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What experts say about who has the world's best health-care system | Opinion - YouTube
Channel: Washington Post
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i want to start with a simple question
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which country in the world has the best
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health care system
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yeah so i hate that question
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here's where you should ask me why i
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hate that question
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i knew you were going to start with that
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question i think it's a question that a
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lot of people ask which country
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has the best healthcare system and i
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don't think there's a
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correct answer to it it depends on
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what it is that we value i'll give you
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an answer
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but then i'll tell you why the answer
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might not be applicable
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if you look at the world health rankings
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the country that came out on top is
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france
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i think in general starting from france
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and working northern
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you tend to get the best healthcare
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systems but the reason why it's not
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entirely
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applicable is that what works in one
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country may not work in another country
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so a number of years ago just a few
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years ago i wrote a piece in the new
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york times with my colleague aaron
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carroll
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we actually did a tournament of health
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systems it was like a bracket tournament
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the way uh march madness is a bracket
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tournament or like a tennis tournament
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and we had me and aaron over reinhardt a
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shisha physician now dean of brown and
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craig garthwaite an economist at
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northwestern and
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we each voted in each of the brackets
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like in each of the the pairings
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for which system we liked better and
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then like we ultimately got a winner but
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one of the important takeaways from that
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whole process
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is that in no pairing did any
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country win five to zero there were five
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of us right
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we were not unanimous in any decision
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there was always at least someone who
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disagreed
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and in many cases it was three to two
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and we each had different reasons
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you know someone was very uh big on like
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the cost
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equity access or the quality and so to
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me like look this is five people who who
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know healthcare pretty well
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and know these systems pretty well and
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we couldn't even agree
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so there's just no clear winner
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actually but the one thing that stands
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out is that among all
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major developed nations it's pretty
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clear that the united states comes in
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dead last
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on the other hand i think everyone
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especially
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experts should be skeptical that they
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know
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the answer because what works in one
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country or one setting doesn't
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necessarily work in another
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so you know there are there are aspects
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of the australian system i like there
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are aspects of the english system i like
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but i don't think that there's a system
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we could just bring over here
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and install like a new fridge so maybe
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the better
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question is what would the best system
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for the u.s
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look like and what would that look like
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so good a good health care system or a
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good
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yeah let's just call it a health care
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system a good health care system has i
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think
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to me several attributes one is how does
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it
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affect our health as a country how long
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is it that people are living
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what is the infant mortality rate what
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is the rate of
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certain types of diseases and how well
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are they doing in prevention and the
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second question
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i'd want to know the answer to is were
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the benefits of the treatment greater
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than the cost of the treatment
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a bad health care system could have
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overspending
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on care that's a really questionable
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health benefit at the same time that it
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has
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underspending on health care that's of
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vital importance to people
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so when people say do we spend too much
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on health care we spend way too much on
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some things and way too little on others
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so a good system would fix both problems
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and the third dimension for health care
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system is
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how well does it reflect our values as a
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society
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and by values i mean
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what are the rich willing to do for the
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poor
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what are the healthy willing to do for
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the sick
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the answer to that doesn't come from
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economics it's just a
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it's an answer that we all have within
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us
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but that answer profoundly affects
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how you answer questions about what's
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good and bad about health care
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and i would hope that going forward as
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we think about the learnings from other
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countries
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we can take a hard look at what it is
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that we have
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and whether they align with our core
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principles that we otherwise hold so
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dear
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so my goal is have a health system that
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does the most it can to improve our
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health
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that protects people from financial ruin
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and that conforms to our values as a
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society
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so yeah that would be the right thing to
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do in principle that
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that the next question should be like
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can we get there from here
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and i don't i just don't see it
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what we've seen over time is that the
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costs of health care have gone up
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but outcomes have also improved so if we
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take some measure and the measure that i
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like to use is
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life expectancy at age 40 and then i
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look on the other axis
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at the cost of health care per person
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and what you find is
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if you look back to 1976 all of these
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countries the u.s
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germany canada look similar in terms of
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what share of gdp goes to health care
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and they are all living people are
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living about 35 years
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after age 40. okay
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fast forward 20 years and the u.s is
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spending a lot more
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of its gdp on health care and
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its life expectancy increases have
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not kept up with the life expectancy
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increases in other countries
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so the us becomes increasingly an
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outlier both in terms of
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outcomes that is life expectancy and in
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terms of spending
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now you can put the two on the same
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graph but that doesn't mean that they're
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related in any way
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i think we're simplifying the other
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healthcare system to the point of
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getting it totally wrong
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but a lot of it depends on who you're
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talking to right i think there's a view
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that some americans have that another
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system's care is terrible
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you know there's very long waiting lines
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and waiting lists
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that the latest medical technologies are
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routinely not available
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i think for a lot of other americans
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there's this view that other countries
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have just figured it out
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and what we should be doing in the
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united states is copying
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what they've already figured out and i
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think both those views
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are not right at all so i think people
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mix up
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this term called socialized medicine
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with
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what i would call universal health care
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one is the insurance part
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that is who runs the insurance and you
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can have socialized insurance where the
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government is running the insurance or
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private insurance or private companies
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or both
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and then second there's the providers of
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medical care who could be either
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government
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run employees or private employees there
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are some methods that
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one could classify as being socialized
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medicine meaning that the government
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is a single-payer the government
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operates all the healthcare
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and people belong to a single government
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system
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so britain has socialized medicine
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because the hospitals are government
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institutions
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and the physicians and nurses are
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government employees
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and france has yet a different kind of a
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system also not
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not government owned in switzerland
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netherlands germany these are places
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that have universal health insurance but
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they have
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active and important private health
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insurance companies that administer it
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so very different structures of these
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systems
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the thing that they share in common is
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that they're universal so i think
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coming full circle my great worry with
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health care reform in america is that it
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has collapsed
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to the level of kind of fighting and
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arguing about these slogans
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and the slogans have nothing real behind
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them
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these slogans have become so politically
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charged
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and tied to a particular candidate or a
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particular viewpoint
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that has become completely partisan
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and will shut down constructive debate
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and if you go back to what i was talking
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about how do you evaluate a good health
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care system
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you don't evaluate it by the share of
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government
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in the system you evaluate it by whether
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patients want the care that they get
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and whether the care that patients get
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is worth it
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i think that other countries have great
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hospitals
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cover a lot of medical treatments have
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fantastic doctors
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and at the same time they have not
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figured out a bunch of things that we
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have not figured out
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so if you are the kind of person who's
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going without health insurance in the
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united states
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i hate to say it but i think they are
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better off
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in many other countries than
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here in the u.s but for a lot of
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diseases
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for a lot of people regardless of income
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this is probably the country where you
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would like to get your health care
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you
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