Friday, October 21, 2011

US versus European health care

Sherman Hospital in Illinois
Photo by James Jordan
I've had occasion to experience health care in the US, the UK and the Netherlands. Overall the quality of the care appears to have been about the same. Even those who argue most fervently in favor of the US profit-based model have to admit that European health care costs are far lower than US health care costs, even the Netherlands, whose health care system most closely resembles that of the United States, is doing a better job of managing both access to care and costs.

When I was younger, I've personally struggled with lack of health care when I was younger, including many years of dealing with a life-threatening medical condition which could be cured with a simple surgery. A surgery, I might add, that I finally received after getting a job with health insurance and waiting a year for the "pre-existing condition" clause to no longer be effective. After I finally got that surgery, I wound up deaf in my right ear and bankrupt. Yes, you read that right. I was "covered" by medical insurance and declared bankruptcy due to the costs it did not cover. They weren't huge costs, but I was poor.

But let's ignore even that. Let's forget about cost and access to health care. There's one telling difference I've repeatedly noticed between European and US hospitals.

The European hospitals I've been in were utilitarian affairs, often looking like they desperately needed a fresh coat of paint. US hospitals were invariable chrome, glass and steel. They drip with money.

When I was recently in the US and visiting a friend, she had occasion to visit a hospital and while I was with her, I was simply amazed at how new and expensive everything was. The health care system in the US not only takes all of your money, but it's letting you know it. I would love to see studies comparing how much money is spent on hospital architecture (not the medical technology) in the US versus the rest of the world. I suspect it would be an eye-opening bit of information. I certainly don't know that US hospitals spend more money on their construction and making them look attractive; it could certainly just be the few hospitals I've attended. I'd be curious to know what others have experienced (such as this description of a Greek hospital).


  1. The one time I had to attend an American hospital - because of my American wife - it was all shiny gleaming surfaces, machines that go ping - and a credit card machine waved at you at every turn.

    By contrast, UK NHS hospitals seem to be much more of a utilitarian "sit there, wait your turn, then go into a portakabin to be treated" affair. Part of me is still impressed that they have computers these days. But it's free, and it works.

    And I'd rather have a health system that's free for 95% than a rich one that only works for 45% (or whatever the figures are)

  2. I've only been to the doctor in one other country---the Netherlands---and I didn't go to a hospital, I went to a doctors office. I was impressed with the richness of the decor, the wood furniture, expensive carpeting, it was really "home-y", *and* the price. I think it was less than $15? This was around 1995, so the dollar was stronger. The medication that I needed was, also, very inexpensive. I remember it was cheaper without insurance in Amsterdam than it was with insurance for me in San Francisco. That kind of blew my mind...

    The hospital that I go to now is a public hospital. It's being rebuilt, so there is a new part and an old part. The old hospital was built around 1930, I think. It's disgusting. So much so, that it actually scares me when I have to go into the old hospital, instead of the new building, for a procedure, because things are so dirty and old. The idea that medical care here in the states is full of money and niceties isn't always true.

    The new part of the hospital is better in that it's cleaner. Everything still looks cheap. There is no "money dripping from the walls" feel happening. I'm sure that the construction is costing a lot of money, as construction is wont to do, but it's sure not getting spent on comfort. Sure, there's a lot of glass, but this is California, there's glass everywhere (we don't have to worry about the cold coming in through the windows). They could certainly do with some new machines--I've twice had to put off procedures or a test, because the equipment was broken.

    I'm getting the medical care that I need on the "tax payers dime." I have two serious health issues. I do not have a monthly cost. I pay $5 for my prescriptions, $5 for an office visit and nothing for the various tests that I need. My (every 6 weeks) infusions are free for me, too, because I contacted the drug company, filled out their forms and now they subsidize me. I'm very happy with the skill level and care of the doctors that I have. I believe that I have better doctors as a poor person on the governments dime than I ever had with access to the "best" and most expensive health care. I am not eligible for medi-cal or medi-whatever. I have a County Based program.

    However, I would feel much more comfortable if I wasn't terribly afraid of getting sick from the hospital I have to go to. I would love a nice steel, glass and *whatever* building---as long as it was clean.

  3. I have to agree with @Curtis on this one. Every hospital I go to seems to have plenty of money. Of course, the doctors always seem taxed out and tired, only to be corrected by nurses who seem to get regular human shifts. Hospitals are a luxury affair here.

    I've only been to one other doctor in China (Shanghai). Being in Shanghai, I think I can't really make a comparison, as Shanghai is the richest place in China. Nevertheless, the visit and treatment cost me on order of 6$ (50 yuan). The environs looked very similar to those in the US.

    As a subscriber to American health "care", I've been completely unhappy with the level of bureaucracy, costs, and, as Curtis mentions, pre-existing conditions. There are tons of exceptions to enable those who "cover" your health costs to _not cover_ you if it becomes too expensive.

    Then, if you lose your job, you're not covered. Or if your employer can't handle 40% year-over-year price hikes in healthcare costs, they'll just _stop buying it_, and you're not covered anymore. And don't get me started on deductibles and all the nonsense insurance companies put you through.

    My experience in the American healthcare system has simply been to avoid it as much as possible. It is a racket, and it is a for-profit nightmare that sucks all the goodness and profit out of it; the hundreds of thousands of dollars doctors make is sucked up in debt for their education, malpractice insurance (which basically is an insult to their 250,000$ education, right?), and the myriad of costs that they have. They end up netting out very little. It is a travesty, a grind, and something I dearly wish to not support.

    And I will mention that for-profit health is a tremendously bad idea: It pits continued corporate operations against human life. It is not fair for _either_ party and is a very bad game to play. Because we all know that individual humans always lose to this when these are the rules.