Ladies, are you receiving better healthcare in the United States?

[Ronnie]

My wife used to say that the doctors in her former country of Ukraine are better than those here in the USA.  While I had some personal experience with Ukrainian doctors, I reserve my opinion because my wife's mother was a pediatrician who worked for the Soviet system.

What opinions can you share?

Here's a 30-year old speech on the subject given my a Noble laureate in Economics whom I revere very much.

[youtube=425,350]http://www.youtube.com/watch?v=VPADFNKDhGM&NR=1[/youtube]

[Lily]

The medicine would be something that I feel concerned about when and if I move to North America.

My US experience was something more of negative. My health insurance excludes the pre-existing conditions. When I went to a doctor, she wrote my complaints the way that it was not possible to distinguish when the complains started. Although I told her right away that it started during the last month only, she recorded that it started during the last months, with plural. This resulted in my problems, as the insurance company refused the coverage because they are not covering any pre-existing conditions. I went back to my doctor, she corrected the records but the insurance persisted anyway. This makes me believe that in the U.S. a patient has also to struggle with the insurance companies.

Also, but I may be wrong about it, I noticed that Russian medicine takes preventive measures rather seriously. For example, with my health insurance arranged by employer, I am sure that everytime I can go to doctors (I can chose between a number) with even the slightest concern about my health, and they will arrange for me all investigations using the most modern equipment. There are some minor discomfort about, for instance, getting my health history in my hands (usually it is stored with the clinics on file and not given to the patient). But I think this is bearable.

[gemini]

American physician wants to make a patient functional and send him to work ASAP. My husband got rash on his legs. His physician wrote the prescription for hormonal pills right away. They are very powerful anti-inflammatory drugs of course and the majority of rashes will disappear with this treatment next day or so.
 What would Russian physician do?  She would start more spare treatment locally with a cream and some anti-histamine pills and then if it did not help she would try some other cream and if spare treatment fail she would write a prescription for the more powerful pills that have more side effects.
I would say Russian treatment looks more like an art and American one is business.

[mies]

Back in Ukraine I had received both excellent and really bad healthcare.
In some cases it depended on the hospital type, in some - on doctor. For example - in the tiny and underfinanced "emergency" hospital in Odessa where I received an emergency surgery I got excellent treatment and I know of some other state-of-the art surgeries that were performed there.

In Kyiv hospital for students which I was supposed to visit during my student years - I received really questionable small surgery which had severe complications and I had to be treated for long time in the hospital in my native town. Doctor's wrong diagnosis led to surgery decision while with the right diagnosis surgery was exactly what should not have been done.
Few other times when I needed serious help - my parents used "contacts" to find the best doctors in the field. I do not think I'd be able to find these doctors myself - the information is not freely available to the outsider - you get it through networking. People build their networks of contacts during the adulthood. Hence - networks are usually geographically limited, and younger people have less contacts unless they are using parents' help.
However, the good doctors provide treatment to everybody who comes to visit them, and for people who are unaware of doctor's qualification - this is a question of random choice - not the size of a bribe/payment or "connections" to get good treatment. Connections only help to get the information about doctors. All doctors I met - were working in public hospitals and health care was free.

One time - i had "avoided" an unnecessary kidney surgery. My mom got many "second opinions" and found a replacement for the unqualified doctor. Had she not - i'd probably be partly disabled now and living with one kidney.

bottom line - I strongly believe that in Ukrainian healthcare it is more important to have connections than to have money. Otherwise - possibility of finding a good doctor is randomized. You may be lucky to meet one, or may be not.

Good things about FSU medicine - doctors usually treat the cause, not just the effect. If there is a pain - they first do all tests to find what causing it, and not give you the painkillers to fight the pain. They also use more integral approach to the health care.
In USA, in my experience, it's exactly vice versa.

-----

now - to the American doctors. My experience so far with them - was either bad or mediocre. Starting with the dentist who had dislocated my jaw joints, another doctor, who instead of giving me anti-bacterial treatment gave me nausea-suppressant with whole page list of side effects , including "dehydration" (while i was already dehydrated) and "unknown mechanism of drug activity".
Some kind of nurse practitioner who was persistently asking me whether gentian violet is antibiotic, and another one - commenting that cold sore/herpes is a VD and not believing that genital herpes and common herpes are not exactly same things. And so on, and so on, and so on.
My luck that I never had any serious health issues while in USA - otherwise i'd be rather scared to visit local doctors.

Bottom line - there was not a case when doctor in USA had helped me. All times when I had health issues - I had to deal with them myself (except for reconstruction of accidentally broken tooth with subsequent jaw dislocation).  

All times when my husband visited doctor - he was always given ibuprofen - to treat virtually everything.

 

[Ronnie]

Do you think that going to socialized medicine would improve the quality of American healthcare?

[mies]

It depends what you mean by quality of healthcare. Healthcare (or "good healthcare") should not be a good affordable only for people with money.
I have not seen healthcare system in Western Europe. Maybe it is better over there.

[Ronnie]

Are you saying that when something is cheap it is higher quality?  Most likely you didn't mean that.

[Ade]

It depends what you mean by quality of healthcare. Healthcare (or "good healthcare") should not be a good affordable only for people with money.
I have not seen healthcare system in Western Europe. Maybe it is better over there.

There are incompetent doctors everywhere no matter if the system is entirely privatised or public. In Switzerland, where very good (and expensive) health insurance still only covers 90% of medical costs my ex-wife experienced absolute idiocy from a doctor specializing in allergies and suffered extreme pain from a "good" dentist that drilled too deep and filled directly onto a nerve. We have also experienced good treatment there of course.

No matter which country I've experienced (Switzerland, France, UK, Norway) the medical profession is as equally variable.

I will say that I had an extended illness that lasted several years, required numerous hospital stays and major surgery in Norway and the treatment was mainly superb, prompt and... free. Okay, free besides the taxes I pay.

[kievstar]

Based on my experience if you have great healthcare insurance a doctor in the USA is going to take your time with you.  Great healthcare insurance is one that does not nickel and dime the doctor.  Not many people have great healthcare insurance.  I prefer the foreign born doctors as they work harder and pay more attention to details.

Socialist medicine in the USA means longer wait times to see doctors and that people who like to go to the Doctor often will not be able to.  It also means many people who cannot go to the doctor can go now.  Treatment prescribed will be the cheap and fast method which is different than what Ukraine used to have.  I say used to have as Ukraine hospitals have 75% less spending money this year compared to several years ago.

I will say the employees in Brussels I work with when they need surgery they come USA for it.  Also, people I fish with in Canada come to the USA for surgery as well.  I know when I had a serious injury in Toronto area the doctors told me I would get better surgery in USA. 

My wife likes Ukraine healthcare now that she has my bluecross card which covers her 100% which allows her to get the better service in Ukraine.  Prior to that she said service has gone downhill ever year for past 10 years. 

[mies]

Socialist medicine in the USA means longer wait times to see doctors

why do you think so? I am tempted to disagree.
Again - speaking from my experience. While in Ukraine there were most always queues in the corridors of polyclinics waiting their turn to visit the doctor. But in my experience - it never happened that a patient was not attended the same day. The longest wait may be 4 hours. Which is inconvenient, especially for an ill person, but you do get help very fast. And if you really feel bad and can't go to see the doctor - you call emergency.

In my first 2 years in USA I had an ok insurance. Not very good, not very bad (now it's much better). It happened not once that I needed to see a doctor urgently, and i was offered the nearest appointment in a week from my call. The last time was particularly memorable - my cold was getting nasty, and though i was reluctant to see the doctors, i needed to ask for prescription for antibiotics. I called to make an appointment - the nearest appointment was in 2 days. I came to the appointment and was told that the doctor is busy for the nearest week, the nurse practitioner would be available only next day, and immediately some other nurse was ready to see me and fill in forms. The nurse could not give me any health recommendations (because with her qualification she is not allowed to do so, and in USA - i believe they even cannot express personal opinions), she could not write me a prescription, she can only fill in forms, check my temperature, and such. I was so mad - because had i known that only nurse will see me - I would have staid at home and not make the trip. What kind of healthcare this is? Waiting for a week to see a doctor about my cold?? It does not make any sense. I went through "storage boxes" at home, found remainders of antibiotics, bought few bottles of Tussin, called home asking to send me medication, and waited until the package arrived. Package arrived about the time when local doctor became available.

[Misha]

Socialist medicine in the USA means longer wait times to see doctors and that people who like to go to the Doctor often will not be able to. 

Never have that problem in Canada. I call to make an appointment and usually my doctor can see me within a week. If it is more urgent, I simply go to the after hours clinic and can often see a doctor within an hour. I haven't had problems with bad doctors or poor service in Canada so far.

[Blues Fairy]

When I was in the US in grad school 11 years ago, I received almost zero care from our university med. center; they failed to diagnose a very serious condition which nearly destroyed me later and took a year of my life wasted in hospitals in Russia, upon my return.  Russian hospitals, however, were not markedly better as the obviously necessary surgery was delayed due to their idiotic therapy standards; hence the lost year. 

More recently, I was enjoying very good medical care in Moscow; doctors were excellent and efficient, but I must say I never used any state-run facilities and always paid my own $$ to get good paid service.  As for the birth of my daughter, I am very happy I was here in the States for that, because Russian birthing centers are notorious for their negligent treatment of pregnant women and mothers and those facilities and doctors who rise above this expectation tend to cost arm and leg.  Here, with insurance, we paid a total of about a $300 for hospital and $50 for newborn checks.  Awesome.

All in all, doctors in Russia can be excellent, if you are lucky to get to them (have $$ or connections).  Here, doctors are good at doing standard procedures but I wouldn't risk getting a more serious or hard to diagnose condition.  Perhaps it's the effect of excessive litigation; doctors are scared to take responsibility for serious diagnoses or aggressive treatments.  Cost-wise, good care is about the same in both countries.  Socialized medicine is no solution for cost reduction, because good care will always be expensive. 

[kievstar]

Mies, lets argue - people who cannot see doctors can now see them - how many tens of millions is that?  How many doctors, nurses, hospitals, ambulances, medical clinics, etc are being added?  Here is the problem.  More people getting healthcare and little added structure.  So people who pay for insurance now and go to the doctor will get worse service in the future.  Plus these same people will have to pay for the new people to get service . Sounds fair???  Their is a shortage of doctors and nurses now.  Will get much worse.

Misha, I can always see my doctors in the same day if their working or an alternative doctor if their on vacation.  I never wait more than a day.  This will change for me and plus since I am a hard worker will have to pay for lazy bastards to get healthcare. 

Regarding the surgery the hospital in Canada would not operate on me as they told me their cost structure does not allow them to do it right.  They basically said if you want to run the same in the future go to the USA.  I tore the tendon in my knee and their only allowed to do a cheap fix even if I handed them thousands of cash in advance.  They just did not have the technology.  This is Toronto and not some small Canadian city. 

President of Ukraine always gets his medical done in western Europe - never in Ukraine.  The former President of Ukraine had knee surgery done outside Ukraine recently. Canadian hockey players go to US for serious knee inures.

[ECOCKS]

I'm a bit surprised and have no idea why there are these stories of poor care in the US. It simply hasn't been my experience. Some observations...

University care - most American University campus clinics are/were only used for emergency care, vaccinations, counseling services (especially with regard to sex and adjustment). I don't know of any who provide(d) anything more than a referral to local medical facilities for diagnosis.

Birthing - my youngest son cost $11.69 when he was born. Benefits of working for a solid company with good insurance programs. Newborn checkups were a $5 co-pay if I remember correctly.

Doctor's waiting rooms - I think one time in 53 years I sat in a reception area for about 2 hours and 15 minutes or so. That was because my records were being couriered from a hospital ER I had visited over that weekend.

Doctor access - some specialists are only available with a month-long wait for an appointment but as someone mentioned above, you can always go to an ER and get an on-call specialist from the hospital staff roster.

Doctor efficiency - There have been a few times when I had a feeling that I should get a second opinion but mostly the doctors have sought second opinions or specialist referrals. So, I really don't get that comment.

Overall, I believe our average doctors are far better educated and experienced before being put into practice. I know the facilities are several orders of magnitudes better in terms of equipment, cleanliness and staffing. The ambulances are far better equipped and training of the EMT's is far and away superior. Yes, you can buy your way to a decent doctor in Ukraine (sounds the same in Russia too) but as mentioned, you have to know who to call to get to them and be prepared for "supplemental" payments to obtain quality meds and care.

[Ronnie]

People need to take responsibility for their own health and know when a doctor is needed and when he is not.  There is a lot of information available on the internet and when you feel something isn't right, you can research the symptoms and possible causes.  It it warrants a doctor visit, then you can ask good questions and show the doctor he can't easily brush you aside. 

Researching you symptoms can sometimes save you and the medical system a useless trip to the doctor.  For instance, colds, however nasty are not responsive to antibiotics as they are viral.  Taking antibiotics needlessly simply makes them less effective when you really need them for a bacterial infection.  Fevers are another normal reaction to infection and actually help fight the infection, yet some people, I was one, worried that the fever might be doing harm.  Having knowledge is the key.

My wife slipped last year going down the stairs and landed on her tail bone.  She was in great pain and I wanted to take her to the hospital but she didn't want to be moved.  I looked on the internet and saw that whether the coccyx was broken or not, there was no treatment that could be rendered but aspirin or Tylenol.  So we save a lot of worry and a doctor's time by just waiting it out as she slowly healed. 

[Ade]

My wife slipped last year going down the stairs and landed on her tail bone.  She was in great pain and I wanted to take her to the hospital but she didn't want to be moved.  I looked on the internet and saw that whether the coccyx was broken or not, there was no treatment that could be rendered but aspirin or Tylenol.  So we save a lot of worry and a doctor's time by just waiting it out as she slowly healed.  

Self diagnosis is a wonderful thing... if you get it right. I amazed my doctors by self-diagnosing an internal fistula. But then again, it was confirmed by scans after the fact. I wouldn't recommend anyone avoiding consulting a doctor after a fall or anything that could be serious as there are just too many ways you could be wrong.

[mies]

Mies, lets argue - people who cannot see doctors can now see them - how many tens of millions is that?  How many doctors, nurses, hospitals, ambulances, medical clinics, etc are being added?  Here is the problem.  More people getting healthcare and little added structure.  So people who pay for insurance now and go to the doctor will get worse service in the future.  Plus these same people will have to pay for the new people to get service . Sounds fair???  Their is a shortage of doctors and nurses now.  Will get much worse.

Sorry, Kievstar, but I fail to see your point.
You are paying now for insurance. In case of socialized medicine instead of paying for insurance you will pay taxes. Instead of wasting money for insurance companies staff - money will be used to increase the quantity of doctors. (This is more of a "silly" example - but it delivers my general idea). As for more doctors needed - maybe local doctors can start working more efficiently and then they can serve more patients.

Why do you think you will get worse service? Do you by default assume that service in socialized medicine is worse? Why? How many years have you lived in the countries with socialized medicine and what were these countries?
And yes - I do think that these tens of millions (or in fact more than tens of millions) of people who currently cannot afford healthcare - need the healthcare too. Because they are part of the society and healthcare should be provided by state.

I respect the traditions of your country (USA), but I think healthcare is a weak point in the current system. Same as tradition of mortgages - which made few people very rich, and many people homeless, as well as led to the financial crisis in the country and whole world. If the healthcare system will not see changes here in the nearest years - I am seriously considering moving back to Europe, or maybe Canada. I do not know what may happen in future, I cannot be sure that I will be always receiving healthcare insurance from my employer, or that I will be always employed, and will not need any costly treatment. But I do want to feel secure and to know that I will be able to receive healthcare whatever happens.

[Blues Fairy]

You are paying now for insurance. In case of socialized medicine instead of paying for insurance you will pay taxes. Instead of wasting money for insurance companies staff - money will be used to increase the quantity of doctors.

Instead of paying for just my own insurance, I'll be paying taxes for a bunch of other people's health care.  How do you suppose money will be saved by adding millions of freeloaders to government plan?  Yes, insurance companies will make less money but what about the bureaucracy running the gov't insurance, which is historically known to consume more resources, and less efficiently, than any private company?  You seriously believe government will use the saved money to increase the number of doctors and quality of care?  Quelle naiveté.

Why do you think you will get worse service? Do you by default assume that service in socialized medicine is worse? Why? How many years have you lived in the countries with socialized medicine and what were these countries?

My experience in both systems tells me that socialized medicine performs markedly worse than commercial, unless
you have special access, through bribes or connections, to the right doctors and facilities.  I wouldn't want my kids to inherit a system like that.

And yes - I do think that these tens of millions (or in fact more than tens of millions) of people who currently cannot afford healthcare - need the healthcare too. Because they are part of the society

Lowering the taxes and creating more jobs (with employer-provided or private health insurance) will solve part of the problem.  As for those who don't want to work but still want to enjoy social entitlements, well, sorry.  

Same as tradition of mortgages - which made few people very rich, and many people homeless, as well as led to the financial crisis in the country and whole world.

Actually the push to relax the rules to provide more mortgages to poor people is the key thing that caused the current financial crisis.  

[Sculpto]

Instead of paying for just my own insurance, I'll be paying taxes for a bunch of other people's health care.  How do you suppose money will be saved by adding millions of freeloaders to government plan?  Yes, insurance companies will make less money but what about the bureaucracy running the gov't insurance, which is historically known to consume more resources, and less efficiently, than any private company?  You seriously believe government will use the saved money to increase the number of doctors and quality of care?  Quelle naiveté.

You are already paying for it now through increased premiums to cover the cost of uninsured people that go to the ER and do not have the means to pay.  By adding a government program this should lower the cost of private insurance.

My experience in both systems tells me that socialized medicine performs markedly worse than commercial, unless
you have special access, through bribes or connections, to the right doctors and facilities.  I wouldn't want my kids to inherit a system like that.

Your experience is limited to the FSU.  My French X highly preferred the system in France over the system here in the States.  From what I saw during the time I was with her, she had very good reason for that preference.  I would also point out that the French hospice system for the elderly and terminal is so far superior to the rotten alternatives in the States as to be on a completely different level.

Lowering the taxes and creating more jobs (with employer-provided or private health insurance) will solve part of the problem.  As for those who don't want to work but still want to enjoy social entitlements, well, sorry.  

Actually the push to relax the rules to provide more mortgages to poor people is the key thing that caused the current financial crisis.  

The problem is it is the employer who decides what plan you will get.  At my last job, I did not like the plan the employer was offering.  I asked to be excused from the plan and paid in pretax money to have my own plan.. which would have provided superior coverage for the same cost.  he refused because as a small company he needed a certain number of people enrolled to get the price he was getting.  Then of course, when I was laid off.. goodbye insurance.  The COBRA cost is absolutely ridiculous.  My only option now until I either get another job, or, get my business solidly on its feet, are to use the Haight Street Free Clinic.  I have used them before in certain situations and got excellent care there, in fact far superior to what I was getting though any health insurance plan I ever had.  The Doctors at HSFC are far more committed and since they are donating their time, which they do not have to do, they are committed to providing excellent care.  When I have had spare money I have made a few rather large contributions to the HSFC as do many people who use them in emergencies. 

Sorry, but I do not trust the profit motive of the insurance companies.  They are not interested in our health, but, only in maintaining their margins.  When insurance companies are making decisions about the care of an individual and instructing doctors how to do their jobs, there is a conflict of interest that diminished the value received.  Not that I think the government is so great or anything, but, the profit motive needs to be removed from health care decisions. 

You do understand that medical tourism is becoming a massive industry?  Americans are the main clients in this.  Mexico, Colombia, Cuba, Brazil, India and a bunch of other countries are the beneficiaries.  It simply doesn't make sense to me that I can get quality dental work done in Mexico for less than the price of the freaking deductible from the rotten plan my employer imposed on me.

[HiTech]

The problem is it is the employer who decides what plan you will get.

This is not always true.

And COBRA would cost you exactly the same as the insurance cost your employer.

But as you state, you would much prefer the government to choose your plan.

HiTech

[Sculpto]

This is not always true.

And COBRA would cost you exactly the same as the insurance cost your employer.

But as you state, you would much prefer the government to choose your plan.

HiTech

Well my point is the plan was costing almost 500 a month with a big deductible.. copays.. etc.. it was a rotten plan and my former boss refused to provide an alternate or an opt out.  That is normal for small companies that need every employee to participate so they can get the "best" rate and has been the only way I have been able to get coverage via an employer since I closed my business and went to work for others.

The government should only be offering one plan.. full coverage.  they need to follow the KISS principle. 

I was reading yesterday that the insurance industry reps have been involved in the reform since day one.  The chair of the committee is the recipient of the largest $ amount of insurance industry campaign contributions.  Under such circumstances there is no way there is going to be a decent result from the process now underway.

They need to kick out the lobbyists and anyone with a conflict of interest and write a bill that has one goal.. get everyone covered with the maximum amount of benefits and least amount of BS. 

[HiTech]

Ahh now I understand you, you want me to pay for a better insurance plan for you now, since you would rather not work to have a better plan.

P.S. I run a small company , my employees have a very good plan, and ever year when we renew the plan all my employs are involved in the choice.

HiTech

[Sculpto]

Ahh now I understand you, you want me to pay for a better insurance plan for you now, since you would rather not work to have a better plan.

P.S. I run a small company , my employees have a very good plan, and ever year when we renew the plan all my employs are involved in the choice.

HiTech

When I was an employer I did the same hitech.  But the reality now is you are already paying for the uninsured. 

http://www.americanprogressaction.org/issues/2009/03/cost_shift.html

http://www.familiesusa.org/assets/pdfs/hidden-health-tax.pdf

[Blues Fairy]

You are already paying for it now through increased premiums to cover the cost of uninsured people that go to the ER and do not have the means to pay.  By adding a government program this should lower the cost of private insurance

The cost of the medical services, ergo insurance premiums, may be cut through malpractice reform.  Signing up everyone to the government plan will not lower the cost of the medical services; as I said in the previous post, good care will ALWAYS be expensive.  Now, the uninsured who go to ER and don't pay are at least guaranteed treatment which is later absorbed by the system, i.e. insured people, whereas under totalitarian gov't program, the bureaucrats will "cut the costs" through deciding who gets treatment and who does not.  It's inevitable if the government manages the centralized insurance, and it's already in the bill.

If I were a terminal cancer patient ineligible for private insurance, I would vastly prefer having an actual choice, whether to be treated (and incur bills) or screw it - rather than depend on the government to decide it for me, whether I need a surgery or a painkiller.  

Besides, putting such a tremendous amount of money into a government program is a terrible idea; the funds will be raped just like Medicare and Medicaid, which are in shambles under "excellent" government management.  Whereas private insurance companies making profits off the premiums do not just benefit the owners but a whole bunch of employees and stock holders, making the economy healthier overall.  Making profit is not a crime in this country (yet).

[SANDRO43]

My experience in both systems tells me that socialized medicine performs markedly worse than commercial, unless you have special access, through bribes or connections, to the right doctors and facilities.  I wouldn't want my kids to inherit a system like that.

Probably because you experienced two opposite extremes, the FSU and USA, to base your judgment on. Europe - and Canada, from what I hear - are more middle of the road .

I'll say it again. It's both the model AND its implementation.

Some years ago we experienced a splurge of privatisations - not unlike Yeltsin's years, but fortunately less idiotic. Most state-sponsored/owned activities were first converted to partially public companies, then sold out entirely, the basic concept being that EVERYBODY would benefit from a competitive market that did not exist before - and of course a cash benefit for our chronically hard-up state budget.

Let me cite a major example, our Telecom. First it was acquired by Roberto Colaninno, now heading the consortium who acquired our faltering Alitalia last year , only through the help of major bank loans. Then it was sold off to Marco Tronchetti Provera, then at the head of Pirelli, again with the help of major bank loans. At the time I acquired Telecom shares for about €10,000 as an investment for my aunt's remaining capital, at €1,70/share because they yielded nice yearly dividends (4%-5%) - probably because MTP had a substantial personal portfolio and high dividends lined his own pockets nicely .

Eventually the pressure from the lending banks forced MTP to sell again the company two years ago. Its shares are now €0.70, and telephone service has improved only marginally through this entire saga -not to mention the thousands of layoffs to 'streamline' operations and improve the once decent balance sheets now burdened by the bank loans.

Were Telecom and its Italian customers better off before privatisation, or afterwards? Not a major difference, but what centainly changed was our perception that a free-market economy is the panacea - the miracle cure - for all economic ills.