We ran a clip of this woman a couple of months back; She's called Susan, she was based in New
York, and she's recently lost her job as a bartender due to the pandemic. This meant
she'd lost her health insurance too. - I had cancer last year and I was just...
right as the pandemic set in was when all of my one-year checkups were due to happen
and so that was a big concern. After my surgery, I was told that most likely I will have a recurrence
of the cancer, and the biggest part of making sure that I do OK is being vigilant with screening and
watching things. And so not only do I lose my job, I'm getting calls from the hospital saying,
well we're gonna have to push these appointments. That was a scary part of it as well. - Have you
had any of those screenings? Have you had any of those checkups, to check on your cancer, to see if
it's OK? - No, no I haven't been able to do that. - How does that feel? - It's terrifying. I lost
my mom to the same breast cancer that I had. And I was very lucky, the first time, I caught it early
because I am super vigilant about it, knowing what my mother went through. I think I'm gonna be okay,
and that, you know, now I'm finally gonna get health insurance back next month, so
I'll be able to go in and get screenings then, but you know, it's cancer. So hopefully it will
be OK. - You're gonna have to pay though, at least up front some of that cost? - Yes, yes I believe
my deductible, so what I have to pay before insurance kicks in, is $5,000. - Where are you
going to find $5,000? Well I don't know. Because I still... I don't have a job. I'm on unemployment.
And we have opened up a lot of restaurants again in New York where I could potentially get a job,
but with my health risk and the fact that everybody has gone to maybe a quarter of the staff
that they had pre-Covid, the jobs are really hard to get. So I'm not sure what I'm going to do. -
It is just one story among millions, obviously, but this is the thing, something that listeners,
even in other developed countries, may struggle to get their heads around: Even individuals WITH
health insurance in the United States are often unable to get affordable treatment.
As to who's to blame for all of that, well opinions differ. Many on the left say it's all the
fault of an increasingly dysfunctional privatised health system. Many on the right, though,
say it was better before the Affordable Care Act, or Obamacare, came in, just a few years ago. But
we'll get to all of that in a moment. First off, a quick explainer of how the US healthcare system
works. Not such an easy challenge, it seems. - The US doesn't really have a healthcare system.
Unlike most other countries, which at some point decided to structure their healthcare system, the
US healthcare system just happened. - Those are the words of Julie Rovner of Kaiser Health News,
a specialist healthcare publication in Washington. She describes the system as a mishmash, which most
agree, on both sides of the political divide, requires some kind of reform. - Whether they have
insurance provided by their employer, or whether they buy it themselves,
most Americans have private insurance. And mostly if you are a senior citizen, or you have a
disability, or you have a very low income, in most states - it varies - there should be a government
program for you. - Right, and these are called Medicare if you're old, and Medicaid if you're
very poor? - That's correct. - So it's a mishmash. It isn't a socialised system, which some countries
have. Does it work? - Not very well. I mean, for many people, it works. If you have a lot of money,
it works. If you work for a generous employer, even if you don't have a lot of money, it works.
Most people are very happy with their Medicare coverage, many people are very happy with their
Medicaid coverage, but there are somewhere in the neighbourhood of 28 million Americans who have no
coverage, and there are people who fall between the cracks and lack coverage for part of the year,
or they have coverage that they can't afford to use. They have these enormous out-of-pocket costs
that go with them, so they may have insurance in name only. - The journalist Julie Rovner. So
the system is largely private, but it's creaking. And one of the big points of contention in recent
years has been the Affordable Care Act: President Obama's signature legislation designed to expand
health coverage to millions of poorer citizens. Now this plan was controversial even back then,
and President Trump has done plenty to roll it back since he gained the White House in 2016,
although he has failed to throw it out entirely. Republicans say that this extension of coverage to
lower income Americans has driven up the costs for everybody, middle-class Americans and employers
too, of health cover. Many Republican-dominated states have refused to bring Obamacare in,
but amidst the pandemic, some states like Missouri have now reversed that position,
after a state-wide poll. Robin Blount is the chief medical officer
for the Boone Hospital Center in the city of Columbia, Missouri. - They're afraid to come in,
they think it's going to cost too much, or they wait until they're very sick instead of receiving
preventative care or seeing their doctor early enough to get their diabetes under control etc,
and that's what Medicaid expansion is going to do for our citizens in Missouri. People
will have access to doctors and be able to maintain their health and have good care and
not necessarily have to rely on an emergency system. - Will it be enough? -It's a step.
It is a step forward. And I think it is going to provide care to a lot of folks here in Missouri.
You know, our rural hospitals are often the ones that bear the burden of so much low-income care,
and 10 hospitals have closed since 2014. And these are in rural areas. - That's a lot for a rural,
relatively low-population state isn't it? - It is, mainly because those people now have to travel
much further to get their healthcare. It's just, these small hospitals in smaller towns
just struggle to keep afloat, and we hope to see that stabilise. - Are you worried about the impact
specifically of the Covid crisis? I mean, I know that you haven't been the worst affected state,
because people in those rural areas are going to struggle to get specialist care that they may need
right now? - Yeah. Well I don't know that it's any different with the pandemic than it was before.
Covid hasn't hit the rural areas near as hard as it has any of our larger towns,
but there are pockets of Covid, and they seek their care here, and we do have the ability to
take care of these folks, they just have to travel a bit to get here. And there is a lot of strain
there. - The healthcare professional Robin Blount in Missouri. Well speaking of the Covid pandemic,
President Trump has been widely criticised for a disjointed response to that crisis,
but on the campaign trail he started fighting back: "The fact is, every time I've called the
president he's quickly gotten on the line." "What the federal government did, working with states,
was a phenomenal accomplishment." "His team has been on it. I know a team when they're on it,
and I know a team when they're not on it. His team is on it." - That's a TV commercial from the Trump
campaign, featuring a number of state governors, including democrats like New York's Andrew Cuomo,
praising the federal response, and by implication, the president himself.
Complete with emotional music, it is meant to show how much the president really cares
about the viral menace, which has claimed close to 200,000 American lives. But critics say this
subject is a presidential weak spot, not least because beyond hating Obamacare,
Mr Trump himself doesn't seem to know what he wants to do on healthcare:
"We're signing a healthcare plan within two weeks, a full and complete health care plan." "We're
going to be doing a very inclusive healthcare plan, I'll be signing it sometime very soon,
it might be, it might be Sunday but it's going to be very soon." "We're going to be
introducing a tremendous healthcare plan sometime prior, hopefully prior to the end of the month,
it's just about completed now." - Three clips there, on three different occasions in July and
August, when the president promised us all an imminent healthcare plan. Now, mid-September,
we've still not seen one. So I went out and sought the advice of the policy fellow Doug
Badger of the Conservative Heritage Foundation. He's been a key advisor to the administration in
the past. What was the president's healthcare vision for a second Trump term in the White
House? - I think the approach is to provide people with the maximum number of choices in terms of
how they receive healthcare coverage, and how they receive healthcare being provided. So the Trump
administration has been for different sorts of arrangements, the use of telemedicine for example.
They've advocated, in addition to the so-called Obamacare policies, other sorts of policies that
don't necessarily conform to those rules, and may be more affordable for individuals and families.
So I think if you were to summarise what the Trump administration has tried to do,
it's been to broaden the range of choices. - So choice is the Republican byword on this.
If the system of choice that you currently have isn't, um well, doesn't give you enough choice,
I guess, how does it get improved? - Well I think there are a variety of ways to do that.
One of the things that's characterised the US health system and distinguished it from others,
is that health coverage has, for basically the course of a century now, been based on your job,
so if you have a job that offers health coverage, you can get the health benefits with that job,
and when you lose that job, you lose it. That's probably not a great idea, but we have 170-180
million people who get their coverage through employment, either as workers or dependents,
and they're reluctant to relinquish that to a centralised government programme, or to
some other arrangement with which they're unfamiliar. One of the things that the
Trump administration has done, and it's gotten very little notice, is to allow employers to
give a tax-free subsidy to their workers, and then allow their workers to go out and choose
a health insurance policy that they believe is best for themselves and for their families.
My own view on this is that this has to be an evolutionary change. People aren't going to
relinquish the coverage they have to the government or to anyone else,
but they might respond to this sort of evolution where they own it and they're
getting basically a tax-favoured subsidy to buy it. - So Donald Trump has promised a new plan,
but you're saying don't expect a revolutionary one ahead of the 2020 election? - I don't see it
after the 2020 election. I mean, when you look at Vice-President Biden's plan, it's basically
more of the same. He would add what's called a public option, a sort of government-run insurance
company that would be sold through the Obamacare exchanges, along with all of the private plans,
but he leaves the employment-based system intact. I think change on healthcare in the United States
is more likely to come on an evolutionary basis, rather than on a revolutionary basis. - Doug
Badger. Well he mentioned there Joe Biden's plan. Where does he stand on healthcare?
"The fact of the matter is healthcare is personal to me. Obamacare is personal to me.
When I see the president try to tear it down, and others propose to replace it and start over,
that's personal to me too. We've got to build on what we did, because every American
deserves affordable healthcare." - Yes, healthcare is always an emotional issue, especially right now
amidst the pandemic of course, and the Biden campaign is not afraid of pulling out all the
emotional stops in attacking Trump. One of the reasons Joe Biden won the Democratic ticket,
it's thought, is because he is not a healthcare radical. He's steering clear of the more extreme
reform plan proposed by many of those on the left of his party who want to see a universal system
of socialised medicine across the nation. It's something more familiar to European models of
healthcare. Here's the healthcare journalist Julie Rovner again: - Vice-President Biden, and
many of the Democrats, would like to put in what they call a public option. That would be more
like the Medicare programme, a little bit more government than we have now. Republicans
obviously would like a lot less government involved in healthcare. That's pretty much
where the battle lines are. A good number of Democrats, if not at least half the party, would
like to go further. Would like to have what they call a Medicare For All plan - a single-payer plan
that the government would provide the insurance, but the healthcare providers wouldn't work for the
government. So it's a three-way fight. - How has the Covid-19 pandemic changed the politics of all
of this? - I think it's been really an enormous change. What the republicans were planning to
do was go after the Democrats about Medicare For All, and socialism, even though Joe Biden doesn't
support that. That was going to be their sort of claim, they were going to sort of march to
the election accusing the Democrats of wanting to socialise the nation's healthcare system,
and right now I think a lot of Americans would like to have some kind of federal leadership
on the pandemic, which we have not really seen in the United States. It's been a state-by-state,
and in some cases, a county-by-county effort, and it's been very confusing,
and people are very frustrated. So it really has made people look at healthcare in general,
and public health in particular, in a very different light. It's also pushed some other
big health issues like prescription drug prices completely out of the discussion. - So the
pandemic has potentially presented an opportunity for those seeking a more radical solution,
a more European-style solution you might call it, towards generalised health care at the point
of delivery? - I think for some people, I mean obviously not for everyone, and there are a lot of
people in the United States who still think that the pandemic is being overblown or it's a hoax,
so it's a very divided country right now, but yes I think that a lot of Democrats are
sort of rethinking the idea of maybe the federal government should provide more leadership when it
comes to healthcare. - Julie Rovner. Well that's the politics; The hard numbers here though are
probably worth repeating: The USA spends 17 per cent - get that, 17 per cent - of its annual GDP
on healthcare. No European nation spends more than about 12 per cent. And the major ones can all
boast better health outcomes, as well higher life expectancy and so on. Now the reasons for this
are complex, as are many of the arguments, but it is hard to argue that the current mishmash
that Julie Rovner has referred to is working well. Whether it's a free market,
or a socialised model of treatment, everyone seems to agree: America desperately needs a plan.