Dr. Stephen R. Keister : Talking Health Care in the Barber Shop
I have had experience, or my family or close friends have had first hand experience, in Canada, the UK, France, Norway and Italy with medical care and in all instances have found the care prompt, efficient, caring, and generally covered by the various national health plans as a courtesy to visitors.By Dr. Stephen R. Keister / The Rag Blog / November 29, 2008
On Wednesday I was in the barbershop and in the next chair was a middle aged man loudly demeaning the Canadian Health Care system: "One has to wait forever to see a doctor,” "the doctors in Canada and Europe are poorly trained,” etc. I asked him the source of his information, and looking at this poor old man, he answered "why from my friends in Seattle and THEY KNOW.” End conversation, as one learns that it is the acme of futility to reason with such folks. About as reasonable as arguing theology with Sarah Palin's pastor!
In truth, the Canadian health care system is not “universal.” The federal government assures financing and established the basic format, but the program is administered by the provinces and their rules vary. As to waiting, this is relative. In an emergency in Canada, as in Europe, acute situations are taken care of post haste; however, elective surgical procedures, i.e. a total knee replacement for instance, may require twice as long a wait as in the United States. One should note as well, that one has faster care from a specialist in a city as one does in one of the rural western provinces.
As to training of Canadian, or Western European physicians, their education is equivalent, or in some instances better, than in the United States. Further, in Western Europe there are more general practitioners per 100,000 citizens than in the USA. In addition they have more hospital beds and CT Scanners available, there is very little paper-work involved, and no-one goes without medical care. I learned what it is to be without medical care when I worked after my retirement as a volunteer physician in a neighborhood free clinic. We provided “care” but we were by and large restricted to practicing Third World medicine due to restraints in doing sophisticated medical testing which most of us normally take for granted in the every day world.
To wait for a doctor’s appointment in this country is not unique. If one wishes to see the chief of a service, at a specific institution, one can wait some weeks or indeed some months. If one is happy to see a subordinate physician one can be seen within several days. However, the enemies of a system, can cherry pick, and cite the time to see the chief of service as a “normal” wait. At best, in this country, one can wait and where I am it may require six months to get an appointment with a dermatologist.
I have had experience, or my family or close friends have had first hand experience, in Canada, the UK, France, Norway and Italy with medical care and in all instances have found the care prompt, efficient, caring, and generally covered by the various national health plans as a courtesy to visitors. I must note than in two instances in Italy the departing patients were asked to pay their TV charges as these were not covered by national health payments. One gentleman who was hospitalized for three weeks with a stroke was not charged but the hospital administration asked for his insurance information in the event they could collect it. Business offices in European hospitals are not necessarily operations that catch ones attention, on occasion being in the hospital basement
Yet medical care, under the system dominated in this country by the insurance companies ain't what it used to be. When did you last talk to your doctor on the telephone? Ist is my recent experience, and that of my friends, that one gets a callback from the doctor's physician assistant or nurse. Compare this with my partner of some 30 years ago. Paul was a diabetic specialist, his practice largely children with diabetes. Every evening at home Paul had a “calling hour,” 7-8 p.m. after dinner, when his patients could call him with questions or problems. Most of us of that era did not go as far as Paul, but made sure before leaving our offices that we responded to every patient who had called us that day and needed personal advice. These days, so very much of the doctor’s time is spent on the telephone talking to insurance companies to clarify rules about how they should treat their patients.
Another recurring problem for the elderly is developing opposition by many members of congress to "Medicare Advantage Plans.” To understand what underlies this debate one must have some idea of what constitutes "neo-liberal" economics (supply side economics) which became the only way under the Reagan administration, per economist Milton Friedman. This is an economic theory that advises that all government programs should be privatized, that all economic controls should be done away with, and that all social service programs, such as Social Security and Medicare, should be excluded as government functions. President Bush tried several years ago to "privatize" social security, and congress, in of its few sterling moments, stopped the plan. Mr. Bush wished to turn Social Security over to the stock market! If he had succeeded imagine that in the present economic downturn that your monthly payment would be 50% of what it was.
"Medicare Advantage" is the Bush attempt to privatize and do away with government sponsored Medicare. Currently the government spends $94 billion per year on "Medicare Advantage,” some $15 billion of that is excessive and mostly represents profit to the insurance companies that administer the plans. The tragedy for the elderly, is that in the long run these excesses will exhaust the Medicare Fund, and no more Medicare. Some privatized plans give an initial impression of better service at the cost to the Medicare Fund of $1100 per enrollee; however, at some point one will find varying restrictions as to what the individual insurer will pay. We are now seeing the fruit of the deregulation of our financial institutions with a looming depression which may rival that of 1929.
Further, the incoming congress and Department of HHS must revise the present absurd Medicare Prescription Act to benefit the patient rather than produce profits for the insurance and pharmaceutical industries. The FDA not only has been staffed by the Bushadministration with incompetent, unqualified ideologues, but the fiscal policies regarding prescription drugs must be revised. An AP analysis found that Medicaid paid nearly $198 million from 2004-2007 for more than 100 unapproved drugs. Further, Medicaid as an entity is a failure as a means of decent health care. Before my retirement 18 years ago the payments to the physician were so meager that one could not cover office overhead if one’s practice contained too many Medicaid recipients. As a result we designated, as I recall, Thursday mornings for seeing our Medicaid patients. This is patently unfair, and a single payer, universal plan should incorporate all citizens equally. Further, when the new FDA appointees take over, the ability to obtain the "morning after pill" should be determined by scientists and not Bush-appointed religious crusaders.
For those with further interest I would once again refer you to the originators of HR 676, Physicians For A National Health Program, as well as a recent article in Campaign For America’s Future having to do with the insurance companies’ offer to provide universal care, and finally The Washington Post re: the FDA.
It is important that the older population and their offspring understand some aspects of the current campaign for universal, single payer health care. I am in perfect accord with Rep. Jesse Jackson Jr.'s recent suggestion of a constitutional amendment guaranteeing health care for all Americans.
There are those in the Obama entourage who feel that incorporating a universal, single payer health care plan, would be another anchor in providing economic recovery. Let us made our wishes known to the President Elect and join in that chorus.
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