Good Health: Too Big to Allow

Americans are great. Really. They deserve everything they get. Big cars. Big debt. Big guns. Big mental depressions. Big waistlines. And most sadly, bad health.

"Fight for your right to be un cared for!" Maybe the words don't seem so eloquent, but that is in essence what many are saying, or at least, the most vocal.

"I don't want the government involved in my health. It's a step towards Communism!" Yep, that ol' Socialism booger. We already entrust the government with way too much, and I refuse to give them any more. We trust them with our children's education, let them support us when we lose our jobs, get them to put out the fire when our houses are burning, let them manage the natural splendor of the country, allow them to round up all the criminals, and have them provide the defense of the nation. But we gotta draw the line with regards to trusting these inept bureaucrats we've somehow chosen to lead us when it comes to our actual lives and deaths (not that any of those other social programs involve our lives and deaths...). I mean, dammit, we've gone too far already and I refuse to pay one cent more which will collectively benefit this great country. I just hate social programs for the common good, don't you?

So here's my prediction: any nationalized health care plan in the US is doomed to fail. Obama should give up this futile and evil agenda, and direct this action elsewhere, where it'd be more effective. (Being involved in people's health is clearly a nasty weapon. Maybe instead of diabolically trying to save the lives of Americans, he can save the foreigners we loath instead. Yeah, he should be exporting this social welfare crap to all the people we despise. Maybe we can have the CIA set up these nasty health programs in the countries of our enemies, and let them wonderfully fail. How dreadful for them indeed! Imagine places like Cuba, and China, and Venezuela, and France, and... er... those bastards!)

Well, maybe its a questionable weapon (hey, get the boys at Lockheed Martin to work on that...), but the president must understand that people don't want health to be a civil right, like education, suffrage, or religious tolerance. They prefer it a commodity, not his Stalin-esque vision. The US is the land of Capitalism, where even the human body has a price tag. You can't take this away, Mr. Obamageddon, as its the base ideology which unifies everyone. Ensuring the good health of the citizenry is not what this country is all about. Money is.

Now, I have a secret. Alas, I must admit that I am an American who long ago re-settled abroad. I don't belong in this debate because well over a decade ago I opted out, having become, I suppose, an ex-patriot in the true sense of the word. So what I have to say can easily be considered mute. And I also have a slanted view on health care as well, as I now live in a country which provides me with nationalized health insurance.

So just call me Comrade.

Actually, the health system here is unlike anything conceivable in the US, which is why I say that any attempt to change the US health insurance scheme will indeed fail. It would be impossible to do in the US what goes on here. The health industry would need to be gutted. So understandably, health insurance corporations will spend every last penny to stop this, and we're talking about some pretty darn wealthy (and thusly influential) companies. Think about it, as with any industry under the laws of Capitalism, they are ethically obliged to prevent their own demise at any cost. Its basic risk management coupled with self defense. Hell, investors could conceivably sue them for not doing so.

However, where I live now, everyone is required to be part of the national system, even non-citizen foreigners like me. As a result, this massive non-profit public health package does indeed have control over prices, procedures, and organization (the horror... the horror). Just like the army, the post office, and my old elementary school.

But wait a second Chekov, can't somebody get a secondary private insurance plan to supplement this plan beyond its limitations? Oh, you mean like getting a fire extinguisher for your home, or a tutor for your kid? Well, sure. Its not like I live in North Korea (possibly the only country where a citizen does not have such a choice).

You see, where I live, health care works much the same as Social Security in the US (that other vile monger of Socialism people are up in arms about not wanting to collect): everyone is required to pay in, based on income (though there is a cap -whether you earn 60 grand or 60 million annually, you'd pay the same). Those with little or no income can be covered for about $200 a year. Top earners run at about $2000 per person. (remember, kids and people that earn nothing pay the minimum). You don't pay more due to health condition, bad habits, workplace dangers, or age; only income. But the benefits are not complete - it only covers medical bills and prescriptions, not hospital rooms, not hospital food, not cosmetic surgery (so there are reasons for private insurance, kinda like wanting to have a 401k). And you are only covered for 70 percent of your bill, meaning you have to pay for the remaining 30 percent (this both promotes supplemental private health insurance, and discourages people from abusing the system with unnecessary hospital visits. It also promotes people to attempt to prevent illness). But there is also a cap to that 30 percent, such that if your medical bills run over about $700 in a single month, the remainder is covered by the health care system (this prevents people going bankrupt from surgery, or from opting to not have a costly procedure).

But it is a complete system. As the government/public must flip the bill, they will not allow price gouging by doctors nor the promotion of unnecessary treatments. If a hypodermic needle costs 23 cents, that's what you and the NHS pay, split 30/70. Modern X-rays wholesale at a couple bucks, and that's what is paid. When hospitals charge an overhead, it must be justified (maintenance costs, operating fees, updated equipment, etc) And since there is no CEO or investors in this insurance company (other than the entire public), there is no profit margin. The aim is to keep the books balanced, not generate way more money than necessary. And since everyone is involved, this enormous pressure can control the operations of the country's medical industry for the common good. (this clout extends beyond the insured limits, ensuring that the room fees, pajamas, and meals are also cost effective.) And lest you medical professionals worry, doctors are well compensated, however it does seems they entered the profession more inclined to follow in the the footsteps of Hippocrates, rather than Donald Trump.

And the affects of the system don't end there. Since the government/public is responsible for the costs of sick people, then the government/public goes out of its way to prevent having sick people (perish the thought!) There are campaigns here promoting good health, heavily discounted cancer scans and testing, subsidized annual check-ups, even commercials in the summer which remind people that soda is not as effective as water for dehydration. (US lobbyists would be freaking out at such legislation!) So, you see, such a system overhaul could seriously undermine the massive profits of not just private hospitals, doctors, and insurers, but also drug companies, tobacco companies, and even the food industry (where I live smoking is widespread, but oddly enough, the tobacco industry is also state controlled, so it runs into direct internal conflict/competition with health care. As smoking is this country's number one cause of death, then this bureaucratic duality, I must say, is a major enigmatic problem.)

But then, of course, you're special, right? You need first class treatment, and don't want to be sharing the same room, let alone operating table, with that scuzzy dude you saw in the lobby (and that is another social issue we shouldn't pay to fix...). Well, if you're so fortunate to have big bucks, want special treatment, want your toes massaged in a completely private Hilton-like hospital by a nurse who shares your same skin tone, then go ahead. Over here those options exist too, but you need to pay for it yourself (with cash or private insurance). While your basic medical bills will still be covered in most private hospitals for all necessary procedures, you just gotta fork over the costs for the unnecessary treatments and snazzy ad-ons (imagine public schools -you can send your kids there and its paid for by taxes. You got a problem with your local school system? Then send them to a private school ...but don't expect a tax break.)

Alright Sir Thomas More, but does it work? What about the gulag-like lines of people waiting to have themselves tended to? Or the crappy, sub-par treatment those national systems supposedly offer? Well, I can't say I've ever seen such trouble here, and my experiences with hospitals truly are extensive. Because as it goes, I have to admit, I am a klutz. A walking medical magnet. Any private insurance company would hate me, so I guess its been better for them that I could never afford to be in one. I've had stitches, burns, fevers, and a variety of intestinal trouble around the world. There was the time I exploded my thumb in a power-saw incident in a remote corner of Laos, the ear infection that was misdiagnosed as malaria in the Nicaraguan Moskitia, and the badly dislocated finger I had while a two day hike away from the nearest road in the Pakistani Hindu Kush. In my opinion, you haven't experienced a country until you see the inside of one of their hospitals. So for comparison's sake, let this emergency room maven say, the place I'm in now is awesome.

Cause in this Marxist system here, I have also had more than my share of work done on me. As not to bore you with the whole list, I'll only give the superlative: you see, the first time I had the tumor in my jaw diagnosed was in the US. The doctor there expensively removed a tooth and dug it out. A few years later it re-appeared, larger. Now in a provincial Thai hospital, the doctor there put me under, removed two more teeth, and dug it out again. A few years after that I was where I am now, in medical Leningrad here, and the tumor came back. The doctor here (as elsewhere) said it will probably keep coming back, unless I opt for the more drastic choice: replace half of my jaw bone. Alright, I finally have some form of health insurance for the first time in my adult life, lets do it, I said. A week later the five hour surgery I was scheduled to have to remove half of my left jaw and scrape my inner flesh for every last tumor cell went smoothly. At the same time they cut out a six inch piece of my hip, fashioned it into a new mandible, and screwed it into my face. After well over a month of eating through a tube up my nose, I eventually recovered. The care was fantastic, courteous, modern, and more than thorough (I had to protest in order to be let out after 5 stir-crazy weeks, as they wanted me to stay 2 or 3 more). Four years later, the tumor has not re-appeared. I am completely fine and only a scar under my new jaw remains. Total cost for me: $2600, for everything (lab work, surgery, post-op, re-hab, months of follow up, room, food, and clothes. But two more weeks in the hospital a year later for the operation to have all the screws removed cost me another $1000). In the US, all this would easily run, what, two, three hundred grand? That's nearly ten thousand percent more! And people are literally fighting to keep such a system?! Are they insane?

And everyone is covered here, no matter their illness (they didn't even reconsider me during my latest visa renewal. Fools). But hey, you gotta admit, the concept of denial due to a pre-existing condition is pretty absurd (I am certain that the re-occurring tumor I had in my jaw would not be qualified for coverage by any of the US private health companies so many are fighting to keep). I mean, try to imagine this concept in another form: "Sorry Mr. Jones, I know you're a tax-paying US citizen, but your daughter cannot enroll into the fourth grade here. Those three years of school she had in Australia while you worked there at the American embassy are considered pre-existing conditioning." Kinda barbarian, huh?

But as I said, Americans are great, and mundane they are not. They always keep me on my toes. I've lived and traveled in many places, including a couple dozen non-European countries, but nowhere are people so ironic and contradictory as the States. They really do put the moron in oxymoron. Their paradoxical extremes make me laugh and cry simultaneously, and nobody else makes me want to give them a high-five with one hand while choking them with the other. Its a place which is home to some of the world's finest hotels and restaurants, but only 1 percent of the population can afford them. Spends the most on the military (nearly as much as every other country on the planet combined) but can't find one bearded guy in a cave. Maintains a global reach unfathomable to any other civilization, while the general public has trouble locating Mexico on a map (but has no trouble finding Taco Bell). And trumps itself as having the best medical care on earth, yet 50 million citizens have no affordable access to it. (Do people every try to put such a number into perspective? This would be like saying the entire country of Spain had no health insurance, or the combined populations of Canada, Norway, Ireland, and New Zealand all must pay the full, inflated-for-profit price for surgery. Back home, its the equivalent of everyone in Ohio, Arizona, New Jersey, Tennessee, Virginia, Colorado, Idaho, Maine, Wyoming, and Vermont. Not to offend your innocence, but Holy f*ck!) And the most ironic part? People don't freak out en-mass at the extreme financial inequalities, the ridiculous overspending on missiles (about a trillion bucks annually on the defense-related industry), the blunderous war on terror, or the lack of comforting assurance regarding their own medical well-being. No, but people do seriously flip out when some gay guys want to get hitched, when a has-been mulatto-wannabe singer dies, and when the elected government tries to prevent the general public from getting fleeced when they inevitably get sick.

Those Americans. I'll tell ya.

(A common question friends from the US have often asked me is regarding the perception foreigners have of Americans. "They must hate us with Bush, right?" "They must be joyful we got Obama, aren't they?" Well, to be honest, I never really met people who hated Americans. Nor do people adore Americans (but we do get kudos for being good tippers). Rather, it has been my impression that when regarding the people from the land of infinite possibilities, all too often foreigners just simply pity Americans. Pity us for our bad choices. Pity us for ignorance. Pity us for being unable to be rational. Pity us for working long hours with little vacation. Pity our depressions, our dissatisfactions, our fixations with money. Pity us for being walked all over by business and blatantly corrupt government. Damn, I gotta say you guys have given me one hell of a reputation to contend with!)

Yet, of course, nothing is ever perfect. And the health system of my current country is indeed having some tough financial problems of its own. As the boomer population here retires, as people live longer, and as couples choose to have fewer children, the numbers in the work force are diminishing, creating a worrisome imbalance in health economics. The per person costs need to rise. But then again, the US population is actually increasing, as opposed to here, so in effect, this would be much less of a problem in the States.