Oh no! I'm going to die because of socialized health care!

[velvetpage]

The last thing I did before leaving this morning was post a debate in booju_newju asking if the U.S. should socialize their health care system. As a result, I haven't read much of my friends page - I've been replying and managing discussion over there ever since I got home.



I'm wondering about the perceived connection between long wait times and socialized medicine. There is a connection, certainly, but it's not, "Oh no! If the government is paying for it, we'll have to wait!" From my point of view, it appears to be mostly about infrastructure. We do not have enough doctors or other specialists, and if we did, we would lack some of the operating theatres, hospital beds, and other necessary things to reduce wait times. This is a systemic problem, certainly, but it is not one that would appear immediately upon instituting socialized medicine. The U.S. already has the infrastructure, and they certainly have enough doctors. (They could send back a few of the ones they've borrowed from us, actually. We need them ourselves.) There might be some shortages when all the currently-uninsured suddenly had access to the whole system, but they'd be manageable, and probably much of it would be absorbed by the current system. After all, everyone would have a lot more time to see patients if they weren't filling out dozens of forms and attempting to get blood from a stone payment from people who have no money.

Also, what's with this idea that "The government will tell me which doctors I have to see!" That is totally, categorically false. In fact, I have more choice of doctors than many insured Americans whose insurance companies tell them which doctors they're willing to pay for. I can see any doctor in Ontario by presenting my health card, if I have a referral. And, while I know many people who have to wait, I never have. It depends on the specialty how long you'll wait, and once you're on their patient roster, you won't have to wait again to see the doctor - though you may have to wait for your surgery. See previous comment about infrastructure.

Last complaint I have little patience with - "Our taxes will be too high for us to afford to eat!" Okay, maybe your taxes would go up - though it should be possible to do it for the amount already being paid for Medicare - but your health premiums would (almost) disappear, and the savings would be rather greater than the increase in taxes. No, the rich are not going to flee to places where they don't have to support the poor. There aren't a whole lot of those places left, at least not places where the rich would actually want to live.

Okay, I'm done now.

Comments

[kibbles.livejournal.com]

I don't think Americans are AWARE what percentage of their salary goes to premiums each month. We're talking around $1000 a month for a family. Imagine if they got that in pocket? Even HALF would be nice. That's a big raise!

I think here, since we have the system sort of in place, a subsidized insurance thing might work nicely. We have it for kids in many states, and some states have it for families too. Expand that. Have the state simply assist with the premium payment for working but uninsured families. That's got to be a lot easier than changing the system completely.

[firesign10.livejournal.com]

Socialized medicine sounds like a winner to me!

[anidada.livejournal.com]

http://accordionguy.blogware.com/blog/_archives/2007/1/17/2658922.html

Hot topic of the day, it seems...

[velvetpage.livejournal.com]

Thanks. :)

[merlyn4401.livejournal.com]

Re: wait times. I get that from the number of complaints I have heard from both RL friends and online acquaintences about how long they have to wait to see a specialist. I *get* that you didn't in your case. I also *get* that it is an infrastructure problem.

But. One of the big reasons we have so many doctors and so many hospitals is that you can make so much money at it. Isn't that one of the reasons your docs are headed down here? So remove that incentive to become rich, or at least extremely well off, and you are going to lose a lot of future doctors. There are not a lot of people willing to work for the government, number one, and even fewer who are willing to work at a very set wage. Especially when they can go free market and make a lot more money. So a lot of docs will quit being docs becasue they don't want to deal with the government in their pocket, and a lot more won't even go to med school. And we'll be in the same place as Canada with having too few doctors.

[thebitterguy]

Yes. Our doctors are poor. Congratulations on that observation.

[merlyn4401.livejournal.com]

Where did I say that?

[thebitterguy]

Somewhere in that blather, you said that doctors go there because they can't become well off here.

[pyat.livejournal.com]

The "brain drain" is exaggerated - not that many Canadian doctors go to the states. The disparity in number of doctors per population existed before Canada had socialized medicine, IIRC, primarily as a function of the fact that the US has a lot more medical universities. And, according to recent studies, more doctors moved TO Canada than move FROM Canada.

Both the US and Canada have relatively few doctors when compared to the socialized medicine states in Western Europe. Italy has somthing like twice as many per captia than the US, or nearly that.

And we'll be in the same place as Canada with having too few doctors.

That didn't happen in any other Western country that adopted nationalized health, so far as I know.

[velvetpage.livejournal.com]

Besides, any other country where people actually want to live, already has socialized medicine. Where would they go to practise?

[merlyn4401.livejournal.com]

I honestly have no idea about the brain drain. I was going off a couple comments posted in booju about the exodus of doctors from Canada to the US. I'm happy to sit corrected on that. :)

[velvetpage.livejournal.com]

Me too - I didn't know that.

[velvetpage.livejournal.com]

Have you got a link on that, dear?

[pyat.livejournal.com]

To the brain drain stuff? Yeah.
http://www.irpp.org/archive/policyop/sep99/emery.pdf

It's a PDF file.

[velvetpage.livejournal.com]

Judging from the doctors I know, it's not the difference between middle-class and rich - it's the difference between a bit rich, and very rich. The doctors I know live in the nicest parts of town in houses that are worth three or four times what mine cost. My SIL once overheard the doctor she works for telling her banker to pay off the rest of a mortgage on a house she'd only owned for a few years.

You can still make an excellent living as a doctor in Canada.

[merlyn4401.livejournal.com]

Good to know. I'm glad docs do well there, I really am.

I just think that there are going to be an awful lot of docs here who are going to get super pissy when they have to work for the gov't, and essentially have a cap on their earnings.

I'd be happy to be proven wrong, because it would prove people are more altruistic than I give them credit for. :p

[velvetpage.livejournal.com]

I can imagine there will be a few who will be happy not to have to change their preferred line of treatment based on what the patient's insurance is prepared to pay for, too. What are they called - Health Management Offices - are the worst idea in the history of health care. The only person who should be making those decisions is the patient on the recommendation of the doctors involved in their care. Period.

[dornbeast.livejournal.com]

Health Maintenance Organizations.

Although I liked one person's rewrite of that, to "Healthy Members Only."

[dornbeast.livejournal.com]

I'd like to think that the doctors who are ticked about not having tons of money will be outnumbered by the doctors who are happy to have the freedom to practice medicine, instead of being restrained by bean-counting HMOs.

[dagoski.livejournal.com]

Does the Canadian government do anything to subsidize or otherwise support medical education? One reason why doctors in the US are under so much pressure to make money is the level of debt as they come out of medical school.

[velvetpage.livejournal.com]

Medical school is subsidized, but not as much as it used to be. Hopefully doc_mystery will chime in here - he knows more about that than I do.

[neebs.livejournal.com]

I have no idea about Canada and I have no actual facts to back me up (so it sounds like I would fit right in with this Booju community =P) BUT I DO have friends in med school and vaguely remembering reading in a few places (washingtonpost.com comes to mind) that with the rate that malpractice insurance is going up, being a doctor isn't all that lucrative anymore. (Except for plastic surgery, which apparently is booming.)

So, really, if the gov. covered malpractice stuff, it might be even more incentive to go into medicine.

AS I SAID, though, I have no facts to back this up. So nobody yell at me. I'll cry. ;)

Also are people complaining that if we go to socialized health care they'll have to wait? Because I waited one hour and thirty-f-ing-two minutes last time I went to see my doctor. Granted, she's a f-ing moron, but still...that's outrageous.

[velvetpage.livejournal.com]

I think they mean waiting for surgeries or getting an appointment with a specialist, either of which can take months depending on who and why you're trying to see. My friend's mother waited six months for her hip replacement, and my aunt will wait most of a year for her double knee replacement.

Canadians are less inclined to sue, and I think judges are less inclined to find malpractice, so there are fewer malpractice insurance costs in Canada.

[neebs.livejournal.com]

Ahh, my apologies, I see now that I missed the "specialist" in that sentence.

Amen for Canadians being less likely to sue. *Another plus for moving to Canada*

[anidada.livejournal.com]

...also where, when, and how desperately the surgery is needed. For instance, knee surgeries in Toronto (Alex's mom) and Kingston (our friend M), it seems, have very short wait times -- at the moment. Six months from now, who knows? Go west, it might be better, or not!

It's all a rich tapestry. ;)

[velvetpage.livejournal.com]

Meanwhile, I know a lady who went for her first "routine" checkup in a long time a few years ago. The doctor was very concerned. He got her in for tests, and she was on the table for major cancer surgery within the week. That probably meant that someone else had to wait a day or so longer - but it was the doctors' judgment that they could afford to, and this lady clearly couldn't.

[pyat.livejournal.com]

One more point - Canada doesn't have "too few" doctors, we just have fewer than the US. We have 2.1 per thousand, the US has 2.8.

Japan has 2.0, New Zealand has 2.1., the UK has 2.1, Ireland is 2., and so on.

Slovakia has 3.6. Italy has 4.4. All the raging leftie Western European nations have more than 3.0

[urban-homestead.livejournal.com]

The raging leftie Western European nations are all less lefty than Canada on health care - "two-tier" care is the norm in some, and in the rest there are user fees. So there is still a general pattern of higher numbers of doctors in countries with a partially-private health system. What's the number in Cuba, do you know? I believe that's the only country in the world that bans private health care as strictly as Canada.

I'm in favour of socialised health care, don't get me wrong. But I think the concern that exclusively socialised health care lowers the number of doctors per capita in the population is a fair one.

[nettlefly.livejournal.com]

I actually wandered to your journal after reading that debate - I don't take part in any of these kind of discussions online as the opinions of the 'other side' tend to leave me exhausted just from reading it all. But I wanted to tell you that I really admire the way you stayed calm and explained how your system actually does work. Perhaps it is something one cannot really change people's minds on but it did make me feel a little better about the whole discussion seeing someone...well, agreeing with me:)

What I mean is that while I know that people leaning on the right don't have my views on life and even though I've read through similar opinions by the people not in favor of nationalised healthcare each time this topic is brought up, it actually seems a bit intimidating to read these opinions. Especially when one goes to the part whether healthcare is a basic human right - I know I've lived through enough hard times to know that had I lived in certain other countries I would probably be dead already so I just tend to take these very personally. In good and bad.

Well, take care of yourself and everything, I just wanted to let you know that at least someone heard and agreed with what you were saying:)

[velvetpage.livejournal.com]

I appreciate that. Thank you. I try very hard to keep my cool, because bitterness and accusations don't convince anyone. It's something a few people in that thread haven't learned yet.

[pthalo]

I'm responding to this so long after the fact that I almost feel like perhaps I shouldn't do so, but I've been reading through some of your public entries (via your tags list) on topics that I find interesting.

And, I think when Americans hear socialised they think of communism and people waiting in long lines for the chance of bread and all that. Or they think of the kind of socialised medicine we have here today in Hungary. (Actually, I doubt most Americans think of Hungary specifically or could find it on a map. When I encounter them online and I tell them I'm from Hungary, sometimes they ask me what continent that's on. But I think they think of something like what we have here, without knowing it's what we have here. *g*)

In Hungary, doctors are paid less than teachers and teachers aren't paid very well. Many hospitals have closed in recent years because there's no money. Our economy has been quite badly effected by the global economical crisis so I don't see things getting better anytime soon. But we do have socialised medicine which means that I or any other Hungarian citizen with a social security number can go to the hospital and pay a "visit fee" of 400 forints (google tells me $2.07 canadian dollars) and be x-rayed or stitched up or have a tooth out or what have you. We also have family doctors, assigned by where you live, but you have a different one if you like. It's more for convenience to have one who lives in the same block of flats. I don't have one currently because I haven't gotten around to it since I moved in October and I have to find my birth certificate and I've been lazy/busy/sick.

The visit fee is new, it was instated a few years ago and people protested it greatly, because the people who are affected by it most are the elderly, who may need to see a doctor several times a week and are mostly living off pensions that are very small. The visit fees means that many of them can no longer afford to go to the doctor.

When I sprained my ankle last year, I was taken to the hospital in an ambulance (for free, and it would've been free even if I wasn't a citizen because it was an emergency, so of course it's free.) where I waited about four hours and then I was x-rayed and told it wasn't broken, that they couldn't give me a brace because there weren't any, they'd run out, and that they couldn't give me crutches because the only doctor who is allowed to give out crutches was on mandatory leave for working the previous night. They didn't give me pain killers, but wrote me a prescription. They called a taxi to take me home and I scooted up the stairs on my butt.

There are private doctors too, which are much more expensive. Those who can afford them go there, because the free medicine is barely adequate.

I think Americans picture something like this when they hear socialised medicine. They don't realise that in the United States, socialised medicine would probably look a lot like it does in Canada, which is the ideal of socialised medicine.

Anyway, I just felt like sharing, in case you were interested in hearing what socialised medicine is like in Hungary.

[velvetpage.livejournal.com]

I think you're probably right - Americans have been carefully conditioned by a lot of groups to believe that anything socialized = anything communized = anything Soviet, and that the Soviets never did anything right. I'm not even going to get into that part of the argument, because it's not important. What's important is that the American insurance companies, in conjunction with a lot of right-leaning think tanks and their media outlets, have carefully constructed a worst-case scenario as a straw man. The actual fact is that socialized medicine in America would look a lot like American medicine looks now. The faces would be the same, the buildings would be the same, the procedures and suppliers would be the same. Two things would change: the red tape required to pay for anything as it wends its way through an obstacle course of insurance forms and offices, and the level of access. The first would improve dramatically for practically everybody. Few co-pays or none, one health card or one form to fill out, everyone (whether in a state or at the national level) billing the same government office. The second would improve dramatically too, for the people who had reduced access before.

Here's the kicker, though: the people who care enough to vote, the people who pay the taxes and make contributions to politicians? They're in the group for whom access would not improve. All of a sudden, approximately 20% (more, depending on which stats you believe) of the population would have access to medical care, and in dealing with the influx, the people who used to get same-day service and surgeries in two weeks might find themselves waiting a bit. If their surgeries weren't urgent, they might find themselves waiting more than a bit. (I just waited two months for a hysterectomy. Mind you, that was fine with me - I needed that time to get things together for an extended absence at work, and I was expecting a wait for an elective surgery. Would I have been so accepting of that wait if I'd known what I'd be going through in February, or if I'd expected to be squeezed in the following week? Probably not. It's about differeing expectations.)

When you're less than two decades out of a massive social upheaval, you can expect things to not be functioning quite smoothly. Hungary (and yes, I CAN find it on a map) has European ideals but a struggling second-world economy, and I would have been surprised to learn that the medical system ran smoothly in that situation. It's interesting to get the perspective on it, though.

Thanks for stopping by.

[pthalo]

Oh, yes I agree with you. I think socialised medicine would be a wonderful thing for Americans. And also a better system for disability. I know someone my age (twenties) who had to wait several years after losing their eyesight to be able to see a doctor because they had to be blind for a certain period of time before disability kicked in. By that point, the damage was irreversable. And I know of plenty of people in the states who don't have access to health care. It's quite sad.

I'm glad you can find Hungary on a map. :) I'm not surprised to learn this, though.

You're right about Hungary. A lot of people here don't realise that, though. With the change over in 1989/90 and the brand new democratic government, people were bright and hopeful for the new system. When the newly elected government did not succeed to get us out of debt (it was a huge debt and we're out of it now. Kádár, the communist politician who was in power for the last few decades of the communism borrowed a lot of money from foreign banks to increase the standards of living, which was good in the short term and people were pleased with him, but it was a problem for the government that inherited the debt), when homelessness appeared (it was unheard of before), and inflation and the problems of privatisation and all the stuggles of massive social upheaval... when that wasn't fixed in four years, people were upset and elected a different party. And the elections swing back and forth each time, since it's too big a problem for anyone to fix in four years, but things have been steadily improving.

Still, we're not there yet and things take time, and many people I know talk nostalgically of communism, when they had enough to eat, but my friends who see the bigger picture understand that it's a process.

Hungary's in the EU and we want to be part of Western Europe and we have taxes like in Western Europe (59% is the tax bracket most people are in) but we have wages like the Balkans.

(Don't get me wrong, I love the Balkans. I speak two Balkan languages (Serbian and Macedonian) which means I can make myself understood anywhere in the former Yugoslavia, except, perhaps, in Kosovo because I don't speak Albanian (yet), but their economies, level-of-living, and crime rate are worse than ours. Health care is much better in Serbia, though, than in Hungary.)

I don't know, give us another 20-50 years. We'll get there. We were occupied by Russia for 40 years, and before that it was Hitler, and before that was about 30 years of golden age with Austria-Hungary (before that we were part of the Hapsburg empire but were just one of many minorities) and before that it was the Turks... :)

[velvetpage.livejournal.com]

I spent a year in Western Europe - France - as an exchange student when I was eighteen. I don't pretend to have a huge insight on Europe as a result, but I do have a bit more than most Canadians and Americans. I have a deep respect for the depth of historical connection in Europe - the way a family can live on the same property as a ruined castle and hardly ever go in it because it's just part of the landscape. North Americans don't get that. They don't understand about memories going back centuries and spanning four or five different, completely separate regimes. The idea that Serbians routinely recall to mind a battle that was fought hundreds of years ago against the Turks is totally foreign to us over here - which means the effect of that depth of culture is totally foreign, too.

Meanwhile, I love the optimism of North America. We believe that, if we work at it, we can accomplish anything - because we have. To some extent, we gave that back to Europe after Europe had long since lost it under centuries of, "It's always been this way."

I tend to take the long view, too, and I tend towards optimism in my politics. I think Hungary will come into itself as a modern nation within my lifetime, because it's already most of the way there.

[pthalo]

I've never been to the ruined castle in my city. :)))) I've been by it a bunch of times, usually on my way to somewhere else. It's right by the river. I keep meaning to go. I've been to the museum, though.

Szeged, my city, was rebuilt in the late 19th century by Franz Ferdinand (who was loved and adored by the Hungarians, especially after this, but before that too), after a flood destroyed the city. Our main...circle street, boulevard is what the dictionary says but I'm not sure that means "a street which is in the shape of a ring that goes around the city", has six names, one for each of the cities that helped rebuild the flood (Vienna, Moscow, London, Paris, Brussels, Rome). Moscow didn't give money, actually, but a section of the street was renamed by the communists. :)

So, all of the architecture is in the Art Nouveau style. The whole city was rebuilt, with circle-streets and ray-streets, because Szeged is the Sun City (we get 2000 hours of sunlight a year, the most of any city in Hungary). But there are some older buildings left, churches mostly, and the ruined castle. My favourite is the church in King Mátyás (Mathias) square, built in the 15th century. It's pretty.

I like history a lot. There's so much of it here. March 15th is coming up, which is a national holiday, commemorating our uprising against the Hapsburgs (1848-9), which was put down. Franz Ferdinand was only 18 at the time. Thirty years later Franz Ferdinand's wife, Elizabeth, was sympathetic to the Hungarians and changed his mind, thus beginning our golden age. :) We have a lot of holidays celebrating uprisings that were put down. We celebrate 23rd October as well (1956).

North America has a lot of history too, but most of the history is that of the native Americans, who did not build castles.

I admire North America's optimism as well. Hungary could use some of it. Hungarians are happiest when they have something to complain about.

And you're right about our traditions keeping us back. Many of our traditions are beautiful, but it slows our progress and makes it harder to make changes for the good. Christianity, for example, seems very different in the Americas. In Hungary, it was surpressed during communism but most people are Roman Catholic by name, but a lot of things are just rote and ritual. In Serbia, Orthodoxy is a very important part of the culture and I've tried to learn about it as much as I can. I see people who are very religious and love going to their churches and listening to the chanting and looking at the icons and feel a very deep, personal connection with God -- yet, they've never read the Bible. It's interesting to me, because I don't understand it.

Hungary is my third country. I lived in the Carribean till I was three and a half, then I lived in the states with my parents, and I moved to Hungary alone when I was seventeen for a year abroad, but I liked it here, so I stayed and got my citizenship and have made a life for myself. My mother is Hungarian and my father is American. I've tried to make myself as Hungarian as possible and can usually pass as one when speaking. It gives me an odd view of things. I can see beyond the borders of Hungary, and I can see things about Hungary that those who have lived here their whole lives don't see or notice, because I have more to compare it to. I've been back to the states a few times, but I feel like a foreigner when I'm there, and get homesick for Hungary.

[velvetpage.livejournal.com]

I remember sitting through the debriefing of the exchange students who had been to the States the previous year. One of them described a story that made me laugh, and years later I still think it's very revealing of how Europeans and Americans each tend to view religion.

She was living with an American family who were evangelical protestants. She never said that, but I knew, because I recognized so many things she talked about that could easily have happened at my church. They asked her to come to church, involved her in the youth group, lent her a Bible, etc, etc. She went along with it all because exchange students are supposed to please their host families, right? Well, eventually, they took her to an evangelism meeting, where she was offered the chance to "accept Jesus into her heart." To the American family, this was the single most important decision she would ever make. It was life-changing, earth-shattering.

For her, it was something she did to please her host family. End of story. Eight months later, I sat in a Rotary Club meeting in France and listen to her wax eloquent - and very, very confused - about why her host family had been so excited.

I could have cleared up the mystery for her, but my French was good enough to understand her but not good enough to express those concepts, so I didn't. But it was one of several events that shed new light on my own faith that year. Sixteen years later, I'm not a Christian anymore.

She saw religion as rituals people went through at points in their lives, and as an element of cultural history. Her American host family saw it as a defining feature of their worldview. I think the European way is healthier, personally.

[pthalo]

That's a wonderful story.

I'm not a Christian, and I'm not from a Christian family, but I'm friendly towards Christianity and interested in learning about other people's beliefs (and have read more of the Bible than many Christians I know personally).

I'm not sure what my opinion of rituals are. I'll have to think about it some more.

[velvetpage.livejournal.com]

I've migrated to the Unitarian Universalist church fairly recently - like, within the last year - and for the moment I'm happy there. But it wasn't easy, and it's still not.

[pthalo]

It's not easy, no. But I don't think it's meant to be. I believe one of our purposes in life is to try to get closer to God, in terms of our relationship with God. And for any relationship to be meaningful, there has to be struggle and hardships endured. My best friend is the person I pooled my money with to buy milk and bread for dinner at the end of the month in university (something I remember quite fondly, mostly because it was shared and we always had something to laugh about), the one who's seen me through many hard times and I her, not the people I've never scratched the surface with. I think if things get too comfortable, it means we're not growing. But I think it's okay to take breaks from growing and be comfortable for a while too.

But I'm still figuring things out.

I've done a lot of looking around and stayed with what I was raised with, deciding it was what fit me the best, all things considered. And I'm happy here, for the most part. I deal with religion is a fairly cyclic fashion. I'll work on my God issues for a while quite intensely and then I'll make peace with things or at least give it a rest for a while. Right now I'm more working on other issues, and I can't muster the energy to iron out my relationship with God too (most of my God issues have nothing to do with religion, luckily), so I'm sort of in an accepting place, where I don't think too much about the things that bother me, and when I do, they don't bother me all that much.