As I wrote awhile ago, I am not impressed with socialized medicine. Normally, I refrain from writing about incendiary subjects but this one does have to do with being an expat. Disagree with me, as is your right, I am just here to tell you that, having witnessed it, it is not pretty. For the sake of this discussion on a possible government health care plan in the United States, the focus will only be on the level, or lack thereof, of medical care in the socialized countries in which I have lived. I wrote this last week, sat on it, and did not post it because I did not want to inflame passions. But the urge is still there. Why? Because, as I have pondered this for a week, I want to spare my readers a similar fate. Go back and read the thesis so we are clear on this. Maybe the same thing has happened to you in America but I have had few bad experiences there so I am not really a good judge on that front.
But before I take you on a trip to the local ER, I think it is only fair to expose my own biases, even at the risk of being flambeed by my readership, let me lay before you a few facts which influence my opinion. Your personal bias, as you read this, will naturally influence your own opinion. Here they are:
1) a father who, as a lawyer, defends insurance companies, mainly automobile accidents
2) former employment as automobile insurance (personal injury) adjuster in Maryland and Florida
3) eldest daughter, born with genetic syndrome
4) same daughter who receives treatment for said syndrome annually at Johns Hopkins Hospital with world-reknowned pediatric cardiologist/geneticist
5) two nephews with rare, unrelated genetic disorders; these disorders are unrelated to each other and to that of my child
6) my father had his kidney, and its malignant tumor, removed within 3 days of it being diagnosed in the United States
7) first-hand experience in hospitals in the US, Mexico, Brasil, China, and now Spain –
8) we have health insurance via my husband’s employer in the US
9) although we pay taxes in Spain, we do not apparently pay enough and so do not qualify for their socialized medicine program. We are legal immigrants.
10) I am not a germaphobe – although I encourage my children to wash their hands and not use hand rails if at all possible but the five second rule for food is fine with me (except in China).
Every year, my daughter and I, sometimes the whole family, travels to Baltimore to see her set of specialists. We are very blessed for a variety of reasons: we have insurance, generally have the means to travel there, and have access to the world’s best doctor, the latter of which is stupendously serendipitous. Not to mention having friends in that fair city, having been a former resident. Mr. Understanding works very hard, in part, to provide our daughter with the best treatment possible. We pay for the trip out of our own pocket. Thus far treatment has been minimally invasive, a true best case scenario. In any event, Mr. Understanding has an incentive beyond filling our coffers. In the US during the summers, we also have physicals with the local doc-in-a-box or get treated for the occasional illness such as shingles. Sometimes I even have an organ removed (there are getting fewer and fewer). I am generally pleased with the situation.
Contrast that with Spain, a “First World” country with socialized medical care. To me, medical care here is on par with its restaurant service. Pretend you are having lunch in the restaurant, Museo de Jamon (Ham Museum), a large franchise with relatively inexpensive, simple fare; rows upon rows of cured ham hocks dangle from the ceiling, veritable pork garlands, little plastic cones inserted at the ends to prevent oil from spilling out. There is no tipping for service in Spain. As a result, grumpy waiters deign to take orders, forget half the food, and slam plates down on the customer’s table in random fashion as the plates are prepared, sort of like in China but worse (the Chinese aren’t snoots). Talk about your perdonavidas! The Museo de Jamon is always busy and the waiters always stressed, never smiling. They are not partial to tourists. So when a family of tourists sits down to eat, it is double grump.
Now we come to the TOO MUCH INFORMATION part of the post. If you are a male or my mother-in-law, just stop reading. But if you are a woman, put yourself in my shoes. For about a month, I had a little female problem. First, I self-medicated and, for the first time ever, probably exacerbated that particular situation. Very bad. So I called Expat Doctor to the Stars, explained my problem, and got a prescription, all without an internal exam (he is not a gyne) for 75 Euros. This was on October 13. After about a week of no improvement, I asked for a referral to a gynecologist. The next available appointment was November 18. Ruling out suicide, the next best option was the ER or a trip to the US, if the situation did not improve. Finally, and fortunately, the doctor wangled me an appointment with a gynecologist for October 25. Fab!
On the appointed date, after waiting an hour and watching no less than fifteen women come and go from the doctor’s office, it was my turn. In Spanglish, the doctor and I discussed the problem. After a quick, pseudo-exam, I was out of the office five minutes later with a new prescription. I forked over 100 Euros and left. A week later, the problem persisted, but had mutated slightly. The gynecologist recommended I go to the ER next door – she was too busy to see me.
And here is where it gets icky. After paying 350 Euros (approximately $550 USD), I sat down in Swine Flu Central, a hospital located within ten miles of my house. Feverish, hacking folks surrounded me with nary a face mask, bottle of hand sanitizer, or tissue in sight. GADZOOKS, I thought, good thing I’m getting those B12 shots! Finally escorted in, I met with a doctor, who told me to pee in a plastic cup. Ever the logistician, I wanted to know precisely what to do with the urine, since I was given no little personalized, computer generated label to afix to the plastic urn, no little handy wipe, no special room. “Go to the bathroom and then take it to the front desk.” GADZOOKS, I thought to myself, haven’t they heard of secret sample doors? I will not even describe the restroom but let me just say there were no paper towels and the hand dryer did not work. So, hooking my wet finger in the door latch, I swung open the door, and with my sample dried off via toilet paper, swanned off down the hall to the receptionist’s desk where I was told to put it on the counter. Where on the counter? Right there on top of the requisition order, the only piece of evidence that the urine belonged to me. Apparently, I did not dry the sample off completely because it left a little ring, I noticed, when the receptionist, ungloved, took it off the counter and told me to return to the waiting room. GADZOOKS. The results would be ready in an hour – they would call my name over the loudspeaker system.
In the meantime, I meandered down to the cafeteria for a quick coffee where the other customers were smoking, sucking back beers, and chewing on bocadillos. The smoke drove me back into the waiting room. After waiting two hours, I went back through the swinging doors and finally began to ask if the results were ready. After two and a half hours, I camped outside the doctor’s office. A different doctor was inside the exam room reading a magazine. He told me the result was not ready – they would call my name. He did not look at a computer screen or get out of his seat, barely lifting his head from the rag he was reading. After three hours, I went and stood in front of the receptionist’s desk. Perhaps my name had been called and I just did not understand it? The PA system of the hospital has speakers that function akin to every McDonald’s drive-in in America. Try deciphering your name pronounced in a foreign language on top of this. But no, my name had not been called. Then I saw the doctor who attended me. After much prodding she went and chased down the results. Nothing wrong with my test! Did she know what the problem could be, I asked? Nope. No idea. Better luck next time. Could I even feel certain they checked out my urine and not someone else’s????
When I got home that evening, I was $550 poorer, had no idea what was wrong with me, and discovered that my car had been keyed in the hospital parking lot. Nice. I could go on and on … because this is a subject I have thought a lot about over the years, sitting in various hospitals, both in the ER and in the surgical ward, around the globe, observing the level or lack of care. This is just one experience in Spain and it was not a truly dire situation. If there are others, I hope they will be better. But I know it won’t be, especially since Expat Doctor to the Stars worked as the head of this same ER for a year and gave up because he could not institute new, better, more hygienic practices.
Is this our American future? Where are we going to go for better health care when it ceases to exist? Nowhere else I’ve seen yet. And I am not saying things don’t need to fixed. But I am saying that other countries with socialized medicine do not do it better. I have seen it for myself. The above anecdote is just one of many, the latest and freshest. If, however, the US government ends up running our health care system, I suggest we rename all the hospitals “Museum of Hams” because there will be no incentive to be polite, the service will suck, and the fare will be rudimentary. Bring your own wipes. Print your own labels. Give the doctors your old People magazines. But maybe, just maybe, they will serve beer and wine in the cafeterias so we can all anesthetize ourselves while we wait. That’d take the edge off.
*The title refers to my post of 4/17/2007 – it is only funny to me, so don’t worry if you don’t get it. The case of shigella when pregnant in Mexico probably was more expensive, if I am being honest though …..