Some Thoughts on Healthcare

Portrait caricatureThroughout the three years I lived in Canada, and the eight years I lived in Denmark, I would periodically return to the U.S. to see family and friends. I would regale my American acquaintances with stories of what it was like to live in a land with little to no poverty, absurdly cheap to outright free higher education, a generous minimum wage and free government healthcare. I was surprised and even hurt to find that instead of inspiring my listeners to lobby for such things themselves, I was branded an “America hater.” My hope that we might bring the quality of life indicators in the U.S. up to, or at least approaching, those of every other economically developed nation was viewed not, as I had conceived it myself, as an expression of fervent patriotism, but as outright treachery. How dare I say that anyone anywhere in the world was actually living better than people in the U.S!

Everyone knows there are lies, damn lies and statistics, so why would any intelligent American give credence to fantastical claims about such abstract and esoteric things as life expectancy, infant mortality, rates of disease, obesity and malnutrition? And how can you be malnourished anyway if you’re obese? Clearly these statistics are just part of a leftist conspiracy to make us feel stupid for believing what everyone knows is the God’s honest truth–that the U.S. is the greatest country in the world, and that no people on earth live better than we do!

I am beginning to wonder, actually, whether the people who are opposed to a government option in the healthcare debate might not be right. That is, I am coming to view it as irrelevant to the debate that my experience of the Canadian and Danish systems was very positive, far more positive, actually, than has been my experience of the American system since I moved back to the U.S. in 1998. I saw physicians in Canada and Denmark for bladder infections, colds, sinus infections, acne, toxoplasmosis, migraines and suspected melanoma. I could always get an appointment within a few days of calling. Never did I wait more than twenty minutes to see the doctor and usually the wait was less than ten. I did have one bad experience in Denmark. I went to a doctor for acne and was told pointedly that I did not suffer from acne and that I should not be wasting the doctor’s time. But then I just went to another doctor who was very sympathetic and who prescribed a topical antibiotic–all without paying a dime.

My best experience with the Danish system was the treatment I received for migraines. I was diagnosed with migraines by a friend who was a physician and who very kindly wrote me a prescription for some new medicine, Imitrex (Imigran in Denmark), which he said was very effective. I was initially put out when I had the prescription filled and learned that my little 100mg pills were approximately $5 each. Five dollars a pill, I thought, that’s outrageous! It was only later when I ran out of the medicine in the U.S. and found out that it would cost me $100 for a 100mg dose that I came to appreciate how reasonable was the $5 price.

I asked my friend, when I returned to Denmark, why there was such a huge discrepancy in the price of the Drug in the U.S. versus the drug in Denmark. The Danish government, he explained to me, negotiated with the pharmaceutical companies to buy drugs in bulk at very low prices, then on top of that, the government subsidized 75% of the cost so that the public paid only 25% of what the government had paid. We both quickly did the math and realized that the Danish government was paying Glaxo Smith Kline $20 for a 100mg dose of Imitrex.

But if the Danish government could get it for $20, why did Americans have to pay $100 for it? Of course most Americans who take Imitrex don’t really pay $100 for it, not directly anyway; their insurance companies pay $100 for it. That’s why, as I learned to my distress when I moved back to the U.S., my insurance company would not cover more than six doses per month of Imitrex, Maxalt, or Zomig, or any other of the new migraine drugs. If I needed more than six doses (as I sometimes do), I was on my own.

Of course it would be easier for U.S. insurance companies simply to negotiate with the pharmaceutical companies the way the Danish government does to get drugs at a more reasonable price–but then it would be harder for them to charge such high premiums! Or perhaps it is just that the drug companies know that Americans are blithering idiots whom they can easily milk for five times the cost of what they feel is sufficient to justify the sale of the same medicine to Danes if they can convince us that by paying more we are avoiding the taint of socialism. No matter that the Danish money goes into the same capitalist coffers as our American money. We won’t see the implications of this because we are just irredeemably stupid.

If you want proof of Americans’ stupidity just listen to the talk in the U.S. about how government healthcare would limit people’s choices. My experience has been precisely the opposite. It’s private health insurance that is designed to make a profit off people’s illnesses that limits their choices. That’s how these companies make a profit, actually–by limiting people’s choices. That’s why Obamacare isn’t going to be much better than the old system: it still depends on insurance companies. How much money can insurance companies make if they cover every visit to the doctor, every medicine or treatment you need and make sure you were fully and completely taken care of?

No, insurance companies make their money by cutting corners on your care. We’d understand that if we weren’t butt stupid. My doctor in Denmark could prescribe for me as many doses of Imitrex per month as I needed, and I could afford to pay for as many doses as he prescribed, whereas my doctor in the U.S. bemoans that her patients cannot get more than six doses per month.

In Philadelphia, I used to have these really long waits in my gynecologist’s office. I waited almost two hours once. I don’t go to that gynecologist anymore. It wasn’t my choice though. The cost of malpractice insurance in Pennsylvania drove the good doctor into early retirement. When I went back to my primary care physician for a referral to a new gynecologist, she just threw up her hands. Everyone was leaving PA, she told me, because of the cost of malpractice insurance. She did know of one doctor who was very good and who might be willing to take me on as a new patient. “She doesn’t take insurance though,” my doctor explained apologetically. So even though I am fully insured by my university employer, I have to pay through the nose for my annual gynecology exams. And no, I can’t get reimbursed because the cost doesn’t exceed my “out-of-network deductible.” And I have to drive to New Jersey for my exams, because this doctor too has now left PA.

Oh how I long for the days when if I did not choose my own physician, the Danish government would simply appoint one for me within a four block radius of my residence, when I never waited more than a few minutes for first-class care, never paid even a small “co-pay” for it and when I could get as much medicine as my doctor felt I needed at a price I could afford even when I was still a student.

Americans don’t want to hear these stories though. I’ve had people become so angry with me when I explained how positive was my experience of two different government run healthcare systems that I actually feared they might spit on me. In a way, I don’t blame them. Hearing how the rest of the economically developed world lives is, for Americans, like hearing that everyone else is riding around in shiny new cars while we are having to make do with our broken-down bicycles. This, coupled with the knowledge that the U.S. is one of the wealthiest countries, per capita, in the world–well, it’s just too much to handle. Smoke begins to come out of people’s ears like the robot in “Lost in Space.” “Can’t compute, can’t compute” our little underdeveloped intellects scream until we begin to fear that our brains might actually explode. And they probably would explode if information about how other country’s health care systems work actually begins to filter through the Neanderthal-like layers of ignorance, prejudice and chauvinism that constitute the American skull.

Yes, it’s true. I have become an America hater. When I lived in Denmark, I used to long nostalgically for the open-minded, socially egalitarian culture of my forefathers. I felt a deep connection to the country where my ancestors had come before it even was a country. It actually took being back here to turn me off of it. I think we Americans have to look the facts squarely in the face and admit that we are hopeless losers. No matter that other countries’ governments can provide their citizens with quality health care–WE will not be able to do it. Someone in the halls of power would figure out a way to siphon off all the money for him or herself so that we would be left with a system that is just as bad as the one we have to endure now. No matter that other peoples would not accept such a system from their governments–WE would accept it.

We would accept a wretchedly bad government-run healthcare system because we will accept anything from the government. Poul Schlüter had to resign as prime minister of Denmark in 1993 after it was revealed that someone in his administration had conspired to keep political refuges from bringing their families to Denmark, as Danish immigration law clearly stated they could. Schlüter wasn’t even directly involved, but it happened on his watch. Someone in his government had broken the rules. Danes don’t like it when their politicians break the rules–so Schlüter was forced to resign.

Americans don’t mind when politicians break the rules though. We’ll accept election fraud, torture, the violations of our civil rights. A president, or other elected official, can even tell outright lies to trick us into a war that by conservative estimates has killed tens of thousands of completely innocent people, not only without losing office, but without even losing face!

Yes, we’d accept a completely dysfunctional system of government-run healthcare. We’d accept it and with characteristic fatalism tell ourselves that, after all, that was all one could expect from a government-run system. No matter that other governments can run such systems effectively–we would not be able to do it … because we are complete losers!

Look at what we have already accepted: hours-long waits at the doctor’s office, insurance companies telling us they will not cover our “pre-existing conditions” and will allow us only so much medicine, even for conditions that are covered. No matter that it wasn’t always this bad. We’ve accepted a long, and apparently inexorable, diminution in the quality of healthcare in the U.S. It doesn’t matter that, for example, the Canadian system and the Danish system are far superior to the system we have now in the U.S.–even for the fully insured .

We are going to hell in a hand basket and we know it. Things can only get worse. Any change, our experience of the last twenty-five years tells us, can only be for the worse, so we resist change. We know things can only get worse because we know, on some level, that the entire rest of lthe economically developed world left us in the dust long ago. Mention the French, high-speed trains and see what kind of reaction you get out of people. It might be wise, however, to check for the location of the nearest exist before you mention that they can reach speeds of almost 200mph miles per hour and get you from Paris to Frankfurt in four hours (Amtrak would take about 14 hours to go the equivalent distance).

(An earlier version of this piece was published in the 14 September, 2009 edition of Counterpunch )

15 responses

    • Yes, I know, but they do not actually have the waiting times they are fabled here in the U.S. to have. Danes complain if any of the social services the government provides do not function perfectly. I love that about the Danes. We tolerate unbelievable degrees of incompetence and corruption in our elected officials here in the U.S.

  1. I really appreciate your post on the differences between Danish and American “healthcare.” This further substantiates my beliefs that we, as Americans, need to abandon not only our healthcare “system,” but the entirety of government. No one should have access to the kinds of powers afforded within the walls of the congress, the senate and the white house. Absolutely no one.

    On the subject of “healthcare,” I underwent cardiac five bypass surgery in 2007. Five months later, it failed. From research I discovered that fifty percent of these kinds of surgeries fail. No matter, someone is making money, now at about $50,000 dollars a bypass. Wonderful capitalism.

    Erik

    • Thanks for this nice comment. I can’t tell you how sorry I am to hear that your cardiac surgery failed. I’m afraid the healthcare industry has completely lost perspective in this country. I’m not saying procedures with only a 50% success rate shouldn’t be performed. People should definitely be informed, however, that that is the success rate they are looking at BEFORE they make any decisions about whether to undergo a particular procedure.

  2. I wonder if its quite right that that there is only a 50% succes rate on that surgery, which I myself underwent nine years ago – with succes untill now. Of course there is a risk – but there shall also be a risk doing nothing. The price as in Denmark – but you don’t have to pay it yourself here. But – you have to accept taxpaying higher than in countries where you have another system…

  3. There was a documentary made many years ago about the American healthcare system. Apparently, different hospitals can have widely divergent “success rates” with different types of surgery. Perhaps that 50% figure is for that particular hospital. It does seem very low.

  4. Australia has a two-tier system: public and private health systems. If you are acutely ill, public looks after you OK. Private can too but is more geared to long term problems like orthopaedic , eye, obstetric or surgical interventions.
    Each system complements, poaches from, each other. Its complex.

  5. The idea that an individual’s health should be traded like a commodity on the open market is highly distasteful to me as a person with health (or not, depending on the day). This is to me the chief difficulty with “market fixes.” Healthcare should not be an industry, and the only way to avoid that is to place control of the system into government hands.

    As for the “fully insured,” there is in practice no such thing in the US. Take my wife, for example: I have above average healthcare with Blue Cross Blue Shield through my employer, but even with (comparatively) excellent coverage, she has been unable to acquire certain vital medications by way of our insurance provider. Which means one is still left to decide between health and finances.

    • I could not agree with you more. Healthcare should not be an industry. Government should control it. Health is a basic human right and to deny it to people because they cannot pay for it is simply wrong. That ought to be obvious. That it is not obvious to everyone in this country does not speak well for us as a nation.

  6. Once more, I feel the need to point out that “free government healthcare” is an incorrect formulation (albeit rampant). Healthcare, like everything else, is not free. We pay taxes for those services in Canada. From “free government healthcare” floats the impression that healthcare is a “gift from the government”, which it is not; that citizens don’t have to do much to get this gift, which is not true (citizens work hard and pay high taxes). But most important of all, I think, is that while we keep comparing private healthcare with “universal healthcare” (that’s the correct one), we tend to forget that the latter’s existence is due to people who understand and cherish the qualities of “sharing” and “empathizing” in a world ravaged by the excess of capitalism and the idea of profit over everything else.

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