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Three score and ten or more

Monday, August 24, 2009

Socialized Medicine

I sat last night and listened to Sean Hannity's program featuring the Medical program that was filled with attack after attack after attack.  I started out with a sense of  approval since, as an active senior with major heath problems in the family I find many feature of what seems to be coming extremely frightening, but as an old teacher of persuasion and logic, I became very frustrated with the half truths, assumptions and faulty trains of logic in the program.  I would like to follow with specific examples but I was lying in bed when the program came on and I didn't get out to get notes, but I have to write for a minute about health care.

Most folks as conservative as I shudder at  the idea of governmentally managed health care.  Indeed governmentally managed "anything" has a bad record in my lifetime.  Most of my conservative friends feel that the only real functions of government are National Defense and Law Enforcement.  Neal Boortz's tirades with standing, I feel that education is a governmental function, though almost every time the National government gets into it, it messes things up.  My deep philosophical feeling is that there is a moral imperative to provide access to health care as well.

I have had only a few experiences with socialized medicine and they all occurred in Finland, and they all had a substantial affirmative affect upon the lives of me and mine.

My first experience was during my term as a Mormon Missionary in Finland.  I had a number of physical problems including a lot of abdominal pain that was diagnosed a chronic inflammation of the gall bladder, a spastic colon, a stomach ulcer, and a few other minor things.  My medical care at that time was quite good, and was paid for by the church, but I did end up  in hospitals a few times and talked to doctors  and could tell that a real socialized medicine program was supported by most of the doctors though it was not really in place.  My experience at that time also included being vaccinated for Tuberculosis (My GP at home denied that any such thing existed, but every time I took a TB skin test thereafter I tested positive (as the Finnish nurse told me I would and everybody accepted the explanation, though I had to show a couple of nurses the vaccination scar --in a place where one has to drop the pants for the demo-- to be convincing_).  I also became a blood donor (I had a two gallon pin from the Red Cross before I went to Finland) and found that, as a blood donor, I didn't just give a pint, but often I would be called and asked to come to the hospital (or clinic) to lie down beside someone and actually watch my blood flowing into the other person.    Weird sensation.  (Actually I say "often" but the combination of giving transfusions directly and giving a pint for the future only added up to about four or five events in three years.)

I went home with my gallbladder in place and with a major set of x-rays rolled up in my suitcase but was otherwise unscathed.

In 1966 I returned to Finland as a Fulbright - Hayes fellow to work on my dissertation which included a translation of a major play by Finland's most famous playwright,  and a lot of research on the way his plays were performed.   When we arrived in Finland (Passport pictures will be seen) my youngest son, who had had medical problems from birth, came down with asthmatic pneumonia.   He ended up in the hospital for over a month.   Nobody asked me how I was going to pay for this, and I was really nervous.  Even with stipends, graduate students with four children do not have much spare money.   It turned out that I was billed the equivalent of about a dollar for each day he was hospitalized.  The medical care was superb, but the doctors, nurses etc. were paid by the government and my son was healthy.

I asked one of the doctors how the program worked, and , if I remember the answer correctly, he said that education, even medical education was paid for by the government, and that when a doctor received his MD, he owed five years of service to the government.  He was just finishing his service, which had also included pediatric training.  He grinned, "We're not slaves, we work long hours but we are well paid".

Partly as a result of my son's hospitalization, within a few months we adopted a little girl through "Save the Children".  She had been given up because her birth father was a gypsy and her mother's new husband was not.  

She was a lovely addition to our family, but about four months later (she was barely walking) she went into the kitchen while my wife was setting the table, got hold of the tablecloth and pulled a pot of hot pea soup over her.  I snatcher her up and put her in a cold shower, and called an ambulance.  She ended up hospitalized in a wonderful burn unit (and having some skin grafts).  When she got out of the hospital we had excellent follow up treatment, and again, we were charged about a buck and a half a day for this treatment.  (In the United States, without insurance, I would have been bankrupted for sure).  Again, Socialized medicine made life liveable at least.

That was not our final episode.  In the spring, my wife contracted either some type of flue or food  poisoning and between diarrhea and vomiting she became dehydrated and was having spasms by the time I got in touch, first with a doctor, then with an ambulance, and she was transported to the hospital where she was on intravenous fluids for a day and was treated for a couple more days.  The cost was more, due to the ambulance, I think, and perhaps because she was not a Finn, but the bill was still less than a hundred dollars.  I returned to the U.S. a firm supporter of some kind of government health care.

Our final experience with Finnish Medicine was very different, though, in some ways, the same.

I have already written about our experience in 2006 when Janet suffered and aortal aneurysm.   When I took her to the Emergency room in Porvoo, no one asked for my insurance or anything else.  They treated her, and after some "feeling around discovered the aneurysm, put her in an ambulance and sent her to Meilahti hospital, the hospital of the University of Helsinki.  By the time I negotiate the fifty kilometer drive, and being lost in Helsinki, when I got to Helsinki she had already been in surgery for over an hour.  The surgeon explained, when we could talk about it, that her ascending aorta had "shredded" and he had replaced about five centimeters of the aorta with a dacron tube.

She spent over two months, one and one half of them unconscious, had a total of three major surgeries and two strokes (suffered when the "paddles" would not stop fibrillation, and the doctor had been forced to manually massage the heart, which led to a bypass to prevent further fibrillation.   The people called her their miracle lady, and the doctors in the U.S. basically stated that almost no-one has survived that sort of surgery.   Her doctor was one of the best in the world (I looked him up on google), and no-one asked any questions about "end of life issues" though before they took her completely out of sleep, the neurologist warned me that her ENG was almost a flat line (meaning no brain activity) and that I should be aware that there was a possibility that she might not remember me, or, for that matter have any conscious mental activity at all.   (She woke up feisty and her first words, shouting at the nurses who were changing her bed and her bandages were "Stop that, you guys are too rough."  It scared the nurses half to death at first)

The financial arrangements were very different from our experience forty years before.   Before the first week was over, the hospital representatives were beginning to ask how I was going to pay for this.  My answer was that I had no clue at all.  I contacted the embassy, the University from which I had retired, and all  the other sources I could think of and still had no clue.  When we were almost ready to return to the states, the doctor came in to reassure us  that they weren't going to make her stay in the hospital till the bill was paid.

It was at that time, that I learned that Medicare stops at the country's borders.  I had a Blue Cross/Blue Shield supplementary insurance but when I became eligible for Medicare the University required that I sign up and change my B C policy to a supplementary one.   I had a bill from the hospital for something in excess of sixty thousand Euros (at about 2.25 bucks to the Euro).  After I got home, after pleas from the embassy, the University and heaven knows who else, Blue Cross sent me a check for some sixty seven thousand dollars, which I sent to the hospital, who wrote me  a note of thanks (actually an Email) and informed me that I still owed them thirty odd thousand Euros.

I discovered that for non Finnish citizens, socialized medicine wasn't as generous as it had been forty years before.   It took some legal advice and a variety of other things before i got out from under that bill, but there was nothing in that country that showed anything but that the very first task was healing and care, and I will be forever grateful to the doctors and staff of Meilahti Hospital.  They performed a miracle.

I spent a lot of time talking to Finns about health care there.  They have well baby health care, care in the schools, excellent care from Doctors and Hospitals.  In 1954 most of the more well off Finns were looking for American trained doctors and paying through the nose for them.  I detected nothing like that  now, and I never spoke to a Finn that had any desire to go elsewhere for medical care.

On the other hand, most Finns pay between forty and fifty percent of their incomes for direct taxes, and there is an additional value-added tax on everything sold in Finland.  Automobiles are tariffed  to the degree that they are almost twice the cost as the same car in the U.S.  The Finns I talked to complain about taxes like everyone else but when I suggested that taxes wouldn't be as high if they didn't have free health care, free education (including University education--up to and including Mediciine), I never heard anyone who would make that trade.

I truly think that there should be some way to provide health care for everyone, though I don't believe for one second that anything that has been proposed this year will do that, at least without rationing.

Some criteria I would think would be necessary for any nationalization would be"

1.  What is good for the goose is good for the gander.  Congressmen, Presidents, soldiers, teachers, and the poor should all be treated alike, and if anyone wants private health care, (and many would) they should have the opportunity to get it, and pay for it 100 percent for themselves.

2. Doctors  (and Nurses) should be very well paid.  (Anyone who has my life in his or her hands should be happy to do the work, and that means adequate pay- - not like the pay that we are now giving teachers-- but I digress here.

3. Personnel who are not providing care (doctors and nurses are providers) should have no right or impulse to dictate the nature or limits of care for patients.i

I have some other criteria, but, I have taught problem solving techniques for most of my life and one of the most important parts of that  process is to clearly identify the problem (which is NOT just that forty some million people don' have insurance).  Then, after a clear identification of the problem, it's causes and results, criteria must be established for the solution that can be shown to directly effect a solution to the problem as identified.  That hasn't begun to happen at all.  Everybody is shouting generalizations at each other and certainly if anyone who is proposing the present program has identified elements of the problem in a clear way, I haven't heard it.

Some problems are complex.  I went for years without dental insurance, and sometimes went without care when I couldn't afford it.  My kids got first dibs.  When the university (in this University town) provided dental insurance it was a blessing, but dentists found that they could charge a lot more, and I now pay, after insurance, about what I paid before insurance.    When the University first made prescription insurance available, I would go to the pharmacy, pick up my prescriptions, pay for them, and the insurance would rebate my share of the cost.  When it was discovered that if a co-pay was set, the pharmacies could charge any darn price they wanted for the drugs (actually the manufacturers more than the pharmacies) and the price of drugs accelerated insanely.   Advertising prescription drugs became legal  (dang liberal Supreme Court) and drug  prices took another jump.  I'm not sure how you work these things into universal medical care.

I know that government can't arbitrarily set costs and prices.  I remember a friend who was a pharmacist who attempted suicide because the state had withheld so much of his income for Medicaid costs that he couldn't pay his supplier and employees.

I think that there should be access to universal care now.  I don't know how in heck we could get it, but the current process isn't hopeful. 

In summation, the British system, with it's death board and limitations is not a good model, neither is the Canadian, and if we wanted to follow a Scandinavian process, we had better check our wallets at the door.

A true problem solving model of problem identification and clear solutions would, I think, be possible, but not with greedy politician and talk show hosts spouting generalizations and calling each other names.  My son who has cirrhosis of the liver, and no funds at all could be aided by some program, there are government programs that are supposed to help in those situations but rationing already exists.  Any one who has studies what goes on the the doctors office knows that rationing by insurance companies is already as real as rationing by government is likely   to be.

I am grateful for a reasonable retirement income, and can hardly imagine my fate without it when drug co payments alone for Janet and myself total over 300 dollars a month.

Janet has disintegrating hips and has been told on several occasions that she needs surgery on her descending aorta which has a dissection (sort of a full length aneurysm) that has killed one of her kidneys.  My oldest son has no functioning liver,  and I am a physical mess with my memory going fast, and my physical abilities about twenty percent of what they were four years ago.As far as the plans that have been proposed so far, (that have almost no research into the real nature of the problem, such as it is), I am terrified that they might be passed into law, and almost as terrified that they might not be.

I should have started this earlier.  As I read it I realize that I am rambling, but, for that matter so is almost everyone else that is "discussing " this issue. 


At 11:17 PM, Blogger Patrick Joubert Conlon said...

Whew! I don't know where to begin because, like you, I am in two minds about it when I read about how people are ripped off by insurance companies.

The first thing that jumped out at me was that Finland is an almost all white, all middle-class country where nearly everyone pays their fair share - unlike the Third World country that we live in. Scandinavian type socialism works fine if everyone is civilized and responsible.

Britain's NHS worked well for 20 years before the large influx of freeloading immigrants.

As you know I worked in hospital pharmacies for 30 years and am very cynical about the drug companies, doctors and hospitals.

Yes, we need to do something but Obama's plan is equally cynical. It's a bread and circuses power grab.

At 10:19 AM, Blogger Graeme said...

Im an expatriate Australian living in the UK. I am retired with an English wife. Im NOT a UK citizen. 5 years ago I suffered a massive aortic dissection. Should have died. Did actually. Thanks to the UK government's FREE NHS health system and superb medical care I am alive today 5 years later. 'Freeloading immigrants'. Hmmm.. racism is still alive and well in the good old US of A. Guess that includes me as well.

FYI most of the NHS 'freeloaders' here were new EU country citizens looking for work. That's no longer an option as they have all gone home. Anyway - UK citizens get reciprocal health care in EU contries.

Don't knock socialised medicine. It works.

More at www.aorticdissection.co.uk

Graeme Archer

At 1:00 PM, Blogger Three Score and Ten or more said...

Graeme, I have tried the URL which you gver us several times, and it won't pick up your page. I don't know if it is a missspelling or a security problem. As you can see from my post, I am very interested in aorticdissection. My wife was diagnosed almost two years ago, and she is still not in surgery, and is being maintained by blood pressure medications.

At 1:00 PM, Blogger Three Score and Ten or more said...

Graeme, I have tried the URL which you gver us several times, and it won't pick up your page. I don't know if it is a missspelling or a security problem. As you can see from my post, I am very interested in aorticdissection. My wife was diagnosed almost two years ago, and she is still not in surgery, and is being maintained by blood pressure medications.

At 3:30 PM, Blogger Norma said...

When people say socialized medicine works, I say it should--they are really paying for it through exhorbitant tax rates. Our friends in Finland go outside the system for special care and unusual health needs. I noticed Uncle Teddy didn't go outside the U.S. for his brain tumor, nor will any of us have access to his care if they rename that bill.

At 3:07 AM, Blogger hari said...

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At 6:51 AM, Blogger Russell Thomas said...

Pray, good sir, what evidence have you of British "death boards"?
Do you mean the National Institute for Clinical Excellence which occasionally
will decide that spending an insane amount on a medication that will only prolong life for a few weeks is not a good use of a scarce resource. You will find that most
of my fellow Brits will support this policy I am led to believe that US insurers use the same formula of "Quality Adjusted Life Years" to deny treatment
As an 80 year old I have lived with socialised medicine since the National Health
Service was introduced in 1948. I have never had any treatment denied or stopped
and some have been serious - angioplasty in 2003 and curently ongoing treatment for
lymphoma. I have only ever had small co-pays for medications which ceased at age 60
when prescriptions are dispensed free of charge
For what I regard as a good service from the NHS I have paid reasonable levels of tax


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