Tuesday, November 06, 2018

2 views of socialized health care

One American's relatively positive experience in Europe:

Right-leaning Steve Crowder goes to Canada to experience the Canadian system up close and personal (and he even speaks a stumbling French that's American-accented to the point of sounding almost Québecois!*):

Finally, here's Prager U. weighing in on Crowder's side:

My own experience in Korea (along with the testimonies of some fellow expat bloggers here) and the experience of witnessing my mother's and father's quality of care in America leave me with mixed feelings when it comes to health care. My own tentative conclusion is that no system, be it more free-market or more socialist, can guarantee your quality of care.

Maybe it's true that wait times in the States are orders of magnitude smaller, but there are still horror stories, in the thousands, about people contracting MRSA and other nosocomial infections, or the occasional news article about the poor bastard who gets the wrong foot amputated. In my father's case, I remember when he was in the hospital in 1997 after getting into a car accident (the other guy, a drunk driver, was at fault). Dad had a hematoma the size of a large orange on one bicep. A male nurse came in to take Dad's blood pressure; he was starting to put the cuff on Dad's bruised arm before I barked, "Watch it!"—causing the nurse to go "Whoa!" and rip the cuff off once he saw what he was about to do to Dad. This was a classic case of not reading the chart before treating the patient (not to mention not actually looking at the patient), and it's one reason why so many family members grumble about the constant need for patient advocacy in US hospitals: without a guardian angel hovering about, you might end up with a BP cuff on a severely bruised arm. In Mom's case, she was in the hospital quite a lot, and for long periods, during her decline from brain cancer. There were instances where nurses came in to perform tests or do other procedures that had been done barely an hour before by a different nurse. This redundancy problem extended even to the giving of meds; my brother Sean was infuriated, once, when a nurse came in to dose Mom after she had already been dosed. Again, no one was reading the charts carefully. That, or the charts weren't being updated correctly. Dad would shake his head when he saw the insurance-related printouts provided by the hospital: people had gotten Mom's age wrong; they'd gotten her condition wrong; they'd listed her meds incorrectly. Dad had to correct all that information as he encountered it. Sloppiness is endemic to US hospital care, it seems.

But switch the focus to South Korea, with its more socialized health care, and the picture isn't much better. Granted, I've never had a reason to complain about wait times; I always see the doc at my local clinic within thirty minutes of walking into the place, even if there's a long line in front of me. (This is both good and bad, obviously: it means the doc is efficient, but it also means he's not looking at any one patient in any real depth.) But I've talked before about my blogging acquaintance Jeff, who used to blog at the now-defunct Jeff in Busan. Jeff chronicled his horrific experience in a Korean hospital after he'd had a serious motorcycle accident. The worst incident was when a cheap-quality metal strut placed inside his leg snapped, causing part of his shattered femur to poke into his quadriceps, forcing it to bulge frighteningly outward. Jeff also observed that, because he was a large American guy (about my size), the hospital staff had trouble finding gurneys and other equipment to fit his dimensions. Korean hospitals aren't really set up with foreigners in mind. I've written about my own experience with my previous doctor at the local clinic, back when I had an infected finger: the doc drained the pus by basically ripping at the skin over the infected area, with no concern for pain management (an issue that my friend Young brought up on his blog, back when he too was in the hospital after a motorcycle accident; Korean medical staffers are stingy with painkillers and aren't all that concerned about your comfort or your privacy).

Korean hospitals and clinics are also often grimy and generally substandard; they don't seem all that concerned about infection-control protocols (a fact that made the news during the MERS outbreak in 2015). Back when I was living near Daegu, the local hospital that I'd visited for my required health check was positively filthy. One coworker, who'd had a blood sample taken there, said the nurse clumsily splashed some of his blood onto the paperwork on her desk. To be fair, American doctors seem just as unconcerned: my mother's primary oncologist at Fairfax Hospital would never glove up, gown up, or mask up when visiting Mom under a MRSA protocol, as if he were magically impervious to infection. (Doctors are among the biggest vectors for disease inside a hospital, and they rarely follow infection-control protocols as rigorously as nurses do.) This sort of carelessness mixed with arrogance was infuriating to me. That being said, my experience of Korean dental clinics has been excellent. I don't go nearly often enough, but when my friend Sperwer, a few years back, recommended a particular dentist in the Banpo area, that dentist provided great care and worked in a very clean, bright, legitimate-looking facility stocked with modern equipment.

So whether you're in Korea or the States, whether you're talking about a market-based paradigm or one that's more centralized/socialist, you really can't tell what sort of care you're going to receive. That's disconcerting from the patient's point of view, the realization of how little control one has over one's own care. Is it possible to make a general argument about the overall level of suck in one system versus another? I don't know. Maybe. In the above Crowder video, and in the above Prager U. video, people try to do just that. But individual testimonies vary so greatly that, for a prole like me, it's hard to say, one way or the other, which paradigm comes out on top. I instinctively side with the more market-based approach and feel a bit safer vouching for the quality of care that comes out of that approach, but there's no denying how expensive it can be, especially without insurance. The one thing I know for sure is that, from the patient's standpoint, there are downsides to both systems that can affect your quality of life, either by leaving you sicker or by draining your bank account.

Go ahead and leave your thoughts in the comments, especially if you strongly believe that one system is objectively better than the other. All I have, aside from anecdotes and my own experience, is a general intuition that you're fucked no matter where you turn, so the best strategy is to stay healthy for as long as possible.

*I don't know much about Crowder, so I just looked him up on Wikipedia. Turns out he's Canadian-American, so if his French sounds Québecois, it's because it probably is Québecois!


John Mac said...

I'm firmly in the camp of free market medical care. I find it interesting that folks advocating for government run healthcare overlook the realities of what socialized medicine provides. My Canadian friends have said that rich folks there often travel to the US for treatment. Not so much that the treatment is better, just more available. For example, you might be able to get a "free" knee replacement in Canada, but you may have to wait a year for the surgery to be scheduled. And in the UK the horror stories of rationed health care are legion. And heaven forbid you are an old fucker like me because if treatment is deemed too expensive for your expected longevity, you might not survive the cost/benefit analysis.

As for Korea, I had a mixed bag experience. I really liked the relatively cheap comprehensive annual physicals. My time in a Korean hospital was nightmarish and I would have been even more screwed but for my Korean girlfriend staying by my side 24/7. When I was having breathing problems, for almost 6 months the Korean doctor diagnosed bronchitis and put me on antibiotics. After almost dying one night I went to the American hospital on base and was promptly given the correct diagnosis of COPD and the proper medicine, including inhalers.

Too soon to judge the situation in the Philippines. The government sponsored hospitals are supposedly hell holes where people go to die. One Filipino friend told me she had to actually SHARE a bed after her surgery. No thanks, I'll stick with the private hospitals should I have the misfortune to need one.

John from Daejeon said...

1st--Best doctor I ever had is in Daejeon. He studied and practiced in the U.S. for decades first. However, he runs a clinic and can only prescribe 3 days worth of medicine. http://daejeonaccess.blogspot.com/2013/01/dr-yoon-in-noeun-dong.html
2nd--Had a simple and inexpensive appendix surgery in Daejeon at a moment's notice at an Appendix hospital. Came very close to dying due to the fact that the hospital had become a prostate hospital and the doctor had not updated his specialty and had not performed a burst appendix removal in several years. Luckily, St. Mary's hospital was close by and one of my future students helped save my life. A day later my doctor/owner of the hospital and my boss had a drinking party in my recovery room celebrating the fact that I didn't die in either the hospital or my classroom in front of my students.

As this was in a privately-owned hospital, I thought I was being ushered into a third-world type of institution. It was grimy, tattered, and a quite a bit out-of-date, compared to the better hospitals on the peninsula. To save money, I got a double room, but I never had a roommate. I thought it was because I was a foreigner, but it seems that the hospital isn't all that great and is hurting for customers. To this day, my old boss/good friend likes to rub it in as to just how close I came to cashing out permanently.

Cost is definitely much better in South Korea, but doctors are more omnipotent there and hate being questioned.