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<p align="left"><font face="Times New Roman, Times, serif">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.<br>
Lynn<br>
</font></p>
<p align="left"><font face="Verdana" size="1"><font face="Verdana"
color="#993300" size="2"><b><a class="moz-txt-link-freetext" href="http://www.opinionjournal.com/extra/?id=110006785">http://www.opinionjournal.com/extra/?id=110006785</a><br>
</b></font></font></p>
<p align="left"><font face="Verdana" size="1"><font face="Verdana"
color="#993300" size="2"><b>ACROSS THE POND</b></font> </font></p>
<font face="Verdana" size="1"><font face="Garamond, Times" size="5"><b>There's
No Place Like Home</b></font><br>
<font face="Verdana, Times" size="2">What I learned from my wife's
month in the British medical system.</font><br>
<br>
<font face="Verdana, Times" size="2"><b>BY DAVID ASMAN</b></font><br>
<font face="Verdana, Times" size="2"><i>Wednesday, June 8, 2005 12:00
a.m.</i></font><br>
<br>
<font face="Verdana, Times" size="2">"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. </font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p></p>
<p align="center"><font face="Verdana" size="1"><font
face="Verdana, Times" size="2"><img
src="cid:part1.00050401.04030403@solution-consulting.com" alt=""
width="88" height="6" hspace="0" vspace="0" border="0" align="middle"></font></font></p>
<p></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2">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.</font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p></p>
<p align="center"><font face="Verdana" size="1"><font
face="Verdana, Times" size="2"><img
src="cid:part1.00050401.04030403@solution-consulting.com" alt=""
width="88" height="6" hspace="0" vspace="0" border="0" align="middle"></font></font></p>
<p></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p></p>
<p align="center"><font face="Verdana" size="1"><font
face="Verdana, Times" size="2"><img
src="cid:part1.00050401.04030403@solution-consulting.com" alt=""
width="88" height="6" hspace="0" vspace="0" border="0" align="middle"></font></font></p>
<p></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2">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!). </font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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>I never
claimed you would walk again.</i> </font></font></p>
<p></p>
<p align="center"><font face="Verdana" size="1"><font
face="Verdana, Times" size="2"><img
src="cid:part1.00050401.04030403@solution-consulting.com" alt=""
width="88" height="6" hspace="0" vspace="0" border="0" align="middle"></font></font></p>
<p></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2">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.) </font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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.</font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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? </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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. </font></font></p>
<p></p>
<p align="center"><font face="Verdana" size="1"><font
face="Verdana, Times" size="2"><img
src="cid:part1.00050401.04030403@solution-consulting.com" alt=""
width="88" height="6" hspace="0" vspace="0" border="0" align="middle"></font></font></p>
<p></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2">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! </font></font>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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.) </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">"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. </font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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.
</font></font></p>
<p><font face="Verdana" size="1"><font face="Verdana, Times" size="2">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? </font></font></p>
<font face="Verdana" size="1"><font face="Verdana, Times" size="2"><i>Mr.
Asman is an anchor at the Fox News Channel and host of "Forbes on Fox."
This article appears in the May issue of <a
href="http://spectator.org/" target="_blank">The American Spectator</a>.</i>
</font></font>
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