From 'Sicko' to Socialized Medicine

I watched Michael Moore’s movie ‘Sicko’ recently on TV. I had not seen it when it was in the theaters. It was an interesting movie to watch—a typical Moore movie with him shuffling about everywhere in pursuit of his targets. In this case he was interested in specific health insurance cases in the USA that had turned into fiascos for the patients involved. Some of the patients were 9/11 volunteers and firemen, and of course that gets to you right away. Here they served their country willingly in a time of need, and the greedy insurance companies deny their claims for treatment. He made a lot of good points in the movie, and showed (as best he could) how healthcare functions in other countries, for example Canada, France, England and Cuba. He did not visit Scandinavia or other countries in southern Europe. It is one of those movies that should be watched and discussed by students in high school and college. I learned quite a bit that I never knew before, for example, that it was Nixon and his cabinet that were interested initially in setting up what eventually became HMOs like Kaiser Permanente in California, medical care for profit. I also was surprised to find out that France had unbelievably good healthcare (and other social) benefits, probably the best in Europe.

I know a number of people in the USA at present who are struggling to make ends meet. Most of them are self-employed and health insurance is not a top priority, even though some of them have health issues like high blood pressure and cardiovascular problems. Some of them have children. One of them claims to have gotten his high blood pressure under control by changing his diet and eating more healthily, and I hope that is the case, because he is not going to the doctor to have his cholesterol levels measured or blood pressure levels checked because visits to the doctor and lab tests cost money. It is possible now to check your own blood pressure at home with a little monitor that is sold (at least here in Norway) in the pharmacies. It costs around 100 dollars and is well-worth the investment; I purchased one several years ago. If it is possible one day to measure my own cholesterol levels by pricking my finger to draw a little blood for a test kit, I’ll do that too. I’ll do anything to keep me out of doctors’ offices. I have finally realized the value of preventive medicine—taking care of oneself, eating a good diet, exercising, and not overdoing stress. The problems arise when genetics kick in—when your family history of cardiovascular disease or glaucoma or diabetes rears its ugly head and demands attention. What do you do then? You cannot ignore the problem, and diet by itself may control but not cure the problem. Then treatment with drugs or surgery may be required at some point. At that point, it might be nice to know that your eventual operation will be covered by your health insurance so that your illness does not bankrupt you. Such considerations are not problematic in Norway generally. For example, if I need an operation, the cost is covered due to socialized medicine. That is a relief. If I visit my doctor for a regular checkup, buy prescription drugs or have some lab testing done, I may have to pay out of my own pocket until I reach the deductible which is set by the government (about 300 to 400 US dollars for 2010). Once I reach the deductible, I get what is called a ‘frikort’ (free card) where the government then pays any future costs for that calendar year. But the prices I have to pay before I reach my deductible are not outrageous, at least not in my opinion. The last time I visited my ‘fastlege’ (primary care physician or regular GP) I paid her about 30 dollars for a 15-20 minute consultation. I don’t know what it costs these days in the USA to visit your regular GP. Dental visits and visits to the optometrist or eye doctor are not covered by socialized medicine generally except in some specific cases. Dental care costs about half of what it costs in the USA but prices are slowly increasing. Eyeglasses and contact lenses cost about the same as what one would pay in the States. A visit to the optometrist who does a routine eye exam costs about 50 dollars. Eyeglasses of course can cost a fortune depending upon whether or not you need special lenses or if you want the latest designer eyeglass frames from Versace.

I have not had much need of the healthcare system in Norway in the twenty years I’ve lived here. The most serious problem I have had was a major slipped disc that almost led to surgery some years ago. Luckily I escaped the operation. But then I saw another side of the public healthcare system, and that was a bit more disconcerting. I had to wait quite a long time to get an appointment to see my regular GP, so that had I waited the time they wanted me to wait, I would have recovered by that time (I had in fact recovered by that time). I was not considered sick enough to be admitted to the emergency room at the local hospital, so I ended up paying a physician who worked in a private healthcare facility (yes, there is private healthcare here too) to see me immediately so that he could schedule the necessary tests to confirm that I had a lower back prolapse and to give me the prescription for pain medication that I needed. The private facilities cost much more money than the public healthcare facilities. The advantage with them is that you can make an appointment to see a specialist without a referral from the primary care physician. That is terrific in my book. It is just irritating to be in pain and to have to see your regular GP first whose only role is to give you permission to see a specialist. My thoughts on this are—if I know I have back pain, then I can call the specialist myself and make an appointment. I don’t need a middle-man or middle-woman. So that is one advantage of private healthcare. The other is that you don’t have to wait very long to see the doctor as you might have to do in the public healthcare system. If you pay an annual membership fee of about 225 dollars, you can get treatment at a private healthcare facility at discounted prices (compared to non-members) and in some cases this is well-worth the money because it saves time and aggravation. But of course critics of the private facilities have a point when they say that these facilities are undermining the public healthcare system. Many of the doctors choose to work in the private rather than the public facilities because they can earn more money. But generally I would say that public healthcare and socialized medicine function fairly well in Norway, despite that it can take a while to see your doctor and/or to get a referral to see a specialist. The major problem at present is that healthcare costs are soaring here just like they are in the USA, and we already pay high enough taxes (25% sales tax; taxes on gasoline and alcohol) to cover the costs of socialized medicine. It will not be possible to offer each patient individualized care without it decimating the public healthcare system. This is the same discussion that is going on in the USA at present, except that it is the health insurance companies who are trying to deny claims and cut costs. Their motive may be profit, whereas here the motive is to prevent costs from spiraling out of control. It is not a problem that has many obvious solutions, because the population is living longer and illnesses such as cancer (with costly treatments and testing) will therefore be more prevalent.

When I worked at Memorial Sloan-Kettering Cancer Center in New York, I had very good medical coverage as I recall. I needed an operation while I worked there and ended up (luckily) paying only a fraction of the total cost. Doctor’s visits were cheap, and prescriptions cost me 5 dollars a month. When my husband and I worked at UCSF in California in 1993, we were part of the Kaiser Permanente system of medical coverage. We have only good things to say about their coverage and we never had a problem with them denying our claims. They also offered very good dental and eye care coverage. But we were not their most frequent users and I have no idea what it would have been like had either of us needed treatment for a chronic illness or the like. That is the key point—that healthcare coverage becomes tricky when the health problems become more complex and difficult. Therefore it does not seem fair to me that if you lucked out by working for a company that gives you great coverage at minimal cost to you, that this will guarantee you treatment while if you are self-employed, you are not guaranteed the same treatment unless you pay through the nose for it. Both parties work hard, work long hours, strive to meet deadlines and goals, and stress is a part of the workdays of both. The health problems that arise for both parties may be exactly the same but the end result in terms of treatment and coverage (or lack of treatment and coverage) may be quite disparate. This is the best argument for general healthcare coverage for all, in my opinion. But general healthcare coverage will not preclude the eventual and necessary discussions that are coming/have arrived for most westernized countries—how to tackle the soaring medical costs in all segments of the population—a major problem for the coming years.