Health Care: Two Countries, Two Stories

NEW ORLEANS--Viewed from this city, which lost its main hospital for the indigent and working poor (so-called Big Charity) in the aftermath of the flooding and which is just now beginning to start a neighborhood-clinic approach to the problem, the national debate on health care reform has been less than enlightening. The money that both sides are spending on television ads -- the pro-reform side (if you include Harry and Louise) outspending the anti-reform side, to this point -- insures that most of what most people "know" about the subject boils down to simplistic slogans and fear-based half-truths.

And I don't know any more. But I do have two family members, one in America and one in England, each of whom has had a recent experience with the local health system. I offer their experiences for your consideration, and leave any conclusions up to what George W. Bush might have described as "the concluder".

Anna (not her real name) complained for years of chronic pain following a hip procedure. She belonged to a prominent California HMO, one which spends millions advertising on television its devotion to patient wellness with the zen-like slogan, "Thrive". In reality, doctors who saw Anna -- a bewildering series of entry-level doctors, necessary for referral to specialists, and specialists -- seemed to be practicing medicine by the clock. The appointments were brief, and each round of appointments had the same result: a prescription for increasingly strong pain medication.

By the time I intervened, and started taking her to a couple of private doctors for second opinions, she was hooked on oxycontin -- a dose that, one private doctor said, was appropriate only for terminal cancer patients. Ultimately, during one weekend in which she was hospitalized in a private facility, a stroke of good fortune brought a talented neurologist to her bed as the doctor on rounds that afternoon. He talked to her for 20 minutes, reported she had no clinical cause of the pain, and suggested it was psychological. He recommended some counseling, along with a program of weaning her off the drug. In six months, she was oxycontin-free and pain-free.

Donald (not his real name) lives in Britain. He recently began complaining of pain and stiffness, interfering with his active life. Though initially reluctant to seek medical attention, he finally made an appointment with a National Health specialist, and two weeks later, he was seen and diagnosed with a form of myalgia (Google it, I did). He was prescribed a medication which almost immediately relieved his symptoms.

All the rest is commentary.

PS: I have the best health insurance available, thanks to my show-business union.

Follow Harry Shearer on Twitter: www.twitter.com/letwits

Comments

[230AL]

Yes Medicaid is over budget.Look at your pay stubs and calculate the percentages compared to the health insurance.

[schmuckwithearlaps]

Wow! What a scientific sample! It is also interesting that Kaiser is not for profit and has no shareholders. Where is all the money going? To try to break even when delivering care? Hating Kaiser is somewhat like hating government health care, is it not?

[BadHaBritt]

Now widen your perceptive a little and look at the cost of medical care by local health facilities and doctor costs and realize that Kaiser has to compete to get qualified staff. Next look at the much lower cost of prescription drugs in other countries i.e. Canada and the UK for example.

Quoting individual cases is a very poor way to make an argument, I agree. In my earlier post I noted that I had many years experience of health care both in the UK and here. I have been hospitalize and had many occasions to use the health systems in both countries. At one time, while here, I was between jobs, with no health insurance and had to have emergency heart surgery, completely out of the blue. I was very fortunate to be taken to one of the very few remaining county hospitals and my bill was based on 'pay as you can' about $7,000. Any other hospital and I would have either been refused treatment for lack of insurance, or been bankrupted by the final cost, or I would have died from lack of treatment. Had this happened in the UK then getting the treatment wouldn't be an issue and there would have been NO charge from the hospital. The low cost national health contributions I would pay while employed would covers every penny

[odyssey58]

If our system is so much better, and people in other countries are so dissatisfied with their health care, why aren't other countries switching to our type of system?

[BadHaBritt]

A few very important things to keep in mind.

1. On average, US health care cost per individual is ALLREADY many times more than other leading civilize countries.

2. If you are currently provided with health care insurance from your employer it is NOT FREE.
it is calculated as part of your remuneration. (actually, not too different to a form of taxation)
Things CHANGE and have done so for millions of people who also thought they had no problem getting job related health coverage.

At some point you situation will change, and most likely not from your own choosing. Please try to view the situation in the context of coverage for your entire life time and how YOUR EMPLOYMENT and your HEALTH will change.

Trust me, it's only a matter of time before most people find themselves with no health coverage they can afford. I am English and lived for 37 years in the UK. I have lived here for 25 years so I really do know both sides. Fore the long term health care, from child to pensioner, the UK system is fare more assessable, humane and less expensive. NO ONE IN THE UK GOES BANKRUPT OR DIES because of lack of health care coverage.

[230AL]

I need a proof reader.I always remember what was said on a radio show in 1992 or so."Every word in an insurance policy after the insurer and insured is a reason not to pay."

[230AL]

Thanks for the story,We need real comparisons.The best health insurance I ever had was from a British company doing business in America.They were trying to provide care ,in America (for their relocated Brits)to match what they had back home.Remember the Brits started their universal health system while rebuilding their their war destroyed country.

[Jazzcomedian]

I've been a permanent resident of Australia since 1997, and have universal healthcare called Medicare. I've had excellent care, and I can see any doctor I want. Private health insurance is also doing well as people who sign up get a 30% rebate on their premium from the government. Due to the global financial crisis the government has proposed means testing the rebate in order to save the government revenue, and a survey showed the mostly affluent people who have private health insurance would keep it even without a rebate.. Their system has problems, but all in all a very good healthcare system

I'd like to see single payer like in Australia, however Australians are ready and willing to do something that Americans have absolutely no appetite for---pay substantially more taxes in order to have a better social safety net for the benefit of all. .

The rich don't want to be the only ones to pay for health reform, and the middle class says don't raise their taxes to pay for it. Americans don't want to pay for what they want. That's what the Republicans hate about Canada, UK, France, Australia, Germany, Sweden, etc.--they all willingly pay more taxes. Though everything that once made this country great was achieved when there was a higher tax rate. I'm willing to pay more taxes to have a public option, and a better society. If you really want a public option, then stop hamstringing Obama, and agree to pay more taxes.

[odyssey58]

I second that. What if you look at your health insurance premiums like a tax? What percentage of your income are you paying? You have to include your out of pocket costs in that amount.

[230AL]

I agree.I'd give up my earned income credit allowance.(About 4000.)

[nk007]

My nephew is an Australian citizen. He likes the Australian Healthcare system because it is both universal (guaranteeing every Australian basic health care) but allows those with means to supplement their public insurance if they want more than basic health care. I think it is a disgrace that the richest country in the world, which spends billions each year on all types of arms, can not find money to insure forty millions of its citizens to receive basic health care; or allows health insurance to: deny care for pre-existing conditions, drop people from coverage because of catastrophic illnesses, terminate insurance for those who loose their jobs. Personally I don't mind paying more taxes to provide universal health care. If I had my preference, I would be for cutting down defense spending and raising spending on health care. As it stands now, the United States spends more on defense than the rest of the world combined, and yet Americans are still programmed to be fearful of the world. At what point will our country's defense spending bring us a sense of security? My proposal to Congress: If you can't enact a public option then let us tax payers choose how to spend our tax dollars.

[1sparrow]

the amount of health industry commercials you typically see on an early evening sunday t.v., has gotta tell ya these guys are rolling in money. each commercials has enough disclaimers to choke a horse.

[TLV]

I have been fortunate throughout periods of my life to be a patient of osteopaths. They use a minimum of medications and believe strongly in helping the patient to know how to prevent illness and be healthy rather than having to treat it medically and expensively later.

Never smoking anything, drinking on;y in moderation, trying to live with less stress, being kind and speaking nicely, avoiding the sun, eating fresh, healthy low-salt, low-fat foods, maintaining a healthy weight, and getting daily exercise helps a whole lot, too.

[ivyleager]

Let's compare experiences when it is NOT an HMO insurance plan. HMO's are notorious for poorly skilled entry level primary care, with a lack of (or restriction on) referrals up the chain into the specialty level of care . That's why they are cheap. You get what you pay for.

I'm one of the lucky American's that has an individual insurance plan, and pay for premium coverage. When I worked in a large company and opted for group insurance coverage, I made sure I picked the premium package. Again, you get what you pay for.

[fnygy]

You are indeed a fortunate soul to be able to afford premium coverage. I hope you're as fortunate all your life - even when premiums double by 2020, as one study suggests they will.

My husband and I have the coverage we can afford - that is, if we want to afford other things in life, like housing, food, clothes, transportation, retirement savings, etc. As self-employers, we're not covered by a group and pay substantially higher premiums because of it.

I used to have similar health coverage to Mr. Shearer through a union but, alas, no longer have the job that afforded such a luxury. I miss it.

[230AL]

Unions.They are mostly gone.UPS offers heath ins. to part-time workers,because they're union.Jimmy Hoffa was less a crook than our current financial "talents" who receive bonuses while destroying the economy.

[pithy]

Our story - hubby sliced through 3 fingers on a table saw - one down to the bone. 5 minutes to check in at ER at 5:30 pm - moved to "Express Care" - surgeon (who had been there when we arrived and went home for dinner and maybe a movie) arrived back at MIDNIGHT - procedure done at 3:30 am.

Staff in "Express Care" came very quickly to hate me as I have a loud, insistent voice after say, five hours of watching my husband slowly drip blood on a towel they never once changed!

Best health care in the world? I'm thinking no.

[luziannagirl]

"What do health care insurers do?" asked Romeover a few comments down. Excellent question, Romeover, and you hit right into the heart of the issue.

Healthcare insurers are gamblers. They are a sort of reverse "house" for those who don't want to play the odds with their health. So instead, the house--the insurers--- plays the odds and takes a kind of reverse bet from policyholders---but in order to minimize payouts and therefore maximize profits---the house tries try like hell to stick with only those betters least likely to get sick. If a casino spot a card-counter, he's out on the street fast enough to make heads spin---just like a health insurer can spot a sick person---or one likely to be sick in the near future.

So, that's the size of it. Insurance is a form of legalized gambling, except that when it's spread over the entire population, it's quite beneficial to individuals.

Also like gambling is the importance of the illusion. At any one time, those who have a "good" policy mostly haven't attempted to collect on major claims. Of those who do and are disappointed in coverage, many of them die fairly quickly so they aren't around very long to voice their displeasure with the system.

[alumcreek]

In for profit insurance the object is to provide the least amount of care for the highest possible collected premium. It is never to provide needed healthcare and hope that a profit is left to disburse at the end of each quarter.

In gambling the casino always wins since it sets the odds in its favor. The same can be said for insurers. Providing care can be costly, withholding care is often profitable.

They used to quip that doctors bury their mistakes. Insurers just wait till policy holders make a mistake or die.

[luziannagirl]

And, alumcreek, that's the real difference between a public "single payer" plan and the status quo. It's all about bottomline. Primary reason for existence. For the former, it's public health. For the latter, it's profit.

[sneez54]

Harry,
Did you see in that medical care facility that says "thrive" ( kaiser Permanente) they are using the money they make on us to put little rubber mats down to tell us where to walk and stand? geesh
My father in law has been with Kaiser at least 45 years. Last year he was at doctor appointment one block away from Kaiser hospital on Zion in San Diego. The Doc wanted to keep him overnight at hospital for observation. Thats fine. But the hospital charged my father in law 2000 dollars for the ride (and that is all it was) to the hospital a block away! As my inlaws argued with Kaiser about this bill, they sent the claim to a collection agency, fast. Now for the first time in their adult life together ( 65 + years) they have bad credit report. And no Harry that is not easy to get erased. No matter what people say.
These insurance companies are "socialist" systems in themselves. They take a bunch of peoples money "for profit" and spend it anyway they want. With a government plan giving competition it would help alot.

[hacksto]

I've had healthcare through an employer in the US - Aetna - and I've been in the UK under the NHS in the last 2 years. In the US, I saw a doctor many times. I described a dental procedure at the NY dental school that left my jaw in a lot of pain. After 9 months of complaining about jaw pain, I was sent for a CT scan of my neck.

When the scan came back noting severe muscle loss in my neck, the doctor gave me a photocopy of a page of a directory of specialists - neck specialists - that was 2 years old, and told me to have at it. Not one of the numbers was connected.

I am a dual national, so I came to the UK and was refered to a Maxillofacilal Unit for an MRI. I was interviewed by a dentist, who passed my answers to a specialist who said I was a teeth grinder, and offered me a tooth shield. He didn't look in my mouth for evidence of grinding. I asked for the MRI, but was told that was impossible.

I went back to my doctor, who said she thought that was odd, but never offered an alternative.

I suffer the basic lack of attention in both systems. I stand slack-jawed at it, literally. My muscle has deteriorated to the shoulder.

Have money, people. Have money.

Love you in the Simpsons, by the way. And everything you've done. Best wishes.

[chirps]

Here’s a little something I posted on another board, which might help to explain where the opposition to healthcare reform is actually coming from. This is a list of Republican Senator Chuck “Death Panel” Grassley’s campaign contributors:

Contributor……………….. Total……Ind­ivs…..PACs

Amgen Inc…………………­$33,300…$2­4,30…$9,00­0
Blue Cross/Blue Shield…….$­26,750…$14­,250..$12,­500
Select Medical Corp………..$­23,000…$23­,000...$0
Occidental Petroleum…­……$21,000…­$11,000…$1­0,000
DaVita Inc…………………­.$18,000…$­8,000….$10­,000

Top 5 Industries, 2005-2010, Campaign Cmte

Industry……­………………………T­otal……….In­divs………PAC­s

Health Profession­als………………$­222,406…..­.$32,300……­.$190,106
Insurance…­……………………….­.$184,998…­...$32,600­…….$152,39­8
Pharmaceut­icals/Heal­th Products….­$145,150….­..$47,950…­…$97,200
Lobbyists…­……………………….­.$137,846…­…$130,346…­..$7,500
Hospitals/Nursing Homes………….­$137,337….­..$54,537…­…$82,800

[chirps]

Hey Chuck, how about you tell us about YOUR healthcare coverage? Start with these simple questions:

Who's picking up the tab for your coverage?

How do you rate your healthcare? Poor, adequate, pretty good or really good?

Do you think average people are entitled to healthcare such as what you have? If not, how come?