great podcast and just before my politics and policy exam! :)

In the introduction, Kaiser said that the state of health care in the PRC is "a fair sight better than it was, or different anyway, than it was in the age of the storied barefoot doctors. While in many ways things have improved (life expectancy has risen very very fast in the years since reform and opening began),..."

But it can't have risen as fast as it did in the Mao era, if you accept the following statement:

"[T]he fact remains that, despite all the horrors of the Great Leap Forward, Mao's time in power saw life expectancy within China jump from roughly thirty-five to seventy" [p.61, "China in the 21st Century: what everyone needs to know" by Jeffrey N. Wasserstrom]

And according to the CIA World Factbook (2011 estimates), quoted in Wikipedia, the present life expectancy has advanced only a little beyond 70 – they say it's 73.47 years.

---- http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

I'm no expert, but I would like to be able to reconcile these seemingly contradictory statements.

I enjoyed this on the whole, but having Rutstein & Shobert on was a bit like getting a couple of poachers in to talk about the future of gamekeeping - it was tiring hearing constantly about the future of the private sector when its involvement so far has been basically parasitical, and while I appreciate you all use United Family Hospital you should respect that 99% of Chinese have no access to these services and that your discussion should generally concern them.

Great podcast. I appreciated Jeremy's persistence, but his question about the U.S. vs. China largely went unanswered. It's complicated and the two really can't be compared effectively, but here's a few observations.

1) U.S. federal law (EMTALA) requires emergency physicians to see, treat, and stabilize any patient, regardless of insurance status or ability to pay. Only after these things are done can they be sent away. Safety net hospitals do not kick out the indigent, but private hospitals might. There is no such law in China (or most other countries) and stories of Chinese peasants bleeding to death in an ED waiting room as the staff ignores them are numerous and almost certainly do not scratch the surface of actual cases. Any poor, uninsured illegal immigrant in Boston who gets hit by a bus will receive the world's most advanced medical care at Mass General and pay absolutely nothing for it.

2) As the good doctor pointed out, the ~98% insurance coverage rate frequently reported by the media is largely a smoke screen. It's a huge achievement that should be recognized, but non-treatment or under-treatment and bankruptcy due to medical costs remain very real problems for a large portion of China's population.

3) As Jeremy knows firsthand, media coverage between the two countries is night and day. Medical malpractice in the U.S. is often turned into sensational front page news. In most circumstances, similar cases in China are either not reported or buried in local Chinese language newspapers, far away from Western eyes. Occasionally they make it into international press, but the relative absence of reporting on bad medical outcomes due to poorly equipped or poorly trained clinicians should not be interpreted as an absolute absence.

I fell ill in Beijing last year and ended up in one of United's hospitals. Felt like I never left Sweden, except that they did make me wait for almost an hour until my insurance company could give them the green light. Not saying that to point out UFH -- I'm sure any other Beijing hospital would've done the same. I can only imagine what it would've been like if I weren't a privileged westerner with a nice health insurance.