This post is going to be a fairly short discussion but I thought that I would include it even though I am on vacation. I know, this will not be my normal 6-9 pages of long-winded discussions, but I think that it is worth the read. I couldn’t post this last night due to many Internet problems as we were sailing up the Danube River, but here it is!
As I traveled through Hungary, Austria, and Germany I was asked by a number of my European shipmates to explain this healthcare system called Obamacare. They wanted to truly understand how Obamacare could be controversial to anyone with an ounce of human empathy. It seems that they thought that the U.S. had hospitals for poor people and hospitals for rich people. Show up at the wrong hospital and you will be shown the door, or if you are lucky, you get a ride to the correct place. No money, no care. The idea of EMTALA was a true surprise to them. What is EMTALA, I pointed out that this is the Emergency Medical Treatment and Labor Act, which was passed in 1986 and this federal law requires that anyone coming to an emergency department must be stabilized and treated, regardless of their insurance status or ability to pay and has remained as an unfunded mandate. They asked me to provide references. Mostly because their family is leftist and no one would believe them and anything that I provided as evidence needed proof. I pointed them to the many references on the Internet, but I also invited them to visit any Emergency Department and just look on the wall of the hospitals and clinics. The law is not secret.
I went on to tell them that to give away free care to Medicare patients is considered fraud and punishable with substantial fines. They had never heard of Medicare and Medicaid. That the poorest and the oldest are cared for already absolutely shocked them. They were well aware that the middle class of the U.S. is considered rich by world standards and capable of caring for others, not just themselves and do not merit charity. Their next question was always why in the world do you need Obamacare if this is all true?
To the people of the third world, to take care of people first, and ask for money later is indeed quite generous. I told them multiple times that they had been duped by the press. The same words even in English simply do not mean the same things even to people in the U.S. The challenge of Medical care in the U.S. is taking care of the obese, the inactive and smokers before they were sick, because their care is so very expensive. That was a fact that they could fully comprehend, Americans are massively obese and justifiably mocked by the world. Money is being spent mostly to stop people from making poor choices; we call it “preventative care”, expensive public education that has no data to support its effectiveness that is Obamacare.
As I continued the discussion, including surrounding politics, the national debt they all realized that Obamacare was a great pipe dream but there was no long-term provision for financial sustainability. You can’t continually increase the premiums on the young healthy population to care for those who don’t want to do their fair share of working and financial contribution. And further, the amount of computer documentation and impersonal telemedicine using social media and the Internet was putting an unhealthy burden on both the physician/healthcare delivery person as well as the patient.
The interesting thing is as I spoke to more and more of the people from the European countries both my shipmates from around the world as well as those living in our cruise destinations I started getting some different views of their own healthcare systems, somewhat different than what I had written about last week.
The older people seemed to be fairly satisfied with the way things were, i.e. the basis of socialized medicine, that they were all cared for but that waiting was part of the system. They were also confident that the government would continue to care for each and every one of them.
The younger people including our cruise tour guides from these countries were concerned as they watched the possible need to raise taxes again. I was told and this was discussed and revealed multiple times that their taxes across the board was 55-64% in order to pay for their free care, medications, education, nursing facilities, and other social services. Today we visited the Czech Republic and I found out that with all their multiple taxes the total that they ALL paid was around 51%.
But with the increase in the immigration population the feeling is that there may be another increase in one or more of there taxes and the quality of care was already not optimal, but adequate. The waiting periods to see physicians were often months; surgical services were often delayed for months depending on the patients other co-morbidities. That is if your diabetes was not well controlled your surgical procedure would be delayed until you were “in better shape” for your surgery. However, emergencies seemed to be cared for in a timely manner. The younger population wanted choices. These were educated people who were waking up to the realities of a socialistic system, enjoyed by many with multiple areas of differences to our freedom of choices that we enjoy here in the U.S.A.
I saw examples of the care given to their patients as a male patient who broke his arm was placed into a plaster cast with a “handkerchief” type of sling for support. I don’t think I have seen a plaster cast in 10 years here in the “States.”
We use fiberglass casts, which are sturdier, waterproof and slings that are more supportive. They do it cheaper and maybe this is not such a bad thing.
But I also examined a male patient with Dupuytren’s disease of the hand who had a finger amputated instead of treating the hand deformity either non surgically or with the appropriate surgical procedure to correct the flexion deformity and give the patient a functional hand.
The patients do get emergency care as I mentioned and as experienced by one of our shipmates who was diagnosed with a small aneurysm in his brain and had a titanium coil placed in the dilatation/enlargement of the blood vessel avoiding leakage or bursting of the blood vessel in his brain.
However, he and his wife stated that their healthcare system was indeed breaking down both financially and in the delivery of care to all except to those who had money.
The older population was comfortable with socialism and that care and resources had to be rationalized to those who need it, i.e. the youth, etc.
I found this all fascinating and it reinforced my beliefs in the power of a government-run socialized medicine system, but more important was the failure of this type of system including the prioritizing of care based on age, multiple morbidities, etc.
We also discussed the education system. It was pointed out that education is free but lately some countries are charging a “small amount” of money to attend the university system and maybe for medical school. There just doesn’t seem to be enough money to go around with an aging population, the cost of “new” equipment, etc.
Remember, I have already pointed out that the influx of the large population of immigrants, 90% who are not employed are placing a financial drain as well as a drain on the healthcare and social system. These 90% unemployed therefore don’t pay their fair share of taxes and still require food, housing, and healthcare. But the older Germans that I spoke with today are still accepting the need to take in these immigrants and pay them their monthly checks even though they are not contributing to the financial support of the socialized system The youth are starting to see the fallacy in this thinking and wonder how are they, the taxpayers are going to be able to sustain this system.
So, what are they, the multiple European countries except for those countries who already pay huge taxes like the Scandinavian countries who pay 64%, going to do next? Maybe we should pay attention to the history of health care in the various European countries, the past, the present situation and the future.
At the end of all of our discussions during our cruise, we all agreed that we Americans in the U.S.A. were truly spoiled and wanted their cake and wanted to eat it without the investment and the difficult decisions and restrictions, delays in service or in fact the lack of service.
Most of what I learned during my visit to these various countries was not really news but did confirm my research, which many of my liberal colleagues don’t believe.
The questions still are:
1. What is the best health care delivery system and how does the government or the system pay for it? Is it Medicare for All or another Single-Payer system or a combination including Medicare for Many and Medicaid for those who cannot afford Medicare or even a system like the Veterans Association medical system?
2. Should the government pay for the education of healthcare workers including doctors, nurses, physician assistants, nurse practitioners, and others as is done in most other countries?
3. Should tort reform/ medical malpractice be considered in our reform of the health care system?
4. How do we strategize and develop this health care delivery system?
5. What have we learned from our own mistakes as well as those mistakes made by other countries?
Onward in our search for the answer to our healthcare conundrum.
And remember if you get a chance to pick up our new book: The Search for Excellence in Clinical Practice A Handbook on Clinical Process Improvement for Providers, Sentia Pub.