Posted by: viewfromtheriva | September 30, 2009

Croatia vs. US: national health care wins!


Having just received my Croatian National Insurance Card, I was anxious to put the system to a test.  I’ve been using private clinics for the past six months; waiting for my paperwork to get all approved so as a temporary resident so I could get the same national health insurance that Croatian citizens get.

It’s an odd wrinkle that even if you have private insurance that covers you abroad, you need to be part of the Croatian system if you work here.  The cost is about $60 a month.

The system is very direct and simple.  First, you choose any primary care physician you want.  When you need specialized health services, he or she refers you to a specialist.  Almost all specialists are based in local hospitals which are well equipped and easy to access.

Not speaking the language, I wasn’t worried since most MD’s here speak English and those with advanced training usually go to other parts of W. Europe or the US to get additional training.

I have a bit of history of glaucoma and cataracts in the family and last year I had one of those flashing light episodes (retinal detachment, but nothing serious or surgical) and saw an ophthalmologist.

So it was time to check my vision again.  In the states, the cost for an exam to check inter-ocular pressure, dilation to see into the pupils, and a physical exam by the doctor using standard equipment to check vision, cataracts, etc. was $250.

Here, the same exam, same equipment was $7.  And oh yes, another $3 “referral fee” from my primary care doctor.

Including the wait (there are no appointments) I was in an out in an hour and 10 minutes–which included waiting in the lab 20 minutes with my eye closed to let the dilation take effect.

The MD was smart and thorough; he recommended a field of vision test with a sub specialist in glaucoma “just to be sure”.

For another $7, you bet.

The whole experience made me think again about what is wrong with American medicine. When I was the CEO of a small, innovative medical products company during the 1990’s, I had to deal both with the FDA and the medical community almost every day.

Self-protective, parochial, greedy, ego-maniacal are the words that come to mind.  Hard-working and smart, absolutely.  The kind, gentle, humanistic folks I met were far and few between.

In America, the focus is not on community medicine or even serving the public.  The public are poor people and folks on welfare.  American medicine is focused on private care.  Private patients.  Folks who can pay or have very good insurance.

Is it any wonder why the cabal that controls American medicine is so against national health care?

The sad truth is that everything wrong with American health care has its origins in how America creates its doctors.

What often starts out rooted in idealism and common good too soon gets twisted by a system whose only goal is to perpetuate its mystique, its power and its wealth.

Getting into medical school is tough enough.  It’s a grind to graduate and every step of the way you’re told how good you are or how crappy you are.  I think it’s more competitive than being a pro baseball player, where at least you get a starting salary of $250K and a pension after less than 10 years.

In America every single medical student has to hope and pray and fight to get an internship at one of the top medical facilities in the country when he or she graduates.

Proponents of the system argue that giving the best and brightest the top spots turns out top doctors.  This sounds reasonable, but it isn’t.

Because the current system still operates like some medieval guild, it’s purposely designed to protect the profession at all costs.  This means keeping prices high, supply of physicians carefully regulated and constantly focusing on specialized medicine at the expense of GP’s and family medicine.

Like graduating from Harvard, once you’re a Harvard man, who cares if you graduated last?  There’s no such thing as a “bad” doctor.  So no wonder botched surgeries are routinely covered up and bad physicians “eased out” with about as much publicity as a Boy Scout leader who fondles an 11 year old.

The American myth says that the richer the clinic, the richer the hospital; the richer the doctors, the better the medicine. And everyone connected buys in–the insurance companies, the medical associations, and the profession.

Imagine if you had to begin your professional life faced with a six figure loan you took out got to go to medical school?  And then spend your first 5 years as an intern earning way less than a truck driver?

So of course you’re thinking “if I can get a top tier internship, then I can get a top tier appointment to a top tier hospital or private clinic–and then my money worries are over a LOT faster!”

But boy it is tough.

Here’s a typical scenario:  200 graduates and only 3 openings at Stanford in pediatric radiology.   If you get relegated to some hospital in Arkansas for an internship–not that hospitals there are bad–your chance of making a top tier income at a top tier clinic associated with a top tier hospital is pretty remote.

Let’s take Seattle, one of the major medical centers in the country.  The University of Washington is a top medical school.  And one of the top hospitals is Overlake, in nearby Bellevue.  Like many top universities and hospitals, surrounding the medical school and hospital are a coterie of private clinics.  Most of these clinics are owned and operated by physicians who have “hospital privileges”–meaning that they get to use millions of dollars worth of high technology equipment and surgical suites and labs in return for part time work at the hospital treating all comers.

The pay off is that when they have their own patients, they get to charge top dollar and pay nothing for the technology, the staff or anything else in the hospital.  Every graduate medical student knows this and if they are lucky enough to get a top notch internship, they will get a top notch job at one of these top notch clinics affiliated with a top notch private hospital.

No problem getting patients or referrals from other clinics in the same league and of course the private hospital gets to gloat that “it has the best doctors in town”….which perpetuates the myth that the city or county hospital is much worse because their doctors don’t earn as much, aren’t in the society pages or piloting their own planes.

But the real tragedy of young physicians in America is that to keep them in place, the deck is stacked no matter where they intern.

There simply is no escape.

Exhausted from working insane hours, poor and taking crap from every other resident with more seniority, by the time they are done with their internship, most are more than ripe for conversion to worship at the golden altar of private practice.

If American medicine truly had better health statistics than European countries with national health care–i.e. people lived many years longer; less heart disease and cancer; fewer alcohol and other drug-related deaths; less obesity; much better infant survival rates; etc. then maybe it would be worth it to keep the current system intact

But here in Croatia and in other countries where treating people in a public hospital or public clinics is the norm, “star” doctors, “star” hospitals and private practice take a back seat.

And what are the results?  Lots of healthy Canadian, Croatian, French, German and British babies are born, broken bones are set, CAT and PET scans are done (usually with world class German or Swiss equipment), etc. at far less cost, with pretty similar outcomes to US facilities.

And in some cases, the results are even better.

The only thing that is different is that you do wait longer and Americans are not used to this since we are taught at birth that the only people who wait in line are probably poor and take the bus.

I believe that the first step to national health care in America is to change the system to train and create a cadre of national health care doctors.  And that means changing the way medical schools operate–put a focus back on family medicine, not on specialty medicine–so we’ll have more doctors who will be happy to train and work at the kind of hospitals and clinics we all will need in the future.

With a true national health care system in place, MD’s will finally be able to work a 40 hour week; enjoy their family and friends, and without a doubt, suffer a lot less  suicide and drug abuse  (which is significantly higher among doctors than the general population).

Yes, MD’s will earn less money, but much more than the national average.  But the overall benefits to society will be immense–physicians will finally be free to be focus on doing their best for us, not their practice or their hospital or themselves.

Enjoy our new Croatian vacation portal

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