Robert Scheer SI Podcast

The US Spends Almost as Much on Healthcare as the Rest of the World Combined and Has One of the Worst Outcomes

Esteemed physician Dr. Stephen Bezruchka explains why spending the most in the midst of inequality and flawed politics produces an unhealthy prognosis.

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Health can be a complicated matter within a society. For example, the United States spends almost as much as the entire world combined on health care, yet millions remain uninsured and drowning in medical debt. To help understand this, Scheer Intelligence host Robert Scheer welcomes Dr. Stephen Bezruchka, a former emergency physician, current scholar of the impact of economic inequity on health, and author of “Inequality Kills Us All: COVID-19’s Health Lessons for the World.”

Dr. Bezruchka’s journey through some of the country’s most elite universities including Harvard, Stanford and Johns Hopkins landed him in a position to study medicine not only in the field but in the macroeconomic sense as well. In the 1970s, he worked as an emergency physician in the U.S. and taught medicine in Nepal, setting up a community health project there. Since then, he’s worked with Physicians for Social Responsibility, the 1985 Nobel Peace Prize winner, and drawing attention to socioeconomic factors affecting the health of societies.


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He points out that in the 1950s, life expectancy in the U.S. was within the top five or ten healthiest countries in the world. But other countries began surpassing us. By 1970, the U.S. ranked 17th, dropping to 22nd by the early ‘90s, and more recent data has the U.S. ranked as 44th. “That is, among UN countries, which doesn’t include Taiwan and Monaco and other small populations, there are 43 countries where people live longer lives” he said.

His new book explores just how deadly inequality can be to humanity and explores how even the smallest of policy changes, like parental leave, can make a huge impact on the long-term health of an individual’s life. “Only two countries in the world with a population of a million or more don’t provide [paid] time off to parents after you have your baby. So that is really important. Why do we not have a paid parental leave act in this country?… And this is for the richest, most powerful country in world history,” Dr. Bezruchka said.

Credits

Host:

Robert Scheer

Producer:

Joshua Scheer

Transcript

Robert Scheer:

Hi, this is Robert Scheer with another edition of Scheer Intelligence, where the intelligence, I hasten to say, comes from my guests. And in this case it’s Dr. Stephen Bezruchka. I hope I got that right. But who has written a fascinating book. He’s a fascinating guy, I’m going to let him describe his own life. He’s a mountain climber. He’s been in Nepal teaching medicine. You know, he worked with Physicians for Social Responsibility, which won the Nobel Prize for their concern of nuclear war. But this new book, which is just out now, as we’re doing this interview, is called “Inequality Kills Us All: COVID 19 Health Lessons for the World.” And tell me the thesis, because basically you acknowledge we’re in some ways doing more than we’ve done now with Medicare and everything, the Expansion and Affordable Care Act. And yet we have terrible outcomes and you even keep some kind of record like a health Olympics. So, you know, just basically tell us why we spend a lot of money. Why do we have such lousy outcomes? 

Stephen Bezruchka:

So I worked as an emergency physician for 30 years, and the easiest diagnosis I could make in the emergency department was that somebody was dead. So it’s very hard to fake being dead. And so I’d like to look at whether you’re dead or alive as a measure of health. And all rich countries collect birth and death information and this allows us to come up with a number called life expectancy or lifespan, average length of life for a year in question if the mortality didn’t change. So I got… So back in the 1950s, although we didn’t live such long lives, our health, measured by life expectancy, were within the top five or ten in the world. That is, we were one of the healthiest countries in the world. And the same is true for other mortality measures of health. But then other countries began seeing more rapid improvements in length of life than we did. So by the time I went to medical school in 1970 at Stanford, we ranked 17th among countries, remember we were in the top five or so in the early fifties. By the time I went to public health school—because I decided after playing doctor for so many years that I had to figure out why the United States was not so healthy compared to other countries—so when I went to public health school in 1992, we were 22nd, meaning people in 21 countries had longer lives. Well, in the most recent data published by the United Nations Human Development Report in September, we now rank 44th. That is, among UN countries, which doesn’t include Taiwan and Monaco and other small populations, there are 43 countries where people live longer lives. And I don’t know about you, but I think most of us would rather live a longer life than a shorter one. So among these countries that have longer lives are all the other rich countries, some like Chile or Czech Republic or Slovenia or China or even Thailand now have eclipsed us, people there appear to live longer lives. So this begs the question why? And so what I just described is what I coined the term health Olympics. Suppose health were an Olympic event and the race was how long you live. Countries compete in the Olympics and so if health were an Olympic event measured by life expectancy, we wouldn’t be there for the final day’s race. We would have been disqualified in the trials. 

Scheer: Course, in your book, I just want to jump in for a second because we have this recent example of the pandemic. And in your book, you discuss our terrible performance with the pandemic. And you, I want to say, what is so pressing about your book, I think, is that you raised the question of inequality, not just in delivery of health care, but inequality in the society. And one thing that’s happened to the states, income inequality for the last 40 years, we’ve had a terrible downward spiral. And we have, you know, a dramatically more unequal society in terms of how people live. So that, to my mind, reading your book was sort of the main contribution. We’ve had some recent books showing this horrible inequality. We’ve also had discussions about why we lead the world in and deaths connected with the pandemic. Could you connect those two subjects to where we are? 

Bezruchka: 

Yes. So, you know, as I tried to figure out why this was happening, I came up with two ideas that really explain it. The primary one is, as you say, increasing inequality. And this is something we actually have chosen to have. That is, we decided to aggrandize the billionaires and let them have as much as they can take. Starting with Reaganomics back in the 1980s, and it’s continued at pace so that now our inequality is scandalously extreme. So how can inequality kill? I mean, that’s the title of the book and kills us all. There’s no one who can escape the mortality caused by inequality. Well, one thing inequality does is create a lot of stress in society. And we can see this in today’s newspaper with the mass shootings down in Colorado Springs. Inequality is creating more stress amongst us, and we act out this stress in a variety of ways. Studies have linked mass shootings to county inequality and the presence of high incomes in those counties. And in Colorado Springs, there are some pretty wealthy people there. The longest life expectancies are in two nearby counties in Colorado, in the whole country. Not that far away are the lowest life expectancies in the country, namely Pine Ridge Indian Reservation in Oglala Lakota County. So we have a huge difference in health outcomes within the country and studies show this is true. This is related causally to inequality and COVID comes into this because if you look at the states with the highest mortality or the counties with the highest mortality, depending on which particular period of the pandemic you look at, inequality kills people from COVID. 

Scheer: 

Can you explain how that works? 

Bezruchka: 

Okay. So when you have a highly unequal society, poorer people within that realm actually have poorer physiology. I tend to do this when I’m teaching a class by looking at lung function. If you take a deep breath and try to blow out as much as you can in one second, poorer people are going to blow out less air in one second than richer people. So poorer people through epigenetic mechanisms are constituted differently biologically than richer people. And the people who mostly succumbed in the pandemic have been poorer people by and large and older people, you and I fall into that realm, but older, poorer people rather than richer, poorer people. That’s the most important thing to consider. Poorer people have poorer health. And the reason is the inequality within the society that causes that. 

Scheer: 

But in your book, I just want to clarify, because I found it fascinating. You say it’s not just a question of what money we spend because we spend a lot on health care or the gadgets or the mechanics and so forth. You say it starts with birth or it starts with your first years. So take us through that because and connect it with the word you use in the book quite often, neoliberalism. I mean, we have an idea that has dominated us for the last 40 years. You know, Reagan and Bill Clinton, these were the two pioneers, really, of the kind of deregulation that led to increased inequality. But, you know, in your book, you mention we came out of World War II with a great belief in increasing, improving health care, improving everything, and we abandoned that. So show us how it actually works. 

Bezruchka:

So the first point or early life lasts a lifetime. So as we go from the erection to the resurrection, it’s the first thousand days after conception when roughly half of our health as adults is programmed. You know, there are exceptions. But by and large, if you don’t have a healthy early life, if you’re conceived in poverty and grow up in poverty, you’re not going to be so healthy later on. So, societies can privilege early life in a variety of ways. One way is to give a working woman who’s pregnant paid time off after she has her baby. Only two countries in the world don’t provide that ability. One is, of course, the United States. We can’t afford it, it said. And the other country is Papua New Guinea, half of a big island north of Australia. Only two countries in the world with a population of a million or more who don’t provide time off to parents after, paid time off, after you have your baby. So that is really important. And why do we have policies? Well, why do we not have a paid parental leave act in this country? Well, you know, it’s being discussed in the current administration, but it’s thought to be too costly. And this is for the richest, most powerful country in world history. Now, as you pointed out, we came out of World War II with a much more equal society where the people who gained the most income in the first decade or two after the war were the poorest fifth. In other words, the rising tide lifted the  rowboats more than it lifted the yachts. The rich didn’t like this of course, the rich have always wanted only one thing throughout history, and that’s everything. So they began scheming to lower the highest marginal tax rate, which was 96% in 1946, to, well, Reagan lowered it to below 30%. And now it’s a bit above that, but not much, not much above that. And that was through a variety of political policies that we embraced beginning in the 1970s called neoliberalism. And that basically means let’s go back to the liberalism of the 1800s, when markets sort of determined what happened and governments did not spend money for the people. And we were touted as a meritocracy. You know, you work hard and you get what you deserve. And so we’ve done this through decreasing taxes on the rich and somehow we believe in the American dream, namely before we die, we’ll strike it rich. But the American dream is a nightmare. You’ve got to be asleep to experience the American dream. So we have come up with a situation with absolutely staggering economic inequality and worse health outcomes than, well, 50 or so other countries. And to achieve this, we spend one sixth of our total economy on medical care, which is almost as much as the rest of the world combined. So having worked as a doctor… 

Scheer: 

Wait, I got to stop you right there. Now, I know you got a master’s in public health along with an M.D. and your book is well documented. Is that really true, what you just said? I’ve never heard that before. 

Bezruchka: 

Okay. So if you go to the World Health Organization or even to the… 

Scheer: 

Well, repeat the statement, first of all, because I just want to make sure I heard it right. 

Bezruchka: 

So we spend on health care about $4 trillion. If you take the amount of money that other countries spend on health care, all the other countries in the world, it’s a little over $4 trillion. All the other countries combined. But not much. 

Scheer: 

How come? How come? I’ve never heard this statistic. It’s stunning. I’ve heard a statistic that we spend as much on the military as the rest of our countries combined. I’ve never heard this. Because if that’s true, how could we have such miserable outcomes? 

Bezruchka: 

Well, that assumes that health and health care are synonymous. You know, do you want health or health care? Most people in this country use the phrase health to mean health care. We invest in health access. Help pay for health. Ensure health. So just by using that phraseology, we think it’s healthcare that is produced, it’s healthcare that produces health. You know, so we should ask the question, do we want health or health care? Clearly, we don’t have health. We have a lot of uninsured people now numbering in the tens of millions or more. A lot of people don’t have access to health care while it’s being considered now, you know, Bernie Sanders and AOC are talking about Medicare for All. Ralph Nader, people like that. At least it’s on the table. But it was never discussed, it was off the table for discussions about the Affordable Care Act. So you know, if you ask the question, how much do we spend, it’s easy to come up with the figures on the Internet. For 2019, it was $3.8 trillion. We don’t have accurate figures for 2021, although most people estimate it’s in the same $4 trillion ballpark and adding up the rest of the country’s expenditures. You can get that from our own, well from the Institute for Health Metrics and Evaluation website, funded by the Gates Foundation. You can get it even. Well, our Central Intelligence Agency in its World Rankings website, this is our own country’s CIA, produces a lot of this data. So if you think I’m spinning a lie, just go to the CIA World Rankings website. There’s no question that what I’m presenting is out there in the public domain. 

Scheer: 

So let me just get the statement correctly. We, the United States, with hardly the largest population, spent as much or roughly as much as the rest of the world combined. And yet, where we’ve got, what, 50 nations that have better outcomes? 

Bezruchka: 

Yes, that’s right. 

Scheer: 

How do you square that? 

Bezruchka: 

Well, you assume it’s health care that produces health. And the evidence for that is actually very limited. I think in the book I cite a study that shows, from Stanford University, that looks at all the studies, considering the rigorous studies, considering the impact of health care on health, and concludes that at most, health care is responsible for about 10% of mortality, avoiding health outcomes. 

Scheer: 

All right. So what are we doing wrong? And why is it connected with income inequality? Because that is the thesis of the book. And you make a compelling case and I forget his name, Pinckney, or whatever, the French scholar who did the major most important recent work on inequality demonstrates that… What’s the causal connection? 

Bezruchka: 

So you’re probably talking about Thomas Piketty. 

Scheer: 

Yeah. 

Bezruchka: 

Right. No capital in the 21st century and in ideology and his most recent book. A lot of people point out the adverse effects of inequality, but very few want to point out the tremendous number of studies that causally show that inequality produces worse health. First studies appeared in 1979. Now there are but at least 400 studies produced, making the link between inequality and worse health. Income inequality. Wealth inequality. And worse health. And it takes a fair amount of courage to say this in public, even if you believe it, because it sounds preposterous. But, you know, as I say, I look at the morning newspaper today and here’s this mass shooting. And we have quite a few studies linking mass shootings in the United States to measures of income inequality at the county and state level. 

Scheer: 

All right. So let’s you know, we’re going to run out of time here. And I it is probably the most important discussion we could be having, because there is an assumption that if you throw money at problems or spend money and we haven’t talked about the inequality of how that’s spent, but nonetheless, there’s an assumption of a moderate modernity is this assumption with high tech, we have a great medical system and and yet we have lousy outcomes. So give me the main thesis here and how do you fix it? 

Bezruchka:

So we need to rein in inequality… 

Scheer: 

Why? Other than that, it’s, I think, morally defense…I mean, how is inequality killing us? Let’s cut to the chase. 

Bezruchka:

By producing a highly stressed society. For example, if you try to measure stress among countries, we’re in the top five of self-reported stress. So we’re a highly stressed society, and that stress is killing us through a variety of mechanisms I began to describe earlier. The stress is most important when it is there in early life. In other words, if your mother and father were stressed as you were conceived and you lived in a stressful uterus, looking at the world outside, you programmed your physiology to survive, to reproduce. That’s all we’re here for. We’re here to reproduce so the species doesn’t die out and then we pay the price later with all the chronic diseases that we suffer from. Other countries… And another important thing to consider is that other countries have different ways of taking care of the stress in society. Japan, the longest lived country, everybody is stressed there. It’s a stressful society, but they do things together. And one way to observe that is: do you ever see a lone Japanese tourist? No. They’re always together. Have you ever seen a lone American tourist? All the time. I mean, COVID sort of put tourism into a bit of a quiet zone, but it’s recurring now and once again, Americans do things individually. We don’t work together. The big income gap fosters that. I mean, this is a whole variety of ideas that I’m throwing at you. And to try and put them all together is difficult in this short period of time. 

Scheer: 

Well, that’s a reason to buy the book, by the way. We’re talking about a new book and which spells all this out. I don’t expect that in a podcast. This is not a substitute for buying, let alone reading a book. The book is called Inequality Kills Us All. Incredibly documented, thoughtful by a leading expert on health care, Dr. Bezruchka. And the subtitle is COVID-19’s Health Lessons for the World. Okay, so what are COVID-19’s health lessons? I want people to get the book. Check it all out. But just in the time we have, give us the urgency of your message. 

Bezruchka: 

So we are… It is speculated that the SARS-CoV-2 virus is going to continue to pester us, and I think we’re at the end of the beginning of the pandemic. We have had the most deaths of any country in the world and the population in the top ten or 20. And what needs to be done to prepare for the next contagion in what I call the pandema-scene? That is, we’re going to be seeing an era of a lot of these contagions that are going to kill us. And we have to change the political system that has created the catastrophe that COVID visited upon us in the last few years. That will require political choices that we, the people, make. We have chosen to have a few billionaires, and we can choose to not have them. 

Scheer:

Well, what does that really mean? I mean, we spend a lot of money, but some people spend more money and have more money spent on them. What is your subtitle is COVID-19’s Health Lessons for the World. What are they? If I’m preparing for the exam. Okay, I’m going to take the final now. And what are you looking for here? You’re going to ask that question. What are COVID-19’s health lessons for the world? 

Bezruchka: 

Very simply, economic inequality portends worse. COVID 19 outcomes. We have studies of 84 countries. We have studies within the United States at the state and county level. You know, the studies are very clear. And so the lesson is we have to decrease inequality. We also have to do something about poverty in this country. Inequality and poverty are close cousins. And we have more poverty within the United States than any other rich country. And this is killing us. 

Scheer: 

How? How does this inequality kill us? 

Bezruchka:

I go back to the same idea. It causes more stress. Basically, for example, there’s a study done on air rage, namely, if you go in a passenger airplane that has a first class cabin. And there’s more air rage, you know, various kinds of behaviors in the plane, then if there is no first class cabin, if you enter through the first class cabin rather than behind it, as on many jumbo jets, there’s less air rage in first class. So when the people in first class see us walking by, they really get wigged out if they don’t see us walking by, there’s a little less air rage, but it’s especially present in coach class. What is that telling us? It’s telling us that class differences are making a huge impact on our society. That’s air rage. And there’s been more air rage now with the pandemic just because inequality has soared. Similarly, there’s more road rage. You can read about that in the papers as well. People are driving more expensive, you know, two garage cars. They’re the ones perpetrating the road rage. What are they doing? They’re expressing the stress in their lives. 

Scheer: 

Well, we saw that in an election. I mean, people seizing the house. Yes. You know, the people’s house of Congress and supporting a president, soon not to be a president then, you know catered to that rage or, you know, as demagogues often do of any party. You know, is that also a health problem? 

Bezruchka: 

Of course. Of course. And who were the people in the, you know, storming the Capitol? They were from Republican jurisdictions who were relatively poor. And so we’ve actually seen that coming from a Republican state or county. Your health is going to be worse than coming from a more Democratic county. You see this at the political jurisdiction level. And that’s because, you know, there are these factors called deaths of despair. White, middle aged adults are dying in greater numbers from alcohol, drug and suicide causes of death because they’re not achieving the American dream and they’re blaming themselves. That’s the weird thing in this country. You know, you blame yourself for what is basically a political problem. It’s not your personal failing. 

Scheer: 

Well, you know, we’re both of an advanced age. And in your book, you talk about how our consciousness about class has evolved. And I would say in the post World War II period, there was an illusion. It had long been a powerful idea in the American experience, that we were going to become a classless society in terms of at least opportunity. It didn’t happen. It went the other way, actually. We haven’t solved our systemic racial problems. So that’s an important source of class distinction. But now we, as you point out in the book, have all of these mechanisms for increasing class distinction. And so I wanted to tap into your wisdom as a practicing physician who’s practiced in other countries as well, but also, given your master’s in public health, the idea of your book and really introduces is that the main reason America has become less healthy, considerably so, is because we have failed really the early promise of that postwar period of the New Deal, of a kind of idealism that we grew up. People like us grew up accepting it as the norm. 

Bezruchka: 

Yes. I mean, what can I say? You brought up racism. And, you know, we’re a very highly racialized society and African-Americans have much worse outcomes, not as bad as the American Indians or indigenous populations. And the other thing is that I mentioned several times, poorer people have poorer health. And that’s a class distinction. And the two are tied together as Isabel Wilkerson’s book on class, The Origins of Our Discontents, points out we, you know, we’re supposed to be a middle class society, but the middle class has been hollowed out. You know we have half of the country really… it can be classed as being poor and we have a much smaller middle class. And then we have not the richest 1%. It’s really a 100th of that, that basically has all the power in society. They make the decisions. They control the corporations. We think we have democracy in terms of electing our political leaders. But given the corporate power, we don’t have democracy in the workplace. So that’s another thing that needs to be worked on. But, you know, you get what you measure. And as long as we measure wealth creation, remember the Dow Jones Index, that’s about wealth creation or the Nasdaq. We need to measure our health compared to other countries. And rather than seeing our health decline now, absolutely. We need to reverse that and get it moving, improving and improving compared to other countries. And what’s that going to take? Well, it’s becoming aware of how healthy we are in comparison to other countries. So we should report the Doug Jones index. You know, how is Doug and his family doing rather than the Dow Jones index? And I would offer Doug Jones and his family, they’re not doing so well. 

Scheer: 

So that’s a summary. I mean, you’re looking at the world figures as well as the U.S. So which countries are doing better and how do they escape this or minimize the impact of this insecurity? I mean, what you know is that they were social democratic countries like Germany, France and England to some degree or once of considerable degree. What is the difference? 

Bezruchka: 

So let’s take the longest lived country in the world, Japan. We have a lot of lessons to learn from Japan because in the Second World War… 

Scheer: Oh, can I just interrupt you? I found that fascinating in your book, you point out that we encouraged the Japanese in the occupation to do sensible things that we haven’t done ourselves. 

Bezruchka: 

Exactly. Exactly. We put in place the policies that Japan needed to have to become the healthiest country in the world. So what were those? You know, we had destroyed Japan at the end of the Second World War, dropped two atomic bombs on them, firebombed Tokyo, and their life expectancy was estimated to be around 24, 25 years at the end of the war. We then occupied the country and sent the world’s greatest population health doctor there, General Douglas MacArthur, to occupy the country and revive it, resurrect it, so to speak. And so he came up with three policies that he actually wrote into the Constitution. The United States is responsible for producing Japan’s post-World War Constitution. One of the articles was Article nine, which said Japan shall never maintain a military, an army. They shall resolve disputes peacefully that’s written into their constitution. They put a public health clause into the Constitution, namely, the government is responsible for the health of the people. That’s Article 23, and they also broke up the large concentrations of power. There were 13 big family owned corporations, Zaibatsu. And MacArthur said, you can’t have such concentrations of wealth and power and have a democracy. That was another part of the constitution, namely universal suffrage. They’re going to have a democracy. But he broke up the concentrations of power of the 13 Zaibatsu. Also, Japan has a rice farming economy and some 37,000 landowners. Had 50 million peasants working the rice farms. And again, MacArthur said, you can’t have such concentrations of power. He bought the land from the landlords, sold it to the rice farming tenants, and gave him a 30 year low interest loan to pay for the land. And the Japanese had poor loans so most of them had paid off the loans in a year and 94% of all the land in Japan changed hands. Historians call it the most successful land reform program in history. So by democratization, decentralization, that is redistributing, and demilitarization, those three principles produced the most rapid improvements in health ever seen on the planet. And by 1978, Japan was the longest lived country. 

Scheer: 

And they are today. 

Bezruchka: 

And remain so today. And Japan is a lesson for us to understand that the political nature matters far more than personal behaviors. Out of all the countries, out of all the rich countries, Japan has three times as many men smoking cigarettes as in the United States. If I told you that’s the reason Japan’s so healthy, namely, everyone smokes there, and by the way, if you’ve been to Japan, you can easily observe their smoking behaviors everywhere. So Japan is an example of a country that achieved the best health status in the world by means of policies that we enforced upon it. And personal behaviors don’t matter so much in producing this. And similarly, health care doesn’t matter that much. 

Scheer: 

But you know, I could stop you there and we’ll get people who will be shocked by this smoking example. But I want to wrap this up. And I didn’t give you a proper introduction, but you’re the rare figure out of the very successful, you know, the best colleges and all. And you haven’t sold your soul to, you know, people try to charge us more money for medical or just collecting greater wealth. So it’s late in the discussion. But I’m trying to get people to read your book because I thought it was fascinating. And who are you? You went to Harvard and then took us through mountain climbing briefly, everything else you’ve done. But how come you didn’t use your privilege to just make our health system worse? 

Bezruchka: 

Well, I started, I grew up in Toronto, Canada. My father repaired shoes. We lived above the shoe repair store. And I grew up in a working class neighborhood. And I never appreciated inequality because most of us were all pretty similar in this neighborhood. And then when I studied mathematics and then I went to the University of Toronto, and then I went to Harvard to graduate School of Mathematics, and suddenly I was among all these privileged people. And I came to understand that there was something wrong about that. I had been climbing mountains. And so I decided to go to Nepal and get close to the highest mountains in the world. And I lived amongst people who had essentially nothing, and they didn’t realize how little they didn’t have because we didn’t have the fancy communications channels that we have today. I then had the privilege of going back to the United States to go to medical school, and I chose Stanford again. How did a shoe repairman’s son do something about his step? But are you still there? 

Scheer: 

Yeah.

Bezruchka: 

How does a shoe repairman’s son up his status? Well, since I did well in school. I went to prestigious schools. So Harvard, Stanford, then Johns Hopkins. But I realized that that kind of status was not something that I really wanted to achieve. I would rather be known for what I did and taught and talked about than the prestigious schools I went to. So although it’s a way to improve your status, I’m hoping that the ideas that I talk about and express are far more important than that. 

Scheer: 

So I feel that’s why we’ve taken this time to get at the book and we haven’t done it justice. The book is a really important contribution to the discussion about health care and the quality of life. It’s called Inequality Kills Us All is just out now. The subtitle is COVID-19’s Health Lessons for the World. Dr. Bezruchka, I always get that wrong. But let me say, it’s really, if you want to read one book about what’s wrong with our healthcare system and what we can do about it, that’s it. And that statistic that we talked about before, I’m still going to as soon as I get off, I’m going to check that out. But if it is true that we spend more. And let me get it right, we spend more or as much on health care as approximately the rest of the world. And we have this poor outcome. Have I stated it correctly in conclusion? 

Bezruchka: 

Yes. I mean, not as much as the rest of the world combined. It’s just, you know, close to where we’re talking about 44% of the world’s health care bill back in 2019 was spent. 

Scheer: 

And where do we rank? Where are we? 

Bezruchka: 

The best figures are those of the United Nations. And there we ranked 44th behind Barbados, Croatia, Thailand, Qatar. And all the other rich countries. 

Scheer: 

Well since you were at one point active in the Nobel Prize winning Physicians for Social Responsibility, there is a parallel where we also spent, you know, roughly about somewhere 40% or whatever to 50% of our military. And yet we’ve had one of these winless wars and endless wars and nonsensical wars after another. So there is a parallel. Anyway, I want to thank you for doing this. Urge people to get Inequality Kills Us All. I want to thank the folks at our NPR station, KCRW in Santa Monica, and for hosting this show, Laura Kondourajian and Christopher Ho. I want to thank Joshua Scheer, our executive producer and J. K.W. Foundation in memory of Jean Stein, a terrific writer and journalist who helped fund these shows. See you next week with another edition of Scheer Intelligence. 


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