Monday, 19 September 2011

Healthcare for all or let them die?

I've been thinking a lot about healthcare in the US lately. People's personal accounts of their (and their loved ones) experiences with it, the attempt at establishing a government-run universal healthcare scheme, the chaos and compromises that ensued and the pushback by right-wing politicians, talking heads and astroturf movements (financed by the health insurance lobbyists) gave me a lot of food for thought.

I lived in Brazil until 1976, when dissatisfaction with Brazilian politics and curiosity took me to England. In one country those who had money simply paid their medical bills and those who didn't died in the queue waiting for free treatment. In the other, I walked into a doctor's office, registered and was immediately put into a system where the only money involved was for heavily subsidised prescriptions (ten pence for a prescription at the time). I had access to specialists, tests and any necessary treatment just for the asking. I think the system in the UK is a bit too universal, so I'm not surprised there are problems financing it. New technology and expensive new drugs also contribute to the NHS's financial woes, of course.

France and other European countries make checks on elligibility, which I think is fair enough.

In Europe, healthcare is seen as a service, patient-centered. It keeps people healthy and productive. If these socialized services were removed and replaced with the American model, bankruptcies, deaths and total chaos would ensue.

In the US, healthcare (and just about everything else) is a business. The patient is purely a little cog in a money making machine. The insurance companies rule and make the most money, through shoddily insuring patients. They move the goalposts with alarming frequency, denying care at the drop of a hat. The health of the patient is incidental to their profits. They also insure the providers of healthcare against malpractice lawsuits. If a doctor makes a mistake, premiums skyrocket. So doctors submit their patients to all kinds of imaginable tests, just in case.

The cost of healthcare in the US is staggering compared to Europe. I googled the price of MRIs in various countries. The difference took my breath away. In 2000 I had MRIs of my cervical spine with and without contrast, and of my brain. The cost was £800 (approx US$1,300) and the price has dropped since then, to a mere $750. The cost of same MRIs would range between $5,000 and $7,000 in the US. Are the machines gold plated in America? Do they play soothing classical music provided by a live orchestra? Does the radiographer cook you a meal and does your laundry, complete with ironing? Do the technicians walk and groom your dogs for a month? In Japan the same thing would cost around $200. Go figure.

Somebody is making a lot of money in the healthcare business in the US. There seems to be a lot of waste in the way resources are used and it doesn't necessarily mean the patients are better off for all the tests and exams they have to endure. They may have the illusion of excellent care, because not an inch of their bodies is left out of exhaustive tests and procedures.

It comes as no surprise that the idea of single payer, universal healthcare in the US seems to be such a harebrained one. The costs are astronomical. When Obama suggested an independent commission to assess some cost-cutting measures, a certain Sarah Palin called it a death panel.

In socialist Europe there are commissions that look into the costs of the services and the standards of care. It doesn't mean care will be rationed, it means it would be rational. Patients in Europe don't have the expectation of being turned inside out every time they walk into a doctor's office. They expect the doctors to have some degree of confidence in their diagnoses and to be spared endless tests and exams just for the sake of it. They're also aware that if tests are necessary, they won't be carried out on the same day, there may be some waiting involved for conditions that are not life threatening. That's the price people pay in Europe: Some delay in receiving non-urgent treatment in exchange for the peace of mind of knowing that if something sinister is suspected, they will be taken care of as a matter of urgency and it won't cost them the earth.

In order to implement a sensible a single payer, universal healthcare scheme in the US, a vicious circle would have to be broken. Doctors would have to regain their confidence (tort reform?) so unnecessary tests could be phased out and patients would have to learn to be... patient. Expectations would have to change. When millions of people share a marvellous service such as free healthcare, a certain degree of patience is involved. Waiting a bit longer for a hip replacement would be ok, because you'd know that if cancer is suspected, you'd be seen, tested and treated immediately, without having to go through the hurdles imposed by the insurance companies death panels.

The pharmaceutical industry would have to keep their greed in check, so that drugs are available to all when needed. In the UK, children under 16, seniors and pregnant women (during pregnancy and for 12 months after the birth) don't pay for prescriptions at all. Certain other groups are also exempt, but I don't recall what they are.

The bill nicknamed Obamacare by rightwingers is not a healthcare bill, it's only a bill that regulates the health insurance industry.

It's quite obvious that the insurance companies would have been the biggest losers if Obama's original bill had gone through, so they poured money into a vicious campaign to make sure it didn't. They're still unhappy about the bits that did go through and are still pouring money into getting it repealed.

I'm afraid America won't have a national health service any time soon. The corporations rule the country and are quite happy to "let them die."

The way things are going, if the conservatives regain power, the US will start to resemble a third world country, like the Brazil I left in 1976...