how
17:09
Speaker 1: you got us in these world clinics and stray dogs
17:11
Speaker 1: are walking the halls of the clinics. But it's not
17:14
Speaker 1: worth a dollar a year. Straight dogs in your hospital.
17:17
Speaker 1: They bring dogs into American hospitals to perk up cancer
17:21
Speaker 1: patients and nice, healthy ones, not one that looks like
17:23
Speaker 1: they're going to die. You don't know whether they're straight
17:26
Speaker 1: or not. You're talking about the uh like they have
17:29
Speaker 1: different names at every hospital, I guess. But Love on
17:32
Speaker 1: four Paws, that kind of programs dogs love to not
17:39
Speaker 1: enough hospitals. Well, okay, so China is in addition to
17:43
Speaker 1: it's ridding the hospitals of stray dogs initiatives. Um, they're
17:47
Speaker 1: planning on building seven hundred thousand I guess probably pet
17:50
Speaker 1: unfriendly clinics in rural areas. I mean, maybe they'll bring
17:54
Speaker 1: the nice dogs into those clinics. But yes, they are
17:56
Speaker 1: in the middle of funneling just a ton of money
17:58
Speaker 1: into their healthcare system and hopes that they cannot eradicate
18:02
Speaker 1: this divide between ten years or so, ten or eleven years,
18:06
Speaker 1: but by the population will have health insurance. They're hoping
18:13
Speaker 1: the billion on it. Yes, e yen you want. I
18:21
Speaker 1: don't really know how to pronounce anything in China. Want.
18:24
Speaker 1: That doesn't sound like very much money to me. It
18:26
Speaker 1: does to build seven thousand clinics. Yeah, and well. The
18:29
Speaker 1: other problem is Molly points out that um of that
18:33
Speaker 1: money UH is supposed to come from the central government,
18:36
Speaker 1: which means provincial governments are gonna have to make up
18:38
Speaker 1: the rest. And right now, no one knows if they're
18:40
Speaker 1: going to pay up right, sort of the problem they
18:42
Speaker 1: had when they first dismantled them. No one wants to
18:45
Speaker 1: pay for healthcare. That's true everywhere, but you know one
18:48
Speaker 1: place where they do pay. There we going back to
18:50
Speaker 1: a bloom. Now, do we have enough game it's run
18:55
Speaker 1: on unicorn tiers? Excellent? Okay? Do we have enough unicorn
18:58
Speaker 1: tiers to make it to tai wall on? You think? Oh?
19:01
Speaker 1: I hope so, because Taiwan's got a pretty nifty system.
19:04
Speaker 1: I don't think it would work in this country. But dude,
19:08
Speaker 1: the smart card. The smart card sounds so convenient, although
19:11
Speaker 1: kind of mirror bracking for someone like me who has
19:13
Speaker 1: the tendency to lose things. Wait, wait, you guys can
19:16
Speaker 1: get to Taiwan. Okay, I wanted to do. I wanted
19:21
Speaker 1: to brief check before we got there. They're chatting along
19:24
Speaker 1: the way. Let's just all sit silently in a balloons. Alright.
19:27
Speaker 1: So we're in Taiwan. Now this is lovely. So back
19:31
Speaker 1: to the smart card before we were exactly Um, okay,
19:35
Speaker 1: So you get a smart card. It's got your entire
19:36
Speaker 1: medical history on it, right, and you can just show
19:39
Speaker 1: up to a doctor and give them your card and
19:40
Speaker 1: they can pull up your entire medical history. And that
19:43
Speaker 1: is how they will also build a government. So it's
19:45
Speaker 1: like your healthcare credit card that you never have to
19:48
Speaker 1: see the bill for and it's your entire medical history. Now,
19:51
Speaker 1: of course, I people who say that's a way too
19:53
Speaker 1: much information for any government to have about a person.
19:56
Speaker 1: I like the idea of the smart card. I wouldn't
19:58
Speaker 1: mind all my medical information being on one car because
20:00
Speaker 1: I'm a little distressed every time I go to the
20:01
Speaker 1: doctor and I see them pull out a paper file
20:04
Speaker 1: in the midst of thousands of paper files, it seems
20:07
Speaker 1: very archaic to me. Well, I've I've moved quite a
20:09
Speaker 1: bit and I just hate having to kind of start
20:11
Speaker 1: over every time with every doctor. And what do you do.
20:14
Speaker 1: I actually haven't changed doctor as much. You get them
20:16
Speaker 1: to send everything to your new doctor. I think you're
20:18
Speaker 1: supposed to. Really, maybe I shouldn't reveal how poorly I
20:21
Speaker 1: manage my health switchovers. So I am a health writer.
20:24
Speaker 1: The smart card sounds word well, yeah, medical medical billing,
20:28
Speaker 1: medical information. It's a huge, huge problem in the US,
20:31
Speaker 1: just an administrative costs and time. Yeah. And that's the
20:34
Speaker 1: thing that was cool about what Taiwan did is that
20:36
Speaker 1: in expanding coverage to cover so much more the population,
20:39
Speaker 1: that they cut all those costs because now they have
20:42
Speaker 1: no administrative costs essentially. But the fact matters is that
20:45
Speaker 1: now Taiwan doesn't spend enough on healthcare to cover their costs,
20:49
Speaker 1: and the Taiwanese have gotten used to these really low
20:51
Speaker 1: healthcare costs, and people of our frager RaSE the taxes
20:54
Speaker 1: the age old story. Yeah, saw, we're a family and
20:56
Speaker 1: average family premium it's six d and fifty dollars a
20:59
Speaker 1: year in Taiwan. So I can't even think about car
21:03
Speaker 1: insurance for that. So are we done with Taiwan? Is
21:05
Speaker 1: that smart card? This place is really clean, by the way,
21:09
Speaker 1: have you noticed the food is good? Yeah, let's go
21:13
Speaker 1: to Russia. Okay, guys, thank you again for nuts speaking
21:19
Speaker 1: during the balloon ride. So we're in Russia now, and
21:22
Speaker 1: unfortunately this is not a good place to get six.
21:23
Speaker 1: So no one drink the water here. Okay, okay, right,
21:26
Speaker 1: but you can't drink the water in Russia. No, okay? Really, wow,
21:31
Speaker 1: I didn't know that. You think they would have had
21:32
Speaker 1: that worked out? So they not in a place that
21:36
Speaker 1: has one of the four worst healthcare systems in the world. Right,
21:39
Speaker 1: is there another one we may have heard of that's
21:41
Speaker 1: in that list? According to Foreign Policy, the United States
21:44
Speaker 1: also makes that list. It was a foreign policy article,
21:47
Speaker 1: so it's it's not stellar. The World Health Organization that
21:52
Speaker 1: we mentioned earlier ranks them out, so, you know, and
21:56
Speaker 1: they've got a fair bit of money. It seems like
21:58
Speaker 1: they should be doing doing a little bit better. And
22:01
Speaker 1: this is another system sort of like China, where they
22:03
Speaker 1: dismantled their old Soviet system which was pretty well admired
22:06
Speaker 1: around the world, and tried to create a public private
22:09
Speaker 1: combo system. And basically this system works well in theory
22:14
Speaker 1: but sucks in practice. Financially, it doesn't work out, right,
22:17
Speaker 1: I don't even think of I mean financially personally you
22:21
Speaker 1: got to show up with a pretty hefty bribe to
22:23
Speaker 1: see a doctor in Russia. Yeah, I thought that was
22:25
Speaker 1: really interesting that the on paper or you know, um spoken,
22:31
Speaker 1: it's um the populations covered, but the government doesn't really
22:36
Speaker 1: pay up and so to keep operating hospitals and doctors go, um, yeah,
22:42
Speaker 1: I need you to give me a donation, buddy, or
22:45
Speaker 1: else I'm not going to you. It's extortion for healthcare,
22:49
Speaker 1: which is nuts. Can we just be careful because I
22:52
Speaker 1: don't want Vladimir Putin to listen to this podcast listen
22:57
Speaker 1: to the word extortion, So let's make stop your brief.
23:01
Speaker 1: I think. I think what's good to know is that
23:03
Speaker 1: the World Health Organization, Love It or Leave It, recommends
23:05
Speaker 1: the countries spend about five percent of their total spending
23:08
Speaker 1: on healthcare, and Russia spends three. Okay, I don't want
23:12
Speaker 1: to alarm anybody. Some guys just pointed at us and
23:14
Speaker 1: are starting to come over, So we should probably get
23:16
Speaker 1: back to our balloon. Okay, a pretty happy place. Canada. Okay, yeah,
23:26
Speaker 1: we had a lot of Canadians right in, So what
23:29
Speaker 1: about us? We have a lot of Canadian fans, and
23:31
Speaker 1: so we're gonna we're gonna talk about you all now
23:32
Speaker 1: up there in the Great White North. Okay, I'm gonna
23:35
Speaker 1: let that one slide. Uh. We're here in Canada now. Um,
23:39
Speaker 1: thank you Molly for not speaking during the journey. I
23:42
Speaker 1: couldn't be quilled any longer. I was writing a personals
23:45
Speaker 1: ad for AMOUNTEE, So let's see if we can find
23:49
Speaker 1: you one here. But first, let's talk about the healthcare
23:52
Speaker 1: system in Canada. This is the one that the US
23:55
Speaker 1: is often compared to. If we're if we go to
23:59
Speaker 1: socialized men or something this this Canada. I always feel
24:02
Speaker 1: bad for him because they serve as like some sort
24:04
Speaker 1: of cautionary tale for what we don't want. But from
24:07
Speaker 1: what I hear that it's not nearly as bad as
24:09
Speaker 1: as we've been told by some quar right, people are
24:12
Speaker 1: trying to treat Canada like the worst case scenario, and
24:15
Speaker 1: I think that, um, this is due to a lot
24:17
Speaker 1: of commercials and from what I can understand, I mean,
24:20
Speaker 1: I haven't talked to these people myself, but it seems
24:23
Speaker 1: like people are very good about going and finding the
24:25
Speaker 1: people who did have just staggering long wait times and
24:29
Speaker 1: put them in the commercial. Right. I have some Canadian
24:32
Speaker 1: friends who I keep up with on the blog and
24:34
Speaker 1: they've they've written me before and said, you know, it's
24:36
Speaker 1: not perfect over here. Wait times aren't nearly as bad
24:39
Speaker 1: as you're depicted, though, and we'll take it any day.
24:41
Speaker 1: And I think wait times were really bad back in
24:44
Speaker 1: the eighties and early nineties, and then in the nineties
24:47
Speaker 1: Canada invested billions of dollars to improve the statistics. And
24:50
Speaker 1: so now if you want to head over to a clinic,
24:52
Speaker 1: before you go over, you type in which clinic you
24:55
Speaker 1: want and they will tell you what the weight time is.
24:57
Speaker 1: So I mean that's sort of transparency. I think it's
25:00
Speaker 1: pretty hard to find in this country. And then the
25:02
Speaker 1: wait times aren't it's it's not for like basic care
25:04
Speaker 1: right and usually for like special elective surgeries and the
25:07
Speaker 1: right the weights are longest for you know, like knee
25:09
Speaker 1: replacements sort of elective things. And I think that one
25:12
Speaker 1: of the ways that Canada does keep their costs low
25:14
Speaker 1: and comparison to the United States is they don't buy
25:16
Speaker 1: every single new fangled machine that comes out. In the
25:19
Speaker 1: United States, we have a tendency to buy every single
25:22
Speaker 1: cool gadget, and that's and that really can make our
25:26
Speaker 1: health care systems seem like it's working really well. It
25:29
Speaker 1: really does provide us a great level of care. But
25:31
Speaker 1: it doesn't mean that the old machines were necessarily in
25:33
Speaker 1: bad shape. Right, But there appears to be something of
25:37
Speaker 1: an equally American sentiment among Canadians that they do like
25:42
Speaker 1: they're pretty machines like an m R I and new
25:45
Speaker 1: r m R I. Because there you mentioned in the
25:47
Speaker 1: article there's a I guess, a subculture of rogue doctors
25:52
Speaker 1: who offer UM unlicensed illegal medicine for people who don't
25:57
Speaker 1: want to wait and can pay up. I assume, right, right, mean,
26:00
Speaker 1: I think that that's sort of the message you can
26:02
Speaker 1: take from any of these systems is the people who
26:04
Speaker 1: have money will use it. UM. We should also say
26:07
Speaker 1: that if you're going to compare country with socialized medicine
26:11
Speaker 1: to what the US, what the fear of what the
26:15
Speaker 1: US might become, you shouldn't you shouldn't point to Canada.
26:18
Speaker 1: You'd be much better off pointing to Britain, because while
26:21
Speaker 1: Canada does have a single payer government system of healthcare UM,
26:25
Speaker 1: the hospitals and doctors are private entities, their private enterprises.
26:30
Speaker 1: Right in Britain, they run the hospitals and pay their doctors.
26:33
Speaker 1: But in Canada it's just single payer. And let's talk
26:36
Speaker 1: about that means, because single payer seems like such a
26:38
Speaker 1: dirty word to people. UM. Here's how Canada pays for
26:41
Speaker 1: their health insurance. The citizens fund you know, their their
26:45
Speaker 1: healthcare by paying income taxes and sales taxes and then UM,
26:49
Speaker 1: all that money is sort of funneled through to the
26:51
Speaker 1: provinces and the territory. So it's not even like Canada
26:55
Speaker 1: as an entity is pushing out the money. Gotcha you
27:00
Speaker 1: clear on that, Josh, I am. Do you want a
27:02
Speaker 1: fun fact? Yeah? Please? Did you know that open heart
27:05
Speaker 1: surgery cost less in Toronto than it does in Chicago? Really? Yes,
27:10
Speaker 1: that's crazy. Also, prescription drugs tend to cost a lot
27:13
Speaker 1: less in Canada, UM, from what I understand from Roison
27:17
Speaker 1: during that phone interview, because UM Canada promotes far more
27:21
Speaker 1: competition among UM pharmaceutical companies. The same pharmaceutical companies that
27:26
Speaker 1: might be based in the US are doing business here
27:28
Speaker 1: in the US or bass why their costs are lower
27:31
Speaker 1: for pharmaceuticals. And also doctors and nurses make a fair
27:34
Speaker 1: bit less. So I don't know if I don't know
27:37
Speaker 1: if doctors want to go to Canadian system. Okay, kids,
27:41
Speaker 1: one last stop on our whistle stop tour, taking a
27:43
Speaker 1: good one. I feel like doing some skiing. Um, let's
27:46
Speaker 1: go to Switzerland, a little good chessolate. Okay, here we
27:51
Speaker 1: are in our last stop. It's beautiful. You see the
27:55
Speaker 1: red crosses everywhere in the Alps and the nice smiling
27:58
Speaker 1: rib apple cheep face. I'm going to stay neutral and
28:01
Speaker 1: not give you an opinion on this. That's their Their
28:06
Speaker 1: health care system is really expensive, really really expensive. And
28:09
Speaker 1: yet um, Americans who are looking for alternatives abroad, seemed
28:13
Speaker 1: to love it. Both Democrats are Republicans because it's a
28:16
Speaker 1: pretty good system. But it's just expensive. Right. Well, you
28:18
Speaker 1: know they have free choice, but they pay for that,
28:22
Speaker 1: they do. What do you mean by that? Well, I
28:25
Speaker 1: will tell you you know how everyone here is all
28:27
Speaker 1: freaked out about public health option. Um, it's all private
28:31
Speaker 1: plans in Switzerland. It's not tied to your employment at all.
28:34
Speaker 1: You just can go into a marketplace, let's say, for
28:37
Speaker 1: lack of better word, pick your private plan and um,
28:40
Speaker 1: you know, making fancily want and it can cost a lot.
28:44
Speaker 1: You can just seven fifty dollars per family per month.
28:49
Speaker 1: Not Yeah, so pretty steep. So generally Republicans like the
28:54
Speaker 1: choice you can have a private plan, and Democrats like
28:57
Speaker 1: the fact that even though that's expensive, everyone's covered because
29:00
Speaker 1: those who can't afford it receives sus tous from the government.
29:03
Speaker 1: But I don't know if you want to go from
29:05
Speaker 1: being a first expensive most expensive healthcare sites from the
29:09
Speaker 1: world's second most expensive healthcare in the world. One of
29:12
Speaker 1: the things I found significant in your article about Switzerland
29:15
Speaker 1: was that, um, your healthcare providers aren't allowed to make
29:19
Speaker 1: a profit off of basic healthcare. They make their profit
29:21
Speaker 1: off of like elective surgeries. Um up tom and trade
29:25
Speaker 1: things like that. I'll turn the medicine. Just the right
29:28
Speaker 1: to get a private room in a hospital, that's a
29:30
Speaker 1: little bit extra. Um. So yeah, every everyone's private plan
29:35
Speaker 1: is essentially the same, and everyone pays the same. That's
29:37
Speaker 1: the key thing. It's not tied to how much money
29:39
Speaker 1: you make. Regressive not progressive. Wow, I got a little
29:43
Speaker 1: efect for you to one of the largest insurance companies
29:46
Speaker 1: in Switzerland pays out claims in five business days. That's
29:51
Speaker 1: awesome and people love it, they said, I'm sure clearly
29:55
Speaker 1: you guys want to go back to the studio. You
29:57
Speaker 1: get your kind of like here in Switzerland. I'm going
30:01
Speaker 1: to go back to the studio and wrap this up,
30:03
Speaker 1: all right, good knowing you. So I'm here with Josh.
30:07
Speaker 1: I couldn't let him go alone. Thanks. We left Molly
30:10
Speaker 1: and her mounty in Switzerland. Let's say those two are
30:13
Speaker 1: a handsome couple. They are. They're going to live out
30:15
Speaker 1: the rest of their days in the alps Um, she
30:17
Speaker 1: promises postcards, Yes, and chocolates. Yes, we have finished the
30:23
Speaker 1: fourth installment of our podcast Sweet, which means it's the
30:27
Speaker 1: end of our special healthcare podcast Suite. I have hot
30:30
Speaker 1: air balloon lag. I know you do, buddy. We'll get
30:32
Speaker 1: you the bed with some warm milk and a beer
30:34
Speaker 1: in a second. Okay, yeah, um, chuck, let's wrap this
30:37
Speaker 1: this puppy up all right. And Molly, she's really here.
30:40
Speaker 1: We've really Oh yeah she is. She's sitting right there
30:43
Speaker 1: just daydreaming about the mount here. I like the life
30:45
Speaker 1: you pulled for us. Yes, um, thank you very much
30:49
Speaker 1: Molly for joining us. I don't know that we could
30:52
Speaker 1: have done this without you. It wouldn't have been the same.
30:53
Speaker 1: Definitely agreed, no problem. Thanks for having me, guys, and
30:57
Speaker 1: thank you, of course, the Dr Roison who gave us
30:59
Speaker 1: like an hour of his time quite generously and for free,
31:02
Speaker 1: like you didn't have lives to say. I was expecting
31:04
Speaker 1: him to be like a Russian physician, be like I
31:07
Speaker 1: demand a donation, right, but no he didn't. Um and
31:10
Speaker 1: thank you for tuning in to listen to our four
31:12
Speaker 1: part series on healthcare reform. It's an important issue, which
31:16
Speaker 1: is why we tackled it and hopefully you learn something
31:18
Speaker 1: from it. Had some of your questions answered. If you
31:21
Speaker 1: have more questions, you can visit Molly's wonderful articles on
31:25
Speaker 1: the site. At how stuff works dot com. You can
31:27
Speaker 1: just type healthcare reform in the handy search bar, and
31:30
Speaker 1: if you have any questions that you want to direct
31:32
Speaker 1: towards me and Chuck, you can send those in an
31:35
Speaker 1: email to stuff Podcast at how stuff works dot com.
31:43
Speaker 1: For more on this and thousands of other topics, is
31:46
Speaker 1: that how stuff works dot com. Want more how stuff works,
31:49
Speaker 1: check out our blogs on the house stuff works dot
31:52
Speaker 1: com home page. Brought to you by the reinvented two
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