Welcome to European Tribune. It's gone a bit quiet around here these days, but it's still going.
Display:
There you are!  I've caught up with you at last.  I'm sorry you feel that this discussion is "bashing."  And I moved it to a new diary because I didn't want to further derail Colman's very good and eminently sensible discussion on unemployment statistics.

That said, why is it bashing to establish the problems that exist in the US system?  Part of the reason heated statements get made about it is that, for some reason, no one wants to admit the problems are here or the extent of them.

And there were not many factually inaccurate statements, merely some strong ones which needed clarification and, for the most part, turned out to be true in context or in certain situations.

Now.  My goal with bringing this discussion to the fore is certainly not to bash anyone.  My goal is to a) establish the nature and scope of the problem; b) discuss said problem and compare and contrast with an eye to finding root causes and ultimately; c) solutions.

I find it particularly helpful to discuss this in an intelligent, international setting such as this one because those who live in different cultures and systems can give me perspectives I can't get otherwise.  Also, I believe that many of these problems we have are global and will require some kind of global solution.  This will entail reaching out and promoting understanding.  It seems to me we can learn some things from our European friends.

So, when we discuss problems is this bashing?  The statement you quote above -- is it not a valid question in light of 45 million people without healthcare?  20% of our children living in poverty?  over a million people including whole families sleeping outside on any given night? -- why aren't we demanding changes?  Why can't we even talk about it?  We need to establish the reality of the problem before we can fix it.

Look at what Katrina exposed, the situation in New Orleans, then read the WSJ article I quoted and tell me which side is doing the bashing.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Wed Oct 12th, 2005 at 10:53:32 PM EST
[ Parent ]
I think the goal you outline is good.  And I respect many aspects of the various European systems.  I think both sides can learn from the other.  It would be very helpful if we could lay out comparative data on income, across a number of countries.  I think it could make the discussions much more productive if we had such a fact base to refer to when we make our comments.  I think asdf agreed in your earlier dialogue that it would be good, if the data was comparative and included European countries.  

But it's quite daunting to tackle issues and hope to solve them that are as large as poverty, and healthcare.  Sure it's disturbing to hear 45 million people are uninsured.  But it's also disturbing to know that nationalized healthcare systems ration healthcare through waiting lists, and many are far, far behind the US in terms of healthcare technology.  I have lived in an nationalized healthcare system, and the American system.  Each has +/-'s.  If I have a serious healthcare problem, there is no question that I would want to be treated in the US.  

And there is so much discussion to have around each one of those statements--45 million uninsured, waiting lists, lag in technology.  Each of those requires a pretty indepth knowledge of the various systems, and the tradeoffs between the various systems.  Do the 45 million not receive healthcare?  Some of them are 20's and 30's working in high tech startups, choosing not to pay for health insurance.  Some of them get healthcare at hospitals as they can not be turned away legally--all hospitals have indigent care budgets, recognizing their need to care for the uninsured--is that an efficient way to handle them--of course not.  But is a one year waiting list for hip replacements for the elderly an efficient way?  Of course not.  Every one of the above comments can be debated, shown to be true some place, not others.  So I guess my answer to your questions on the 45 million, or on bashing, is that often it seems the pot calling the kettle black.  It's interesting because when I first came on this site, someone from Europe was basically making this last point about the "free marketers", I believed they called them--in that they were just on the attack against the more socialist European models.  So I think they were also complaining about bashing.  The lack of a fact base we can agree on probably condemns us to this feeling--because someone arguing the opposite side as you, will have a mental framework they are relying on, and you don't know their framework--and if you did, you might challenge it.

So sorry for the disorganized nature of the above thoughts.  But I guess I'm supporting both your and Coleman's efforts to lead an effort to develop, or more hopefully, find existing data bases that we can use.  Let me close this, and drop you a second note on the WSJ article.

by wchurchill on Thu Oct 13th, 2005 at 02:57:23 AM EST
[ Parent ]
On the WSJ article, my interpretation was the author was lamenting the woeful job we have done with the underclass, but was concerned because he felt the programs are not addressing the root cause, which he identified as:

*Why has the proportion of unsocialized young males risen so relentlessly? In large part, I would argue, because the proportion of young males who have grown up without fathers has also risen relentlessly. The indicator here is the illegitimacy ratio--the percentage of live births that occur to single women. It was a minuscule 4% in the early 1950s, and it has risen substantially in every subsequent decade. The ratio reached the 25% milestone in 1988 and the 33% milestone in 1999. As of 2003, the figure was 35%--of all births, including whites. The black illegitimacy ratio in 2003 was 68%. By way of comparison: The illegitimacy ratio that caused Daniel Patrick Moynihan to proclaim the breakdown of the black family in the early 1960s was 24%.

But illegitimacy is now common throughout the population, right? No, it is heavily concentrated in low-income groups. Perhaps illegitimacy isn't as bad as we used to think it was? No, during the last decade the evidence about the problems caused by illegitimacy has grown stronger. What about all the good news about falling teenage births? About plunging welfare rolls? Both trends are welcome, but neither has anything to do with the proportion of children being born and raised without fathers, and that proportion is the indicator that predicts the size of the underclass in the next generation."

(I've got to figure out how to put these quotes in a neat little box like all you do--I had it, but then lost the notes--I'm an idiot on this techy stuff.)

I doubt this is the single cause, but it is shocking to see the illegitimacy rate going from 3% in the '50's to 35% today.  Just intuitively, this seems like it has to be a major impact on the developing underclass.  But talk about a difficult problem to solve--Wow!

by wchurchill on Thu Oct 13th, 2005 at 03:07:45 AM EST
[ Parent ]
Okay, first, you make the boxes by putting < blockquote > at the beginning of the text and < /blockquote > at the end, removing the spaces between the pointy things.

Now, and I want you to absorb the first part of my next sentence very carefully because it will clue you in to the thin ice on which we seem to have skated and explain any unfortunate future event which may occur in this conversation, but which can be avoided altogether if one is careful.

So as I was saying, being an actual bastard, I find it neither sad nor shocking about the rising rate.  Believe it or not, being born out of wedlock has no impact whatsoever on a person.  If you met me in real life -- you wouldn't be able to tell me apart from the others!

The biggest problem is not having two incomes.  The biggest problem is poverty.  Children raised by middle class and upper class single parents suffer no ill-effects, even if they're bastards.  Thinking that solving illegitimate births will solve poverty is ridiculous.  Giving people jobs, leveling the playing field, and providing social services will help the "underclass."

And I can guarantee that if you look behind the numbers of the rising rates, you will find that the increase correlates with the decrease in access to contraception and abortion.  The slashing of funds for reproductive care, and the closing of many, many clinics.

Oh, and as to your comment above which I'll get to later, hospitals do not have to treat anyone here -- only if it is a life-threatening emergency.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu Oct 13th, 2005 at 01:41:11 PM EST
[ Parent ]
First, thank you for this tutorial on boxing information.  I'm such a jerk here, a little intimidated at reading the material, and I allow that to become an obstacle.  But this is great!!  I'm going to start my own wchurchill notebook on these tips

Second, thank you for pointing out the thin ice.  Your comment makes me realize that I was not as precise with my language as I should have been.  first, let me say i have a number of situations in my direct family where children are born out of wedlock.  For me it is not a moral issue, it's just the world today.  When I lived in London I was initially surprised to see so many people having children, living like a married couple, but not getting married due to a number of issues--taxes being one.  (this was the late '80's.)  but what they were doing was very logical.  the term bastard never comes to my mind, in the literal sense anyway.  And as I say, directly in my family other situations have occured where a single parent situation just evolved--and it was the right thing under the circumstances,,,the children are just as wonderful and well loved as any others.

My point as I intended it, is that I think it is very challenging to raise children in a single parent situation--particularly boys, and perhaps even more specifically, boys with single mothers who live in poorer areas where there are other adult males who are not good role models.  Now, that is not to say that every child, every boy, is doomed in that situation.  Some of those single mothers are strong, committed, brilliant women, who keep their sons in line with wonderful love and an iron hand, and have wonderful material to start with in their children.  Nor is it to say that all children out of the susposedly "perfect traditional two parent family" have a red carpet to success.  We probably both know wonderful successes from both situations, and sad failures from both.

I have also had direct experience, personal, in this area, that unfortunately turned out tragically.  I, and others around, felt that the lack of a father in this young man's first ten years was a major negative event in the way his life played out.  And of course I've seen other situations from further away.

And of course even stating my view more precisely, I realize it's a debatable proposition.  And it's a social trend that would be a challenge to change--though I think the welfare system of the great society, with its negative financial incentive for the father's to live at home, was one of those situations of good intentions, but unintended consequences, that will be hard to recover from.  In other words, a place where policy influenced a social trend.

Though you still may disagree with my thinking, I'm glad that I can better point out that my view is a pragmatic one, rather than a moral one.  And I apologize for stating this poorly in that last sentence.  Kind of ironic that I did that, as you would see if you knew my own family situation in more detail.

I do have to run as I'm very tied up with some matters.  But when I saw your wonderful post, and recognized my imprecision, I had to take the time immediately to respond.

You have also motivated me to do some work on the uninsured in America.  There is much misunderstanding about healthcare for this group of people.  I'm not arguing that things are fine--I would like all to be insured.  But I have friends who are professionally very involved in this area, and am going to see if they would contribute to a diary in this area that I think would be very illuminating.  The situation is far from perfect, but not as bad as it is portrayed in the press, nor as bad as our European friends think--most of whom think this group doesn't get healthcare.  But I'll try to lay something out that will be factual and hopefully documented, that people can review,,,hopefully it will add to our knowledge base, and then it can be challenged and debated.

Thank you again for a very helpful and thoughtful post.  As I realize from your other posts, you are a generous, kind and well motivated person, and I  feel honored to share a dialogue with you.

by wchurchill on Thu Oct 13th, 2005 at 03:54:09 PM EST
[ Parent ]
Some slight editing:
I think it is very challenging to raise children -- particularly boys -- in poorer areas where there are other adult males who are not good role models.

There. I think it's true now.

I think there's rather too much emphasis placed on the role of single mothers in these situations and not enough on the simple fact that young men (in particular) who feel, for whatever reason, that they have been abandoned by or are outside society are inclined not to be very nice to that society. Humans aren't very nice animals, especillay when we're young.

by Colman (colman at eurotrib.com) on Thu Oct 13th, 2005 at 04:30:54 PM EST
[ Parent ]
And, of course, the single mothers themselves are abadoned too - by the fathers of their children and the State at the same time.

*Lunatic*, n.
One whose delusions are out of fashion.
by DoDo on Thu Oct 13th, 2005 at 05:48:36 PM EST
[ Parent ]
Oh, and as to your comment above which I'll get to later, hospitals do not have to treat anyone here -- only if it is a life-threatening emergency.

which is why many lower income and uninsured people do not seek treatment for a condition when it first arises, but wait until it becomes a life-threatening emergency -- at which time it costs far more to intervene than it would have to provide decent preventive care in the first place.  it is not only immoral but financially nonsensical, the current system.  to be financially sensible it would have to go that last Scroogeian eugenicist step and refuse the emergency care as well, leaving the poor to die, and "decrease the surplus population."  (just another instance in which "good financial sense" implies a psychopathic degree of amorality -- and this itself is a rich vein for future discussions to mine.)

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu Oct 13th, 2005 at 05:25:14 PM EST
[ Parent ]
"illegitimate" (i.e. out of marriage) births make up more than half of all births in Scandinavia and France, not countries known for the breakdown of their social systems.

In the long run, we're all dead. John Maynard Keynes
by Jerome a Paris (etg@eurotrib.com) on Thu Oct 13th, 2005 at 05:22:24 PM EST
[ Parent ]
this is a long thread and I wanted to make sure you had seen a clarification I made: "My point as I intended it, is that I think it is very challenging to raise children in a single parent situation-".  Izzy had referred me to the WSJ article on this subject, they were discussing the single parent issue and using the term "illegitimacy rate".  I carried that term forward in my closing sentence and regret using the term

I wonder if the statistics you quote would be a representation of single parent situations or not.  I know when I lived in the UK, there was a large group of young couples that were committed in every sense of the word, but not married due to the tax situation (this was late '80's).

by wchurchill on Thu Oct 13th, 2005 at 08:33:40 PM EST
[ Parent ]
But it's also disturbing to know that nationalized healthcare systems ration healthcare through waiting lists,

wc do you have private (affluent) health insurance? if you have never experienced a waiting list for US health care then you must be among the elitel   'cos I am a middle class worker in America and I have HMO coverage like millions of others, and we could tell you about waiting lists.  6 weeks just to get an appt with my GP -- consultations limited to 15 minutes.  almost 2 months to get access to an MRI scan after a disabling injury.  and for this my employer pays 30 percent overhead to the beancounters?  and if I lose my job I have no health insurance at all, except at extortionate "individual policy" rates?

here is a discussion board for nurses where their frustration with HMO health-care rationing is openly and frankly aired.

my GP once said in a moment of candour -- wasting a precious few seconds of that 15 minutes -- that working under American health system conditions was enough to drive a doctor mad.  every decision he made, he said, after 12 years of medical school and internship, was second guessed by a cadre of MBAs and CPAs who never saw an actual suffering, scared human being in their lives.  [brief pause to cool off].  I don't see that a national health care system can be a whole lot worse.

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu Oct 13th, 2005 at 05:48:05 PM EST
[ Parent ]
And while I'm on a roll:

Sometimes the Paperwork is Worse than the Disease

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization.

    The stacks of papers, folders and Post-It notes related to Ms. Mayer's treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

    "You can't just be sick," she said. "You have to be sick and be drowning in paperwork."

    So overwhelming has the paperwork grown that Ms. Mayer has considered giving up and ceasing all treatment because of the bureaucratic hassle that accompanies it.

And that's a person with health insurance, in the wealthiest nation on earth...

In the days before managed care, most insurance plans operated on a fee-for-service basis. Patients paid 20 percent of medical fees; insurers paid 80 percent. But as health care costs have continued to rise, many patients are being required to pay an ever-larger part of their medical bills, and deductibles continue to increase. And to keep the system churning, close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.

    "The number of bureaucrats between the point of service and the final cash reckoning is just incredible," said Dr. Thomas Delbanco, a professor of primary care medicine at Harvard Medical School who is a leader in the field of patient-centered care.

It says something ghastly about our current system that "patient centred care" should be a speciality field.  WTF else should medical care be, if not patient-centred?  oh, oops, silly me, I forgot -- profit centred.  well we are doing very well on that front...

if I don't take a deep breath I'm going to start using boldface, and that would ruin my rep :-)

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu Oct 13th, 2005 at 08:17:41 PM EST
[ Parent ]
I have a choice and elected to pay the extra money to be in a PPO, rather than an HMO, in California. and generally do not have to wait--except in ER's which can be unbelievable.  though I must admit they do a good job of triaging and handling the most critical cases.

California would be a great example though of what you are talking about.  Doctors are being squeezed by California Medicaid, Medicare, etc.  In fact my urologist just moved back east because he felt the financial situation for him personally is just out of control.  I wouldn't want to defend this statement right now (because I'm hoping to write a diary with a friend on this issue soon), but HMO's have a lot of the practices of a nationalized health care system.  So you may be getting a glimpse of socialized medicine.

Just to finish on this California point however.  The extreme tightening of healthcare mayments by the government, the very cost competitive nature of HMO's in California, are IMO driving down the quality of healthcare for all--even myself as a PPO.  I have an unusual work and travel schedule now, and am able to choose where to have my doctors and main care (obviously not emergency care) and I've moved our doctors and main care providers to Illinois, where personally I've found the care far better.  I know this is an extremely unusual situation (and for me too)--but just mention it because, once again IMHO, I don't think Americans understand the lower quality of care in socialized medicine than they are used too--and HMO's are a glimpse at that care.

IMHO, and obviously all our financial situations are different, but I would recommend people sacrifice on some other area of their spending, and pay the extra for a PPO.  

by wchurchill on Thu Oct 13th, 2005 at 09:02:05 PM EST
[ Parent ]
I have several friends in Canada, where there is "socialised medicine."  They are appalled to hear of the quality of care that I receive as an HMO member.  Nothing in their experience matches the disdain w/which the US insurance/HMO cartel treats patients, the opacity and inefficiency of the bureaucracy, etc. Their paperwork is simple and they do not report excessive waits for services.  Nor do they fear that any illness in the family may lead to bankruptcy, as many American families must.  IMHO the HMO experience is a taste of Fully Corporatised Medicine, which is not quite the same thing as socialised. :-)

And what of those who cannot afford the high premiums for "business class" health insurance?  They should just resign themselves to inadequate care, or no care?

I read a while back that an astonishing percentage of health care expenditure -- more than half of the notorious 30 percent admin overhead -- in the US was dedicated to the denial of health care, i.e. gatekeeping, screening out patients, exhaustive analysis of "savings opportunities", etc.  The author of the article (which I will try to find) contended that the money spent on denial and gatekeeping was almost adequate to provide care for the people who were being screened out -- a typical case of "spending a buck in order to save a buck" ...though of course what this really means is diverting an enormous cash flow into the pockets of middle managers, accountants, financial analysts and the elite upper management of private insurance firms, so it's more like "stealing a buck in order to steal a buck" -- that is, if we accept the fundamental premise that the purpose of a health care system is to provide health care, not to enrich elites or provide permanent job security for unproductive paper pushers.

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Thu Oct 13th, 2005 at 09:22:30 PM EST
[ Parent ]
I probably should have commented that I think the American health care system needs significant improvement.  I don't want to be viewed as an apologist for the current state of affairs.

There used to be a survey of opinions on the healthcare systems in the UK, US, and Canada.  I haven't seen it in many years.  I'll have to see if I can find it.  I also have Canadian friends, and hear a little more about the problems.  So for example, they love living so close to the US, because they can just come across the border and pay for a surgical or endovascular procedure (pay since of course they don't have US health insurance), rather than waiting months for the procedures.

By the way, I'm just realizing that I should have recognized that we miscommunicated on our early posts about waiting.  On my original post, I was referring to the practise of having to wait to get a surgery done.  For example for years the average wait in the UK for an elderly person to get a hip replacement was one year.  So you are 75 years old, in pain, in the latter part of your life and wanting to have as high a quality life as possible, and you have to wait a year for the surgery.  I'm not up to date on the waiting list for that procedure today--and I know the UK is raising significantly the money spent on healthcare so maybe they are lower.  But I don't think many Americans are aware of this aspect of nationalized healthcare.

But, just not to be branded a capitalist here, my own solution to this healthcare crisis is a combination of the US and UK type healthcare systems.  they both have +/-'s.  Another minus is when I was familiar with it 10+ years ago, they were 6 to 7 years behind us in adopting new technologies.  But I shouldn't go on here, as I can't yet take the time to really get into this one.

by wchurchill on Thu Oct 13th, 2005 at 10:17:39 PM EST
[ Parent ]
This is a wait -- four months without part of your skull while insurance haggles.

http://news.bbc.co.uk/1/hi/health/3706631.stm

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Thu Oct 13th, 2005 at 11:02:21 PM EST
[ Parent ]
yes I agree this was total incomptence in this particular case.  But do you think we can't do a review of the UK and France and find similar incompetence?

these individual problems are heart rending and important.  but I dont think we'll fiond beaurocrartic incomptence limited to Americans, english, rrench , etc.

by wchurchill on Fri Oct 14th, 2005 at 05:59:20 AM EST
[ Parent ]
Yes, I realize this was sort of a one-off incident and I did use it as sort of a cheap shot for its shock value, but I think the important point of the story was that this was not incompetence -- it was refusal to pay.

Incompetence I can see -- they lost the skull fragment or dropped her off the schedule or something.  This is different from that.

And there actually is a ton of evidence that our system is broken.  My Unbossed colleague, em dash, has writes a lot on the subject.  Here's a sample:

Code Blue!  Stat!

The Healthcare Crisis and Homeland Security

And my favorite:

Give the Gift of Love:  Buy Grandpa a Pill Splitter for Father's Day!

She's got a lot of good posts in there and they're loaded with statistics, studies, and links.


Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Fri Oct 14th, 2005 at 04:02:23 PM EST
[ Parent ]
Paul Krugman addressed the question in a NYT op-ed last April, and you may be thinking of this: Passing the Buck.

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.

According to the health organization, the higher costs of private insurers are "mainly due to the extensive bureaucracy required to assess risk, rate premiums, design benefit packages and review, pay or refuse claims." Public insurance plans have far less bureaucracy because they don't try to screen out high-risk clients or charge them higher fees.

And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money. ... It's a war with insurance, every step of the way."

Isn't competition supposed to make the private sector more efficient than the public sector? Well, as the World Health Organization put it in a discussion of Western Europe, private insurers generally don't compete by delivering care at lower cost. Instead, they "compete on the basis of risk selection" - that is, by turning away people who are likely to have high medical bills and by refusing or delaying any payment they can.

I'll try to look out the WHO source for this.

by afew (afew(a in a circle)eurotrib_dot_com) on Fri Oct 14th, 2005 at 04:57:49 AM EST
[ Parent ]
I have HMO coverage like millions of others, and we could tell you about waiting lists.  6 weeks just to get an appt with my GP -- consultations limited to 15 minutes.  almost 2 months to get access to an MRI scan after a disabling injury.

I can still barely believe this. And I thought we have to wait long!...

In Hungary, there are very few treatments you need an appointment for - you go to the hospital/medical services facility, and wait until it's your turn. This usually takes 30 minutes to an hour, but can take hours - that's what we see as too much. At some places, an appointment can be made which lets you in without having to sit there waiting. For the few services where we need to make an appointment, it's not emergency issue (say, an allergy test), but still the date is usually within the week.

...and of course, the neoliberal fanatics would like to privatise healthcare here, too... (Some of you may have read my diary about this.)

*Lunatic*, n.
One whose delusions are out of fashion.

by DoDo on Fri Oct 14th, 2005 at 09:31:29 AM EST
[ Parent ]
Now my incredulity is growing. I was unfamiliar with those acronyms - GP is General Practicioner, i.e. family doctor? Now I can't imagine having waiting lists there!... 6 weeks??? My disease is long over by then - or if I need medication for a chronic disease, it'll run out...

*Lunatic*, n.
One whose delusions are out of fashion.
by DoDo on Fri Oct 14th, 2005 at 10:01:01 AM EST
[ Parent ]
That is why you are encouraged to get a 3-month prescription from your doctor each time. They'll probably fill out several shorter prescriptions at once, dated appropriately.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Fri Oct 14th, 2005 at 10:14:53 AM EST
[ Parent ]
I still don't get it! If, say, you have a skin problem, you have to let it fester and grow for six weeks, until the skin doctor will meet you? (Or worse, twice six weeks, the first with the GP who'll send you to the skin doctor?)

*Lunatic*, n.
One whose delusions are out of fashion.
by DoDo on Fri Oct 14th, 2005 at 10:18:54 AM EST
[ Parent ]
When I was at the University of California we had a pretty good (but pricey) mandatory insurance program. You could get an appointment at the Campus health centre within a couple of days, they would give you a referral and you could generally get an appointment with a specialist withina week or two.

However, my understanding is that the situation is much, much worse with an HMO (Health Management Organization). In many ways, although being a graduate student puts you squarely under poverty level incomewise, the standard of living is acceptable as long as you don't own a car or pay for cable TV.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman

by Migeru (migeru at eurotrib dot com) on Fri Oct 14th, 2005 at 10:38:17 AM EST
[ Parent ]
You see, it works, DoDo, it works!

Afew Snark Technology ™
by afew (afew(a in a circle)eurotrib_dot_com) on Fri Oct 14th, 2005 at 11:04:16 AM EST
[ Parent ]
I am skeptical of the value rendered by the med mafia in the first place -- they kill a lot of people every year by sheer incompetence, fatigue, overwork and excessive paper shuffling combined.  120,000 per annum as I recall die in the US from medical mishap or carelessness.  much is made of the shiny state-of-art technocratic icing on the US medical pie but I am firmly in the camp of those who say this is nifty but contributes little to general public health.  I will try to dig up some urls from old discussions in other venues about health care priorities.  iirc more than half our national health care budget is spent on valiant efforts to extend the final year of life, often against the patient's wish or without their conscious participation;  something wrong there.

anyway, I don't generally "go to the vet" unless I am convinced the injury or illness is serious.  have probably visited the doc only 3 or 4 times in 15 years.  it is not a system I trust; and as the pharmacorps suborn more and more docs, turning them into drug salesmen, I trust it less and less.  my experiences with it on the rare occasions when I venture into the waiting room have done little to alter my feelings -- though my GP is a good fellow and I think uncorrupted, his is the last generation of medical personnel who went through the system before near-total corporate infiltration and control of research and hospital management.  I don't trust any of the next generation.

in an emergency the system works fairly well.  but somehow that sums up the essence of corporate culture:  throw money and resources at emergencies in the present moment for quick results -- heroically if need be -- big flashy quick TV-genic results that people will pay big bucks for -- but skimp as much as possible on maintenance and long term investment and the kind of patient low-key effort that helps to prevent the emergencies.  more later...

The difference between theory and practise in practise ...

by DeAnander (de_at_daclarke_dot_org) on Fri Oct 14th, 2005 at 03:36:53 PM EST
[ Parent ]
Staying away from doctors is my goal as well.  They're completely overburdened and don't really have time to figure out your case or history.  If your insurance is good, they'll sometimes order all sorts of tests that turn out to be unnecessary.  And they're simply deluged by propaganda from the drug companies -- drug fads are a huge problem.  

Are you blue? have cramps? back pain? joint pain? neural pain? depressed, nervous, a bit shy? -- change your brain chemistry!  Take these epilepsy pills!  We don't know how or why they work but they sometimes do!!  

Paxil for depression and Neurontin for epilepsy are two of the most prescribed drugs.  I had a friend who was put on them and it turned out she just needed her gall bladder removed.  Another friend on them and it turned out she had a degenerative spinal disease.  I could go on and on -- and the docs present these medicines as though they're pain pills of some sort.  People don't even know they're taking pills that are designed to alter your brain chemistry or prevent siezures.  It's beyond absurd.

Ohhhh, the stories I could tell!  Don't get me started!!

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Fri Oct 14th, 2005 at 04:37:50 PM EST
[ Parent ]
wow! (I'm presuming that is public sector service, no bribes required?)

The Polish health care system works that way for basic care, anything else it's a lottery. You might get decent treatment, or you might be told there's no doctor available for the next six months, or the hospital's quota for a particular medicine is full or the doctor doesn't actually see you - more patients than time for doctors who earn horrible official salaries means many require bribes to do more than just look in. (salary for a doctor with 25 years seniority is about 1800zl/mo  600 euros/mo not including overtime.) If you want to avoid waiting you either go to a private clinic and get the procedure done there or pay a fee to a doctor at the clinic to get the procedure done by that doctor at the public hospital - most doctors work both public and private skimping on their official hours to put in time at the private practices and private clinics where they actually make their money.  Horror stories abound. Recently the government fined a hospital for prescribing expensive chemo drugs to patients over 75. Plus the whole system is a bureaucratic nightmare after two rounds of 'reform.'

by MarekNYC on Fri Oct 14th, 2005 at 06:42:56 PM EST
[ Parent ]
(I'm presuming that is public sector service, no bribes required?)

Half-yes and no. Family doctors, what Americans call GP, and a few others like dentists became private shortly after 1989 - but (1) with strong regulation, (2) and at least with GPs, not much changed in practice: people still would like to go to the nearest doctor, and competition is limited by doctors themselves not wanting too many patients. (I know this from own experience, I dislike my own doctor and once asked the one next door to take me.) As for bribes, they are said to be near-universal in Hungary, for the same reason as in Poland (but, heh, I myself never paid it).

Furthermore, I only spoke about getting tested and looked at - not about treatment. (I don't know about other places, but in Hungary, under communism special centres for all kinds of medical checks and instant treatment were built across the country, separate from hospitals and the even more local family doctors.)

Many hospitals are run-down (tough not as much as at some other places) - patients often don't have enough room, are even sent home, staff is overworked and correspondingly unkind, the buildings are in bad shape, and with machine breakdowns it happens that the ambulance car is sent to another hotel. As I wrote in that diary a few months back, the 'solution' to this in all politicians' head was further wrecking it with first cash-starvation then privatisation of the profitable parts, but the political mess around a don't-privatise-hospitals referendum and the all-too obvious public opinion made them stop. In fact, the 180-degree-turn policies of the current government seem to have borne some improvements (my personal observations only).

(BTW, I myself have the privilege of access to one of the top-rated hospitals in the country: it happens to belong to the state railway, and my job contract gives me full rights to its services free. I also have a second "GP", the 'works doctor', tough unfortunately too far away from home.)

*Lunatic*, n.
One whose delusions are out of fashion.

by DoDo on Mon Oct 17th, 2005 at 06:35:20 PM EST
[ Parent ]
When I went to the dentist in the US, the dentist would have an assistant lounging about whose only role seemed to be to prepare his instruments for him. They hardly ever were at work simultaneously. When I go to the dentist in Spain, the dentist prepares his own instruments. That way, in the US I had to pay for two salaries while in Spain I only have to pay for one.

A society committed to the notion that government is always bad will have bad government. And it doesn't have to be that way. — Paul Krugman
by Migeru (migeru at eurotrib dot com) on Fri Oct 14th, 2005 at 09:43:54 AM EST
[ Parent ]
See Lupin's diary A visit to the rheumatologist (Life in France 2) for a comparison of medical practice between Los Angeles and down here in the French boondocks.
by afew (afew(a in a circle)eurotrib_dot_com) on Fri Oct 14th, 2005 at 10:10:53 AM EST
[ Parent ]

Display: