[Paleopsych] socialized medicine discussion

[Lynn D. Johnson, Ph.D.]

We have occasionally discussed the problems with American health care. I 
have spent 30 years in that system, and know both the shortcomings and 
the dangers of change. While we have lost market incentives in health 
care (too much first-dollar coverage and entitlement attitudes on the 
part of consumers), the alternative is very ugly. Here is an interesting 
first-person account of the competitive system, government-run, 
bureaucracy-planned socialism in health care.
Lynn

http://www.opinionjournal.com/extra/?id=110006785

ACROSS THE POND

There's No Place Like Home
What I learned from my wife's month in the British medical system.

BY DAVID ASMAN
Wednesday, June 8, 2005 12:00 a.m.

"Mr. Asman, could you come down to the gym? Your wife appears to be 
having a small problem." In typical British understatement, this was the 
first word I received of my wife's stroke.

We had arrived in London the night before for a two-week vacation. We 
spent the day sightseeing and were planning to go to the theater. I 
decided to take a nap, but my wife wanted to get in a workout in the 
hotel's gym before theater. Little did either of us know that a tiny 
blood clot had developed in her leg on the flight to London and was 
quietly working its way up to her heart. Her workout on the Stairmaster 
pumped the clot right through a too-porous wall in the heart on a direct 
path to the right side of her brain.

Hurrying down to the gym, I suspected that whatever the "small" problem 
was, we might still have time to make the play. Instead, our lives were 
about to change fundamentally, and we were both about to experience 
firsthand the inner workings of British health care.

We spent almost a full month in a British public hospital. We also 
arranged for a complex medical procedure to be done in one of the few 
remaining private hospitals in Britain. My wife then spent about three 
weeks recuperating in a New York City hospital as an inpatient and has 
since used another city hospital for physical therapy as an outpatient. 
We thus have had a chance to sample the health diet available under two 
very different systems of health care. Neither system is without its 
faults and advantages. To paraphrase Thomas Sowell, there are no 
solutions to modern health care problems, only trade-offs. What follows 
is a sampling of those tradeoffs as we viewed them firsthand.

As I saw my wife collapsed on the hotel's gym floor, my concern about 
making the curtain was replaced by a bone-chilling recognition that she 
was in mortal danger. Despite her protestations that everything was 
fine, her left side was paralyzed and her eyes were rolling around 
unfocused. She was making sense, but her words were slurred. Right away 
I suspected a stroke, even though she is a young, healthy nonsmoker. 
Over her continuing protests, I knew we had to get her to a hospital 
right away.

The emergency workers who came within five minutes were wonderful. The 
two young East Enders looked and sounded for all the world like a couple 
of skinhead soccer fans, cockney accents and all. But their 
professionalism in immediately stabilizing my wife and taking her vitals 
was matched with exceptional kindness. I was moved to tears to see how 
comforting they were both to my wife and to me. As I was to discover 
time and again in the British health system, despite the often 
deplorable conditions of a bankrupt infrastructure, British 
caregivers--whether nurses, doctors, or ambulance drivers--are 
extraordinarily kind and hardworking. Since there's no real money to be 
made in the system, those who get into public medicine do so as a pure 
vocation. And they show it. In the case of these EMTs, I kick myself for 
not having noticed their names to later thank them, for almost as soon 
as they dropped us off at the emergency room of the University College 
of London Hospital, they disappeared.

Suddenly we were in the hands of British Health Service, and after a 
battery of tests we were being pressured into officially admitting my 
wife to UCL. As we discovered later, emergency care is free for everyone 
in Britain; it's only when one is officially admitted to a hospital that 
a foreigner begins to pay. I didn't know that. But I did know that I was 
not about to admit my wife to a hospital that could not diagnose an 
obviously life-threatening affliction. And even after having given her 
an MRI, the doctors could not tell if she had a stroke.

Now, the smartest thing I did before we left the hotel was to delay the 
ambulance driver long enough to run back to my room and grab my wife's 
cell phone. With that phone I began making about a thousand dollars 
worth of trans-Atlantic calls, the first of which was to the 
world-renowned cardiologist Dr. Isadore Rosenfeld, who I'm lucky enough 
to have as my GP. As it turned out, not only did Izzy diagnose the 
problem correctly, he even suggested a cause for the stroke, which later 
turned out to be correct. "There's no reason for her to have a stroke 
except if it's a PFO." I didn't know what Izzy meant, but I wrote down 
the initials and later found out that a PFO (a patent foramen ovale) is 
a flap-like opening in the heart through which we get our oxygen in 
utero. For most of us, the opening closes shortly after birth. But in as 
many as 30% of us, the flap doesn't seal tight, and that can allow a 
blood clot to travel through the heart up to the brain. Izzy agreed that 
I should not admit my wife to UCL but hold out for a hospital that 
specialized in neurology.

As it happened, the best such hospital in England, Queen's Square 
Hospital for Neurology, was a short distance away, but it had no beds 
available. That's when I started dialing furiously again, tracking down 
contacts and calling in chits with any influential contact around the 
world for whom I'd ever done a favor. I also got my employer, News 
Corp., involved, and a team of extremely helpful folks I'd never met 
worked overtime helping me out.

Suddenly, a bed was found in Queen's Square, and by 2 a.m. my wife was 
officially admitted to a British public hospital. The neurologist on 
call that night looked at the same MRI where the emergency doctors had 
seen nothing and immediately saw that my wife had suffered a severe 
stroke. It was awful news, but I realized we were finally in the right 
place.

That first night (or what was left of it) my wife was sent off to 
intensive care, and the nurses convinced me that I should get a few 
hours sleep. We found a supply closet, in which there was a small 
examination table, and the nurses helped me fashion fake pillows and 
blankets from old supplies. The loving attention of these nurses was 
touching. But the conditions of the hospital were rather shockingly 
apparent even then.

The acute brain injury ward to which my wife was assigned the next day 
consisted of four sections, each having six beds. Whether it was dumb 
luck or some unseen connection, we ended up with a bed next to a window, 
through which we could catch a glimpse of the sky. Better yet, the 
window actually opened, which was also a blessing since the smells 
wafting through the ward were often overwhelming.

When I covered Latin America for The Wall Street Journal, I'd visit 
hospitals, prisons and schools as barometers of public services in the 
country. Based on my Latin American scale, Queen's Square would rate 
somewhere in the middle. It certainly wasn't as bad as public hospitals 
in El Salvador, where patients often share beds. But it wasn't as nice 
as some of the hospitals I've seen in Buenos Aires or southern Brazil. 
And compared with virtually any hospital ward in the U.S., Queen's 
Square would fall short by a mile.

The equipment wasn't ancient, but it was often quite old. On occasion my 
wife and I would giggle at heart and blood-pressure monitors that were 
literally taped together and would come apart as they were being moved 
into place. The nurses and hospital technicians had become expert at 
jerry-rigging temporary fixes for a lot of the damaged equipment. I 
pitched in as best as I could with simple things, like fixing the wiring 
for the one TV in the ward. And I'd make frequent trips to the local 
pharmacies to buy extra tissues and cleaning wipes, which were always in 
short supply.

In fact, cleaning was my main occupation for the month we were at 
Queen's Square. Infections in hospitals are, of course, a problem 
everywhere. But in Britain, hospital-borne infections are getting out of 
control. At least 100,000 British patients a year are hit by 
hospital-acquired infections, including the penicillin-resistant 
"superbug" MRSA. A new study carried out by the British Health 
Protection Agency says that MRSA plays a part in the deaths of up to 
32,000 patients every year. But even at lower numbers, Britain has the 
worst MRSA infection rates in Europe. It's not hard to see why.

As far as we could tell in our month at Queen's Square, the only method 
of keeping the floors clean was an industrious worker from the 
Philippines named Marcello, equipped with a mop and pail. Marcello did 
the best that he could. But there's only so much a single worker can do 
with a mop and pail against a ward full of germ-laden filth. Only a 
constant cleaning by me kept our little corner of the ward relatively 
germ-free. When my wife and I walked into Cornell University Hospital in 
New York after a month in England, the first thing we noticed was the 
floors. They were not only clean. They were shining! We were giddy with 
the prospect of not constantly engaging in germ warfare.

As for the caliber of medicine practiced at Queen's Square, we were 
quite impressed at the collegiality of the doctors and the tendency to 
make medical judgments based on group consultations. There is much 
better teamwork among doctors, nurses and physical therapists in 
Britain. In fact, once a week at Queen's Square, all the hospital's 
health workers--from high to low--would assemble for an open forum on 
each patient in the ward. That way each level knows what the other level 
is up to, something glaringly absent from U.S. hospital management. 
Also, British nurses have far more direct managerial control over how 
the hospital wards are run. This may somewhat compensate for their 
meager wages--which averaged about £20,000 ($36,000) a year (in a city 
where almost everything costs twice as much as it does in Manhattan!).

There is also much less of a tendency in British medicine to make 
decisions on the basis of whether one will be sued for that decision. 
This can lead to a much healthier period of recuperation. For example, 
as soon as my wife was ambulatory, I was determined to get her out of 
the hospital as much as possible. Since a stroke is all about the brain, 
I wanted to clear her head of as much sickness as I could. We'd take off 
in a wheelchair for two-hour lunches in the lovely little park outside, 
and three-hour dinners at a nice Japanese restaurant located at a hotel 
down the street. I swear those long, leisurely dinners, after which we'd 
sit in the lobby where I'd smoke a cigar and we'd talk for another hour 
or so, actually helped in my wife's recovery. It made both of us feel, 
well, normal. It also helped restore a bit of fun in our relationship, 
which too often slips away when you just see your loved one in a 
hospital setting.

Now try leaving a hospital as an inpatient in the U.S. In fact, we did 
try and were frustrated at every step. You'd have better luck breaking 
out of prison. Forms, permission slips and guards at the gate all 
conspire to keep you in bounds. It was clear that what prevented us from 
getting out was the pressing fear on everyone's part of getting sued. 
Anything happens on the outside and folks naturally sue the hospital for 
not doing their job as the patient's nanny.

Why are the Brits so less concerned about being sued? I can only guess 
that Britain's practice of forcing losers in civil cases to pay for 
court costs has lessened the number of lawsuits, and thus the paranoia 
about lawsuits from which American medical services suffer.

British doctors, nurses and physical therapists also seem to put much 
more stock in the spiritual side of healing. Not to say that they bring 
religion into the ward. (In fact, they passed right over my wife's 
insistence that prayer played a part in what they had to admit was a 
miraculously quick return of movement to her left side.) Put simply, 
they invest a lot of effort at keeping one's spirits up. Sometimes it's 
a bit over the top, such as when the physical or occupational therapists 
compliment any tiny achievement with a "Brilliant!" or "Fantastic!" But 
better that than taking a chance of planting a negative suggestion that 
can grow quickly and dampen spirits for a long time.

Since we returned, we've actually had two American physical therapists 
who did just that--one who told my wife that she'd never use her hand 
again and another who said she'd never bend her ankle again. Both of 
these therapists were wrong, but they succeeded in depressing my wife's 
spirits and delaying her recovery for a considerable period. For the 
life of me, I can't understand how they could have been so insensitive, 
unless this again was an attempt to forestall a lawsuit: I never claimed 
you would walk again.

Having praised the caregivers, I'm forced to return to the 
inefficiencies of a health system devoid of incentives. One can tell 
that the edge has disappeared in treatment in Britain. For example, when 
we returned to the U.S. we discovered that treatment exists for 
thwarting the effects of blood clots in the brain if administered 
shortly after a stroke. Such treatment was never mentioned, even after 
we were admitted to the neurology hospital. Indeed, the only medication 
my wife was given for a severe stroke was a daily dose of aspirin. Now, 
treating stroke victims is tricky business. My wife had a low hemoglobin 
count, so with all the medications in the world, she still might have 
been better off with just aspirin. But consultations with doctors never 
brought up the possibilities of alternative drug therapies. (Of course, 
U.S. doctors tend to be pill pushers, but that's a different discussion.)

Then there was the condition of Queen's Square compared with the 
physical plant of the New York hospitals. As I mentioned, the 
cleanliness of U.S. hospitals is immediately apparent to all the senses. 
But Cornell and New York University hospitals (both of which my wife has 
been using since we returned) have ready access to technical equipment 
that is either hard to find or nonexistent in Britain. This includes 
both diagnostic equipment and state-of-the-art equipment used for 
physical therapy.

We did have one brief encounter with a more comprehensive type of 
British medical treatment--a day trip to one of the few remaining 
private hospitals in London.

Before she could travel back home, my wife needed to have the weak wall 
in her heart fortified with a metal clamp. The procedure is minimally 
invasive (a catheter is passed up to the heart from a small incision 
made in the groin), but it requires enormous skill. The cardiologist 
responsible for the procedure, Seamus Cullen, worked in both the public 
system and as a private clinician. He informed us that the waiting line 
to perform the procedure in a public hospital would take days if not 
weeks, but we could have the procedure done in a private hospital almost 
immediately. Since we'd already been separated from our 12-year-old 
daughter for almost a month, we opted to have the procedure done (with 
enormous assistance from my employer) at a private hospital.

Checking into the private hospital was like going from a rickety Third 
World hovel into a five-star hotel. There was clean carpeting, more than 
enough help, a private room (and a private bath!) in which to recover 
from the procedure, even a choice of wines offered with a wide variety 
of entrees. As we were feasting on our fancy new digs, Dr. Cullen came 
by, took my wife's hand, and quietly told us in detail about the 
procedure. He actually paused to ask us whether we understood him 
completely and had any questions. Only one, we both thought to ask: Is 
this a dream?

It wasn't long before the dream was over and we were back at Queen's 
Square. But on our return, one of the ever-accommodating nurses had 
found us a single room in the back of the ward where they usually throw 
rowdy patients. For the last five days, my wife and I prayed for 
well-behaved patients, and we managed to last out our days at Queen's 
Square basking in a private room.

But what of the bottom line? When I received the bill for my wife's 
one-month stay at Queen's Square, I thought there was a mistake. The 
bill included all doctors' costs, two MRI scans, more than a dozen 
physical therapy sessions, numerous blood and pathology tests, and of 
course room and board in the hospital for a month. And perhaps most 
important, it included the loving care of the finest nurses we'd 
encountered anywhere. The total cost: $25,752. That ain't chump change. 
But to put this in context, the cost of just 10 physical therapy 
sessions at New York's Cornell University Hospital came to 
$27,000--greater than the entire bill from British Health Service!

There is something seriously out of whack about 10 therapy sessions that 
cost more than a month's worth of hospital bills in England. Still, 
while costs in U.S. hospitals might well have become exorbitant because 
of too few incentives to keep costs down, the British system has simply 
lost sight of costs and incentives altogether. (The exception would 
appear to be the few remaining private clinics in Britain. The heart 
procedure done in the private clinic in London cost about $20,000.)

"Free health care" is a mantra that one hears all the time from 
advocates of the British system. But British health care is not "free." 
I mentioned the cost of living in London, which is twice as high for 
almost any good or service as prices in Manhattan. Folks like to blame 
an overvalued pound (or undervalued dollar). But that only explains 
about 30% of the extra cost. A far larger part of those extra costs come 
in the hidden value-added taxes--which can add up to 40% when you 
combine costs to consumers and producers. And with salaries tending to 
be about 20% lower in England than they are here, the purchasing power 
of Brits must be close to what we would define as the poverty level. The 
enormous costs of socialized medicine explain at least some of this 
disparity in the standard of living.

As for the quality of British health care, advocates of socialized 
medicine point out that while the British system may not be as rich as 
U.S. heath care, no patient is turned away. To which I would respond 
that my wife's one roommate at Cornell University Hospital in New York 
was an uninsured homeless woman, who shared the same spectacular view of 
the East River and was receiving about the same quality of health care 
as my wife. Uninsured Americans are not left on the street to die.

Something is clearly wrong with medical pricing over here. Ten therapy 
sessions aren't worth $27,000, no matter how shiny the floors are. On 
the other hand my wife was wheeled into Cornell and managed to partially 
walk out after a relatively pleasant stay in a relatively clean 
environment. Can one really put a price on that?

Mr. Asman is an anchor at the Fox News Channel and host of "Forbes on 
Fox." This article appears in the May issue of The American Spectator 
<http://spectator.org/>.
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