JUDY WOODRUFF: We continue with our series on universal health care.
As the United States struggles with the most expensive health care system in the world,
some have started looking to Australia.
William Brangham and producer Jason Kane report on how that nation has achieved universal
coverage at a lower cost.
Their story was filmed before the pandemic began.
WOMAN: Hello.
(LAUGHTER)
WILLIAM BRANGHAM: Don't be fooled by this happy scene. This is a family divided.
OK, it's not quite that serious, but the division is stark when it comes to, of all things,
health insurance. On one side, Felofani Elisara and her husband Paul Dunn rely on Australia's
public health care system. It's known as Medicare. It's paid for by taxes, and it's available
to all Australians and permanent residents.
That public system has gotten them through some pretty traumatic stuff, IVF treatment
and a hysterectomy for Felofani, and, for Paul, brain surgery to remove a malignant
tumor.
At first, they panicked over what they feared would be a huge price tag.
PAUL DUNN, Australia: I was really scared. I was like, what am I going to do? Do I need
to start a GoFundMe? Which my friends did for me and my family did for me anyway.
WILLIAM BRANGHAM: But then you found out that the public system was going to cover a majority
of that?
PAUL DUNN: A majority of that, yes.
FELOFANI ELISARA, Australia: Well, it covered all of it.
PAUL DUNN: It covered all of it, actually.
WILLIAM BRANGHAM: On the other side:, Paul's parents, Carole and Ross, are evangelists
of the private sort.
They skip over the public system and buy their own private insurance coverage. About half
the country does this. Carole recently had her knee replaced and said she got great care
and terrific perks.
She says, if she'd been in the public system, she'd be in agony, on a waiting list.
WOMAN: Well, I'd be crippled, really, in one leg.
WILLIAM BRANGHAM: This hybrid system, with the public Medicare system as a base, but
then layered with private insurance on top, is by design.
They're meant to work together, with the private system taking pressure off the busier public
one. This unique setup meets two basic values, says health economist Rosalie Viney.
ROSALIE VINEY, University of Technology Sydney: Just as one of the tenets of Australians'
beliefs is that they should have access to public care, there's also an element that
choice is part of what a lot of Australians seem to value.
WILLIAM BRANGHAM: Help me understand. If you have a system where any person, any Australian
can go and get free care from their G.P. or at a public hospital, what is the rationale
for private insurance?
Why would I, as an Australian, ever want to pay extra, if I can get it for free?
ROSALIE VINEY: So, some of it is about access to elective care at the time when they want
it. Some of it is about access to the amenities that a private hospital might offer. Some
of it...
WILLIAM BRANGHAM: Amenities like?
ROSALIE VINEY: Private room, better food, those sorts of things. You have a choice of
menu. Some of it is about choice of your own doctor.
But some of it is actually about getting quicker access. So, waiting lists can be long. And
particularly for elective surgery, waiting lists in the public system tend to be long.
SARAH KOZICKI, Nurse in Training: The whole sense of waiting for me, like, with endometriosis,
you could be in bed, like, chronic pain. So, that could mean a year without working, two
years without working. And it's just -- that's not feasible either.
WILLIAM BRANGHAM: A private health plan makes sense for Sarah Kozicki. She's training to
become a nurse, and every couple of years, she needs a costly surgery for endometriosis,
which is a painful disorder involving the uterus.
SARAH KOZICKI: So, for that, I choose to have private health insurance, that I can go and
have surgery when I need to have surgery. I can do it in a private hospital, or do it
in a public hospital as a private patient, and I get to choose my specialist.
WILLIAM BRANGHAM: The outcomes for both systems have been quite good. Australians live longer
than Americans, they're healthier and they see their doctors more.
They don't die of preventable diseases nearly as often as we do. And they get these results
for less money, spending about half what we do per person.
Costs are kept low partially because the government sets prices for drugs, treatments and other
expenses. But there's one major problem. Increasing numbers of Australians are choosing not to
buy private insurance, people like Emily Maguire. She's a teacher, she's healthy, and she says
the rising cost of living makes it hard to justify paying for a private plan.
EMILY MAGUIRE, Teacher: And, like, the public health system is so great. Like, they do a
great job.
So, I'm just like, no, I think I will trust them. And if I need something, then I will
pay for it myself. I'm not too worried. It's a little bit about, I think, my values as
well. Like, I don't want to be paying for something that I'm not really getting anything
from, if you know what I mean.
WILLIAM BRANGHAM: An estimated 64,000 Australians dropped their private health insurance in
2018, and this creates what's called a death spiral for the system.
Younger people, who tend to be healthier, have been leaving the private market, while
older people, who tend to be sicker, have been joining it.
Rosalie Viney says that cycle then perpetuates itself.
ROSALIE VINEY: Private insurance holders tend to be those who are more likely to use private
insurance, and so we see premiums start to creep up, associated with use of the care.
WILLIAM BRANGHAM: Remember, the private system is meant to relieve pressure on the public
one. So, now the government is spending over $4 billion a year in subsidies to encourage
people to buy private care. And that cost keeps going up.
JANINE MOHAMED, CEO, Lowitja Institute: So, what would be better is if we actually took
a reinvestment of those private health care dollars, and put it into our primary health
care system.
WILLIAM BRANGHAM: Janine Mohamed has a very different idea of where those billions ought
to go. She runs the Lowitja Institute, a research organization that advocates for better health
care for Australia's Aboriginal and Torres Strait Islander populations, people who've
suffered decades of racism and discrimination.
On average, people from indigenous groups, like Kylie Battese, suffer higher rates
of chronic diseases than their peers. Mohamed says they die 11 years earlier, on average,
than non-indigenous Australians
JANINE MOHAMED: It just seems ridiculous that those funds can't be redirected to Aboriginal,
Torres Strait Islander health, when we know that we have the poorest health outcomes in
Australia.
So, for us, it's, you know, giving the most privileged more funding.
WILLIAM BRANGHAM: Dr. Ashish Jha, dean of the Brown School of Public Health and a collaborator
with us on this series, says, yes, there are significant problems here.
But every nation's health system is a work in progress, and Australia has made important
strides that the U.S. hasn't.
DR. ASHISH JHA, Director, Harvard Global Health Institute: When we look across the world,
we see lots of different systems that seem to work. They get universal coverage, good
outcomes, reasonable costs.
They don't all look like each other. And there's a lot we can learn from Australia, from the
U.K., from Switzerland, all of which have very different systems from each other. But
each of them can teach us specific things about how we can improve coverage and lower
costs and improve outcomes for our own country.
That's the key here, is to learn those lessons without worrying about importing any of these
systems wholesale and trying to transplant them into the United States.
WILLIAM BRANGHAM: The members of the Dunn family have given up trying to convince each
other that their health care choices are best.
WOMAN: Cheers, guys.
MAN: Cheers.
WILLIAM BRANGHAM: They're OK with the division.
WOMAN: And I was going to say, vive la difference.
WOMAN: Vive la difference!
WILLIAM BRANGHAM: For the "PBS NewsHour," I'm William Brangham outside Sydney, Australia.