Monday, March 21, 2016

The National Health

When Bernie Sanders says he thinks we need a revolution in politics in this country and then says the United States should define health care as a right not a privilege, he really is talking about a revolution in values.

When you hear any politician, any Congressman, Senator say the United States has the best health care system in the world, the envy of the world, with foreign doctors coming here to learn the most advanced techniques, you know one thing for sure: That politician hasn't the faintest idea of what he or she is talking about.

Yes, foreign doctors come here to train, from Pakistan or India or third world countries, but we send plenty of American doctors to Europe to work with and learn from English, French and German doctors. CT scans were developed in England, laporoscopic surgery was pioneered in Europe. And most Europeans will say the United States may have the best medicine for the richest 10% but for 90% of Americans, medical care is far inferior to European and particularly Scandinavian health care.

When Bernie Sanders says every other industrialized nation offers universal health care and asks what is wrong with America for not being willing to do this, he is suggesting we ought to have a radically different set of values than what we have had in the past.

I really don't know whether you get better care in England or France or Germany vs the United States, but I do know when I watch "Prime Minister's Questions" from Parliament in London, at least 25% of all questions relate to complaints about health care, about a clinic which hasn't been built or refurbished. 
Clearly, the reason so many Senators and Congressmen don't want an expanded government role in medical care is they know that would put them in the position of having to answer constituents' health care complaints, and they already get enough phone calls about Medicare and Social Security--Health care is one more responsibility they do not want anything to do with. 

Not my job! 

Congressmen right now have lots of things on their plates: constituent services, fundraising, committee meetings, dialing for dollars, political meetings, fundraising, trips home to the district every week, dialing for dollars--the last thing they want is the nightmare specter of actually having to solve real problems for real people, like how to get Mrs. Jones the CT scan her doctor says she needs but the federal health care system denies.

Reading about healthcare systems in other countries, it's clear they have faced all the same problems we have faced when it comes to providing services for which there is greater demand than capacity to provide.  Just as we have found in the USA, when access to healthcare has been freely provided the service providers are quickly overwhelmed by demand so in France and Germany, steps had to be taken to reduce access.  

Just as the public abuses the 911 emergency call in number, calling for a ride to the hospital for a routine clinic visit, calling an emergency number for non emergency reasons, the public, given access for free, will always abuse and drive a service into uselessness. 
For years, patients have had free access to their physicians on the weekend for "emergencies," and they have abused this service by calling for prescriptions they hadn't bothered about during the week,  because they knew they could always call the on call physician on the weekend, or patients who haven't been seen for a year calling to have their blood pressure medications renewed at night, after office hours, or patients calling demanding antibiotics for what they insist is a sinus infection, because they don't want to pay the co pay and take time off work to see the doctor during office hours.  

So, the public can drive providers into defense mode. Charge $5 for the after hours phone call and you cut down on that emergency need for the prescription by 80%. Suddenly, not so much of an emergency.

The French have explicitly decided that health care ought to be offered free to all citizens, to all human beings who seek care within their borders, and they have decided doctors' first responsibility is to the patient, not to the government or the health care system, but this has caused them to face the results of this generosity--systems which are quickly overwhelmed and the money runs out.

In Germany, the average citizen can expect to pay 10% of his annual income on a health care assessment tax--how many people in the USA making $200,000 would be willing to pay $20,000 for their health insurance, even if drugs are included? 

Americans will vote for an aircraft carrier with a smile, but they howl bloody murder about their Medicare taxes. 

France has faced the same problems distribution of physicians we have in the US-- getting doctors to live and practice in rural areas, which are typically economically depressed and not at all where people who have been trained in big city hospitals want to live. So, as in the US, the French have found rural hospitals closing, and a deficit of doctors in less desirable towns and communities.  

As doctors' salaries have fallen into the $80,000 range, the medical workforce has changed to 2/3 female physicians, who are often the second salary in their family and who refuse to work long hours or to be on call who say they have more important responsibilities at home with their children.

Both France and Germany have had to deal with poor people and the unemployed, whose healthcare cannot be supplemented by employers, and have had to level taxes upon the well insured workers who have both government and private insurance and who are taxed to support those with only bare bones government insurance.

In England, France and Germany, health care facilities are often operating in the red and special efforts have to be made to shore up these public institutions.

So, when Bernie speaks in dulcet tones about the wonders of universal health care elsewhere in the world, he does not dwell on the problems in those systems. 

By many objective measures, these countries succeed in providing more care than we do, but they pay more for it. They have decided to spend money on health care. They do not have our defense budget. They may economize in other areas. But even if health care is a right, it is definitely not for free.

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