Big, Bad Nationalized Health Care, by Paul Shirley

A disclaimer: Immediately following this paragraph, I’m going to write the topic of this treatise. Initially, you will be put off. You’ll think, “Come on, Paul. I don’t want to read about [the topic I’m about to write]. That’s for old people.” But give me a chance. I promise I’ll work in a personal anecdote and at least one off-color joke before I’m through.

The topic: Health Care.

See, I told you. You don’t want to read about health care. So boring, you say. When you think of health care, you think of Nancy Pelosi and you think of sad, elderly people fighting over Medicare in town hall meetings in Missouri.

I understand. But there’s a story here. And this story isn’t for old people. Old people are nothing more than a block of votes for whichever party can frighten them more effectively. You and I have some years to live, we hope. In those years, we might need to see a doctor now and then. And we might not want to take out a second mortgage to do so.

The story is about the health care system in Spain, one of those scary “socialist” countries that the guy who copies keys at your local True Value hardware store will warn you about. I’m able to tell this story because I’ve lived almost two years of my life in Spain, and I’ve seen their system of health care at work.

While European and, assumedly, a lovely place to live, Spain lags behind ten European countries on the Human Development Index. So, while living in Spain isn’t like living in Sudan, it’s not quite like living in Sweden either. The Spanish don’t have everything figured out. But even Spain, adorably backward country that it is, can figure out health care. The country offers its citizens free, universal health care, paid for by taxes. And it works.

A few facts:

On the World Health Organization’s 2000 report on the quality of country’s health care systems, Spain was ranked 7th.

That is, Spain has the seventh best health care system in the world.

The United States was ranked 37th.

That is, the United States has the thirty-seventh best health care system in the world, behind paragons of modernization like Chile, Costa Rica, and Morocco.*

Perhaps the study was a fluke, you say. Or maybe Spain has a better system than the US because the Spanish spend more on that system, much like they spend more than the US on soccer players and the production of Rioja.

In the World Health Organization’s report on average yearly health expenditure from 2000-2005, Spain came in at number 40.

The US: number 2.

Keep in mind that in this, the latter comparison, a higher ranking indicates that a country spent MORE. As in, the US spent the 2nd most of any country in the world. Spain spent the 40th most.

The difference is significant. In 2005, the Spanish spent 8.2% of their Gross Domestic Product on health care. That same year, the US spent 15.2%.

To summarize, the United States spends more on an inferior product. My home country is like the retired couple that chooses a Cadillac over an Acura.

Statistics, schmatistics, you say. Anyone can toss around a simple inverse relationship between money spent and services rendered. What’s the story on the ground?

Fear not, dear reader, I have experience from which to draw. Experience that I’m going to share with you now. I’ve lived the nationalized health care nightmare. I’ve seen into the mouth of the beast.

Informed reader that you are, you draw upon articles you’ve read, in which horror stories were told, and you say, “Oh, the lines to get in must have been terrible.” Or, if you’re British (or pretentious), you say, “the queues”. You ask, “Were people stretched around the block, with four-hour waits to see a doctor?”

No.

Well, in that case, the care must have been dreadful. Did you have to do your own X-rays?

No.

Write your own chart?

No.

Give yourself your own barium enema?

Um, no.

Here’s what I saw:

While in Murcia, Spain, playing basketball with my professional team, I broke my ankle. After the game, I walked (with the aid of crutches) with team officials to a nearby emergency room. I waited for 20 minutes, was ushered into a clean, modern X-ray bay and films were taken of my leg. Five minutes later, a radiologist analyzed those X-rays on the computer in his office, showing me where I had torn apart my ankle. The charge, even though I was not a resident of Spain: Zero dollars. (Converting to Euros, that’s…Zero Euros.)

A year and a half later, I lived in Barcelona with my then-girlfriend, who was (and, I’m assuming, still is) half-Spanish and half-Dutch, but who maintains citizenship in Spain. One week, in between bouts of depression that were paralyzing our relationship, she endured a bout of sickness that was paralyzing her ability to breathe. Ever the supportive boyfriend, even in times of woe, I went with her to the doctor.

We walked to a public clinic in the early evening on a weeknight. When then-girlfriend arrived at the front desk, she presented her identification card to the secretary, who examined it and told us to wait in the chairs around the corner for a doctor. No paperwork, no confusion, no co-pay.

Fifteen minutes later, she was summoned by the doctor to an office. At this point, I was left outside to wait so, conceivably, all manner of witchcraft was deployed in the search for a cure. When then-girlfriend returned, she was unable to corroborate such a theory, saying that, instead of utilizing a leech and a voodoo doll, the doctor had asked multiple questions before examining her respiratory function. The doctor had then written a prescription for an antibiotic and a heavy-duty decongestant.

A-ha, I thought, a prescription! This must be where the money changes hands.

We hiked to the Farmacia with me feeling smug, thinking I had finally divined the flaw in the system.

Once inside, then-girlfriend handed over her prescription. After five minutes, the pharmacist appeared, drugs in hand. He told us that it would be “eighty-five”. Ha! Eighty-five euros, for a simple decongestant and an antibiotic!

Then-girlfriend dug through her purse, counted out 85 Euro-cents, and handed it to the pharmacist.

I picked my jaw off the floor and followed her out the door. I asked a flurry of questions:

Me: “Did that really just happen?”

Her: Yes.

Me: “How does this work? Are you paying a monthly fee for prescription benefits?”

Her: No, Paul. The government pays for almost everything. Why shouldn’t it? Why should people have to pay when they’re sick?

Me: “Yeah, but don’t people take advantage of the system?”

She looked at my quizzically, before saying, “Why would people want to go to the doctor? For fun? Is going to the doctor like going to a roller coaster park?”

Going to the doctor is, of course, not like going to a roller coaster park.

I was mildly crestfallen. A large portion of our relationship was spent arguing – mostly playfully – about the relative merits of our two ways of life. While in the US, I’ll bash my country often and resoundingly. But in a foreign country, dating a girl from that country, I’m as staunchly patriotic as the average Tennessee-born, Chevy-driving, gun-toting hillbilly.

But this was too much.

Now, dear reader, you say, “But….” And you say it like your mother would say it when she’s set a trap and you’ve walked into it. Like this:
Buh-ut…

Buh-ut, you say, what about the taxes?

Good question. Astute, even.

I was in Spain because I was working there. Per my contract, my Spanish taxes were paid by my employer, meaning that I was forgiven that tax against my tax responsibility in the US. When I returned to the US each year, I had to figure out what the tax rate in Spain was. Presumably, with all this free health care and, therefore, rampant socialism, the personal tax rate in Spain should be higher, right?

Wrong.

I learned from the aforementioned girlfriend (you can learn a lot about a place by living with someone from there) that most single people in Spain make around 1200 Euro per month. Keep in mind that the Spanish don’t work particularly hard. The siesta period, usually from 2 pm through 5:30 pm, remains in effect. Returning to work at 5:30 is encouraged, but doesn’t appear to be mandatory, which helps explain why they don’t make very much money.

In other words, the “average” single Spanish person makes around 15,000 Euros per year. Federal tax rate for 15,000 Euros per year: 15%. (Note: This is country-wide tax. There is also a provincial tax, which is similar to US state tax.)

The “average” income in the US: around $32,000. Federal tax rate at that income level: 15%.

This, dear reader, is the socialist bogeyman that the guy at the hardware store – the one who’s never actually been to Europe – would have you believe is lurking over our heads, should the US enact a program that provides for nationalized health care. I understand his concern: Similar, if not better care, for less money, paid for by the same tax rate? It is a frightening specter to behold.

But surely, SURELY, elected American Congresspeople are intelligent enough to see through the fear-mongering. Surely, they, of all people, can put aside reactionary thinking and remember other successful programs provided by the government. Programs like the generally effective policy of providing universal elementary through secondary education to all American citizens. Surely these intelligent, popularly-elected souls can wade through the propaganda in time to arrive at the conclusion that universal health care, first, is nothing to be feared and, second, might actually be an improvement over the current system.

Alas, it appears that they cannot.

Which, I’m sure, has nothing to do with the $396 million spent by lobbyists on behalf of health industries (including pharmaceutical companies, HMOs and hospitals) in the first nine months of 2009.

Sometimes, numbers like $396 million become so big that we lose track of what they mean.

Three-hundred and ninety-six million dollars is enough to pay each of 6,947 nurses a yearly salary of $57,000.

Or enough to buy 132 MRI machines.

Or enough to buy 50 million cans of Campbell’s chicken soup, 16.7 million gallons of Tropicana Pure Premium orange juice (the good, not-from-concentrate version) AND 15,076,923 bed pans from Target.

Or, it’s enough to keep this country of ours, a country we claim to be so very modern and benevolent and free, lagging behind Spain, a country ruled until 34 years ago by a dictator, in our ability to provide health coverage, not just for the poor and disenfranchised, but for the average citizen.

Good job, home country of mine.

By most accounts, any hope that the American government would create a health care system like Spain’s will have to wait for the failure of whatever hodgepodge of health care dike-fingering is enacted by our Congress. It seems likely that we will be forced to continue to endure escalating costs, subpar care, profiteering on the sick, and our own flawed (and very real) version of universal health care.

Because we have universal health care. What that means, in the US of A, is required (by law) emergency room treatment for whomever walks in off the street, regardless of that person’s ability to pay. Such a system has hardly proved efficient, passing costs from hospitals to insurance companies to, ultimately, the very taxpayer who might have originally claimed to be petrified of, gasp, universal health care.

It seems logical to aspire to learn from the success stories of countries like Spain. The alternative – to learn from our own mistakes – is a poor idea. Because, in this case, mistakes mean a story that is far from boring. Mistakes mean sickness, death, and human suffering.
Eventually, I hope the United States can swallow its collective pride and make sweeping and productive changes to its system of health care. Our goal should be to keep stories about the health of our neighbors the way we’d all like them to be: very, very boring. There’s nothing wrong with a dull tale about American citizens living long, healthy lives without paying too much for the right to do so.

Oh, and one more thing. Guess how much it cost that same girlfriend to go to college, regardless of her parents’ income or her social status.

If you guessed zero dollars, you guessed well. (That’s still zero euros. The euro/dollar exchange rate fluctuates wildly, but it hasn’t changed since 1000 words ago.)

*Note: The accuracy of the 2000 WHO report has been debated, notably, and recently, in the Wall Street Journal. The main sticking, point, however, is that the rankings do not account for “factors beyond the control of the health-care system…such as dietary habits”.
I’m no dietician. Nor am I a doctor. But I think it’s safe to say that dietary habits are, in fact, an important factor in one’s own health care. It seems to me that this myopic view toward the impact of preventative care is a telling one. It’s akin to saying (as has been done) that the reason our health care system is less effective than Japan’s is that we have more obese people. “Reason” is the wrong word. “Symptom” would be more effective: A symptom of the fact that our health care is less effective than Japan’s is that we have more obese people.