Socialized or single payer medicine gets a bad rap from everyone with their hands in the cookie jar. With costs approaching 20% of our GNP, we pay an exorbitant amount of money for what amounts to disease care in this country. However, that money flows to vested interests who embrace the status quo.
Many of us only know single payer health care systems via disheartening headlines regarding delayed care, waiting lists, mismanagement, and fraud. How many of us get to compare the American brand of health care with care delivered in other countries?
In The Healing of America, journalist Tim Reid traveled the world to experience how different health care systems would treat the same condition. I just went on vacation.
While touring Stonehenge last summer I experienced a second episode of Idiopathic Thrombocytopenia Purpura (ITP), a autoimmune condition that destroys blood platelets. Both the National Health Service hospital in London and medical care in the Netherlands impressed me in every way.
THE MYTH OF SOCIALIZED MEDICINE
Critics of socialized medicine fan consumer fears with reports of rationed health care and poor access to care, however that was not my experience. I was more than impressed with health care delivered from the National Health Service in England, as well as health care provided in Holland.
In London we navigated public transportation to the hospital, winding through modest neighborhoods on the local bus. Once we arrived I self consciously googled the facility and took heart. Much like County USC in East Los Angeles, this teaching hospital offered a wide range of services and specialists.
EVERYONE DID THEIR JOB, EVERYONE SEEMED TO CARE
Thoughtful and attentive health care workers problem solved from the get go. After a moderate wait, the triage nurse took my history and determined next steps. Phoebe, my ER doctor, systematically assessed my condition and conscientiously checked on me throughout the process. They all knew we were trying to make an overnight ferry to Holland.
The phlebotomist went out of his way to try to speed up the diagnosis. When the first blood draw wasn’t able to pick up my platelet count, he independently decided to draw two vials, sending one to the hospital lab and while still trying to assess the second in the ER.
THERE WILL BE NO CHARGE
Once blood tests confirmed my suspicions, the on call hematologist met with me to discuss discharge. Unlike my first experience, I would not be hospitalized. Instead, the doctor reviewed our itinerary and mapped out a care plan, providing me with documentation for the next practitioner in Holland.
Despite everyone’s efforts, we missed the ferry. Frank was able to reschedule our travels for the following morning, and we left the hospital with a prescription, along with directions to an all night pharmacy. When Frank inquired about paying for my medical care, Phoebe told us she didn’t know, and left to find out. When she returned she reported, “There will be no charge.”
COMPETENT CARE AT EVERY STAGE
Once we arrived in Haarlem, our family friends directed us to the local community hospital. Frank speaks Dutch, but his language skills proved to be a bonus, not really a necessity. Everyone spoke very good English.
We checked into their version of urgent care, and again I met with incredibly caring and competent practitioners and staff. The front office clerks navigated the paperwork for our unusual circumstances. We did not have records at the facility nor domestic health insurance.
The triage nurse listened carefully to my report, reviewed the discharging physicians notes from England’s NHS, and determined that she too would draw two vials of blood to avoid an unnecessary delay. It didn’t escape me that in both countries health care workers were empowered to make decisions and execute meaningful care, not just the physician or other authority. Both Frank and I noted that everyone seemed happy to be helping.
HOLLAND’S HEALTH CARE MODEL
The Dutch health insurance system more closely models our own, and everything about the delivery of care impressed me. The facilities were busy, but not hectic. The space light and airy. When we needed to wait for laboratory results, the front office staff directed us to a small cafe in the next building where we could purchase refreshments.
At a return visit I saw an internist. He greeted me in the waiting room, and we walked back to his office together. No staring at office walls while waiting for the clinician to swoop in.
The conversation en route eased into a more involved discussion in his office. The doctor determined I was well enough to travel back to the states. However, he realized the computer system kept him from providing documentation for my practitioner at home, and then proceeded to prepare a hand written note with his phone number and email address.
PERSONAL CARE AT A FRACTION OF THE COST
When I completed my visit at the urgent care facility in Holland we paid a modest sum of €250. I remember taking my son to urgent care in Juneau, Alaska over four years ago. We paid $650 to get wax cleaned out of his ears.
The €250 fee covered the urgent care visit and all care that day. I spent €10 for blood tests the following week, about the same as my co-pay for blood tests in the states. When I asked to pay for the follow up visit with the internist, I heard a familiar refrain from the staff. “I don’t know, but I’ll find out.”
I was promptly directed to another clerk who offered me tea, and then she reviewed the day’s charges . She determined that the original fee would probably cover this visit as well. As I prepared to leave she remarked, “If there are additional charges, we will send you a bill.” I didn’t receive one until this fall, over a year later supposedly due to clerical error. The bizarre billing identified total costs with no cost breakdown, and neglected to include our initial payment. I get the sense that someone had to generate a bill for us outside of their computerized system, and all the billing was sent in Dutch.
Despite Frank’s language skills, problem solving proved challenging with the nine hour time difference and lack of detail in the paperwork. Despite the confusion, the additional $180 dollars for a total of approximately $450 dollars of care the cost of medical seems incredibly reasonable–especially since my costs with Kaiser insurance would have totaled at least $120.00 and possibly as much as $ 570.00 for similar services at home.*
GRACE AND COMPASSION
I was most impressed with how every professional delivered competent care with a grace and compassion that’s often missing in the US brand. Every practitioner seemed happy to be working and helping. I never felt the angst of a system over-scheduled, over-burdened, and running late.
Not once did I bump up against attitude. Even when staff and practitioners needed to contact someone to “find out”, the extra effort was exerted with ease. They knew who to call and they got answers in the moment. How refreshing.
To be fair, during my first episode of ITP the emergency room staff at Kaiser Permanente in West LA took great care of me, although it helped that I arrived at 4am with no one else in the waiting room. However, I should have gone in the night before.
I’ve learned to navigate the system because more often than not, the system determines care. What does it say about our health care system that I couldn’t bear the thought of arriving at a crowded ER at 10pm on a Thursday night, so I decided to wait until the next day?
I can’t compare inpatient care domestically with these two European models. Mostly I have no complaints, although a staffing shortage after inpatient surgery in February revealed the strain on nurses when they are stretched too thin. I can personally attest to the fallout when health care workers seem like they don’t enjoy what they do, or are too frazzled to do their job well.
WE PAY A LOT FOR RATIONED HEALTH CARE
Americans spend a lot of money for health care that doesn’t favorably compare to other developed countries. Reid’s research blames for profit health insurance companies for draining the coffers with no concrete contribution to actual medical care. Insurance companies also ration care.
All too often underwriters or medical professionals employed by the insurance company determine who or what will be reimbursed for any given procedure or service, not your own physician. Others are rationed because of cost, as we still have millions without insurance or with co-pays they can’t afford.
FOR PROFIT HEALTHCARE DISTORTS PRIORITIES
For profit health care is further distorted by Wall Street’s priorities. Profits for each fiscal quarter trigger fluctuations in stock valuations, effectively minimizing any impetus to pay for preventative care that could save health care dollars down the line. No wonder prevention garnered so little attention until the Affordable Care Act demanded a few modest changes.
Unfortunately, most efforts at preventative care today translate to additional screening. We are still not investing enough in true prevention, such as meaningful nutrition education and medical nutrition therapy. Counseling an adult or child who is already considered obese shouldn’t count as “prevention”.
REFORMING THE MEDICAL MARKETPLACE
Increasingly I hear of large corporations contracting directly with providers and hospitals to provide care, cutting out the red tape and costs from a bloated insurance industry infrastructure. How many other businesses and consumers are looking for a leaner model?
I’m not sure how medical care will be delivered in the future. However, we need to stop pretending socialized medicine is somehow inferior to what for profit medicine delivers today. Ultimately, we need fewer hands in the cookie jar, and we need to stop paying for so many cookies.
*Cost estimates reflect difference between using urgent care vs emergency room services. This post was updated on 11/30/16 to reflect additional charges from health care in the Netherlands.