Ed Hintz ([info]ehintz) wrote,
@ 2003-11-03 23:00:00
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Blasphemy
This will probably get the rasberry from most of my audience, but so be it.

My experiences with US healthcare vs. socialized. US: Sam's seemingly got a bit of strep. We tried to self-medicate at first, but cipro wasn't helping and it got pretty bad. So today we had to breakdown and visit the doc. Unfortunate, since our insurance ended on Friday with my last day at work. Anyway, we popped into the Brookings Clinic unannounced, with no insurance. After an interminable wait, we saw the doc, got a scrip, and got it filled. Time, start to finish: 3 hours. Cost: ~ $200; $85 for the doc, $116 for the scrip. Based on my experience over the years, I'd say this is relatively par for the course; come in with no insurance and no appointment, and you'll spend lots of time and money.

Contrast this with our recent experiences back in March in New Zealand with their (gasp!) socialized system. We visited 3 docs, in 3 towns (Oamaru-small, Paraparaumu-bigger, Christchurch-full on city by NZ standards). All 3 times, we popped in with no appt., no insurance, just a couple of dumb gringos. Each appt. cost us $40NZD, we saw the doc within 20 minutes, and had scrips filled within the hour, at a maximum of $10. Had this happened once, even twice, I could see it as an anomaly. Three in a row is hard to buy. Especially when my personal experience with the cheap side of the US system is that it generally takes minimum twice that amount of time and about 3x times the cash. I've heard the horror stories of multi-year waiting lists for operations, but I've also heard the horror stories of domestic misdiagnostics and those without cash not getting the needed care. And in the end, I've got to say that the socialized system, regardless of theory, seems to work better in practice. In my personal experience anyway. It will be interesting to see if this observation remains consistent over the course of the next couple of years.

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[info]visgoth
2003-11-04 06:46 am UTC (link)
I think it goes back to what I was saying in one of the guns/no guns discussions.

What works in one society won't necessarily work in another, and what fails in one might succeed in another.

Sounds like New Zealand might have a good system worked out for their culture. My one experience with England's health-care system brings to mind the insane asylum sequences from "Jakob's Ladder."

Go with what works for you.

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[info]ehintz
2003-11-04 10:14 am UTC (link)
Good point. A socialized system might not work as well here as it seems to there. Anyway, I'll be able to make a more accurate observation of the system after a year or two, assuming I get residency. It's entirely possible that more experience with the system will sour me on it, though so far I'm obviously favorably inclined.

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Universal Health Care need not be called Socialised Medicine
(Anonymous)
2003-11-04 08:00 am UTC (link)
As well as the possible differences for those who have the ability to pay (which in the instance cited may be due in part to population, the time factor)there is something nice about health care for the poor who cannot pay. That is a philosophical difference that is worth considering. Perhaps it is in fact reasonable to judge a society by how it treats it's weakest members.

Rodney

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Re: Universal Health Care need not be called Socialised Medicine
[info]ehintz
2003-11-04 10:16 am UTC (link)
Yeah, from this side of the street the grass looks greener. I'm looking forward to an opportunity to judge once I've crossed the road, as it were.

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[info]simonfunk
2003-11-05 07:01 am UTC (link)
I have no direct experience w/the NZ system, but I have asked around a bit about it and I know a few non-residents like yourself who have had to use it in a pinch as well. In short, it sounds way more functional than the US system at this point, and I think I actually consider it a point in favor of moving to NZ for myself rather than a point against as I would have initially thought.

But if I step back and look at the big picture, the real question is not why is NZ's system as good as it is, but what the hell happened to the US system?

I have a feeling that if medical certification were up to some number of competing private organizations rather than one government sanctioned monopoly, then there would be more of a competitive balance between quality of health care and cost -- and in particular as this brought the cost of poor health care down, the medical profession would no longer be a place where anyone willing to go through the paces can make lots of money even if they don't give a shit about their patients, and this in turn would mean more people going into medicine out of interest and care and fewer just looking for a promised dollar.

Further, there is the issue of liability, which is very differently handled in New Zealand than here. I don't know about medical liability specifically, but in general it's much harder to sue someone in NZ and I have a feeling suing a doctor there is damn near impossible -- for better or for worse. In the US, I believe a substantial portion of your medical fees goes to lawyers (via malpractice insurance which even the best doctors pay in large amounts).

And then in New Zealand, the body regulating all the medical devices is also the one who is buying them, so they have incentive to be reasonable with themselves, whereas in the US, there is every incentive to over-regulate every object in order to funnel large sums of money to a small number of politically connected manufacturors who then funnel some back to politics. An analogous example of this is that little piece of yarn on the nose of an R-22 helicopter -- you know, the one that indicates yaw? It costs $5 (a few years ago--probably more now). For a 4 inch piece of (FAA certified!) yarn. You can be sure every piece of medical gauze is similarly sanctioned and priced.

This is not capitalism here in the US. I don't know what to call it, but it's nothing like capitalism.

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[info]mathemajician
2003-11-05 12:07 pm UTC (link)
This is a general reply, not just to Simon. For those who don't know I'm from NZ.

Anyway. It was strange to hear you call the NZ health system socialised. I don't think I've ever heard it called that in NZ. What we have is a mixed system of public and private health care. Basically what you get is that really serious things will get done in the public system. So when my appendix went bad last year I just walked into a hospital, told them my name and address and some basic ID. I then had it removed after signing a form for the operation to take place, had a 3 day stay in hospital and then just walked out at the end not having to pay for anything at all.

But for things that are "less serious" you go on a waiting list. So if you are old and need some operation to stop some pain you will be put on a waiting list for ages. This is where private health care and health insurance comes in. With private health care you can get it done much much faster but now it's also costing a lot more money. Drs who are experts often work in both systems at the same time. The public hospital stuff is their bread and butter work and they do private hospital work on the side. As public hospitals cover a lot of stuff private health insurance is relatively cheap as it only covers things that you wouldn't get done in the public system.

I quite like the system but you still get lots of people complaining about as it's far from perfect... people with cancers having to wait longer than they should and so on. Balancing cost and service is always hard in something like this.

One of the big differences I think is that, as Simon pointed out, it's much harder to sue somebody in NZ. Though it does happen alright. The other thing is the dollar value when you sue: In the US you seem to be able to sue for $10 million dollars if McDonalds coffee is 5F too hot and you burned yourself. In NZ you would just laughed out of court if you asked for $10 million for something like that! The judge would tell you to go and earn it the hard way. :-) We don't have this "sue people and get rich" thing that the US does. So the insurance that Drs need to have is much less, in fact I don't actually know if they usually even have it. This of course lowers costs and isn't anything to do with capitalism vs socialism; it's just about how the US legal system works.

Anyway, like I said I quite like the system being a mix of social and market. This way a kid from a poor family who has something seriously wrong with him can walk straight into the best care in the country without any problems, while some rich guy can also get a expensive and not absolutely-totally-necessary operation done quickly so long as he fronts the cash for the procedure himself or has health insurance that will.

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[info]ehintz
2003-11-07 11:48 pm UTC (link)
Thanks for the comment, it's good info. It's what I'd seen from my visits, but it's nice to see my observations backed up by a native. My general impression is that the level of common sense is much higher in NZ than in the US, which is one of the key things that has attracted me. Not to say that there aren't lapses (the recent cow flatulence bit comes to mind), but overall it seems a much more sensible place. The "sue people and get rich" concept is one that I've always found annoyingly stupid, and it annoys me more that it results in my paying more for healthcare (and lots of other things).

So far I think the NZ system makes a lot more sense than ours. As I've said before, it will be interesting to see what I think of it after we've been there for a while.

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[info]mathemajician
2003-11-08 04:24 am UTC (link)
I've had the "NZ pro's and con's" discussion with people many times before and I think my answers have evolved a bit over the years. When people ask me to describe New Zealand now I say: It's a nice little place; which is great if you like 'nice' and you like 'little'. I think that's pretty much as close as I can get to describing the country in one sentence. I also think that what is good or bad about a country all depends on what you are looking for. Not only that, but more deeply, the features that a country has usually have both an upside and a downside.

So what do I think are the worst things about NZ? After all I'm not living there now and to be honest I think I'm most likely to end up living in the US longer term! For me the biggest problem comes down to scale and location. The whole population is just 4 million and it's pretty much at the end of the earth location wise. So, for example, if you were to produce some specialised medical equipment where you sell about one a year for every 4 million people then in the NZ market you sell just one each year while in the US market you might be able to sell two a week. So a niche market that could be a big business in the US might not be even close to viable in the NZ market. Similar things go for other areas like research and education. In New Zealand I might be able to get a job doing AI research at some university but probably not where there were many people working in areas all that closely related to my work. In the US of course the scale is vastly larger and it's likely that there will be numerous groups of researchers around the country working on stuff similar to me. NZ certainly has some good AI research, but with just over 1% of the population of the US we just can't have anywhere close to the depth and breath of research.

The other thing is the attitude of the people. I find that in America there are more people who are willing to take a risk and do something pretty crazy. Americans to me seem to be idealists. Whether it is about being Christian, about having guns, about democracy, about the market system, about what you eat, about the environment, about abortion, about sexuality, about drugs... in America people seem to see things more in black and white and they take things to the extreme. Which can be a problem, but it also means that if you do want to do something a bit extreme then in some ways it is easier. Being very "middle of the road" like New Zealand can be good, but sometimes you need to be a bit crazy to really do something bold and interesting and new.

I will watch with interest to see how your impressions of NZ shape up once you're living there.

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