Wednesday, June 08, 2005

An Innocent Abroad......
From Opinion Journal: Fox News host David Asman describes his wife's experience in the British and American health system:There's No Place Like Home Mr. Asman has nothing but good things to say about the people who took care of his wife:
The emergency workers who came within five minutes were wonderful. The two young East Enders looked and sounded for all the world like a couple of skinhead soccer fans, cockney accents and all. But their professionalism in immediately stabilizing my wife and taking her vitals was matched with exceptional kindness. I was moved to tears to see how comforting they were both to my wife and to me. As I was to discover time and again in the British health system, despite the often deplorable conditions of a bankrupt infrastructure, British caregivers--whether nurses, doctors, or ambulance drivers--are extraordinarily kind and hardworking. Since there's no real money to be made in the system, those who get into public medicine do so as a pure vocation.
And the collaborative nature of care was impressive:
As for the caliber of medicine practiced at Queen's Square, we were quite impressed at the collegiality of the doctors and the tendency to make medical judgments based on group consultations. There is much better teamwork among doctors, nurses and physical therapists in Britain. In fact, once a week at Queen's Square, all the hospital's health workers--from high to low--would assemble for an open forum on each patient in the ward. That way each level knows what the other level is up to, something glaringly absent from U.S. hospital management
But the facilities left much to be desired:
When I covered Latin America for The Wall Street Journal, I'd visit hospitals, prisons and schools as barometers of public services in the country. Based on my Latin American scale, Queen's Square would rate somewhere in the middle. It certainly wasn't as bad as public hospitals in El Salvador, where patients often share beds. But it wasn't as nice as some of the hospitals I've seen in Buenos Aires or southern Brazil. And compared with virtually any hospital ward in the U.S., Queen's Square would fall short by a mile.
The equipment wasn't ancient, but it was often quite old. On occasion my wife and I would giggle at heart and blood-pressure monitors that were literally taped together and would come apart as they were being moved into place. The nurses and hospital technicians had become expert at jerry-rigging temporary fixes for a lot of the damaged equipment. I pitched in as best as I could with simple things, like fixing the wiring for the one TV in the ward. And I'd make frequent trips to the local pharmacies to buy extra tissues and cleaning wipes, which were always in short supply.
There is also the technology gap:
For example, when we returned to the U.S. we discovered that treatment exists for thwarting the effects of blood clots in the brain if administered shortly after a stroke. Such treatment was never mentioned, even after we were admitted to the neurology hospital. Indeed, the only medication my wife was given for a severe stroke was a daily dose of aspirin. Now, treating stroke victims is tricky business. My wife had a low hemoglobin count, so with all the medications in the world, she still might have been better off with just aspirin. But consultations with doctors never brought up the possibilities of alternative drug therapies.

Defensive medicine seems to be absent from Great Britain:
There is also much less of a tendency in British medicine to make decisions on the basis of whether one will be sued for that decision. This can lead to a much healthier period of recuperation. For example, as soon as my wife was ambulatory, I was determined to get her out of the hospital as much as possible. Since a stroke is all about the brain, I wanted to clear her head of as much sickness as I could. We'd take off in a wheelchair for two-hour lunches in the lovely little park outside, and three-hour dinners at a nice Japanese restaurant located at a hotel down the street. I swear those long, leisurely dinners, after which we'd sit in the lobby where I'd smoke a cigar and we'd talk for another hour or so, actually helped in my wife's recovery. It made both of us feel, well, normal. It also helped restore a bit of fun in our relationship, which too often slips away when you just see your loved one in a hospital setting.

Now try leaving a hospital as an inpatient in the U.S. In fact, we did try and were frustrated at every step. You'd have better luck breaking out of prison. Forms, permission slips and guards at the gate all conspire to keep you in bounds. It was clear that what prevented us from getting out was the pressing fear on everyone's part of getting sued. Anything happens on the outside and folks naturally sue the hospital for not doing their job as the patient's nanny.

Why are the Brits so less concerned about being sued? I can only guess that Britain's practice of forcing losers in civil cases to pay for court costs has lessened the number of lawsuits, and thus the paranoia about lawsuits from which American medical services suffer.
The Asmans also get to see how the other half live during a trip to a private hospital:
Before she could travel back home, my wife needed to have the weak wall in her heart fortified with a metal clamp. The procedure is minimally invasive (a catheter is passed up to the heart from a small incision made in the groin), but it requires enormous skill. The cardiologist responsible for the procedure, Seamus Cullen, worked in both the public system and as a private clinician. He informed us that the waiting line to perform the procedure in a public hospital would take days if not weeks, but we could have the procedure done in a private hospital almost immediately. Since we'd already been separated from our 12-year-old daughter for almost a month, we opted to have the procedure done (with enormous assistance from my employer) at a private hospital.

Checking into the private hospital was like going from a rickety Third World hovel into a five-star hotel. There was clean carpeting, more than enough help, a private room (and a private bath!) in which to recover from the procedure, even a choice of wines offered with a wide variety of entrees. As we were feasting on our fancy new digs, Dr. Cullen came by, took my wife's hand, and quietly told us in detail about the procedure. He actually paused to ask us whether we understood him completely and had any questions. Only one, we both thought to ask: Is this a dream?
Ms. Asman then returns to the States for her rehab.
So how much did it cost?
But what of the bottom line? When I received the bill for my wife's one-month stay at Queen's Square, I thought there was a mistake. The bill included all doctors' costs, two MRI scans, more than a dozen physical therapy sessions, numerous blood and pathology tests, and of course room and board in the hospital for a month. And perhaps most important, it included the loving care of the finest nurses we'd encountered anywhere. The total cost: $25,752. That ain't chump change. But to put this in context, the cost of just 10 physical therapy sessions at New York's Cornell University Hospital came to $27,000--greater than the entire bill from British Health Service!
There is something seriously out of whack about 10 therapy sessions that cost more than a month's worth of hospital bills in England. Still, while costs in U.S. hospitals might well have become exorbitant because of too few incentives to keep costs down, the British system has simply lost sight of costs and incentives altogether. (The exception would appear to be the few remaining private clinics in Britain. The heart procedure done in the private clinic in London cost about $20,000.)

"Free health care" is a mantra that one hears all the time from advocates of the British system. But British health care is not "free." I mentioned the cost of living in London, which is twice as high for almost any good or service as prices in Manhattan. Folks like to blame an overvalued pound (or undervalued dollar). But that only explains about 30% of the extra cost. A far larger part of those extra costs come in the hidden value-added taxes--which can add up to 40% when you combine costs to consumers and producers. And with salaries tending to be about 20% lower in England than they are here, the purchasing power of Brits must be close to what we would define as the poverty level. The enormous costs of socialized medicine explain at least some of this disparity in the standard of living.
A way I have read about how to compare this is that even the exchange rate today is 1 pound= $1.82 the purchasing power between the pound and the dollar is roughly equal. That is a pair of shoes that cost $70 here will go for 70 pounds over there, but I digress. Back to the article:
As for the quality of British health care, advocates of socialized medicine point out that while the British system may not be as rich as U.S. heath care, no patient is turned away. To which I would respond that my wife's one roommate at Cornell University Hospital in New York was an uninsured homeless woman, who shared the same spectacular view of the East River and was receiving about the same quality of health care as my wife. Uninsured Americans are not left on the street to die.

O.K., who wants to sign up first?
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