Sky High: Aerial Objects, Healthcare Costs, and Rihanna

TOPICS DISCUSSED

  • The U.S. Shoots Down Additional Aerial Objects

  • The Cost of Healthcare with Callum Williams

  • Outside of Politics: The Super Bowl

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EPISODE RESOURCES

East Tennessee State University Festival of Ideas: Tuesday, February 28, 2023

Sarah and Beth live at the Abbey in Orlando for The Politics of the Most Magical Place on Earth: Wednesday, April 5, 2023 at 7 pm

HEALTHCARE COSTS

TRANSCRIPT

Sarah [00:00:08] This is Sarah Stewart Holland. 

Beth [00:00:08] And this is Beth Silvers. 

Sarah [00:00:10] Thank you for joining us for Pantsuit Politics.  

Beth [00:00:24] Thank you for joining us here at Pantsuit Politics. We are excited because we have such a special guest for you today. We're going to introduce you to Callum Williams from The Economist. He wrote such an illuminating article about why health care is in crisis around the world. It put a lot of pieces together for us. I'll be honest, when we were looking at the article, it has a lot of data in it and I thought, "How is this going to translate to a conversation?" Well, the answer's perfectly because Callum was an outstanding guest, so we're so excited to share this with you. But first we are going to have to spend some time talking about what is happening in the sky and then Outside of Politics, we'll obviously talk about the Super Bowl.  

Sarah [00:01:01] Also, happening partly in the sky. Y'all we are so excited to be heading to Orlando for our first live show of the year. If you are in the Orlando area or will be visiting there, we would love for you to come to our show Wednesday, April 5th at the Abbey. It's going to be a blast and you can get all the details in the show notes. So check it out.  

Beth [00:01:21] Up next, just a check in with the unidentified aerial phenomena of the weekend. I made a lot of notes, Sarah, but I think the title of this segment is there's a whole lot we don't know happening in the clouds. Since the giant balloon from China was shot down off the coast of South Carolina, we had on Friday an unidentified object the size of a small car shot down near Dead Horse, Alaska. P.S. the names of Alaskan cities-- I just can't wait to go spend our month in Alaska that we've been contemplating because I just am fascinated by the [Inaudible]. On Saturday, we had another unidentified object, this one cylindrical. Similar in shape to the balloon, but a lot smaller. And it was shot down over Canada's Yukon. And it was flying a lot lower than the balloon, which meant it could have been a problem for civilian aviation.  

Sarah [00:02:20] Good luck getting that back. I think getting something out of the ocean would be easier than getting it out of the Yukon.  

Beth [00:02:25] No kidding. Okay. And then on Sunday we have an object shaped like an octagon shot down over Lake Huron. This one had some strings hanging off of it.  

Sarah [00:02:35] Sure.  

Beth [00:02:36] They have remarked in reporting that there is no detected payload, which I thought was an unnecessary detail that made me more nervous than comforted when it was mentioned. The administration said this one was low. This one was flying at 20,000 feet. And so it really potentially threatens civil aviation. So just to kind of regroup here, we've closed our airspace twice briefly to investigate what's going on. We seem to be closely coordinating with Canada. As we're recording, we don't know what these objects were. We don't know why they were here. We don't know who sent them, or how they were sent, or when they were sent. We just don't know a lot of things.  

Sarah [00:03:14]  I feel confident that they're not aliens. I'm just going to put that out there. Do I have any expertise, inside information, access to data relevant to this situation at all? No, I do not. But I do live in the gut triad, which I feel like is relevant. And I'm just telling you right now, my gut says these are not aliens.  

Beth [00:03:31] Well, your gut and an anonymous official to several outlets have said nobody seriously thinks these are extraterrestrial.  

Sarah [00:03:36] So let's eliminate that. I think that's helpful.  

Beth [00:03:39] That's cool. That's helpful. Yeah.  

Sarah [00:03:39] Okay. Yeah. So here's my perception of events. The China balloon went a little awry and as a result, we shot it down. And then when we scooped it up out of the ocean and everybody was, like, hold up. Y'all were taking way more than we thought you were. Ev1erybody has the balloons. No big deal. Sort of like agree to ignore each other's balloons. And then we got access to a balloon, and we were, like, this balloon was gathering way more information than we thought it was. And now we're big mad. And so then the people from NARAC came out and said, okay, we're going to adjust our filters a little bit. We're going to pick up more of what's out there in the sky. And with the finer filters we, in fact, did identify some objects that we thought should come down. Is that your overall perception of what happened?  

Beth [00:04:28] I mean, there's definitely a lot of reporting that we are finding these objects because we are looking for them now. And that has not always been true. I don't know if there seemed to be a lot clustered right now because four and eight days is a lot in peace time. I don't know if there are a lot because China is messing with us at this point-- or China and Russia. The balloon kind of set off a, "Hey, let's test things out. Let's see what they do next." I don't know if the administration is saying do not interpret our patients with the first balloon as a signal that we're going to be cool with things in our airspace. I don't know if it is sort of political. Okay, Republicans, you think we were too slow? We'll watch this. We will blast the things. I just don't know. I don't know what's going on. I don't feel particularly alarmed by it. I feel unsettled, but not alarmed because I think we are surveilled in so many ways that are so much more intense than this constantly. Now, that I think is an interesting and worthy subject to explore. This is just a strange moment because there's so much that we don't know, and I just want to know more.  

Sarah [00:05:42] Well, and sneak peek, we are planning an episode this summer about Edward Snowden and his leaks with regards to surveillance. I started some of that research over the weekend, so I'm in a very surveillance state of mind. I'm also not alarmed about these additional objects that they shot down this weekend. I am alarmed by how much the Chinese were gathering from the very first balloon. That makes me angry. It's really unfortunate with regards to the timing and our diplomatic relationship with China, but I don't think we can ignore it in the service of diplomacy. For a country that complains so much about their sovereignty being violated, that was a massive violation of ours. And so this just seems like the first sort of immediate reaction-- maybe not measured response, but reaction to what we discovered about the balloon. I think it's normal. I think it's natural. And I think we're just going to learn more and more. And maybe it's just because I was doing all the research this weekend, I feel like we'll have a whistleblower sooner rather than later, saying, "You want to know what's going on with these balloons?" Maybe from China or Russia, I don't know. But I feel like we are just on the beginning of this journey into these aerial objects.  

Beth [00:06:53] I think that's right. I don't know if it was unfortunate related to our diplomacy or if it was intentional related to our diplomacy, because China has a long history before meeting with U.S. officials of doing something to just mess with everybody a little bit. And I think they could just be messing with us. And then some of these objects may have nothing to do with China. It seriously may just be that the filters came down and we're finding a bunch of stuff from even non-state actors that we haven't noticed before. So it's hard to say. I do just have that like on edge sense that happens to me occasionally. Every once in a while we'll hit on a run of stories that will make me feel a little off-kilter. And I think that story, plus the earthquake in Turkey and Syria-- and not the earthquake itself as much as the government's inability to respond to the earthquake there. And then we've got this cyclone approaching New Zealand. And these travel advisories, the United States just said if you're in Russia and you're an American, get out because the risk of wrongful detention is so high. The State Department has said don't go to these parts of Mexico because kidnaping and violent crime is so high. And all of that has left me just feeling a little wobbly.  

Sarah [00:08:09] I don't know if I feel wobbly. I feel furious about the earthquake in Turkey and Syria because this death toll was so unnecessary. I can't stop thinking about the earthquake in 1999 and that this death toll is so much higher when we should have learned plenty at that time to protect people. And the idea that people were crying out alive in the rubble and died for lack of rescue is so unnecessarily tragic, as is the entire situation in Syria. I think Erdogan is a terrible leader. I hope he loses the election in May. I hope all the conservatives in our country who have propped him up feel enormous shame and guilt-- although I know that is unlikely. I'm just so angry for what has happened to the people who have lost their lives and continue to be affected by this earthquake. And it just seems so unnecessary on so many levels. And I think instead of feeling disconcerted by things that come that we can't control, maybe that's why I'm just focusing on this thing that was preventable. The death toll in those countries did not need to be this high.  

Beth [00:09:28] Yeah. As we're recording this morning, officials say that 36,000 people have died. That number changed while I was preparing for the episode. I saw reports that was 32,000 and then it became 36,000. And it's hard to even trust the number, given how chaotic the response has been, how unprofessional the response has been in certain parts. I don't want to take anything away from the people who are doing their very best, but the rescue workers aren't getting what they need to do the job that I know that they want to do there. So when we have all these stories, which to me bring a longer list of questions than information, my sort of coping mechanism is usually to just look up at the sky and think, "Wow, we don't know anything. Here we are." I was in my backyard this weekend. It was so beautiful here this weekend and I was looking up at the stars and I thought, "I think this is so beautiful. And also any one of these could just explode right now and take out everything." And it's just hard to live with that reality. And I think we're not really wired to live with it all the time, but every once in a while a story just kind of pokes at that sense for me. And I think the unidentified objects-- that we're not even calling balloons yet because we don't know-- is doing that.  

Sarah [00:10:42] As consumers in a mass media environment, we take in a lot of stories with a lot of death. But this is generationally impactful. We don't often hear of events even across the globe with this amount of life lost, it is exceptional and unique. And my husband and I were walking this morning and he was, like, it makes everything seem fragile. And I said, "No, it makes us feel fragile because we are." That's the difference, right? It just makes us feel fragile because we are. And any sense that there is stability in our own lives, these stories are a reminder that it is just a sense. It is not a reality. And I think that is always hard to hold and is particularly hard to hold with a story that can leave you feeling not only fragile but powerless in the face of all this suffering. And that's really difficult.  

Beth [00:11:40] We wish that as natural disasters occur, every government were doing its best to be prepared for them, both on the front end and in the aftermath. Building the kind of infrastructure that supports that response matters across the world. And so we're going to transition now to a different type of infrastructure, but a related one, which is our health care systems. We are really prioritizing better understanding health care this year. And we are so delighted to have Callum Williams with us for a conversation. Callum Williams is a senior economics writer at The Economist. He joined in 2014 and covers global economic trends. He's the author of The Classical School, a book about the history of economic thought and an absolutely delightful conversationalist.  

Sarah [00:12:33] Callum, thank you so much for joining us here at Pantsuit Politics.  

Callum Williams [00:12:36] Thank you for having me.  

Sarah [00:12:37] I have to tell you, this article in The Economist: Why health care services are in chaos everywhere, hit me at just the right moment. The article talks about in the beginning that with the pandemic there was this concern about overwhelmed health systems. The pandemic begins to wane, but it's like the stories about overwhelmed health systems just increase. And I think why it struck me so powerfully is we kept planning a show on health care in the United States. Like, it just kept getting bumped. We knew that health care costs were rising and we knew something was going on that just kept getting bumped and we kept getting bumped. Because I was also reading these stories about the U.K. and the crazy waits they're having for ambulances. And so when this article came along and said, "Knock, knock, this is a global problem," everything sort of clicked into place. And I thought, okay, that helps. So how did this click come about to write the article that we're seeing this problem across the globe? What exactly is happening?  

Callum Williams [00:13:36] So the click came really from travel. My wife's Canadian. I have some family in France, and I've got family in the U.K., which is where I was born. And then I live in the US. And so over November and December, I was in all four of those places. And you had these kind of weirdly similar conversations with people where they would say the health system, by which they mean our health system-- so French people talking about the French one, Canadians talk about the Canadian system-- it's an incomplete crisis. Like the government's messed up. People are having to wait for months and months of operations or the emergency rooms are ready full, and this is just a disaster. Which is true. But what I think occurred to me when I was traveling was everybody thinks that their health system is unique in some way; whereas, actually what's happening at the moment is reflective of like a global thing. And I just kind of realized that no one had quite said it in those terms. And so that was really the inspiration for the article.  

Sarah [00:14:33] And it was so helpful, so helpful. You kick it off talking about excess deaths. That you're seeing excess deaths in a lot of places.  

Callum Williams [00:14:43] Not absolutely everywhere, but certainly even in places that did reasonably well during the pandemic, say like Germany, for example, didn't have a huge number of people dying from COVID. It wasn't as politicized as it was in the US and so forth. But certainly by the end of last year, excess deaths-- which is basically like how many deaths would you expect there to be in December versus how many deaths were there actually in December? The actual number of deaths is way, way, way high like 25% higher. So it's just not like a little bit high, but really quite a lot higher. And it was true in the U.K. it's true in the U.S., but it's been on the order of like half a million excess deaths in 2022, which is massive. And that was the other thing. That was the other kind of weird thing for me, which was that until about a year ago, people that were interested in the news were very interested in like data on COVID cases and type of deaths and like deaths in general. It was quite a morbid time. And then in the past years as kind of people have moved on from COVID, the conversation around those things has kind of stopped. But then I was like-- looking at the data, there's actually quite a lot of countries where 2022 was actually had more people dying than in 2021 when there were all these big waves of COVID. There were lockdowns in lots of places in 2021. There was no vaccine for a lot of 2021. And then 2022 comes along and we think basically everyone who wants to be vaccinated is vaccinated or they've already had COVID, so they're not going to get sick again. We're through it. We're past the worst. Actually, for a lot of countries, that wasn't even the worst. It was going to get even worse. We just don't really talk about that anymore.  

Beth [00:16:25] You point out in the article that some of the getting worse comes from what I'm going to call pent up demand. Is that a fair characterization from the COVID times? I was reading the article thinking it sounds like what we have been trying to prevent, especially in the early days of the pandemic, we just put off and accepted a different form of.  

Callum Williams [00:16:45] I think that's right. Yeah. So 2022 was, as I said, deadlier in lots of countries than 2021. But it is true that the people that are dying in 2022 are on the whole not dying from COVID, they're dying from non-covid things. So you're absolutely right. You had this pent up demand, which is basically people in-- I think this was probably more true in Europe than it is in the U.S. But you had a lot of people who kind of maybe felt a bit sick in like March 2020 or April 2020 or May 2020 and were like-- in normal times they would have been, like, I'm going to go to my doctor. And they didn't. And it turned out to be something that would have been preventable or solvable in 2020, but by 2021 was like more acute. Or, at least this was true in America, what you had was a big decline in just routine examinations, just wellness checks and stuff. And there's a paper which looks at that and basically says, well, it turns out that a lot of cancers are discovered during these checks. If you don't have these checks you can't discover cancer until it's too late. So that's kind of one piece of it. But then there's another piece of the pent up demand story, which is basically to do with how robust our immune systems are now to just stuff that's normally in the air and on other people. And so obviously people have been talking a lot about kids getting sick and RSV and flu and all this sort of stuff. And there is good evidence that this is really to do with people just not being exposed to those bugs for a long period of time. As with everything, there is this kind of more political argument or like maybe even conspiratorial argument where on the one hand, some people say that getting COVID itself has weakened people's immune systems and therefore make them more likely to get sick today. There's not really much evidence for that, basically because of the types of things that people are getting. It doesn't suggest that it's because COVID itself has made people weaker. And then on the other side of the argument, you have people who say it's the vaccine which has made people less immune to stuff today. Again, there's no evidence for that really.  

Sarah [00:19:01] Also how they separate those people out, can you neatly organize everybody in your life from people who had COVID and people who got the vaccine? There's a big Ven diagram of overlap there, how do you sort those out?  

Callum Williams [00:19:13] That is a very good point. But in any case, this is really getting to the very levels of my understanding because there are many debates about the economics of health care rather than like viruses and stuff. But my understanding is that there's basically the sorts of things that we're seeing today, like RSV, are the kind of things that tend to kind of do really well when people don't have kind of built-up immunity from like not having had it for a few years. So that's why I think it's fairly well accepted that it's to do with that.  

Sarah [00:19:42] So we have this feeling inside of the health care systems. We have the reality that we have excess deaths. I think we definitely have this pent-up demand. When I was reading this, I thought, the only funeral that I went to in 2021 was from an elderly man who definitely didn't go to the doctor because of COVID and something got worse and he died. But that's the excess death that affected me. I mean, it was not COVID, even though I live in a red state where there were not a ton of precautions and literally everyone I know had COVID. But that statistic you have about Italy, that cancer diagnosis fell by 40% in 2020 compared with 2018/19, of course that's going to have impact. But I thought the really interesting part was that economic argument where you're saying we're still spending money. The spending is there and the staffing-- this is the part that got me. The total employment and so many of these health care systems is either at like pre-pandemic levels or above it. And you still have this sense of like this industry in crisis, this career in crisis even though the employment is there. But the burnout is the productivity. That really filled into the missing pieces for me.  

Callum Williams [00:20:58] Yeah. It's not what people think, certainly not what I thought. When I started looking into this, I assumed that what is true is that a lot of health care providers they say it's become a lot more difficult to get workers and that they're putting out all these vacancies and people aren't coming forward and they've got fewer workers than they want. But it's definitely true that in basically every country there are more health care workers than ever before. Basically everywhere and by a long way as well. It's not as if every year the health care employment goes up and then it's just kind of carried on going off as normal during the pandemic. It’s gone up by law by about 10% I think for like nurses, for example. And then some people say, well, yeah, but this is all because what's happened is that there's loads of bureaucrats and administrators and managers and all the kind of boogeyman of healthcare discourse. But actually, this is doctors, practicing physicians, nurses proper on the ground patient facing stuff. That number has gone up a lot. And so, the question is like, well, so what's going on then? So how can we have more staff than ever before and more money than ever before? It's not that surprising that health care spending went up doing Covid because obviously governments had to buy these tests, the government had to buy vaccines and all the treatments and everything. But then it kind of basically stayed really high and has stayed really high since. So, all this money is being spent on health care. And so, as an economist, essentially what that means is that productivity has fallen very substantially in the health care industry since really over the past year. And that is not saying that health care staff are not working hard or working less hard. They could be working even harder, it's just that what their efforts are being put towards is less kind of useful than it used to be. And this is a big question. Nobody knows exactly why, and there's a few suggestions that are put in the piece. But what is definitely true is like you get the inputs into the health care system, which are like money and people, and then you get the outputs of the health care system, which is basically like people getting better and essentially how much money hospitals are taking in from treating patients. And that has gone way down. So, there's something going wrong in the middle, which is a bit of a puzzle.  

Sarah [00:23:26] Around the world.  

Callum Williams [00:23:27] Around the whole world. Yeah, absolutely.  

Beth [00:23:29] And that's really helpful. I think another reason, honestly, that we keep punting, talking about this is that we know from our listeners in health care that they are working hard and that every story about health care feels intensely personal. And when I read the line in your piece that the health care system is essentially doing less with more right now, I thought that was such a straightforward and excellent encapsulation and it's so hard for individual providers to hear.  

Callum Williams [00:24:00] Yeah, totally.  

Beth [00:24:02]  I know you said no one knows exactly what's going on but I just keep coming back to the question, where is the more stuck? Is it a resource allocation problem? Like in a global sense, even when you compare the United States to countries with single payer systems, we're seeing the same issue. So where is the more getting stuck?  

Callum Williams [00:24:21] Okay. So, I think there's one reason that I feel confident about, and then there's one reason I feel less confident about to explain this. The reason I feel confident about is that staff are in general just much more tired than normal. And you often hear and did long before the pandemic in many countries that the health care staff were overworked and losing motivation and underpaid and all that kind of stuff. That may well be true. But after the pandemic-- and you can see this in very high-quality data-- it is true that health care staff on average are just feeling more burned out than before. For example, they're less likely to say they would recommend it as a career to others. They feel generally like more disempowered than they did before and that kind of thing. And that has an impact in a very significant way on productivity. Because if you imagine the situation before COVID, a nurse, for example, they may have come to work 15 minutes early to help the previous shift finish. They might have stayed half an hour afterwards. They might help set up the next person coming in. They may have helped out on a ward that they weren't really responsible for to help out a friend or something. If you're feeling less motivated in general, you're going to do fewer of those kind of things that like kept the show on the road. So I think that's one thing. There is another thing that is, I think, very important, which is to do with COVID itself. You see this in lots of hospitals around the world, even though society at large has sort of moved beyond pervades almost everywhere, it's still the case that hospitals and health care providers generally are still bound by more COVID rules than they were. So, for example, it is still true in other countries that if you get COVID in a hospital you get put into another ward, into a COVID ward. There's lots of things like mask wearing, more checks. Whenever I go to a doctor in the US, there's all these forms you've got to fill out. Have you been traveling?  

Sarah [00:26:34] Right, right, right.  

Callum Williams [00:26:36] Can you take 20 minutes to take a test? All this kind of stuff. And it might seem kind of marginal for each individual person, but these things accumulate. I'd actually think about a business, like a well-managed business that, the margin of error are quite small. So, once you add in all of these things to do with COVID, it's not that surprising really that hospitals just manage less efficiently than they used to be. And then the third thing, which is more speculative and this one's harder to say, but I reckon is true. Which is there's this common idea that you read in the news, for example, which I sort of referred to earlier, which is no one likes it when there's more health care managers. No one like's it when there's more health care bureaucrats. What people want is they want more nurses; they want more doctors. But if you say we're going to boost the number of managers in the French health care system by 10%, everyone's like, "That sounds terrible, you should just let doctors do their own thing." Which I understand, but I do think that-- as what you heard, as this is very true in the U.K. over the past 10 years is like a bit of a war on managers in the health care system because it gets good headlines. No one likes health care managers. They want doctors. But the reality is that every kind of business, whether it's health care or anything else, does need good management. And if you cut management, there is a risk that you basically end up giving doctors managerial tasks that they don't really want to do, like hiring or sorting out payroll or all this kind of nonsense which they don't really want to get involved in. And so the reason I'm not certain, this is the reason. It's because there hasn't really been any research on that specific question, but it I kind of believe it to be true.  

Sarah [00:28:23] Yeah, that makes a lot of sense to me.  

Beth [00:28:25] It feels related to a sentence that I thought was pretty revelatory at the beginning of your piece about how we have much better data about most economic issues than we have about health care, despite the fact that it's this enormous percentage of economies. And I thought, well, maybe this is part of the issue. I mean, we've had so much conversation around the CDC that data collection is a stumbling block for us to take meaningful action. And to your point about putting people in health care who aren't doing direct health care, I wonder if we would find outcomes that we like better if we tightened up that business perspective-- not for the purpose of maximizing profit, but for actually measuring what's happening.  

Sarah [00:29:06] Efficiency. Yeah.  

Callum Williams [00:29:07] Yeah, totally. So, the weird thing about America in this regard, is that America does actually have loads of managers relative to its population size or whatever. So the US health care system is much more managed than it is in, say, Europe. There is way more managing. The managers to doctor ratio is much higher in America than it is in Europe.  

Sarah [00:29:34] Well, that makes sense because there's more business than politics if it's not a government run health care system in a way.  

Callum Williams [00:29:39] Yeah, I think that's basically correct. And also, it's interesting because if there's one country which is suffering least from the trends that we're describing at the moment, it probably is the US. There's just a lot of spare capacity. I mean, the thing about America is you folks spend a lot of money on health care.  

Sarah [00:29:58] We do.  

Callum Williams [00:29:59] A lot of money, way more per person relative to GDP, all that kind of stuff, than any other country. And there's a whole argument about whether that's a good use of money. And some people say it is, some people say it isn't. But what is I think undoubtedly true is that when your system comes under strain, such as in 2020 or today, there's just more spare capacity, there's more redundancy built in. And so, you don't have those kind of capacity problems that you do in, say, the UK where it's a much, much, much tighter ship. So it's that tradeoff between those two things, basically.  

Sarah [00:30:36] Well, and you hear that trade off when people are like-- it's like you can say we have worse outcomes. Our mortality rate, our infant mortality rate, they're bad. And people are like, y'all, we don't have to wait. That's what matters. I don't have to wait. Well, and it's so interesting because we don't have this sort of data. You know, we are left to like sort of feelings and anecdotes. And when I read your article, I immediately sent it to a friend of mine who, to her eternal credit, she's a nurse anesthetist. She works inside the health care system. And she was on this train before I was reading it in any other news articles. She was like people aren't getting cancer diagnosis. And she does a lot of elective surgeries that was getting pent up because it's not just like cancer that didn't get diagnosed, it's like 16 different kind of surgeries people weren't able to get and now they're like, "Now, want it now, want it now" because they don't like to wait again. And it was interesting I sent it to her and she's, like, this is yes to everything. She's like the only thing is some of this was a problem before. So, if you're comparing it to like 2018, the staffing was too low then. I've heard nurses say that for a long time, like, our ratio especially of intensive care units where the ratio is the difference between life and death and how many patients nurses are caring for. And that's like what they were striking for in New York City. So, she's like it's helpful to compare 2018/19, just don't pretend like that was a paradise either. And that was the outcome we wanted, right? And I was like, well, that's probably fair too.  

Callum Williams [00:31:54] Yeah, I totally take that point. So, one thing that I didn't get into the article, which I think is both quite controversial but also is very interesting and hard to measure, is there have been conversations about a shortage of healthcare workers in the US for literally close to 100 years. Like it's just every year, every month you get an article or a campaign or a report written about how there aren't enough nurses and doctors, that kind of thing. And so, one issue I was never able to resolve in my mind is how do you know when there actually is a shortage versus people who are-- essentially, I mean, to be frank, people who want to make sure that their business is really well funded. This is certainly true in the UK where there's a very strong lobbying effort by a lot of unions and interest groups and that kind of thing for more money for the NHS, which is like the state-run provider in the UK. So, it's always a difficult balancing act between obviously you want a well-funded healthcare system, but it's one of those beasts that will just eat more and more and more money. So, at some point you have to be like, "No, we're not going to give you any more money." And so, it's really hard to know where that point is.  

Beth [00:33:09] When you're thinking about data from the U.S. and our peer countries, how do you account for just the difference in size and geography represented in America? Because I think about what would my experience be in a Texas hospital versus a Kentucky hospital versus a Swedish hospital?  

Callum Williams [00:33:28] Yeah.  

Beth [00:33:29] How do you think about that in your work?  

Callum Williams [00:33:30] Yeah, that's a really good question. One thing that I was very keen to establish, which is talked about at the start of the article, is where there any parts of the US during the first or second waves of COVID that were actually overwhelmed by hospitals did go beyond the point that they were supposed to go and where the worst predictions did actually come true. And I was not really able to find anywhere where that was true. Like in the place that I was interested in for a while was South Dakota, where you'll know better than me, but they kind of had a lockdown-- but they basically didn't have a lockdown at all. And the bars were open really soon after being closed, if I can say. So, if there was a place where you'd think this was going to get seriously awful, it would have been that. But it didn't seem to really happen there. 

Sarah [00:34:18] And those are rural hospitals which we read constantly are underfunded and shut down and serve too many people. There's like a constant news narrative about that type of health care system in the diversity that we find in America. You know what I mean?  

Beth [00:34:31] On the other hand you have like super low population density, which matters a lot for COVID transmission. So, it's like a big mix of factors.  

Callum Williams [00:34:38] That's true.  But then on the other hand, you have New York and probably New York came close than anywhere because they had all those field hospitals in Central Park or wherever they were. But those opportunities didn't really get used, from what I understand, from looking at the research on this. To be clear, I think it was a good idea to have them because you couldn't know what was going to happen. But did you actually need them? No, you didn't. So, in that sense, it was not necessary to have them. I mean, the question of does care in the US vary significantly from one place to another?  I'm sure that must be true. I'm sure that in San Francisco with loads of people who work in tech they're getting super fantastic all the time. But it wasn't clear to me that those differences were so stark in 2020 that some areas were fine and other areas were totally on their knees. Everywhere was really working hard, obviously under a lot of pressure, but it wasn't kind of a catastrophe anyway so I could say.  

Sarah [00:35:38] Well, I love the end of your article where you say the effects of malfunctioning health care systems go beyond unnecessary deaths. People come to feel that their country is falling apart. Back to that feeling, if you're supposed to assure my safety and I call for an ambulance and no one comes, it just contributes to the sense that things are very bad. And I think there is a comfort where you'd feel like it's not just your country, this is some global stress. Same with inflation. I think all the coverage that was like inflation is everywhere, inflation is everywhere, it doesn’t make this about the failing of our individual government or politics. This is the upside of the global coverage. It can produce a lot of anxiety, but I think articles like this to me reduce it because they're saying there's nothing special. This is just a hard thing we're all going through together.  

Callum Williams [00:36:28] Yeah, that's true. It's so weird that how even now basically journalists-- because they framed the analysis on the whole, journalists’ perspective of the world on the whole, it's just so parochial, so narrow. And I don't know why it is really. I mean, why is it? I guess partly because for good reason journalists like to criticize the government or whoever's in power on the whole. A good journalist likes to hold power to account and show where people abuse their power, whatever. So, people like me always have an incentive to try and find ways of criticizing whoever's in power. And I think the other reason why people tend to focus on their own countries, just frankly they're just not aware of where to find numbers or data or statistics about what's going on. So, I'd say if that was easier to find then maybe people would open their minds a bit more, but who knows?  

Sarah [00:37:27] Well, I thought back to what you said at the beginning. You traveled. It wasn't like from behind your computer screen you were trying to get the facts to the case. You were out in the world taking in experiences. We cannot intellectualize everything because our intellectual bent is criticism. And sometimes you have to be out there experiencing it [Inaudible]. You had to feel this. You had to see this. You had to live it, not just read about it.  

Callum Williams [00:37:49] That's definitely true.  

Sarah [00:37:51] And the last thing where you got me, you just threw it in. You just threw this little piece in and I was like, "Oh, Callum, you're so mean." You're like, "But with an aging population and COVID now an ever-present threat, pre-pandemic health care may come to seem like it was from a lost golden age." I feel like aging population is the only thing we're reading about right now. Beth and I are in a constant conversation putting together an episode-- or, I don't know, 15. It sounds like-- on demographic changes and what that is going to mean for all of us.  

Callum Williams [00:38:21] So I might say something that you might find a bit odd, but it's just true, which is basically that-- although I did advise in the article. I think the aging population story is a bit overdone.  

Sarah [00:38:33] Okay, that makes me feel better. Tell us more.  

Callum Williams [00:38:35] So there were forecasts which I think are pretty good of the average rich countries like the US, France, Australia, Japan, what's going to happen to their health care spending over the next 50 years. And all of these forecasts show it absolutely exploding, like going really very, very, very high and just increasing year after year. And so, the question is why is that? Now, when I first started looking into this, I assumed, well, obviously it's because everyone's getting a lot older. Actually, the Asian population story only explains about 10% of the rise. So, for example, if health care is going from 10% of GDP to 20% of GDP, if the population didn't age at all over that period, you'd expect to actually see growth of 19% of GDP rise to 20% of GDP. Whatever happens with population over the next-- even if all of the elderly people in America moves to Canada, health spending is still going to go [Inaudible] 

Sarah [00:39:39] No, they'd go south because it's warm not north.  

Callum Williams [00:39:40] Oh, South. Yeah. It makes sense. 

Beth [00:39:42] I do like the gentle way you did that, though. It was like if you won the lottery [Crosstalk]. 

Callum Williams [00:39:50] So the main reason for this trend is actually to do with basically the economics of health care, which is health care is just really, really, really weird thing. So, when there's a new discovery in most industries, so say, for example, when Apple discovers a new way of making an iPhone, basically iPhones do become cheaper. iPhone have become cheap over time because they can be made more efficiently. But when you get a new discovery in health care, it actually tends to make things more expensive.  

Sarah [00:40:18] Okay.  

Beth [00:40:18] That is such a helpful insight.  

Sarah [00:40:20] I'm putting pieces together; I see where you're going with this.  

Callum Williams [00:40:24] Yeah. So, for example, if you discover a new drug for the cancer or whatever, you can give that to more people. You can save more people's lives, but because you're giving people more, you're spending more. So that's what I'm saying.  

Sarah [00:40:36] So let's say CRISPR comes on to the scene and we've got some very expensive treatments available.  

Callum Williams [00:40:43] Let's be clear. That's good because you're saving people's lives.  

Sarah [00:40:45] I have a type one diabetic son. Bring the CRISPR. I want the CRISPR. 

Callum Williams [00:40:49] So I'm not saying it's bad, but it's just means you spend more money as society on health care. And then the other thing which is even more difficult to understand but is really important, is basically like-- and this is really hard to explain without offending people who work in health care, but it's basically true. Health care is a bit like so there's a [Inaudible] cost disease, which is basically like imagine if you're sitting at a string quartet in 1950, you go to the concert hall, you watch a string quartet play a Beethoven string quartet. You then come back to the string quartet and see them 70 years later, a different one. Over those 70 years, loads of things in the economy have got way more efficient. You can cook more quickly. You can travel around the country more quickly. You can communicate much faster. You can make manufactured goods much faster. But that string quartet still takes as much time as it did in 1940 to play, and it still takes four people to play it. So, what this basically tells you is that industries that have a lot of people working in them, they find it very hard to have high productivity. So, for example, going to a restaurant today you've still got people waiting on you, you still got cars at the front of the house. You still got basically the same number of people working in restaurants as you did 50 years ago. So, productivity in restaurants hasn't really gone up over 50 years. And it's true in health care also because you have lots of hands-on labor intensive. You've got people on the ward, nurses, doctors. Health care productivity isn't really any higher than it was in a like basically the seventies. But the problem is that because other industries that got more productive, pay in those industries has gone up. And so, what you'd have if you didn't raise doctor's pay would be that basically doctors quit and goes to other industries. So basically, you're left with this situation where in order to stop them from quitting health care-- this is over the long period-- you have to increase people's pay, even though they're actually not doing any more than they were in the past.  

Sarah [00:42:46] Oh, I am feeling very...  

Callum Williams [00:42:50] Yeah.  

Sarah [00:42:50] Puzzles clicking. Pieces are clicking.  

Callum Williams [00:42:53] So a nurse is looking after five people is paid miles more than that person was 50 years ago, even though they're still looking after the same number of people. And that actually violates like a pretty normal thing in economics and economic development, which is you get paid more as you produce more. That's how wages are set. And so because of this cost disease problem-- maybe that is not a problem, but because of this cost disease issue, providers are going to have to just keep raising salaries over time. And if you raise salaries over time--  

Sarah [00:43:24] Things get more expensive. Well, don't be offended. That's just job security.  

Callum Williams [00:43:28] Yeah, that's right. That's true. 

Beth [00:43:30] It's also in every other realm the inputs are advancing also, but bodies are just bodies. I spent a week in the hospital with my mom, and we were on a unit that was seemingly pretty short staffed. Her surgeon told her that he was so sorry he knew this was the situation and that if he has patients right now that need a ton of care, he puts them in ICU whether they need to be there or not, because that's the only place the ratios are where they can receive good care.  

Callum Williams [00:44:03] Yeah.  

Sarah [00:44:04] Which is more expensive. Yeah.  

Beth [00:44:06] I was changing her bed sheets and getting the laundry and just all of those pieces of caregiving that are exhausting physical labor. And it makes sense to me that you can't see increasing productivity because those pieces of just caring for a person are fairly static over time.  

Callum Williams [00:44:25] Right. And also, by the way, there's also the other thing where even if you could have higher productivity, you might kind of not want it. Imagine if it was possible somehow for a nurse to look after a thousand patients rather than five. The whole thing would seem so impersonal. It would seem so clinical in a bad way, so people actually wouldn't want it. So, to say that there's no productivity growth is definitely not a criticism of health care practitioners. They're doing a good job.   

Sarah [00:44:57] Yeah. Because care is not productivity.  

Callum Williams [00:44:59] Exactly.  

Sarah [00:44:59] That's not the same thing.  

Beth [00:45:01] And you see the places where they're fighting with the tools they're given to try to increase that productivity. Like you can see how exhausted nurses are typing everything into their computers on cards that they're rolling everywhere. Like where we're trying to make this happen, it feels like it's just creating a tension instead of solving a problem.  

Callum Williams [00:45:19] Yeah. That's true.  

Sarah [00:45:20] Well, and I think to that other piece, I really feel where there-- again, it's not productivity, although I feel like sometimes we interpret it like that. But the better treatments, the technology. Beth, what was that show we watched where it was like projected into the future with the family in Britain.  

Beth [00:45:37] Yes. And it was like a number in the title. I can't remember.  

Sarah [00:45:40] And Emma Thompson was like the authoritarian, dictator, prime minister. 

Callum Williams [00:45:44]. Okay. I should know that.  

Sarah [00:45:44] Do you know what we're talking about?  

Callum Williams [00:45:45] It does sound familiar, yeah.  

Beth [00:45:46] I'll find it.  

Sarah [00:45:47] But in that show where they're projecting into the future, the part that I thought this feels the most real to me was the take off in health care technology. Like all of a sudden, the grandma could get like brand new eyes. And I was like, this is it. Just in the same way that crazy Tom Cruise movie, like that stuff felt the the realist to me because they really went out and talked to futurist and tried to figure out what was coming. And I thought, yeah.  

Beth [00:46:15] Years and Years.  

Sarah [00:46:16] Years and Years. Yes.  

Callum Williams [00:46:17] I didn't know, actually.  

Sarah [00:46:18] You should watch it. It's good. It's like, that's it. That's what's coming. It's going to be like CRISPR is, revolutionary technology. And it's expensive now, but it won't always be as prohibitively expensive. And they're going to figure some stuff out like regenerative medicine and all that. That's going to change things. And it's going to be really expensive.  

Callum Williams [00:46:36] Yeah, probably good. Hopefully as well.  

Sarah [00:46:37] Yeah. And perhaps-- oh, I don't know-- aligning nicely with this aging population that we have. 

Callum Williams [00:46:44] Well, let's hope so. Yeah.  

Sarah [00:46:45] Yeah.  

Beth [00:46:47] Thank you so much to Calum Williams for joining us today. We can't wait to hear your thoughts and questions and reactions to that discussion. Up next, we'll talk about what's on our mind Outside of Politics, which is, of course, the Super Bowl. So, I went into the Super Bowl trying not to be like a sour grape’s sports fan. But I did cheer for the Bengals, and so I did have to pull for the Eagles because I felt like we got a little bit of a raw deal versus Kansas City. But the Chiefs won 38 to 35 in what I'm told was a very exciting second half. I wouldn't know because I fell asleep. But the beginning of the game was great. I mean, it was a great game.  

Sarah [00:47:30] Yeah, I was rooting for the Eagles just because I think Philly sports fans are the best. I love that video Maggie shared on Instagram where it was like "Kansas City fans, what are you going to do if you win? I'm going to have some barbecue. Philadelphia fan, what are you going to do if you win? I don't know. I'm going to blow some stuff up."  I just love it. I think they're so great. I'm so sad they lost. I had a Philly cheese steak my husband prepared. It was delicious. I watched the game sort of. Mostly I was there for the commercials and the halftime show with Rihanna, which also involved things in the sky. Floating platforms. I know they planned this for months and months in advance. And I read an article today that it was in fact to protect the field which was real grass, but it just felt so on trend. Here we are talking about all these things in the sky. And where is Rihanna when this performance starts? 60 feet in the air. Incredible.  

Beth [00:48:22] You are much more excited about this than I am.  

Sarah [00:48:25] Were you not impressed? Oh my God!  

Beth [00:48:25] Well, that's visually interesting. I thought it was interesting, but it didn't make me stop in awe and wonder the way I think it did to you.  

Sarah [00:48:31] I am so confused because you are a physics person. You were like...  

Beth [00:48:36] No, I don't trust physics. I don't like physics at all.  

Sarah [00:48:38] I know. So, weren't you in awe of the fact that they had these giant platforms from wires that we could only barely see in a middle of a open air football arena?  

Beth [00:48:49] I mean, it's great. I just didn't find it particularly striking. What I thought about her performance is she is so talented. She is a superstar for a reason. I thought it was really interesting. I thought there were a bunch of really interesting choices and I thought it was like medium to low level entertaining. It just wasn't fun the way a lot of Super Bowl halftime shows, especially last year, are so fun. I thought this was like conceptual and good for her for making a whole host of statements with everything she did, and it was fine.  

Sarah [00:49:23] I loved it when those platforms were moving up and down and the dancers were on there and she was on there and you just like got a sense of truly how high in the air she was. I recently went rappelling off a 60-foot rock. You guys, it's high. It's terrifying. And that she was up there-- often you'll go to concerts when they put them up in the air and they have something all the way around their waist that they're sort of holding onto. And she was tethered absolutely, but she was not encased in the way that I would want to be if I was-- oh, by the way-- pregnant and 60 feet in the air on this seemingly hovering platform and giving a performance with cameras in her face. I just thought it was incredible to see and just the visual impact of the way they would change and she would walk across them and then they'd move back in the air. I thought it was so stinking cool because I've seen a lot of halftime performances where it's just everybody going at full tilt and there's a bunch of special guests and it's like, bam, bam, bam, bam, bam. And so, I thought this was just a totally different vibe. And it's her vibe. She is very cool. She just is. Not that a lot of people who perform at the Super Bowl aren't cool. They're rock stars. But her vibe is different, and I thought she captured it so magnificently and with the pregnancy announcement.  I'm sure y'all were just like me. I was like, "Wait, is she pregnant?" I know she just had a baby. But wait, that was last month. I think everybody was like, "Wait, what happened?" So, I just thought it was cool. Now, again, I don't think it was like high octane. Like her physicality of the performance was not high octane, but I thought everything about it was so different and neat and visually stunning. I just loved it. And her music is great. I don't think we're going to be getting any more music out of Rihanna for a very long time. She's clearly just leaned into the makeup mogul, which is good for her because it made her a billionaire. And I love the moment with the Fenty Compact. I think she hasn't put out an album since 2016 and she hasn't performed since 2018. And so, this felt to me like, hey, I want to give you guys something because I really do love you and I appreciate it, but don't think you're going to be given like a tour or a new album out of me any time soon because I'm living my life. And if I was her, that's the exact approach I would take. Good for her.  

Beth [00:51:33] I don't know why you would make the choice to do the grueling life of a musician when you can make all this money selling make up.  

Sarah [00:51:43] Word.  

Beth [00:51:44] I just don't blame her at all. And I also thought it was just not a great reaction that 30 seconds after the halftime show, you have all of Twitter being like, "Congrats on your baby, but I wanted a tour or a new single or an album or something." No, Rihanna doesn't owe any of us anything. I think that was the whole vibe here. Her vibe was very much I could take or leave this Super Bowl business, do what you want. I thought Chris Stapleton was a little bit like that. He was fine, but not overly excited to be there. Just okay you asked me to sing the national anthem? I'll do it at your little football game. It's cool. It was a very different feel all the way around, except I thought for Sheryl Lee Ralph, who approached it in the traditional Super Bowl. I thought she was like, hello, this is a special thing. I am a big star. I am an entertainer, and I am going to show up for you.  

Sarah [00:52:40] And I thought the commercials were the same. They were good, they were funny, nothing over-the-top except that Jesus ad which, whatever, so silly to spend hundreds of millions of dollars because you think Jesus has a bad reputation? I don't understand the motivation behind that at all, but it just...  

Beth [00:52:57] That's a whole [Crosstalk]. 

Sarah [00:52:57] The gymnastics you have to do in your own mind to say people misunderstand Jesus, he's really humble and loving and empathetic, and we will spend $100 million to making a Super Bowl ad about that. Guys, you don't have anybody around you telling you the truth. But I loved the Ben Affleck ad, perhaps my favorite ad of the evening, because I am just unapologetically here for Ben Affleck. All my boyfriends showed up. Adam Driver. Jon Hamm. Michael P Jordan. Felt really good just having the whole crowd there. I thought all the commercials were fun. I mean, not all of them. Some of them are dumb, like the John Travolta one, but the rest of them were a delight.  

Beth [00:53:37] I thought that there was no commercial other than clueless. I was so happy to see Alicia Silverstone. What ruined that a little bit for me is Ellen, my seven-year-old, goes, "Oh, she's Christy's mom on the Baby-sitters Club. I was like, "No, she's not. Not right now. She Isn't. Shhh." Not to be like let's talk about politics in the Outside of Politics segment, but we do sometimes. And I just was thinking about how these commercials if you are looking at the Super Bowl commercials as a barometer of American mood, it seems like we're doing pretty well. Seems like we're all pretty happy. We're pretty chill.  

Sarah [00:54:09] Let's pick up the pieces. Yeah, we are moving on.  

Beth [00:54:10] We'd like to see some movies. We'd like to have some snacks, but we just kind of want everything to come down to maybe a six from an 11. And I thought that was great.  

Sarah [00:54:21] We're pouring all our emotionality into our pets. Those were the commercials that made me cry. It's fine.  

Beth [00:54:28] And that's a great point because there were a lot of, like, relationship family centric commercials. We're excited about having a baby. We're excited about kids growing up. We're excited about pets. We love our people. And I just thought like this feels like a very healthy America compared to even the last Super Bowl and especially the two before that. If you look at that set of commercials and where we've been, this was nice and normal.  

Sarah [00:54:57] And you had Rihanna up in the sky just asking everybody to chill out and be cool along with her. That's great. Love it.  

Beth [00:55:03] I did worry about Patrick Mahomes ankle the whole game. If we want to do a little bit on actual football.  

Sarah [00:55:09] He came out the second half like he never hurt himself. And I was like, "What happened back there, guys? What did you give him?" Some serious ibuprofen, clearly.  

Beth [00:55:18] When he went to the locker room and the commentators were like he'll get some pain relief, we were, like, hmm, I bet he will. But that worries me for him. I didn't want him to hurt himself even worse. I understand this is a very big deal and it's obviously important to him. I mean, you can see both of those quarterbacks their love of the game just leaps off the screen. But I didn't want him to hurt himself even worse. I hope he's doing okay. I could use some follow up reporting on his ankle.  

Sarah [00:55:46] Yeah, I'm sure we'll get it. I'm sure we'll get it.  

Beth [00:55:49] Well, I hope you all enjoyed the Super Bowl if you watched it. If you didn't, I understand that choice as well. And hope you loved whatever you did with your Sunday evening. I know before we go, Sarah, you had a blessing that you wanted to share.  

Sarah [00:55:59] Yes. Today is the fifth anniversary of the shooting at Marjory Stoneman Douglas High School in Parkland. To the people whose lives were forever changed that day, we just wanted to say that you are in our thoughts and our prayers. I know that's a weighted term, but it's still the truth every year. But I know some of these milestone years can be really hard and impactful. And we're just sending you all the light and love.  

Beth [00:56:26] Thank you all so much for joining us today. Please don't forget to check out that link in our show notes. If you'd like to join us live in Orlando, we'd love for you to be there. We'll be in your ears again on Friday. Until then, have the best week available to. 

Beth: Pantsuit Politics is produced by Studio D Podcast Production. Alise Napp is our managing director. Sarah Maggie Penton is our community engagement manager. Dante Lima is the composer and performer of our theme music.  Beth Our show is listener-supported. Special thanks to our executive producers. Executive Producers Martha Bronitsky. Ali Edwards. Janice Elliott. Sarah Greenup. Julie Haller. Helen Handley. Tiffany Hasler. Emily Holladay. Katie Johnson. Katina Zuganelis Kasling. Barry Kaufman. Molly Kohrs. Katherine Vollmer. Laurie LaDow. Lily McClure. Linda Daniel. Emily Neesley. Tawni Peterson. Tracey Puthoff. Sarah Ralph. Jeremy Sequoia. Katie Stigers. Karin True. Onica Ulveling. Nick and Alysa Villeli. Amy Whited. Emily Helen Olson. Lee Chaix McDonough. Morgan McHugh.   

Beth Jeff Davis. Melinda Johnston. Michelle Wood. Joshua Allen. Nichole Berklas. Paula Bremer and Tim Miller. 

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