Transcripts For CNNW CNN Presents 20120708 : vimarsana.com

CNNW CNN Presents July 8, 2012



health care costs continue to climb. no other nation spends more than 12% of its economy on health care. america spends 17%. what is more, we really don't benefit from the huge price tag. our healthy life expectancy ranked only 29th in the world behind slovenia. our infant mortality rate ranks 30th and it's more than twice that of sweden and japan. so what is our problem? in this hour and "time" magazine essay, we will take you around the world to study health care systems it other countries to find out what lessons we can learn from others. we will visit great britain and taiwan and switzerland to find out what they are doing right and wrong. we will show you some interesting innovation going on back here in america in one of the poorest, most crime ridden cities in the nation. but, first, let's talk about the one thing americans are certain is bad. government-run health care across the atlantic in great britain. is the nation's health service an evil death panel as some say? let's take a look. >> reporter: during america's >> reporter: during america's debate over health care reform britain's said the system that rationed care to those in need. were they right? britain does have a system that is as close to socialized medicine as any rich country gets. the government pays for everything, owns most of the hospitals, and pays most of the doctors. but consider this. compared to americans, the britts have longer life span and lower infant mortality rate and a health care system that consistently ranks higher on every measure. all this and everyone's care is covered. no payments to doctors and no monthly charges from your insurance company, no copays, no fees, nothing. at king's college hospital in london the doctor here performs a liver transplant surgery with a live donor. a young man is giving part of his liver to his younger brother. the liver is cut in half with one part for the younger brother and the other part staying in the donor. >> the liver is remarkable organ and made of eight segments so you can take pieces of the liver and it will function perfectly well. >> reporter: this transplant costs tens of thousands of dollars but under britain's national health service or nhs, the patient doesn't pay a thing. >> when patients come to us, we only evaluate them from the point of view than need. do they need a liver transplant? the cost never comes into it. as a surgeon, i love that because it means the focus is on the care that i can deliver. >> nobody pays a doctor's bill on the nhs. people will go their entire life without paying a single up front cost. hello. >> reporter: dr. claire girardi is the chair of britain's college of general practitioners. >> are health services fair? it's irrespective of what you can afford and your illness. you will be able to access health care and that is what we require and that is what is a fair and honest health system. >> reporter: compare that to the u.s. where an estimated 137,000 people died over seven years because they were uninsured. of course, the britts do pay for their health care in another way, with taxes. the sales tax is whopping 20% and income taxes as high as 50%. all of that money feeds a health care behemoth. the largest employer with more than 1 million people on the payroll of nhs so you would think it would be inefficient. >> that seems. it doesn't work in health care. >> reporter: this man turped the world's health care systems for his recent book "the healing of america." the least efficient payers in the world are the american private insurance companies have administrative costs of 20% to 30% and 30% tax on every dollar you spend on health care. britain is totally socialized medicine, and administrative cost 5%. canada is private doctors and public payers 6% administrative costs. it turns out in health care, government are doing this more efficiently than our private sector. >> reporter: one reason said reid? private insurers in america spend more money on nonmedical costs like ads and reviewing claims to help them stay profitable. another way governments can be more efficient when they are footing the bill is by having a more coordinated approach to health care. for instance the nhs rewards primary care doctors with bonuses for achieving certain measures of good health like getting patients to quit smoking. that's money well spent because fewer sick people means lower health care costs for the country. on average, the british spend about $3,500 a person on health care. in the united states, we spend around $8,500. what about the argument the only way to make the system work, the only way to get costs under control is to be -- you got to be a little cruel, you got to say we will pay for this and we won't pay for that. >> that's absolutely true. the british health minister said to me we cover everybody but we don't cover everything. >> reporter: not covering everything. the so-called rationing of care is the british system's most controversial element and one man in particular is at the center of that system. >> occasionally we do find ourselves up against everybody. the physicians, the patients, the media. sometimes a real challenge. >> reporter: so andrew dillon is the chief executive of the national institute for health and clinical excellence known as n.i.c.e. for short. it's the government body that decides which treatments the government will and will not pay for. >> this is not about politics. it's not about money at the outset. it's about the evidence for what works best. the clinical studies and the other research done in this country and right across the world. >> reporter: the evidence is weighed by independent panels that include doctors and patients, not government bureaucrats. and decision making process is transparent. the public can weigh in. but the policies n.i.c.e. involve some of the most morals in medicine whether to fund a last line of defense cancer drug. >> in the end there is nothing else in life like facing death and we have to be sensitive to that. we try to be hard to be but equally we need to make sure that we are keeping our eyes on everything else that's we need the nhs to do for us. >> reporter: another controversial aspect of british health care? long wait times for certain procedures. in the early 1990s, you could wait more than a year to be admitted to a hospital for a nonemergency. the nhs rule back now gives patients the right to be treated within 18 weeks of being referred. but that's still a long time to be standing in the cue. britain's government run system provides good care for all and is more cost effective than one might imagine. but the quality of its care can shift as funding waxes and wanes. so is there a way to provide care for all with less government? when we come back, we will visit a country that went from almost half its population being uninsured to nearly full coverage in less than a year and without breaking the bank. my cut hurt! mine hurt more! mine stopped hurting faster... 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[ male announcer ] the spark business card from capital one. choose unlimited rewards with 2% cash back or double miles on every purchase, every day! what's in your wallet? i tell mike what i can spend. i do my best to make that work. we're driving safely. and sue saved money on brakes. now that's personal pricing. what would happen if a country were given a blank slate to design its health care system? if it could choose from any nation in the world, which one would it imitate? taiwan had that unique opportunity and its story provides eye-opening lessons for the united states. asia's tiger economies like taiwan and singapore and south korea skyrocketed out of poverty in the 1980s and '90s. taiwan was growing at 7% a year and joining the ranks of rich countries in no time. >> the country was getting richer, however, the health care insurance system was not all good at the time. >> reporter: a health policy expert at princeton says 41% of taiwan's population had no health care insurance in 1995. >> we paid out of pocket and for the really poor, then you pray a lot. >> reporter: so taiwan's government decided to reform its system of care from the ground up. william shower, a professor of economics at harvard, is one of the world's leading health care gurus. he proposed a bold approach to taiwan's health care reform. >> we invited experts from all of the -- a whole range of countries so we can draw out the lessons and their experience for taiwan. >> reporter: the panel considered the u.s., its close geo political ally as a model for health care. they were not impressed. >> you can learn what not to do from the united states rather than learn what to do. >> reporter: they also looked at great britain. but the brits government-run system was producing long wait times in the '90s. >> bureaucracy is not the best and the most efficient way of running operations. >> reporter: then there was germany which had private insurance but they had so many different funds, their administrative costs were just too high, so taiwan with another insurance model where only one insurer in the market, the government. they combined that with private doctors and hospitals to avoid too much bureaucracy. the system looks like american medicare, only it's for everyone, not just the elderly. taiwan's president, at the time, made a huge push to implement the plan quickly in 1995. dropped from 41% to 8% in less than a year. taiwan has a highly rated health care system. once more, it's a rock star when it comes to holding down costs. the taiwanese spend just 7% of their economy on health care. that's a paltry sum compared to our 17%. the government drives a hard bargain on fees with providers and taiwan can monitor its spending with this cool device -- the smart card. you swipe it any time you go to the doctor. they can pull up your recent medical history and when you're done, he'll have a record of that day's visit. then he'll send an estimate for your bill to the government right away, so officials know how much has been spent at any given time. compare that to medicare in the united states which can only estimate its spending levels two years after the fact. >> in taiwan, all of that is recorded on a daily basis. >> reporter: wouldn't all of that government stinginess make it hard to see the doctor? surprisingly, that's not the case. americans go to the doctor four times a year on average. the taiwanese go around 14 times a year. >> and they stay in hospitals much longer than americans stay in hospitals. the average length of stay for a in a hospital is ten days. in the united states, we're five days. >> reporter: so how do the taiwanese provide all of that care for such low costs? one way, the doctors work their tails off. dr. gary lind's primary care clinic is open 11 hours a day, six days a week. >> i take care of more than 200 patients a day. >> reporter: fees that government insurance doctors are very low. dr. lind only gets 14 dollars for each primary care visit. his colleague in the u.s. makes a hundred dollars per patient. taiwan's legislature just raised the insurance premiums people pay to get more money into the system but don't expect politicians to do something unpopular like that very often. >> in the 16-year-old history, taiwan has raised premium rates twice. just twice. >> reporter: no matter which health care system you visit, politics always comes into play. the next country we are going to visit has some remarkably similar politics to our own. it passed a version of obama care 18 years ago. has it worked out? or is it a disaster? find out when we come back. 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will we have to pay for treatment of obese people? >> switzerland is extremely business friendly and it's always gone its own way on the euro and charting its own course in health care with private providers and private insurance. that's actually not so rare according to journalist t.r. reid. one of the things that many americans believe about health care around the world is that other rich countries in the world all have socialized medicine. is that true? >> that is baloney. some governments provide the care and pay to it but a lot of rich democracies cover everybody. germany, switzerland, they don't have medicare. people stay with the insurer cradle to grave. >> the swiss was getting fed up with their private insurance in the early 1990s. costs rising and premiums were higher for women and the elderly and those with preexisting conditions had trouble getting coverage. some were foregoing insurance altogether. >> the people were flying out of the insurance so we had to stop this. >> reporter: dreyfus, who would later become switzerland's first woman president, pushed for a law that required everyone to buy insurance, gave subsidies to the poor and stop rejecting people for their medical history. sound familiar? that's exactly what president obama's law would do but in switzerland, it was uphill battle. the law passed parliament and barely squeaked by the referendum with 52% of the vote. >> nobody was really happy but everybody could accept. >> reporter: how is the swiss version of president obama's law faring almost 20 years after it was put in place? >> i show you x-rays.. >> everyone is now covered and the care is still top-notch. the swiss enjoy one of the longest healthy life expectancies in the world. >> we have an extremely comfortable system. i mean, the access is easy. you don't have to wait. >> thomas was the swiss secretary of health from 1991 to 2009. >> hospitals have become more like five-star hotels, offering health care. >> reporter: the swiss law went above and beyond obama care. insurance companies were already banned from making a profit on basic health care coverage. under the new law, they had to expand that basic package covering even more procedures. >> even very expensive pharmaceuticals are paid by the insurance plans and have to be paid. >> reporter: the swiss system is world renowned for the choice it provides its users. >> i chose the doctor i wanted to go to. i went there. and it was seamless. >> reporter: we caught up with joseline mills and her husband phillip thompson living in switzerland. johnson was expecting. >> i always waited three hours in an overcrowded waiting room, you know, to see somebody, then to see a specialist if anything was wrong. so i don't have that here. >> reporter: another bonus, health insurance isn't linked to employment. plus you can change your insurer every year if you want. >> the choice is such that it is sometimes confusing. you know, you have in each town you're living a choice of probably a hundred to 200 different plans and you almost need a coach or someone helping you to choose your insurance plan. >> reporter: experts worry the swiss don't reap the cost savings from their insurance choices because there are so many of them. that might explain why health care costs in switzerland are still very high. 11% of gdp. >> you cannot make a perfect law, but you can make a perfectible law and i would say any law has negative side effect and this is, listen, you are still working to make this law better. >> health care costs are rising all over the world. but in the united states, health care is almost twice as expensive as everywhere else. why is that? 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