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08 July, 2009

The best medical care in the world

I have little doubt that the best medical care in the world is available in the United States. We have access to technology broadly, and we have excellent medical training in the latest techniques. But the catch is the term "available", because not everyone has access to this. Some people in this country have no medical care. Or limited coverage. Or extremely poor quality facilities that offer nowhere near the highest level of care.

But even if you have great medical care, there is a compartmentalization and corporatization of your healthcare that is maddening. Everything is governed by the policies of the insurance companies. And the staff at the insurance companies know nothing about your health, and for the most part nothing about the medical aspects of the procedures or care that is required or provided. They only know what their pamphlets say is covered or not covered. And they also have a vested interest in making sure that as little is covered as possible according to their terms. Because they are in this for a profit, not for your well-being.

Thus, to see a specialist, you often need to see your primary care physician, who understands nearly nothing about what the specialist will provide. This primary care physician needs to be the gatekeeper for determining if you have permission to see the specialist. It isn't really called "permission" though. It's their professional expert assessment of the need. And one thing doctors are great at doing is giving you expert assessments, regardless of whether they know what they're talking about or not. Of course, the doctor will tell you what you need to do, but they have no idea whether this is covered by insurance, and they also have no idea what the typical costs are for such a procedure. It is not their business to know such things. You could argue that it's better the doctor doesn't know, because then your medical advice is based purely on need, rather than on cost savings or profit. But if the doctor knew that procedure A is $1000 and is not covered, whereas procedure B is $100 and is covered, and 90% as effective as A, then they could offer you the choice.

After figure out what is covered and what is not, which requires great nuisance, and often embarrassment and feelings of privacy violation, you see your doctor, and then perhaps you are given a prescription. Again, the doctor knows nothing about costs or coverage. And then you need to go to yet another place, the pharmacy, to have this prescription filled by someone who knows about as much about biology and medicine as I know about astrophysics, and they give you your medicine.

This process seems messed up.

Contrast this with the European system, where everyone has healthcare. And where you go to the doctor when you think you need to go to the doctor. If you need to see a specialist, you are sent to a specialist. And for many basic types of illnesses, the doctor gives you the pills that you need, and you're done. There's no talking to beaurocrats. And there's no red tape. The process is that you get treated, and it costs you little or nothing. It's humanizing. Nobody is in that business to make a profit.

You hear stories about the long wait to see a doctor, or the poor quality of care. But the same exact thing is possible here in the US, unless you have the most elite of health plans. If you go to a typical HMO clinic, you will have long waits, and poor quality care. If you go to even the best of emergency rooms, you will undoubtedly have a long wait unless you are literally almost dead on arrival.

Nobody in control in this country wants you to take a good, hard look at what happens in the civilized world, because it would be unfathomable the discrepancies between here and the rest of the world. We need to resort to asinine assertions of poor quality care (which we also provide in great portions here, when we provide coverage at all), and when that fails, we throw out the big "S" card: Socialism. Somehow, "socialism" has become a curse word in this country. We heard it thrown around left and right during the presidential campaign. But somehow, it was not socialistic to bail out our banking corporations and our auto manufacturers. Is it more, or less socialistic to subsidize corporations or citizens? I am not sure. I guess there's a difference between socialism and corporate welfare.

How a nation can allow individuals to live without medical care, and yet call itself civilized, is beyond me. But I guess that's what being "free" is all about. It's the freedom to have nothing.

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