Health Care Systems Around the World


Announcer

Welcome to Stuff You Should Know from howstuffworks.com.

Josh Clark

Hey and welcome to the podcast. I'm Josh Clark. With me as always, is Charles W. Chuck Bryant.

Chuck Bryant

Sliding into my seat.

Josh Clark

And with us is Dr. Molly Edmonds, M.D. Esquire PhD, LLC, right?Dr.

Molly Edmonds

Yes.

Josh Clark

Did I get all those, Molly?Dr.

Molly Edmonds

I think so.

Josh Clark

This is the final installment of our four-part healthcare reform suite. We've reached the end of the final countdown.

Chuck Bryant

Can I just say, speaking for Molly and I, thank God?

Josh Clark

Yeah, you're not speaking for me to? You think I like this, Chuck?

Chuck Bryant

You ready to move on?

Josh Clark

Yeah.

Chuck Bryant

Yeah. Okay.

Josh Clark

Okay, so we've talked about healthcare reform. First of all, Molly, what was that statistic that you mentioned a long time ago in a podcast far, far away where you said like only one in eight Americans think that the healthcare system in the US needs reforming?Dr.

Molly Edmonds

Eight out of ten people are happy with their healthcare as it is.

Josh Clark

Okay. So what we kind of deconstructed is why healthcare reform is even on the table. And we've talked about the uninsured. We've talked about the fact that America has really terrible mortality rates or disease rates, chronic disease rates; that kind of stuff. So that in and of itself makes the healthcare system worth fixing, right?Dr.

Molly Edmonds

Um-hum.

Josh Clark

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 healthcare system is actually keeping us from competing as well as we could on a global scale, which is why we would compare ourselves to other healthcare systems around the world.Dr.

Molly Edmonds

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 can find anyone who lives in another country who wants to trade places with an American when it comes to their healthcare.

Josh Clark

Well put. Let's talk about competitiveness and the healthcare reform system via Dr. Michael Roizen, who you guys might remember, right?

Chuck Bryant

Yes.

Josh Clark

What is he?

Chuck Bryant

Dr. Roizen is a chief wellness officer of the Cleveland clinic.

Josh Clark

And?Dr.

Molly Edmonds

My hero.

Josh Clark

And the co-author of the You: The Owner's Manual book series, right?

Chuck Bryant

With Dr. Oz.

Josh Clark

Here is what he had to say.Dr.

Roizen

Because healthcare is an 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 for jobs, and for us to not worry about a falling standard of living and for people to not worry, not have the stress of worrying about "Will there be healthcare for me when I need it that I can afford?"

Josh Clark

Okay, so if we're going to keep up with Europe and Asia like Dr. Roizen suggested we could by reforming our healthcare system, maybe we should kinda peek in on what other countries around the world are doing, whether for better of for worse. Molly, you wrote this article, "Ten Healthcare Systems Around the World," right; which is up on the site?Dr.

Molly Edmonds

Yeah, it's sort of, I think, a virtual hot air balloon ride through the world of healthcare.

Josh Clark

It was. It was a delightful one too. It was beautiful.

Josh Clark

Bloody bandages.

Chuck Bryant

Very peaceful.

Josh Clark

So was there any particular healthcare system that struck you as arguably better than the US -Dr.

Molly Edmonds

Oui.

Josh Clark

- or better than all the other ones actually? Oui?Dr.

Molly Edmonds

Oui, oui. Let's talk about France.

Chuck Bryant

France transition.

Josh Clark

Oh, got you.

Chuck Bryant

Get it?

Josh Clark

Yeah, I do now.

Chuck Bryant

Oui means yes.

Josh Clark

I got you.

Chuck Bryant

And touché means touch.

Josh Clark

Touché means touch, yeah.

Chuck Bryant

Okay, France. They apparently have the best healthcare in the world, so says the World Health Organization, right?Dr.

Molly Edmonds

Yeah. It's hard to argue with WHO.

Chuck Bryant

All right, moving on then. What's next?

Josh Clark

No, that's actually - I think just because it's become a relic in the healthcare reform debate in the United States that the WHO 2000 report of 191 countries' healthcare systems rankings is controversial. I think we should say that.

Chuck Bryant

Yeah, we got -

Josh Clark

Well, WHO said that, so okay, it must be true, but again, you can pick apart anything. So let's just stick to the fact that France was rated No. 1 in the year 2000 by the World Health Organization's rankings of 191 countries, right?Dr.

Molly Edmonds

Right, so all French citizens will put in money based on their income. You can't opt out of it, and then I return, they'll get about 70 percent of their healthcare paid for by the government. You can get same-day appointments; you can choose any healthcare provider you would like, but - okay, so we said 70 percent. How do they pay for the other 30 percent? They all have supplemental insurance with either a public or a private plan. And that is more similar to have we have it in the US where that supplemental plan might come from your employer.

Josh Clark

So there are a couple problems with the French system. It's not flawless.Dr.

Molly Edmonds

No.

Chuck Bryant

There is no flawless plan. We should go ahead and say that.

Josh Clark

You lie.

Chuck Bryant

I saw one guy that said it like this; he said, "It's sorta like Medicare for everybody."

Josh Clark

With the French system?

Chuck Bryant

Yeah.

Josh Clark

I got you.

Chuck Bryant

And he was a pro.

Josh Clark

So they make up the other 30 percent with private plans, right?Dr.

Molly Edmonds

Private or public and that's the problem: 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, those who can't: don't.

Chuck Bryant

Right, but they do that in England too. You can get - also get your private insurance.

Josh Clark

Right, yeah. And we should say for kind of a comprehensive rundown of England, Molly gave one in the third podcast.

Chuck Bryant

Right, so we're not gonna talk about those.

Josh Clark

We're gonna skip it.

Josh Clark

Okay.Dr.

Molly Edmonds

And it was a nice stop on the balloon ride, but here's how France got its awesome rating, okay? It spends $3300 per person on healthcare, while the US spends over twice that. 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.

Chuck Bryant

Yeah, that's what I saw that your article and some other stuff I read is that 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.Dr.

Molly Edmonds

Exactly, but it's not just the really sick who benefit because I think what's cool about France is 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 are - if you had had an early diagnosis or if you'd had an early treatment for a condition.

Chuck Bryant

Right. I did see also in another article I read that one of the criticisms is that there's not great coordination between the GPs and the specialists 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 preexisting condition, I think; wouldn't you say?

Josh Clark

I would say it, yeah. You guys done with France because I'd like to get back in the balloon.Dr.

Molly Edmonds

Okay.

Josh Clark

And just head on over a few kilometers, a few clicks if you will to Germany.

Josh Clark

Which is the - out of the healthcare systems 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.Dr.

Molly Edmonds

True.

Josh Clark

In even the public health insurance plans, right?Dr.

Molly Edmonds

Right.

Josh Clark

And there's 200 of them, correct?Dr.

Molly Edmonds

Um-hum.

Josh Clark

And they're employer and employee funded, right?Dr.

Molly Edmonds

Yeah, and you know where that comes from is actually in 1883, old Otto von Bismarck was like -

Josh Clark

He had the spikiest -

Bruce

Old Otto.Dr.

Molly Edmonds

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 the podcaster's guild, the cloth maker's guild - that was Germany; that was how they named them - they all paid for each other's 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."

Bruce

I - we can't even get podcasters to unite under this roof. I doubt if we can get it all around the world.

Josh Clark

You never know.Dr.

Molly Edmonds

So this is a -

Bruce

We'll call it a Bismarck model.Dr.

Molly Edmonds

This is a pretty old system and it's been around for hundreds of years, but it's because they're always willing to keep reforming it.

Josh Clark

Yeah.

Bruce

I noticed in another article from Berlin University actually it was kind of a rundown of the German healthcare system. All these different years kept coming up. They try new things every year or two. 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. And I think you make a very valid point that it has to keep evolving and changing as problems come up or as things prove very effective. You put more money into this or take funding away from that.Dr.

Molly Edmonds

Right. Some of their cool new initiatives are these disease management programs 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, sticking with their diet, these people have much lower rates of hospital admissions and much lower rates of death from people - that 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.

Chuck Bryant

I don't know. I could see like half the people in the United States thinking it's a really nice thing to get a call and half the people being like, "Stay out of my business, nurse. How'd you get this number?"

Josh Clark

Right.Dr.

Molly Edmonds

Well, and it's not like the nurses and the doctors love this system. I would say that you read a lot of articles about how the German doctors feel underpaid.

Chuck Bryant

They're the ones who protest the most often, right?Dr.

Molly Edmonds

Right.

Chuck Bryant

German doctors?Dr.

Molly Edmonds

Yeah.

Josh Clark

It says they're paid about two-thirds what American doctors make, but they pay less for malpractice insurance and some of them go to school for free, med school.Dr.

Molly Edmonds

And you know one cool fact that I did not manage to squeeze into this article, but those plans, those 200 plans that we were talking about, those plans get incentives if they get sicker people on their roster. So instead of a system like in the US where -

Chuck Bryant

We deny people.Dr.

Molly Edmonds

- we tend to deny people; they get benefits for doing that in Germany.

Chuck Bryant

That's pretty cool. I also saw where you can - in Germany, you can go straight to a specialist. You don't have to go through your gate keeper GP. It's kinda cool.

Josh Clark

Also, there is a private insurance market for people who make over 48,000 Euros a year.

Chuck Bryant

Oh, really?

Josh Clark

It's not compulsory for those people. Actually, long term health insurance is compulsory for everybody, but basic healthcare coverage isn't compulsory for people who make over 48,000 Euros a year. So there's another, I guess accompanying private insurance market, but that's still regulated by the government. There's like a - you can't deny for preexisting conditions. And apparently, your rates are assessed when you enter that private system 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.

Bruce

I'm just gonna go ahead and say that.

Josh Clark

You miss the Deutschmark?

Bruce

Yeah, I miss the Deutschmark.

Josh Clark

What an odd thing to say.

Bruce

I miss the Franc. I miss -this whole Euro business.Dr.

Molly Edmonds

Yeah, but I hate to change money from country to country.

Bruce

Oh, see I thought it was kinda thrilling.Dr.

Molly Edmonds

But then your leftover coin -

Bruce

Yeah, but then you take them and you give them to your cousins and nephews and nieces.

Josh Clark

You're just a giver, Chuck.

Bruce

I actually haven't been to Europe since they introduced the Euro. So I'd probably love it.Dr.

Molly Edmonds

Speaking of redistributing money.

Josh Clark

Oh, I know where we're going next. This is gonna be kind of a long balloon ride, so let's just flash forward to when we land in Cuba.

Chuck Bryant

So Cuba; let's talk. They have healthcare for - well, you give the skinny because I have - I just read some articles where they say it wasn't so great.Dr.

Molly Edmonds

Well, the famous example, I think, Cuba - if you're a Michael Moore fan, it's when he took people to Cuba so they could get better care than they could in the United States. And it was meant to embarrass the US healthcare system. There are obviously a lot of critics as with anything Michael Moore does. How it was portrayed in the movie and some people say that there is sort of one level for the people they're gonna impress and then one level for everyone else, but I do think that even those people who are in maybe that lower echelon get an immense amount of preventative care that's pretty cool.

Chuck Bryant

Well, that's - it sounds like they do a pretty good job with the preventative care because they kind have to.

Josh Clark

Well, you guys were talking about Germany and doctors or nurses calling you up going, "How you doing?" If you had a problem with that, you'd probably really have a problem with Cuba because any person is subject to a surprise visit from their physician.Dr.

Molly Edmonds

Once a year.

Josh Clark

Yeah.Dr.

Molly Edmonds

They just are gonna stop by.

Josh Clark

Show up at your door.Dr.

Molly Edmonds

See what you're doing, what are you eating?

Josh Clark

And they're like, "While we're here, what's under your mattress? And what's in your closet?"Dr.

Molly Edmonds

Well, see that's sort of the problem is that because they - they have good preventative care because they may not have let's say a fridge or access to really fatty food or a really great car, so it's almost like what we would see as the deficiencies in Cuba have created a culture whereby they walk a lot. They don't have fast food. It's coming. They say that that might be sort of the next wave of obesity is Cuba is getting some fast food.

Josh Clark

Really?Dr.

Molly Edmonds

Yeah.

Josh Clark

Well, as a result, Cuba - they have - I think they spend $260 a person on healthcare.

Chuck Bryant

A year.

Josh Clark

A year?

Chuck Bryant

Yeah.

Josh Clark

Right, because they're really good with preventative wellness.

Chuck Bryant

Right.Dr.

Molly Edmonds

But I do wanna point out, sometimes - I believe you brought it up, Josh - there's the thought that if we spend a lot less on healthcare, we'll really skimp on our innovation, but Cuba, surprisingly is known for its innovation and medical breakthroughs.

Josh Clark

I have heard that, yeah.Dr.

Molly Edmonds

They - the medical sector is their sixth largest in exports. Obviously, not to the US, but they really put themselves on the map for some vaccines they've come up with for Meningitis B and then Hepatitis B. And so they're really making a name for themselves in terms of their pharmaceutical and medical equipment exports.

Josh Clark

Chuck, you referenced some articles that you'd read that had criticized the Cuban healthcare system.

Chuck Bryant

Yeah, I think this is one of those systems where you - it all depends on who - what 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 healthcare systems: one for health tourists, which apparently Michael Moore is a health tourist. And that's a big deal.Dr.

Molly Edmonds

If you've got a camera crew following yourself around, then -

Chuck Bryant

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 if you're the rest of Cuba, you can't get things like Aspirin; you can't get antibiotics unless it's on the black market and you don't have access to a lot of basic medical care. You have to bring your own sheets to the hospital; stuff like that.Dr.

Molly Edmonds

Well, and 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 infant mortality.

Chuck Bryant

I thought that was interesting.Dr.

Molly Edmonds

- but in the United States, if a baby is born and only lives a very short period of time, we count that whereas if it was in the same - if it was alive for the same period of time in Cuba, they may count that as dead on arrival.

Chuck Bryant

Right. And didn't you also say that some doctors allegedly will suggest abortions -Dr.

Molly Edmonds

Um-hum.

Chuck Bryant

- in the womb if -

Josh Clark

No, the government suggests they abort a fetus that might be developmentally disabled or something, right?Dr.

Molly Edmonds

Right. There's just concern that they have great numbers, but because we don't really know much about what goes on inside the country, we don't exactly know how they get them.

Chuck Bryant

I've heard Cuba's really nice to visit.Dr.

Molly Edmonds

It can be hard to separate your opinions on the Cuban health system from your opinions just on Cuba the country. So I don't wanna oversell Cuba, but I'm glad I got to visit in the balloon.

Chuck Bryant

I don't have any opinions on Cuba other than what I've heard from a couple friends who've traveled there and said it was really awesome and the people were lovely and the country was beautiful. And politics aside, the country itself, they loved.

Josh Clark

That's illegal.

Chuck Bryant

It's illegal? Actually not true.

Josh Clark

So you guys, let's head on over to China.

Josh Clark

Okay, well, here we are in China and this place is kinda screwed up, huh Molly?Dr.

Molly Edmonds

I don't know if I'd wanna get sick here.

Josh Clark

It used to be pretty good from what I understand in your article, that there was a cooperative healthcare system, right?Dr.

Molly Edmonds

Right. And they dismantled it and that just didn't go very well because no one knew where to send the bill and the places they were sending the bill didn't pay up. And what the - the huge effect of this was that there's a giant divide between healthcare in cities and healthcare in the rural areas.

Chuck Bryant

Yeah, one of the ideas for Chinese healthcare reform was that all farmers pay $1 for healthcare -Dr.

Molly Edmonds

In a year.

Chuck Bryant

In a year and they balked at that as being too expensive.Dr.

Molly Edmonds

Um-hum.

Chuck Bryant

Are the rural Chinese that poor really?Dr.

Molly Edmonds

Well, I think they were -

Chuck Bryant

Or is healthcare just not really taken seriously over there or what?Dr.

Molly Edmonds

Well, I think they were also saying that yes, the dollar was high, especially for the care they got. I was reading one article, [music] I believe it was in the New York Times about how you go to some of these rural clinics and stray dogs are walking the halls of the clinics.

Chuck Bryant

But it's not worth $1 a year?Dr.

Molly Edmonds

Stray dogs in your hospital?

Chuck Bryant

Still, they bring dogs in to American hospitals to perk up cancer patients.Dr.

Molly Edmonds

Yeah, nice, healthy ones; not ones that look like they're gonna die.

Chuck Bryant

You don't know whether they're stray or not.

Josh Clark

You're talking about the - they have different names at every hospital I guess, but love on four paws?

Chuck Bryant

Sure, stray dogs. We'd love to.

Josh Clark

Not in hospitals.

Chuck Bryant

Well, okay, so China's - in addition to its ridding the hospitals of stray dogs initiatives, they're planning on building 700,000 I guess probably pet unfriendly clinics in rural areas?Dr.

Molly Edmonds

They'll be able to 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 in the hopes that they can eradicate this divide between the rich and poor.

Chuck Bryant

Over the next ten years or so; ten or 11 years?Dr.

Molly Edmonds

Um-hum. Yeah, but by -

Josh Clark

2011.Dr.

Molly Edmonds

By 2011, 90 percent of the population will have health insurance.

Josh Clark

They're hoping. They're -Dr.

Molly Edmonds

Fingers crossed.

Josh Clark

They're spending 124 billion on it?Dr.

Molly Edmonds

Yes, 850 billion yen.

Josh Clark

Yuan?Dr.

Molly Edmonds

Yuan? I don't really know how to pronounce anything in China.

Chuck Bryant

Yuan.

Josh Clark

Yuan.

Chuck Bryant

That didn't sound like very much money to me.

Josh Clark

No, it doesn't.

Chuck Bryant

To build 700,000 clinics.

Josh Clark

Yeah. And well, the other problem is Molly points out that 40 percent of that money 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?Dr.

Molly Edmonds

It's 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?

Josh Clark

Are we going back to our balloon now?Dr.

Molly Edmonds

Sure.

Josh Clark

Do we have enough gas?Dr.

Molly Edmonds

It's run on unicorn tears.

Josh Clark

Excellent, okay. Do we have enough unicorn tears to make it to Taiwan, you think?Dr.

Molly Edmonds

Oh, I hope so because Taiwan's got a pretty nifty system. I don't think it would work in this country, but -

Chuck Bryant

Dude, the smart card.Dr.

Molly Edmonds

The smart card sounds so convenient, although kind of nerve racking for someone like me who has the tendency to lose things.

Josh Clark

Wait, wait. You guys, wait until we get to Taiwan.

Josh Clark

Okay, here we are. We're in Taiwan.Dr.

Molly Edmonds

I wanted to brief chat before we got there.

Josh Clark

No chatting along the way. Let's just all sit silently in our balloon.

Chuck Bryant

It's a silent flight.

Josh Clark

All right, so we're in Taiwan now. This is lovely.

Chuck Bryant

So back to the smart card before -Dr.

Molly Edmonds

Exactly. Okay, so you get a smart card. It's got your entire medical history on it and you can just show up to a doctor, give them your card and they can pull up your entire medical history. And that is how they will also bill the 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 there are gonna be people who say that's way too much information for any government to have about a person.

Chuck Bryant

I like the idea of the smart card. I wouldn't mind all my medical information being on one card 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.Dr.

Molly Edmonds

Well, I've moved quite a bit and I just hate kind of having to start over every time with every doctor.

Chuck Bryant

Right. And what do you do - I actually haven't changed doctors much. Do you get them to send everything to your new doctor?Dr.

Molly Edmonds

I think you're supposed to.

Chuck Bryant

Really?Dr.

Molly Edmonds

Maybe I shouldn't reveal how poorly I manage my health switchovers because I am a health provider.

Chuck Bryant

The smart card sounds way -

Josh Clark

Well, yeah, medical billing, medical information: it's a huge, huge problem in the US just in administrative costs and time.Dr.

Molly Edmonds

Yeah, and that's the thing that was cool about what Taiwan did is that in expanding coverage to cover so much more of the population that they cut all those costs because now they have no administrative costs essentially, but the fact of the matter 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 are afraid to raise the taxes; the age old story.

Chuck Bryant

Yeah. I saw where a family - an average family premium is $650 a year in Taiwan.

Josh Clark

So are we done with Taiwan? Is that smart card -?

Chuck Bryant

This place is really clean by the way. Have you noticed?

Josh Clark

I have.

Chuck Bryant

And the food's good.

Josh Clark

Yeah. Are we done?Dr.

Molly Edmonds

Where are we going next?

Josh Clark

Let's go to Russia.

Josh Clark

Okay, guys thank you again for not speaking during the balloon ride. So we're in Russia now.Dr.

Molly Edmonds

And unfortunately, this is not a good place to get sick, so no one drink the water here, okay?

Josh Clark

Okay.

Chuck Bryant

Right. They got -

Josh Clark

Wait, you can't drink the water in Russia?Dr.

Molly Edmonds

No. Oh no, Giardia.

Josh Clark

Okay.

Chuck Bryant

Really? Wow, I didn't know that. You'd think they would have had that worked out.Dr.

Molly Edmonds

No, not in the place that has one of the four worst healthcare systems in the world.

Chuck Bryant

Right.

Josh Clark

Is there another one we may have heard of that's in that list?Dr.

Molly Edmonds

According to foreign policy, the United States also makes that list. It was a foreign policy article so it's not stellar. The World Health Organization though I mentioned earlier, ranks them 130 out of 191. So and they've got a fair bit of money. It seems like they should be 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 combo system. And basically, this system works well in theory, but sucks in practice.

Chuck Bryant

Financially, it doesn't work out, right?Dr.

Molly Edmonds

I don't even think that financially, personally. You've gotta show up with a pretty hefty bribe to see a doctor in Russia.

Josh Clark

Yeah, I thought that was really interesting -

Chuck Bryant

A donation.

Josh Clark

- that on paper or spoken, it's - 90 percent of the population's covered, but the government doesn't really pay up. And so to keep operating, hospitals and doctors go, "I need you to give me a donation, Buddy or else I'm not gonna treat you." It's extortion for healthcare, which is nuts.Dr.

Molly Edmonds

Can we just be careful because I don't want Vladimir Putin to listen to this podcast.

Josh Clark

And come wrestle the tiger?

Chuck Bryant

Yeah, he'll take his shirt off -Dr.

Molly Edmonds

And listen to the word "extortion." So let's make our stop here brief.

Josh Clark

Okay.Dr.

Molly Edmonds

I think what's good to know is that the World Health Organization, love it or leave it, recommends that countries spend about five percent of their total spending on healthcare. And Russia spends 3.4 percent.

Josh Clark

Okay, I don't wanna alarm anybody. Some guys just pointed at us and are starting to come over. So we should probably get back to our balloon, okay? Let's pack our Rubles and get out of here.Dr.

Molly Edmonds

Let's go to a pretty, happy place: Canada.

Josh Clark

Okay.

Chuck Bryant

We have a lot of Canadians write in and say, "What about us?" We have a lot of Canadian fans and so we're gonna talk about you all now. [Inaudible]

Josh Clark

Okay, I'm gonna let that one slide. We're here in Canada now. Thank you, Molly for not speaking during the journey.

Chuck Bryant

I couldn't be quelled any longer.Dr.

Molly Edmonds

I was writing a personals ad for Mountie.

Josh Clark

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 go to socialized medicine or something. This - Canada, I always feel bad for them because they serve as like some sort of cautionary tale for what we don't want, but from what I hear, it's not nearly as bad as we've been told by some [inaudible].

Chuck Bryant

Me too. I've heard that too.Dr.

Molly Edmonds

Right, people are trying to treat Canada like the worst case scenario and I think that this is due to a lot of commercials. And from what I understand - I haven't talked to these people myself, but it seems like people are very good about going and finding people who did have just staggering long wait times and put them in the commercial.

Chuck Bryant

Right. I have some Canadian friends who I keep up with on the blog and they've written me before and said, "You know it's not perfect over here. Wait times aren't nearly as bad as they're depicted though and we'll take it any day."Dr.

Molly Edmonds

And I think wait times were really bad back in the '80s and early '90s. And then in the '90s, Canada invested billions of dollars to improve the statistics. And so now if you wanna head over to a clinic, before you go over, you type in which clinic you want and they will tell you what the wait time is.

Josh Clark

Oh cool.Dr.

Molly Edmonds

So that sort of transparency, I think, is pretty hard to find in this country.

Chuck Bryant

And then the wait times aren't - it's not for like basic care, right? Isn't it usually for like special elective surgeries and stuff like that?Dr.

Molly Edmonds

The waits are longest for knee replacement; sort of elective things. And I think that one of the ways that Canada does keep their costs low in comparison to the United States is they don't buy every single new fangled machine that comes out. In the United States, we have atendency to buy every single cool gadget and that really -

Chuck Bryant

It's pretty; buy it.Dr.

Molly Edmonds

And that really can make our healthcare system 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.

Josh Clark

Right, but there appears to be something of an equally American sentiment among Canadians that they do like their pretty machines like an MRI, a new MRI because there - you mentioned in the article there's a subculture of rogue doctors who offer unlicensed -

Chuck Bryant

Illegal -

Josh Clark

- illegal medicine for people who don't wanna wait and can pay up, I assume, right?Dr.

Molly Edmonds

Right. I think that's sort of the message you can take from any of these systems is the people who have money will use it.

Josh Clark

We should also say that if you're going to compare a country with socialized medicine to what the US - the fear of what the US might become, 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, the hospitals and doctors are private entities. They're private enterprises, right?Dr.

Molly Edmonds

Right. In Britain, they run the hospitals and pay their doctors, but in Canada, it's just single payer. And let's talk about what that means because single payer seems like such a dirty word to people. Here's how Canada pays for their health insurance: the citizens fund their healthcare by paying income taxes and sales taxes. And then all that money is sort of funneled through to the provinces and the territories. So it's not even like Canada as an entity is pushing out the money.

Chuck

Got you. Are you clear on that, Josh?

Josh

I am.

Molly

Do you want a fun fact?

Josh

Yeah, please.

Molly

Did you know that open heart surgery costs 30 percent less in Toronto than it does in Chicago?

Josh

Really?

Chuck

Really?

Molly

Yes.

Josh

That's crazy. Also, prescription drugs tend to cost a lot less in Canada, from what I understand from Roizen during that phone interview because Canada promotes far more competition among pharmaceutical companies. The same pharmaceutical companies that might be based in the US or doing business here in the US.

Josh

That's why their costs are lower for pharmaceuticals.

Chuck

Right.

Molly

And also, doctors and nurses make a fair bit less. So I don't know if doctors wanna go to a Canadian system.

Josh

Okay, kids; one last stop on our whistle stop tour.

Molly

Make it a good one.

Josh

Do you feel like doing some skiing? Let's go to Switzerland.

Molly

Oh, good chocolate.

Josh

Okay, here we are in our last stop. We're in Switzerland.

Chuck

It's beautiful.

Josh

Do you see the red crosses everywhere and the Alps and the nice, smiling, red apple cheek faces?

Molly

Guys, I'm gonna stay neutral and not give you an opinion on this.

Josh

Okay.

Chuck

I saw that one coming. Their healthcare system is really expensive.

Molly

Really, really expensive. And yet, Americans that were looking for alternatives abroad seem to love it, both Democrats and Republicans.

Chuck

It's a pretty good system, but it's just expensive, right?

Molly

Well, it's the - they have free choice, but they pay for that.

Chuck

They do.

Josh

What do you mean by that?

Molly

Well, I will tell you.

Josh

Okay.

Molly

You know how everyone here is all freaked out about public health option?

Josh

Um-hum.

Molly

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 a better word, [music] pick your private plan and make those fancy [inaudible]. And it can cost a lot.

Josh

It can.

Chuck

[Inaudible] $750 per family per month; not per year.

Molly

Yeah, so pretty steep. So generally, Republicans like the choice you can have on private plans and Democrats like the fact that even though that's expensive, everyone's covered because those who can't afford it receive assistance from the government. But I don't know if we wanna go through being a first expensive - most expensive healthcare system in the world to the second most expensive healthcare in the world.

Josh

One of the things I found significant in your article about Switzerland was that healthcare providers aren't allowed to make a profit off of basic healthcare. They make their profit off of elective surgeries, optometry; things like that.

Molly

Alternative medicine; just the right to get a private room in a hospital. That's a little bit extra. So yeah, everyone's -

Chuck

To not use a gatekeeper, right?

Molly

Everyone's private plan is essentially the same and everyone pays the same. That's a key thing. It's not tied to how much money you make; regressive, not progressive.

Chuck

Wow. I've got a little fact for you too. One of the largest insurance companies in Switzerland pays out claims in five business days.

Molly

Whoa.

Chuck

That's awesome and people love it, they said.

Josh

I'm sure.

Chuck

Clearly.

Josh

You guys wanna go back to the studio?

Molly

Not really.

Josh

Did you get your chocolate?

Chuck

I kinda liked it here in Switzerland to be honest.

Molly

I wanna stay here in Switzerland.

Josh

Okay, I'm gonna go back to the studio and wrap this up, all right?

Chuck

Okay, good knowing you.

Molly

Enjoy your silent ride.

Josh

So long kids.

Chuck

So I'm here with Josh. I couldn't let him go alone.

Josh

Thanks, Chuck.

Chuck

We left Molly and her Mountie in Switzerland.

Josh

Let's - yeah, those two are a handsome couple.

Chuck

They are. They're gonna live out the rest of their days in the Alps.

Josh

Yep. She promises postcards.

Chuck

Yes and chocolates.

Josh

Yes. Well, we have finished the fourth installment of our podcast, which means it's the end of our special healthcare podcast suite.

Chuck

I have hot air balloon lag.

Josh

I know you do, buddy. We'll get you to bed with some warm milk and beer in a second.

Chuck

That sounds good.

Josh

Yeah. Chuck, let's wrap this puppy up.

Chuck

Okay. And Molly; she's really here.

Josh

Oh yeah. Yes, she is, isn't she?

Chuck

She's sitting right there.

Molly

I was just daydreaming about the Mountie. I like the life you pulled for us.

Josh

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.

Chuck

Agreed.

Molly

No problem. Thanks for having me guys.

Josh

And thank you of course to Dr. Roizen who gave us like an hour of his time quite generously and for free.

Chuck

Sure, like he didn't have lives to save.

Josh

I was expecting him to be like a Russian physician like, "I demand a donation," but no, he didn't. 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 learned 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 howstuffworks.com. You can just type healthcare reform in the handy search bar. And if you have any questions that you wanna direct toward me and Chuck, you can send those in an e-mail to stuffpodcast@howstuffworks.com.

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