Damien Evans
Up The Irons
Eh, well, good luck with your studies
Michael Moore's "Sicko"
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Eh, well, good luck with your studies
Oliver
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No, it's no propaganda. In Germany I live in a similar health-system like in the mentioned, other "foreign" countries - and actually I watched how it works in America and thought about them: "WTF?".
quixotecoyote
Howling to glory I go
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Another anecdote. I had $3000+ worth of dental work done, the insurance was supposed to cover all but $200. Unfortunately because the insurance company shipped the Addendum to Limitations to the wrong office in limited supplies, I didn't know that they only covered certain types of fillings and my dentist used the other ones (after checking with the ins company and being told it was ok).
Fortunately it wasn't that much of a difference and I only had to cough up another $800. I could deal with that, but to someone else it could've been crippling.
I could appreciate a system where the ins company wasn't trying to avoid paying.
ETA: Us'ian speaking.
Fortunately it wasn't that much of a difference and I only had to cough up another $800. I could deal with that, but to someone else it could've been crippling.
I could appreciate a system where the ins company wasn't trying to avoid paying.
ETA: Us'ian speaking.
One the things that I have noticed over the years of reading this Forum is that the USA system seems to make a long-term illness or disability much more stressful because there is so much hassle regarding insurance and paying for treatment. Even for those with what would be considered a good level of insurance.
This is one thing in a country like the UK we do not have to worry about. For instance if I needed a heart lung transplant and then years and years of very expensive after treatment I have no more concern about the costs of that health treatment then if I had had an ingrowing toenail removed.
This is one thing in a country like the UK we do not have to worry about. For instance if I needed a heart lung transplant and then years and years of very expensive after treatment I have no more concern about the costs of that health treatment then if I had had an ingrowing toenail removed.
Oliver
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I can't even imagine how scary it must be to live in America just because you have this pressure that health-care and welfare are not granted for free if you need it. Quite frankly - it sounded somewhat prehistoric when I heard about the US way the first time.
Did you see Sicko yet? They also have a part talking about the UK-Health-Care NHS in it.
Granted for free? In Germany? I suggest you check your pay stub, Oliver. I'm self-employed, and shell out nearly EUR400 per month for "free" health insurance.
When I was a regular employee, they used to take about 200EUR per month out of my paycheck for "free" health insurance. The company paid the other half - which is the usual setup as far as I know.
Everyone in Germany is required to be insured. There are public inusrance agencies (gesetzliche krankenkassen) and private agencies (private krankenkassen.) Well off people go private, and everybody else pretty much sticks with the public agencies. Private agencies pay higher rates to the doctors, and they also cover more elective (and not strictly proven) treatments. Guess which patients are handled better by the doctors? Oh, surprise. The privately insured patients.
Health care anecdotes:
Germany:
My wife nearly lost an uncle a few years back. He wasn't feeling well, and went to his family doctor. He hooked him up to an EKG, and told him nothing was wrong with his heart and come back tomorrow if he didn't feel better. My wife tlaked him into going to a university clinic, and they found he was having a major heart attack and would have been dead with in 24 hours. My wife knows the uncle's family doctor, and got a look at the EKG trace. It was made with smushed out felt tip pen - it was hard to tell there was a heart beat, let alone see any problems.
Doctors have a budget of how much they are allowed to prescribe per month. Medicine is covered by the health insurance, and every prescription comes out of the budget of the doctor that prescribed it. If the budget is used up before the end of the month, oh joy, you don't get a prescription from your doctor. You get to try and find another doctor who will see you and who will prescribe you your medication (really sucks if you are on something you have to take long term, like blood pressure or thyroid stuff.)
I went through a bout of depression a few years back. Our family doctor told me I just had "spring fever," get over it. I talked to another doc, he diagnosed depression and prescribed me St. John's wort.
I happened at about that time to visit my folks in the US, and visited my parent's doctor. He diagnosed depression, and told me what I needed to be taking. I went back to Germany, and hunted up a psychiatrist and (finally) was treated for what was becoming a major problem - six months after I noticed myself that something was wrong.US:
My father has had heart problems since 1985. He has been on and off various health insurance plans since then. He has not been bankrupted by costs, despite multiple bypasses and various other treatments (angioplasty, stents, etc.) The doctor's office and the hospital where he goes are very good about getting the costs covered through various federal programs and assistance organizations. When his heart gives him trouble, they treat him first, then worry about what it's going to cost.
Sir Robin Goodfellow
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Do you really need to use ethnic slurs? If the article mentioned Israel, would you have said, "Kike health care..."?
Segnosaur
Penultimate Amazing
That sounds like a bureaucratic foul-up, not something that is systemic to private insurance. (Well, that's assuming it was a good faith error on the part of your insurance company.)
I have a similar anecdote: Normally dental care in Canada is not covered under our health care system; however, if someone is on social assistance, their dental care (or parts of it) ARE covered, but only certain procedures.
I knew someone who, because of a few VERY bad teeth, it was recommended that they have them removed and replaced with false teeth. It wasn't until AFTER they had them removed that they found out that the public system didn't cover false teeth, only work on existing teeth.
Segnosaur
Penultimate Amazing
Keep in mind the old saying: The plural of 'anecdotes' is not data.
If you look, I'm sure that you can find bad examples in ANY health care system. You may have encountered some. Moore, likely used them to great effect to show how 'bad' things are.
But then, anecdotes don't tell the whole story. They don't really describe how well or bad off the 'average' person is (under American or any other health care system.)
As you should know, it's income-rated; which means it's basically free for those with no or very small income. Additionally, as you would know, its major advantage over the UK (let alone the USA) is that it covers dental work too.
Actually, no. This is quite fascinating, but what I learnt from one doc is that actually many many very highly paid people stick with the public agencies, and it's only those who want to impress others, usually self-employed who are not very rich at all, who go private.
Not really so in the main.
This is a problem with a particular doc, not with the system per se at all.
This is true --- but most usually, it is never a problem. Certainly it has never been a problem for me ever in Germany.
Again, problems with particular docs, not with the system; you could just as easily run into the same kind of problems out in Ohio or Idaho or Georgia.
Rolfe
Adult human female
You see, that's the thing. In the UK you don't have to worry about what it's going to cost, not at the time and not afterwards, and the doctors don't have to spend time trawling charities to try to help their deserving cases.
There's no such thing as a free lunch, but the point it the NHS is free at the point of need. Everybody pays, but in proportion to their means, so someone on a very low income will not be inconvenienced by their contribution, which may in fact be zero. But the system means that the young and healthy pay in, and those with large incomes pay a relatively large amount, and so the system manages to creak on.
With the result that if an elderly man's heart is giving him trouble, he can rest easy that nobody will even dream of sending him a bill.
Rolfe.
Which doesn't change the fact that it is not, in fact, free. I didn't realize that dental wasn't covered in the UK. That explains the German stereotype of Brits with bad teeth.
The common reasons that I know of for going private are 1) Better coverage and 2) Lower premiums. The lower premiums usually come at the cost of some restrictions. Also, if you go private there can be problems with going back to public. Private also doesn't (neccessarily, not all are the same) cover your family. Final note: You must earn above a sertain minimum wage to even have the option of going private. I don't know the limit now, though at times in the past I've been above it.
Then check into the doctor's offices with the separate waiting rooms sometime, or some of the docs who only accept private insurance. Or be the poor SOB on AOK who gets told there are no appointments available for the next month, but whose neighbor gets a same day appointment because he has private insurance.
It's a problem of the system. This isn't an isolated case of outdated equipment or procedures - those cases are common. The fees are structured by the insurance system. Each individual test or procedure has a fee that the doctor can bill the insurance agency. If that fee isn't high enough to pay for updated equipment, old equipment will be used until it is no longer functional. If a piece of equipment costs EUR10,000, and you are allowed to charge EUR20 for using it, you will have to use it 500 times to get your investment back. If you use it unnneccessarily, you will get dinged, so no just using it to pad your bills. That doesn't even consider the fact that using it will take up work time for the doc and his assistents that has to be paid for as well.
Then you've never had a doctor ask you if you didn't have 5 or ten left over from the previous prescription to hold you until the first of the month? I've had it happen. The anti-depressants were a good example. I would make an appointment with the doc for a progress check and a refill, and she'd sometimes ask if the refill prescription could wait until the first of the month.
I didn't tell you how many doctors I talked to here in Germany before I finally got help.
Part of the problem is the budget. That budget isn't in presscriptions, it's in euros (DM back then.) Doctors are leary of prescribing expensive stuff because that will impact their medicine budget for months, possibly years. Another part of the problem is belief in woo crap. The only doc I know of personally who completely rejected woo was kidney specialist my wife worked for. Woo does F all for a failed kidney. I've yet to meet a family doctor who wouldn't push homeopathy or some herbal remedy.
Most folks here have no idea what stuff really costs. They bitch because there's a 5 or 10 EUR co-pay on most medications. That an anti-depressant may cost EUR60 for 30 pills totally escapes them, but that's what the doctor has to budget for. When I was on the anti-depressants, I asked my doctor for a private prescription (pay the full price out of pocket) for emergencies. I was not a pleasant person if I missed my medication - and sometimes it could be very difficult to get an appointment at such a time that the doc could also give me a presciption (on insurance) for my pills.
The system works, more or less. It's inefficient as hell (the monthly AOK slick paper newsletters piss me off) and it's a political football. Doctors lobby for higher fees and more freedom in choice of treatment. The insurance companies keep reaching deeper in the patient's pocket and chucking more of what they get out the window while telling the doctors they can't have more.
And the patients keep paying every month, and have no idea what their health care really costs.
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Yeah, so tell me it's an egalitarian system. If Joe Putz off the street staggers in to the hospital with heart trouble, are they going to pull all the stops to help him or are they going to go by what the system says a heart patient needs?
Where my Father goes, they do whatever ever it takes to keep you going and get you back together. Tests, operations, medications. Whatever. Cost $100,000? Whatever. They've got bookkeepers in charge of tracking down ways to pay for it. You live and are in good shape again. Farking around with a little paperwork is a good trade, I'd think.
I've been in German hospitals around people wh had heart attacks. I'd a damned site rather jump a plane to the US and get treatment there if I thought I were having one - taking the risk of problems inflight and bills to come against the risks of inadequate, mediocre care.
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Rolfe
Adult human female
I don't even understand that question. A heart patient needs all the stops pulled out.
You need to ask some of the people on the forum who work in the NHS to get the truth on this one. However, suggesting that NHS staff will selectively choose not to give best case to someone they perceive as "Joe Putz" who has just "staggered off the street" is pretty insulting, you know.
Rolfe.
PS. I do recall one funny story. University lecturer, minor professor, PhD and all that, goes hillwalking. He has some sort of accident and shows up at A&E with a gash on his face. He looks like a tramp. Junior doctor cobbles gash together with about three big stitches. Junior doctor then reads admission notes properly. Junior doctor takes in the fact that this "tramp" is actually Dr. Bogan. Junior doctor hurriedly undoes the three big stitches and spends about half an hour carefully opposing the gash with several dozen tiny, near-invisible nylon sutures.
They will get whatever treatment is possible (i.e. what is available) albeit of course some hospitals will be better than other hospitals and some will be able to offer different levels of treatment. No one will consider the cost of the treatment when they are treating the patient.
Yeah, do that. It sucks to need a doctor and find out the hard way that he likes to prescribe sugar pills.
Ask around. Check with some of the other students, find some who don't believe in woo (tough job as far as I can tell) and get recommendations from them.
The problem isn't so much bad care as it is mediocre care. I've gone on about the costs and other problems, but there's more to it than that.
1. Absence from work requires (in most places) a slip from the doctor that says you were really sick. So, doctors get an endless parade of people with a one day bug who need a bit of paperwork done. And, of course, you get the goldbrickers who go to the doctor when they are actually feeling fine and browbeat the doc into handing out a sick slip so they can have a day off of work - that doesn't count against your vacation time. The monotony and the brow beating take their toll on docs. An otherwise good doc who's been worn down by the crap isn't going to do as much for you. A good doc wants to help sick people, not play bureacratic daddy to the nation.
2. Like anywhere, doctors are respected people and the pay is pretty good so you get some who are in it for the money/prestige. They don't give a rat's patootie. You get those everywhere.
3. Everybody pays into the system, so you get lots of them who think they ought to get something out of it - even though they are healthy. These are the goldbrickers. They are also the reason for the medication budgets. People used to talk their doctors into prescribing OTC medications so they wouldn't have to buy them. Aspirin can cost EUR5 for a pack of twenty, larger packs are above the co-pay so with a prescription you could get large pack for the same price as a small one.
4. There's no real pressure to get rid of bad doctors. In the US, a bad doc will lose patients or get sued out of business. You rarely hear of people going after a bad doc here. When someone does, the doc usually gets off with a very light fine (by US standards.) Surgeon left a sponge inside and your husband died? Gee, that's tough. EUR50,000. Next case. And the doc goes on in his mediocrity.
Also, take this all with a grain of salt. We've got Oliver and some of the other Europeans painting a rosy picture (using Moore's color by numbers template) of national health systems. I'm trying to provide some balance.
What you see and experience with your doctors may be different. It isn't all one homogenous blob, and there are differences from region to region as well as by state.
But, do check into a good doctor before you need one.
You have an affiliation with the US gov here? Immediate family in the Army (and stationed in Heidelberg) or diplomatic folks?
Otherwise, I don't think there's much chance. The impression I get from folks who are Army family members is that the military docs' priority is on the soldiers, and that family members often get referred to local (German) doctors.
Can't say that I've ever heard of anyone trying to pay for an appointment with a military doctor, though. I don't know if that's even a possibility.