DOCTOR DOCTOR, MISTER MD
Can you tell me
what’s ailin’ me?
July 28, 2012
Medical Graph. CLICK TO OPEN
By Dennis Gallagher
(ON THE ROAD, SAN FRAN BAY AREA) -- Other countries have different ways of dealing with providing medical care for their citizens and residents. I want to tell you about New Zealand's system. But let me digress a bit first.
Many in the U.S. have heard that the socialized medical systems such as Canada, Britain, New Zealand and France have are inferior to the U.S. system.
I would beg to differ.
And I would suggest that the folks spreading that myth are the same folks who profit mightily from the U.S. system and don't want to see anything changed that might interfere with their profits.
But, this piece isn't intended to be about the greed of the corporate world and its increasing grip on America. I've already written about that so I think we'll give it a rest for awhile.
I have friends who used to live in Monroe, Washington, and who've now lived in Britain for the past three years.
I also have a long time friend who is both a U.S. and a French citizen and he lives in Paris. And I have several friends who either have lived or now live in Canada.
All of these folks have seen the American system first hand and they've seen the alternatives in the other countries and they all say, without reservation, that the U.S. system is inferior.
But it’s not just what these first hand reports say.
International statistics showing how much money is spent per person per country for medical care shows that the cost of medical care in the U.S. is the very highest in the world.
But these same statistics show that we are not getting correspondingly better results.
People in the U.K., for example, live two years longer than U.S. citizens on average but their medical system spends only about a third of what the U.S.'s does per person.
See graph at upper right. CLICK TO OPEN
Well, enough digression. Let me tell you how the system works in New Zealand because that is country with (God forbid!) socialized medicine and it is one I am personally familiar with.
How it works in New Zealand
Health care can be divided into three groups in NZ:
~ Acute Problems
~ And Chronic Problems.
Accidents are obvious; you fall down and break your leg - that's an accident.
Acute problems are things like the heart attack I experienced last year. You need immediate care.
Chronic problems are things like your knee is wearing out and you might need surgery to repair or replace it. But you are not going to die if this doesn't get done immediately.
I'll tell you the worst part of NZ medical care and that's what happens when you have a Chronic Problem like, say, your knee is failing.
They will put you on a list and you, and all the other folks on that list, will be ordered in terms of how severe your problem is.
If they judge you as 'not too bad', you could spend months even a year or two on the list before your case comes up for corrective surgery.
But let's remember this is free care and they have limited resources hence the ranking.
If you are a patient “patient” and you wait, it will get done and it will be free and, most importantly, the quality will be the same as if your insurance paid for it.
Insurance paid for it? How does that work, you say?
New Zealand has private medical insurance
New Zealanders who have the money and the desire can buy private medical insurance. And what they are buying is simply the right to jump the line and get seen and dealt with without waiting on a list for public services.
I've priced this insurance out and it costs 1/4 or less of what U.S. medical insurance costs these days. And it has a very low deductible.
Private medical insurance doesn't cover Acute Problems or Accidents because those are always free and dealt with immediately for New Zealand citizens and residents.
But, there's another way to proceed, if you have a Chronic Problem you want to get sorted out without waiting in a list of having private insurance.
You can opt to pay for the medical care directly out of your own pocket.
Pay for medical care yourself? That would scare the socks off most Americans. Everyone knows that if you don't have medical insurance, the cost of care is astronomical in the U.S.
Indeed, in one of those 'add insult to injury' ironies one sees in the U.S. medical system, most of you would know that if you have insurance then the cost of a specific operation will be lower because the insurance company has negotiated lower prices with the hospitals.
But, if you are so unfortunate as to have to go in without insurance and buy the operation yourself, the hospital WILL charge you full price.
That simply doesn't happen in New Zealand. The cost is the cost and it is the same for everyone.
And medical procedures in New Zealand simply cost less because there's not some huge corporation in the middle of the deal grabbing a big chunk of your money.
A personal story
Recently, I had a problem with my neck. A neurologist had given me an opinion but I decided that I wanted an MRI and I was willing to pay for it myself. And then I wanted to carry the MRI results to a neurosurgeon to have him look at it and get a second opinion based on the finer level of detail in the MRI.
Like most New Zealanders, I have opted not to buy private insurance because, for most things, I find the free system entirely adequate.
But, this was an exception. I wanted to know what was going on with my neck, I wanted to know now, and I was willing to pay for it.
The MRI cost me about $800 U.S. and I got it within two weeks of my request.
My appointment with the neurosurgeon was three days later and his consultation fee (which I also paid out of pocket for) was about $120 US and he spent an hour with me going over the MRI in great detail.
It turned out my concerns were unjustified (always good news) and I thought it was very reasonable to be able to pony up $920 and get a top-notch expert opinion.
So, that's the worst of the NZ system. If you have a Chronic Problem, you have to wait in line for the free services or, if you don't want to wait, you have to have private insurance or you have to pay for the procedures out of your own pocket.
Now the good news
What's the best of NZ medical care? Well that would be what happens when you have an Acute Problem or an Accident.
In these cases, no one is going to charge you anything; it is just going to get dealt with.
Last year, I had a small heart attack and the entire thing cost me about $200 from beginning to end and those costs were for the 24 hour medical clinic's time and the ambulance ride to the main hospital.
In addition to the clinic and the ambulance, I spent two nights in the hospital, used an operating theater, had a cardiac surgeon and his attending staff, all the lab work and had an angioplasty procedure and had a stent placed into my heart.
All of that was free.
This is how an Acute Problem in NZ is dealt with
Accidents and the ACC
Now, I want to delve into the subjects of accidents in NZ. They are a special case and NZ deals with accidents differently than perhaps any other country in the world.
In 1974, the New Zealand government created something called the Accident Compensation Corporation (ACC).
From that time forward, everyone who worked in New Zealand had part of their pay taken for a levy to be placed in the ACC fund.
And from that time forward, anyone in New Zealand who had an accident; citizen, resident or visitor, had their medical costs for the accident paid from the ACC fund.
It was a radical step and the consequences were huge.
One of the consequences is that in New Zealand, liability insurance just simply went away.
The legions of lawyers involved in suing over liability issues had to go find something else to do.
Some might say they had to go and get real jobs again after years of riding the gravy train from ambulance chasing.
And the ACC fund was a huge boon to anyone who wanted to start a business because you no longer needed a million dollar liability policy before you could open the doors and you no longer needed proof of liability insurance to drive a car.
And because there were so many less hands in the pot, the costs of the associated medical care stayed low and honest.
New Zealand doesn't always get it right but this is one time that they truly did.
When I tell potential visitors to New Zealand that if they have an accident in the country it will be covered for them, they are incredulous.
And, well they should be as it is an amazing thing.
Things don't have to be the way they are in the U.S. although admittedly it would be difficult to change things now with so many deeply vested interests ready to resist any change that affects their bottom line.
There's an interesting story about how Britain got its socialized medical system.
At the end of WWII, the country lay in ruins and most of the structures for things like medical care were broken.
Some brilliant people in the government then realized that if they instituted a socialized medical system then and there, they would be able to get away with it before the private vested interests reorganized and resisted it.
For “private vested interests” feel free to substitute “some large corporation that wants to make a lot of money off your medical and health problems.”
So, they created a new socialized medical system within the rubble as Britain began to rebuild and the rest is, as they say, history.
Those who could have and would have cornered the British medical system to profit from it had to go find a real job somewhere.
Look again at the chart above, and see what it says about how long folks live in Britain on average and how much they pay per person for care compared to the U.S.
And, if you know someone who lives or has lived in one of the other major western democracies, talk to them and see what they say.
There's lots of Canadians around. Ask them how things are north of the border.
I'm not making this stuff up, folks. It's all true.
Dennis Gallagher, a systems analyst and computer programmer by trade lived in the Monroe area for 20 years, running for ten years with his former wife the Woods Creek Wholesale Nursery. During that time he spent five years on the Monroe Planning Commission. Mr. Gallagher moved to New Zealand in 2009 and now resides in Christchurch.
Mr. Gallagher’s blog is www.samadhisoft.com