Socialized medicine - an anecdotal view
Thu Jul 26, 2007 at 05:05:12 AM PDT
Tuesday's video diary by uniongal Michael Moore Rocked on Hardball!!! included a question by the Hardball interviewer, which, roughly paraphrased, went something like this:
When a rightwing dictator from a third world country, someone who has huge amounts of money that he's bilked from his country's people over the years, finds himself sick, where does he choose to go for treatment? The U.S., right?
I believe this was supposed to be an argument in favor of the U.S. system. But since the average person doesn't have unlimited funds to draw from, I thought I could offer a few comparisons, based on my real life experience with a few different systems.
I live in Japan, and my family is on the National Health. Today I had a dental visit in which the dentist replaced an old metal filling with a porcelain one. I have the bill in front of me: the total amount was 6,460 yen(roughly $54); the out of pocket cost to me was 1,940 yen (roughly $16). The dentist is reimbursed for the rest. In spite of what you may have heard about dental care in countries that are on this system, the visit was as pleasant as anything can be that involves drilling. The office staff were polite and friendly; the office itself is bright and sunny, with large windows. The waiting room is decorated with photos of the smiling faces of all the patients who are children - and even has some drawings they made themselves. One of the happy children was there today and went running excitedly to the chair for his checkup. The actual work starts with a before photo so that the patient can see what is going to happen. There was plenty of anesthesia so I had no pain. The staff thoughtfully covers my eyes with a towel while they are drilling - which actually makes me feel relaxed, if you can believe that. At the end an after photo shows the completed product!
I can't think of any significant differences between the care I have received here and care I got in the States. I have to make an appointment, and occasionally they might run a few minutes late in calling me in - but doesn't that happen in the States too? The only real difference I can think of is that the dentist will only do one tooth per visit, rarely he will do two if the problem is related in some way. They like to be sure one problem is completely taken care of before they tackle the next one.
I've been to dentists in Australia and Ireland as well. I can't recall any significant difference that I found at the time, except the Irish dentist was old and crotchety. But I've run into that in the States too!
So much for dentistry... How about a routine exam? In Australia I found getting a check-up at the gynecologist no different from the same exam in the States - except for the bill at the end. As I recall in those days, I was expected to fork over around $20 Australian along with my medical card at the end of a visit. Here in Japan a lot of routine medical check-ups are handled at clinics. For example, when my son was little, we found that for routine vaccinations or childhood complaints there are regularly scheduled clinic hours at local hospitals. You just show up at the appointed time and wait your turn. I never recall the waits for these visits with the doctor taking any longer than the wait for a scheduled appointment back in the States. Ireland had a kind of combination of these two systems. If it was routine, as a vaccination or a baby checkup, there was usually a clinic that covered it. If you had something that needed attention right away, you were supposed to go to your family doctor first so that he or she could decide what your next step was. In all these cases, the charge was quite minimal.
Here in Japan I did pay 45000 yen (about $375) for a complete physical last year. We felt the money was worth it. After all I would pay that much for a visit to the ob-gyn in the States plus the separate cost of the mammogram. For that money here, I got a complete physical including both those things as well as blood work, lung tests, heart test with ekg, some horrible thing that included drinking barium so they could look at my innards, ultrasound of liver, x-ray of lungs, dietary consultation based on my weight and blood work, and no doubt some other things I can't think of now. When you sign up for the physical, you are assigned a day and time. You arrive ten minutes early and pay (form has been filled out earlier). They have bar codes for everything, so that your test results can't get mixed up with anyone else's. Women's names are called out in groups of ten (did I mention they were handling a couple hundred people that day?); you are assigned pajamas and a locker for your clothes. Then you start moving through the system. They keep everyone moving until the whole group down to the last person has completed the dietary consultation. This takes from around 8:30 a.m. to about 1 p.m. How could I complain? In the States I would give up a morning each for the ob-gyn exam and the mammogram. And I wouldn't get the cholesterol results for a couple of weeks.
Some other differences... a man did the mammogram! No, that really wasn't weird... he was very professional. When I got the results back on that, I had a spot that needed further examination. If that had happened to me in the States, I would have been terrified, fearing the worst and worrying that it would bankrupt the family. Here, to tell the truth, I didn't lose one minute's sleep worrying about the way things would turn out. And it was nothing to worry about either, just a cyst. To me, that was the biggest difference. It's amazing how little worry can be attached to health problems if you know: a/ someone is going to help you and b/ they are not going to bankrupt your family. That gives you a peace of mind you can't believe if you haven't experienced it.
This diary has already gone on way too long, so thanks for bearing with me. I was going to describe dealing with an actual illness/surgery and hospital stay in Japan. But I will limit my surgery story a little to get to the main points: My husband needed elective, but recommended surgery. We agreed he should go ahead with it. The surgeon offered a day he would be available. We pointed out that would clash with our vacation to Hawaii. He called over his nurse and the bent their heads together, and after some discussion agreed to operate on him the following week! (I know you always hear how you have to wait six months for elective surgery, but this is true.)
For the surgery, you are required to go in a day early to be monitored and to practice some breathing exercises (that is supposed to help with the general anesthesia). Basically he was going to be in for one week. This is surgery where you go home the same day in the U.S. Another big difference: he was in a ward that held six men. His section was curtained off, and he had a private tv with headphones, but it was small. However, there were plenty of places he could go and relax when the nurses and/or doctors didn't need him.
The staff and treatment he received were absolutely excellent. (I can't see how he would have gotten better care even if he were a right-wing dictator with bags of money at his disposal. He just would have had a bigger room. ) One more important point: we had one form to fill out - just one - before he entered the hospital. When the doctor gave him permission to go home, I went to the front office to pay. Now remember he had a week's stay in the hospital; in addition he had a full day of tests to determine he needed surgery; the day of the surgery he had one nurse assigned to him all day (she was there before I arrived in the morning and still there when I went home that night); an anesthesiologist, a surgeon, and other staff members looking after him. He spent a full day in recovery after the surgery before being returned to his room. All meals were included. Our cost for all of this after National Health covered its share: 100,000 yen (around $835). No forms to fill out. No bureaucrats to argue with. I paid that and we went home.
Those are a few of my experiences with national health. We are just an ordinary family with no special problems. Maybe other people on National Health systems have stories they would like to share?
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