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No Politics Allowed: Health Care

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Two things in life are inevitable—birth and death—and they both fall in the domain of the health care system. Although health care is one of the most basic services a government can provide, it's also one of the most ominous and convoluted. Every industrialized nation offers its citizens some form of free health care, but the balance between public and private funding differs from country to country and from administration to administration. 


At one extreme is the United Kingdom, in which universal health care is funded directly from taxes and there are no insurance companies. At the other extreme is the United States, with its dazzling array of public and private services designed to both protect the poorest Americans and let the free market determine the best possible care. But at both ends—and everywhere in between—the systems are messy. To better understand our system and our options, we're fielding your questions about health care around the world.

Are there really no health insurance companies in the United Kingdom?

Pretty much. A few of the wealthiest citizens have private insurance for private hospitals, but for the most part, the Brits use the National Health Service (NHS)—the largest employer in Britain, with more than 1 million workers. The brainchild of the Labour government after World War II, the NHS was created to provide "cradle to grave" service for all members of the realm. Because it was funded entirely by taxes, there were no hospital fees, no hassles with insurance companies, minimal administrative costs, and little paperwork. Patients simply paid taxes, went to a doctor, and received free health care. Sounds simple, doesn't it?

Not entirely.

Soon after the establishment of the NHS, citizens began complaining that customer service was shoddy. The system required specialists to spend half their days working for the NHS, and the rest for private practice. But no matter how hard physicians worked for the government, their salaries stayed the same. Why would an orthopedic surgeon perform 20 hip replacements a week, when he could perform three for the same money? Specialists dragged their feet, which created long waiting lists for treatment. If a patient couldn't wait for a procedure from an NHS surgeon, he could go down the street to the same doctor's private practice and receive treatment right away—for a price. In that way, health care costs for some citizens actually increased.

Things began to change in 1990, when Margaret Thatcher's administration experimented with letting hospitals compete with one another for government funding. In theory, this should have cut costs and promoted self-regulation, but in practice, each hospital had a fairly strong monopoly in its local area. These days, the NHS relies on general practitioners to act as gatekeepers for the whole system. They're the first doctors patients see, and their services are free. They perform routine checkups and recommend specialists. If a patient needs to go to a hospital, the general practitioner helps decide whether it should be a free NHS hospital or a private one. Ultimately, general practitioners help control costs by guiding money towards NHS specialists, hospitals, diagnostic tests, and medications. However, long waits and poor care are still concerns. It's not a perfect system, but everyone gets to use it.

Is the United Kingdom the only nation with universal health care?

Not at all. Most industrialized nations, such as Japan, France, Sweden, and Australia, have universal health care. And in Canada, the government has been doling out free medical services to its citizens since 1962. Its system, called Medicare (not to be confused with America's Medicare, which is totally different), is based on the five principals of the Canada Health Act: It's universal, comprehensive, accessible to all citizens regardless of income, portable inside and outside of the country, and publicly administered. Also, to make the distribution of goods more efficient, the system is managed individually by province.

Unlike the United Kingdom's National Health Service, the Canada Health Act doesn't permit citizens to seek out private doctors to cover services provided by the government. If you want a hip replacement in Canada, there's no running down the street to a private surgeon—you've got to get in line. This prevents physicians from concentrating more on private practice than on public medicine, which has helped keep the system cost-effective and egalitarian.

Of course, this system has its problems, too. To fund Medicare solely with taxes, the federal government matches whatever each province spends on its own system. Unfortunately, that has resulted in wealthier provinces receiving more money from the federal government, because they spent more on health care. Despite efforts to even out funding, large disparities in the quality of services have emerged throughout the country. As a result, many poor, rural communities are still in bad shape.

It sounds like both the United Kingdom and Canada rely solely on taxes to fund health care. Are there other ways to finance the system?

Yes. Some countries, such as Germany and Japan, insist that all citizens own health insurance, the same way that most U.S. states require all drivers to purchase auto insurance.

Germany's health care system began in 1883, when Chancellor Otto von Bismarck set up insurance structures for workers called "sickness funds." Today, German law mandates that all citizens belong to them, unless their income is above a certain level. (Currently, that's about $5,500 US per month.) Sickness funds work like private insurance in the United States, with employers and employees splitting the cost of membership. Germans can choose from more than 1,000 different funds, which offer medical, dental, and drug coverage. Retirees pay with their pensions, while the government supports the poor and unemployed.

While 90 percent of Germans belong to sickness funds, the remaining 10 percent opt for private insurance, which tends to have higher fees. Although people with private insurance go to the same doctors and hospitals as people with sickness funds, private insurance usually means better care. To some, the German system has two tiers—one for the rich and one for the poor. The differences aren't huge, but people with private insurance have beds reserved for them in hospitals and don't have to wait as long to see a doctor. But unlike Canada and the United Kingdom, the waiting lists for treatment in Germany are short. On the downside, the quality of diagnostic testing and palliative care (treating the symptoms associated with serious illness) lag behind the rest of Europe, even though Germany spends more on health care than any other country on the continent. According to a 2000 study by the World Health Organization (WHO), in terms of distribution of goods and services across the population, Germany has one of the most fair and equitable systems of any industrialized nation.

How does the U.S. health care system hold up in comparison to other countries?

In terms of fair and equitable distribution of goods and services, the same 2000 WHO study ranked the United States close to the bottom of the list. But that's because America not only has some of the worst health care on the planet, but also some of the best. The problem is that we don't have a system of health care so much as a mix of independent, overlapping, bureaucratic monstrosities. The United States is the only industrialized nation, except for South Africa, that doesn't guarantee health care to all its citizens. Currently, about 47 million Americans (15 percent of the population) have no health insurance, and about 20 million Americans can't afford the health services they need, even with insurance.

MRIBut the United States also has some of the finest doctors, most advanced technology, and best medical facilities in the world. Our diagnostic screening is excellent, and it's helped America become a world leader at fighting certain diseases, such as breast cancer. Of course, we also spend far more money on health care than any other country. (America spends more than $6,000 per capita on health care—about twice as much as most European nations.) This is partially due to ungainly administrative costs, but it's also because of the abundance of expensive, high-quality services.

Most people in the United States have private health insurance, which simply means they pay an insurance company a monthly premium in exchange for health services. However, U.S. insurance companies aren't obligated to cover everyone who's willing to pay. They can deny coverage if they feel the patient would be too costly. From the insurer's perspective, covering someone who costs $100,000 per year in medical expenses isn't worth the $10,000 premium. In other words, some of the country's sickest people are often also the ones getting pushed out of the system.

Most Americans can't afford private health insurance unless they go through their employers, who shop around for the best insurance deal they can find. The bigger the company and the more employees, the more clout they have when haggling with insurance companies. While employers pay most of the premiums and employees pay the rest, the major benefit of this arrangement is that the entire premium is tax-deductible. The major drawback is that small businesses and the self-employed don't have much pull with insurance companies, which can force them to forego health care altogether.

To rein in expenses, many businesses require their employees to join health maintenance organizations, or HMOs. Like traditional insurance companies, HMOs limit the patient's choice of doctors and hospitals to a restricted "network," but they also review doctors' decisions and can refuse payment for services they deem unnecessary. In addition, HMOs tend to insist that doctors prescribe generic medications instead of name-brand ones. These measures save money, but many doctors feel second-guessed by HMOs, believing they promote the cheapest medicine rather than the best.

Is there public insurance in the United States?

Yes. Federal and state governments fund health insurance for the elderly, the military, the poor, the disabled, veterans, and some children. Many different agencies play a role in this, but the two biggest are Medicare, which covers adults 65 and older, and Medicaid, which covers the 55 million poorest Americans. Unfortunately, the bulk of uninsured Americans are people who either aren't old enough for Medicare or aren't poor enough for Medicaid.

LBJ-MedicareMedicare started in 1965, when President Lyndon Johnson issued the first Medicare card to former President Harry Truman. Medicare automatically covers hospital stays for seniors, and if they're willing to pay extra premiums, it subsidizes outpatient services and prescription drugs. Right now, Medicare costs the federal government nearly $400 billion per year, and that number may escalate rapidly in a decade or so, as Baby Boomers turn 65.


Medicaid is designed to help the poor, but it's run at the state level, so regulations and services change from state to state. And that's part of the problem; you may qualify for Medicaid in one state but not another. The rules keep changing. Most states have a difficult time balancing Medicaid into their budgets, so they tend to cut benefits or add copayments, depending on the fiscal year. This doesn't make life simpler for our nation's poorest Americans.

What are the plans being considered for cleaning up the health care system?

They basically come in three varieties: expanding existing programs to fill in the cracks, using competition to improve efficiency, or creating a new comprehensive plan. The beauty behind expanding the current program is that it won't scrap a system that works well for at least two-thirds of Americans. Most of us already have access to the best medicine in the world, so why not just try to reach out to the rest? Advocates propose raising the salary caps on Medicaid to cover the working poor and lowering the age requirement for Medicare to 55. This would plug up most of the holes, but unfortunately, it would do nothing to increase efficiency. Some studies estimate that 20 percent of our health care costs go to administrative fees.

To make the American health care system more efficient, some people have proposed ways to encourage competition. One alternative is to create tax-free savings accounts to be used specifically for health reasons, which will help lower- and middle-class Americans finance their medical needs. Once people have the means to make choices, health care providers will compete with each other for their business, which will lead to lower prices. Others advocate letting people buy prescription drugs from Europe and Canada. If American drug manufacturers have to compete with foreign companies, it might stop the escalating cost of prescription drugs. On the other hand, it might also lower the incentive for investing money into research for developing new, better drugs.

The biggest problem with trying to create a free market for health care is that it doesn't guarantee medical coverage for everyone, which some people view as a fundamental human mental-floss-magright, like freedom of speech. These people believe that we need a comprehensive new plan, akin to the health care system of Canada or Germany. In the long term, administrative costs would drop because our system would be simpler, and the government could allocate resources to the people who need them the most. It would be costly, but, then again, so is our current system. In the short term, however, overhauling the system and replacing it with a new one would be massively expensive. And, as we know from other countries, universal health care programs have problems of their own.


Editor's Note: This article came from the "No Politics Allowed" series that appears in mental_floss magazine, in which we attempt to answer your questions about some of the most complex issues facing Americans today. Learn more about the magazine here.

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40 Fun Facts About Sesame Street
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Now in its 47th season, Sesame Street is one of television's most iconic programs—and it's not just for kids. We're big fans of the Street, and to prove it, here are some of our favorite Sesame facts from previous stories and our Amazing Fact Generator.

Sesame Workshop

1. Oscar the Grouch used to be orange. Jim Henson decided to make him green before season two.

2. How did Oscar explain the color change? He said he went on vacation to the very damp Swamp Mushy Muddy and turned green overnight.

3. During a 2004 episode, Cookie Monster said that before he started eating cookies, his name was Sid.

4. In 1980, C-3PO and R2-D2 visited Sesame Street. They played games, sang songs, and R2-D2 fell in love with a fire hydrant.

5. Mr. Snuffleupagus has a first name—Aloysius

6. Ralph Nader stopped by in 1988 and sang "a consumer advocate is a person in your neighborhood."

7. Caroll Spinney said he based Oscar's voice on a cab driver from the Bronx who brought him to the audition.

8. In 1970, Ernie reached #16 on the Billboard Hot 100 with the timeless hit "Rubber Duckie."

9. One of Count von Count's lady friends is Countess von Backwards, who's also obsessed with counting but likes to do it backwards.

10. Sesame Street made its Afghanistan debut in 2011 with Baghch-e-Simsim (Sesame Garden). Big Bird, Grover and Elmo are involved.

11. According to Muppet Wiki, Oscar the Grouch and Count von Count were minimized on Baghch-e-Simsim "due to cultural taboos against trash and vampirism."

12. Before Giancarlo Esposito was Breaking Bad's super intense Gus Fring, he played Big Bird's camp counselor Mickey in 1982.

13. Thankfully, those episodes are available on YouTube.

14. How big is Big Bird? 8'2". (Pictured with First Lady Pat Nixon.)

15. In 2002, the South African version (Takalani Sesame) added an HIV-positive Muppet named Kami.

16. Six Republicans on the House Commerce Committee wrote a letter to PBS president Pat Mitchell warning that Kami was not appropriate for American children, and reminded Mitchell that their committee controlled PBS' funding.

17. Sesame Street's resident game show host Guy Smiley was using a pseudonym. His real name was Bernie Liederkrantz.

18. Bert and Ernie have been getting questioned about their sexuality for years. Ernie himself, as performed by Steve Whitmere, has weighed in: “All that stuff about me and Bert? It’s not true. We’re both very happy, but we’re not gay,”

19. A few years later, Bert (as performed by Eric Jacobson) answered the same question by saying, “No, no. In fact, sometimes we are not even friends; he can be a pain in the neck.”

20. In the first season, both Superman and Batman appeared in short cartoons produced by Filmation. In one clip, Batman told Bert and Ernie to stop arguing and take turns choosing what’s on TV.

21. In another segment, Superman battled a giant chimp.

22. Telly was originally "Television Monster," a TV-obsessed Muppet whose eyes whirled around as he watched.

23. According to Sesame Workshop, Elmo is the only non-human to testify before Congress.

24. He lobbied for more funding for music education, so that "when Elmo goes to school, there will be the instruments to play."

25. In the early 1990s, soon after Jim Henson’s passing, a rumor circulated that Ernie would be killed off in order to teach children about death, as they'd done with Mr. Hooper.

26. According to Snopes, the rumor may have spread thanks to New Hampshire college student, Michael Tabor, who convinced his graduating class to wear “Save Ernie” beanies and sign a petition to persuade Sesame Workshop to let Ernie live.

27. By the time Tabor was corrected, the newspapers had already picked up the story.

28. Sesame Street’s Executive Producer Carol-Lynn Parente joined Sesame Workshop as a production assistant and has worked her way to the top.

29. Originally, Count von Count was more sinister. He could hypnotize and stun people.

30. According to Sesame Workshop, all Sesame Street's main Muppets have four fingers except Cookie Monster, who has five.

31. The episode with Mr. Hooper's funeral aired on Thanksgiving Day in 1983. That date was chosen because families were more likely to be together at that time, in case kids had questions or needed emotional support.

32. Mr. Hooper’s first name was Harold.

33. Big Bird sang "Bein' Green" at Jim Henson's memorial service.

34. As Chris Higgins put it, the performance was "devastating."

35. Oscar's Israeli counterpart is Moishe Oofnik, whose last name means “grouch” in Hebrew.

36. Nigeria's version of Cookie Monster eats yams. His catchphrase: "ME WANT YAM!"

37. Sesame's Roosevelt Franklin ran a school, where he spoke in scat and taught about Africa. Some parents hated him, so in 1975 he got the boot, only to inspire Gob Bluth’s racist puppet Franklin on Arrested Development 28 years later.

38. Our good friend and contributor Eddie Deezen was the voice of Donnie Dodo in the 1985 classic Follow That Bird.

39. Cookie Monster evolved from The Wheel-Stealer—a snack-pilfering puppet Jim Henson created to promote Wheels, Crowns and Flutes in the 1960s.

40. This puppet later was seen eating a computer in an IBM training film and on The Ed Sullivan Show.

Thanks to Stacy Conradt, Joe Hennes, Drew Toal, and Chris Higgins for their previous Sesame coverage!

An earlier version of this article appeared in 2012.

How Apple's '1984' Super Bowl Ad Was Almost Canceled

More than 30 years ago, Apple defined the Super Bowl commercial as a cultural phenomenon. Prior to Super Bowl XVIII, nobody watched the game "just for the commercials"—but one epic TV spot, directed by sci-fi legend Ridley Scott, changed all that. Read on for the inside story of the commercial that rocked the world of advertising, even though Apple's Board of Directors didn't want to run it at all.

THE AD

If you haven't seen it, here's a fuzzy YouTube version:

"WHY 1984 WON'T BE LIKE 1984"

The tagline "Why 1984 Won't Be Like '1984'" references George Orwell's 1949 novel 1984, which envisioned a dystopian future, controlled by a televised "Big Brother." The tagline was written by Brent Thomas and Steve Hayden of the ad firm Chiat\Day in 1982, and the pair tried to sell it to various companies (including Apple, for the Apple II computer) but were turned down repeatedly. When Steve Jobs heard the pitch in 1983, he was sold—he saw the Macintosh as a "revolutionary" product, and wanted advertising to match. Jobs saw IBM as Big Brother, and wanted to position Apple as the world's last chance to escape IBM's domination of the personal computer industry. The Mac was scheduled to launch in late January of 1984, a week after the Super Bowl. IBM already held the nickname "Big Blue," so the parallels, at least to Jobs, were too delicious to miss.

Thomas and Hayden wrote up the story of the ad: we see a world of mind-controlled, shuffling men all in gray, staring at a video screen showing the face of Big Brother droning on about "information purification directives." A lone woman clad in vibrant red shorts and a white tank-top (bearing a Mac logo) runs from riot police, dashing up an aisle towards Big Brother. Just before being snatched by the police, she flings a sledgehammer at Big Brother's screen, smashing him just after he intones "We shall prevail!" Big Brother's destruction frees the minds of the throng, who quite literally see the light, flooding their faces now that the screen is gone. A mere eight seconds before the one-minute ad concludes, a narrator briefly mentions the word "Macintosh," in a restatement of that original tagline: "On January 24th, Apple Computer will introduce Macintosh. And you'll see why 1984 won't be like '1984.'" An Apple logo is shown, and then we're out—back to the game.

In 1983, in a presentation about the Mac, Jobs introduced the ad to a cheering audience of Apple employees:

"... It is now 1984. It appears IBM wants it all. Apple is perceived to be the only hope to offer IBM a run for its money. Dealers, initially welcoming IBM with open arms, now fear an IBM-dominated and -controlled future. They are increasingly turning back to Apple as the only force that can ensure their future freedom. IBM wants it all and is aiming its guns on its last obstacle to industry control: Apple. Will Big Blue dominate the entire computer industry? The entire information age? Was George Orwell right about 1984?"

After seeing the ad for the first time, the Apple audience totally freaked out (jump to about the 5-minute mark to witness the riotous cheering).

SKINHEADS, A DISCUS THROWER, AND A SCI-FI DIRECTOR

Chiat\Day hired Ridley Scott, whose 1982 sci-fi film Blade Runner had the dystopian tone they were looking for (and Alien wasn't so bad either). Scott filmed the ad in London, using actual skinheads playing the mute bald men—they were paid $125 a day to sit and stare at Big Brother; those who still had hair were paid to shave their heads for the shoot. Anya Major, a discus thrower and actress, was cast as the woman with the sledgehammer largely because she was actually capable of wielding the thing.

Mac programmer Andy Hertzfeld wrote an Apple II program "to flash impressive looking numbers and graphs on [Big Brother's] screen," but it's unclear whether his program was used for the final film. The ad cost a shocking $900,000 to film, plus Apple booked two premium slots during the Super Bowl to air it—carrying an airtime cost of more than $1 million.

WHAT EXECUTIVES AT APPLE THOUGHT

Although Jobs and his marketing team (plus the assembled throng at his 1983 internal presentation) loved the ad, Apple's Board of Directors hated it. After seeing the ad for the first time, board member Mike Markkula suggested that Chiat\Day be fired, and the remainder of the board were similarly unimpressed. Then-CEO John Sculley recalled the reaction after the ad was screened for the group: "The others just looked at each other, dazed expressions on their faces ... Most of them felt it was the worst commercial they had ever seen. Not a single outside board member liked it." Sculley instructed Chiat\Day to sell off the Super Bowl airtime they had purchased, but Chiat\Day principal Jay Chiat quietly resisted. Chiat had purchased two slots—a 60-second slot in the third quarter to show the full ad, plus a 30-second slot later on to repeat an edited-down version. Chiat sold only the 30-second slot and claimed it was too late to sell the longer one. By disobeying his client's instructions, Chiat cemented Apple's place in advertising history.

When Apple co-founder Steve Wozniak heard that the ad was in trouble, he offered to pony up half the airtime costs himself, saying, "I asked how much it was going to cost, and [Steve Jobs] told me $800,000. I said, 'Well, I'll pay half of it if you will.' I figured it was a problem with the company justifying the expenditure. I thought an ad that was so great a piece of science fiction should have its chance to be seen."

But Woz didn't have to shell out the money; the executive team finally decided to run a 100-day advertising extravaganza for the Mac's launch, starting with the Super Bowl ad—after all, they had already paid to shoot it and were stuck with the airtime.

1984 - Big Brother

WHAT EVERYBODY ELSE THOUGHT

When the ad aired, controversy erupted—viewers either loved or hated the ad, and it spurred a wave of media coverage that involved news shows replaying the ad as part of covering it, leading to estimates of an additional $5 million in "free" airtime for the ad. All three national networks, plus countless local markets, ran news stories about the ad. "1984" become a cultural event, and served as a blueprint for future Apple product launches. The marketing logic was brilliantly simple: create an ad campaign that sparked controversy (for example, by insinuating that IBM was like Big Brother), and the media will cover your launch for free, amplifying the message.

The full ad famously ran once during the Super Bowl XVIII (on January 22, 1984), but it also ran the month prior—on December 31, 1983, TV station operator Tom Frank ran the ad on KMVT at the last possible time slot before midnight, in order to qualify for 1983's advertising awards.* (Any awards the ad won would mean more media coverage.) Apple paid to screen the ad in movie theaters before movie trailers, further heightening anticipation for the Mac launch. In addition to all that, the 30-second version was aired across the country after its debut on the Super Bowl.

Chiat\Day adman Steve Hayden recalled: "We ran a 30- second version of '1984' in the top 10 U.S. markets, plus, in an admittedly childish move, in an 11th market—Boca Raton, Florida, headquarters for IBM's PC division." Mac team member Andy Hertzfeld ended his remembrance of the ad by saying:

"A week after the Macintosh launch, Apple held its January board meeting. The Macintosh executive staff was invited to attend, not knowing what to expect. When the Mac people entered the room, everyone on the board rose and gave them a standing ovation, acknowledging that they were wrong about the commercial and congratulating the team for pulling off a fantastic launch.

Chiat\Day wanted the commercial to qualify for upcoming advertising awards, so they ran it once at 1 AM at a small television station in Twin Falls, Idaho, KMVT, on December 15, 1983 [incorrect; see below for an update on this -ed]. And sure enough it won just about every possible award, including best commercial of the decade. Twenty years later it's considered one of the most memorable television commercials ever made."

THE AWFUL 1985 FOLLOW-UP

A year later, Apple again employed Chiat\Day to make a blockbuster ad for their Macintosh Office product line, which was basically a file server, networking gear, and a laser printer. Directed by Ridley Scott's brother Tony, the new ad was called "Lemmings," and featured blindfolded businesspeople whistling an out-of-tune version of Snow White's "Heigh-Ho" as they followed each other off a cliff (referencing the myth of lemming suicide).

Jobs and Sculley didn't like the ad, but Chiat\Day convinced them to run it, pointing out that the board hadn't liked the last ad either. But unlike the rousing, empowering message of the "1984" ad, "Lemmings" directly insulted business customers who had already bought IBM computers. It was also weirdly boring—when it was aired at the Super Bowl (with Jobs and Sculley in attendance), nobody really reacted. The ad was a flop, and Apple even proposed running a printed apology in The Wall Street Journal. Jay Chiat shot back, saying that if Apple apologized, Chiat would buy an ad on the next page, apologizing for the apology. It was a mess:

20-YEAR ANNIVERSARY

In 2004, the ad was updated for the launch of the iPod. The only change was that the woman with the hammer was now listening to an iPod, which remained clipped to her belt as she ran. You can watch that version too:

FURTHER READING

Chiat\Day adman Lee Clow gave an interview about the ad, covering some of this material.

Check out Mac team member Andy Hertzfeld's excellent first-person account of the ad. A similar account (but with more from Jobs's point of view) can found in the Steve Jobs biography, and an even more in-depth account is in The Mac Bathroom Reader. The Mac Bathroom Reader is out of print; you can read an excerpt online, including QuickTime movies of the two versions of the ad, plus a behind-the-scenes video. Finally, you might enjoy this 2004 USA Today article about the ad, pointing out that ads for other computers (including Atari, Radio Shack, and IBM's new PCjr) also ran during that Super Bowl.

* = A Note on the Airing in 1983

Update: Thanks to Tom Frank for writing in to correct my earlier mis-statement about the first air date of this commercial. As you can see in his comment below, Hertzfeld's comments above (and the dates cited in other accounts I've seen) are incorrect. Stay tuned for an upcoming interview with Frank, in which we discuss what it was like running both "1984" and "Lemmings" before they were on the Super Bowl!

Update 2: You can read the story behind this post in Chris's book The Blogger Abides.

This post originally appeared in 2012.

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