Health care

My friend Alice has gone on a rant about her experiences with health care in her neck of the woods (and her desire for socialized medicine that we living in other countries enjoy). The same day she ranted, I had been to see my doctor. Here is my comment on Alice's blog about that:

Contrast what you say with what I experienced today (as one of those people living in another country - thanks for the linkage!):

I’ve been feeling overwhelmed at work and took a sick day off yesterday to see if that would help. It didn’t (bad sign: wanting to cry today because someone asked me a question). So around 9:30 AM I went down to my doc’s office and asked if my doc could see me at all today. Oh, joy, he could, at 1 PM (he was on time, too!). They set up their day in such a way as to leave about an hour free for emergency consultations. For like when you throw your back out.

Anyway, left his office with a 100% sick-leave for what’s left of this week, and 50% sick-leave for all of next week. If I had needed a referral, then I could risk experiencing the appointment-rescheduling dance and it might be weeks before I saw the specialist. But for primary, emergency matters? I see the doc immediately. And he answers to only one “insurance company”: the government itself. Total cost for me today for my 10 minute visit? NOK 160 (it’s actually co-pay; the government foots the rest of the bill). In spending power that’s the equivalent of $16 (current exchange rate: $23). If I get more than NOK 1780 in medical visits for the year, the government starts paying me back. Howzat?

Now, my own experience with Norwegian health care is quite limited, basically amounting to nothing but sick-leave notices when sick with the flu (or, as is the case this time, stress). The one and only time I got a referral to a specialist was so long ago (20+ years) that I can't remember any details. My other experiences with Norwegian health care have been in regards to my grandparents and their health care, and of course, the elderly are the biggest users of health care. My experience with our local hospital when my grandpa and my grandma have been patients there, is that it is a good hospital with wonderful staff. We may have been lucky, however. Grandma, for example, broke her hip and was operated on immediately, at the age of 92. The newspapers have many stories of other hip-breakers forced to wait in pain, fasting, for days before anyone even looks at their injury or are even denied surgery because of their advanced age. I suspect that there is more to the story than shear incompetence or ageism on the hospital's part, but these are the myths Norwegians are served about their health care. At any rate, Grandma always received the care she needed, also from Norway's in-home care system.

The Norwegians complain about their system. They do. (And the newspapers follow up.) They grumble about the short time allowed with the doctor, after waiting way past the appointment time. (To my surprise, my doctor was on time Wednesday, and after I rattled off the condensed version of what was wrong with me, he followed up with questions, so I ended up giving him the long version.) Not to mention how hard it is to get an appointment in the first place! (I know that my local doctor's office is quite busy. 3-4 weeks to see my doctor when not an emergency.)

The Norwegians complain about the corridor patients, the ones relegated to sleeping in the hallway because the rooms are full. Never a good situation for someone so sick they have to be in a hospital, because the hallway is full of noise, nurses and visitors going to and fro, and without the amenities a regular bed gives you: A reading lamp, a phone, a nightstand, the buzzer to summon the nurse. One co-worker's father ended up in the hallway and was given squeeky toy to summon the nurse with. Not a bad solution, until you realize Dad was actually too weak to squeeze anything. Mind you, the nurses themselves are good people, well-trained, hard-working, underpaid, mostly part-time workers. Uh, I digress. Point is, like in the US (see my second comment on Alice's blog), the problem isn't the medical training; the problem is the delivery system.

There are too many sick people and not enough money or space to accommodate them. It is not a unique challenge to socialized medicine. The US is struggling with it, too. And there is the odd statistic that shows that Norway has one of the most expensive health care systems in Europe, an oddity considering that Norway doesn't offer free dental but the much less costly UK system does, and Norway has a system equal to Sweden's, but Sweden's costs less. However, no European country spends as much per capita on health care as the US does. What is interesting is what the solution may actually be: More socialization.

Norway has slowly been following in the UK's footsteps, in embracing privatization as the plug to stop the drain from government for such things as road and building maintenance, health care, and public transporation. Formerly state or city-owned agencies were privatized and forced to compete on the open market. I can't tell you how many times the local city bus company has morphed since they stopped being wholly owned by the city of Bergen - without any improvement in service. (I'm one of the lucky ones who is near busses that run at least every half hour, also on weekends. But I digress again.)

Recently, a Norwegian report [PDF] came out showing how both Scotland and New Zealand reclaimed their health care systems after a few disastrous years trying a free market model. Scotland brought their NHS (National Health Service) back under the purview of the politicians rather than subject it to competition and brought costs down (by c. GBP 610 million which is about USD 850 million). The simple conclusion: Coordination is better than competition. The US system has failed to produce any coordination or consistent practice in spite of being a market-based system.

There are simply some things that should be given a uniform function and financial support in a society: Health care, communications and education spring to my mind.