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How one series focused on what U.S. can learn from other countries’ health systems Date: 03/16/20

Dylan Scott, a health care reporter for Vox, and his colleagues completed a multi-part series on how other countries have achieved universal coverage. While planning for the project began in 2018, the topic has been a high-profile issue in the 2020 presidential campaign.

Reporting out a project like “Everybody Covered” requires careful planning and a healthy dose of luck. Before I ever stepped foot on a plane, we put a lot of thought into what stories we wanted to tell, how we wanted to tell them and what our overall goals were. But once we got out into the world, we found that the best thing a reporter can do is to keep saying “yes” and keep asking people to open doors for you. You never know what you’ll find.

The project started with a simple question that felt important to answer: how do other countries achieve universal health care? By mid-2018, when Vox’s planning began, the debate over Medicare-for-all was picking up. In that discussion, international comparisons are frequent, both from supporters and skeptics. But the diversity in those foreign health systems tends to get flattened. That’s what we wanted to illuminate.

We picked countries that could serve as archetypes:

  • Taiwan with its single-payer program that looks a lot like Medicare-for-all

  • Australia as a country with two clear health care tiers: a universal public program and private insurance for those who can afford it

  • The Netherlands for its universal private insurance

  • The United Kingdom for its national health service. 

In addition, we decided to look at Maryland as the most interesting setting in the U.S. because some health care experts believe its all-payer global budgets could work in other states. We checked ourselves on the most interesting potential settings by talking with experts. Originally, we had thought about doing a Switzerland story to cover the private insurance lane, but a health policy professor convinced me that the Dutch system would be more relevant. The Swiss model does have some similar features to the ACA, like an individual mandate, but the Dutch system has more in common with the U.S. health care law.

Once we had our settings, we had to find our characters and our scenes. To me, what was always going to distinguish a project like was being there. You can read dozens upon dozens of scholarly articles and how other health systems compare to the U.S., I wanted people to feel like they understood what medical care actually looked in these countries and how it reflected the choices those nations had made. We wanted to show these systems at their best while also surfacing the tradeoffs of these differing approaches to universal health care.

This is where luck starts to kick in, though you must be yourself in a position to take advantage of it.

I did the obvious backgrounding, of course: reading profiles of the different systems and analyzing the comparative data (Commonwealth Fund, our funder, and the Peterson-Kaiser Health Systems Tracker were invaluable). It also wasn’t too difficult to find local experts to talk with to get a general background and possible leads. 

But the trick was always going to be finding the patients and doctors who can ground your stories. Our solution was to look everywhere.

We read local news stories, of course, which led us to sources. We found a Taiwanese medical doctors union cited in a report from a local newspaper, reached out to them, and arranged an interview with two members while we were in Taipei. I reached out to an Australian doctor who had written an op-ed about her country’s health care and she introduced me to one of her cancer patients.

Social media was an essential tool. For the Australia story, we knew we wanted two patients who’d had similar medical procedures but in different settings, public and private. My podcast producer Byrd Pinkerton on Twitter found Eloise, one of the two sisters who would lead off our piece.

I knew we wanted to talk with patients with complex conditions in Taiwan to understand how their single-payer program handles such expensive situations. I went onto a Taiwanese muscular dystrophy community’s Facebook page and found Yi Li Jie, a young woman with spinal atrophy who is an outspoken advocate there. Some good luck fell into our lap: after Byrd and I had interviewed May Cheng in Princeton, she mentioned offhand the rural health care program that served indigenous people who live in Taiwan’s mountains. I decided we must see it and so we conveyed that request to the Taiwanese government officials who could arrange it.

Once we had scenes and characters we knew would be central to the story, we could fill out the rest of our trip: hospital tours in Melbourne (where Eloise and her sister Madeleine lived), interviews with the doctors and former national health insurance administrators in Taiwan, etc. 

So our itineraries were guided by knowing precisely what we needed to get while we were on the road. But even so, some of our best reporting moments required spontaneity, the simple acts of asking permission and saying yes. In Taiwan, on our visit to the rural coast, we had backtracked so our photographer could take a few extra shots when I decided to hop out of the van and walk around. It was then I met Wong Shin-Fa, an indigenous man with a great story to tell about his friend in Los Angeles who broke an arm and flew home to Taiwan to get it fixed. 

In Australia, on our tour of a private hospital, the orthopedic surgeon we were interviewing unexpectedly asked if we wanted to check out his operating theater — with a patient on the table. We were in scrubs within minutes. 

In the Netherlands, at an after-hours care clinic, I asked one of the doctors on site who was supposed to make home visits if I could tag along in her car. She said yes, and by the end of the night, I had my lead anecdote.