Fun with Ladders and Doctors

I don’t usually talk about health issues on social media, but I recently became (once again) a health care consumer when I fell off a ladder at the mökki about a month ago. You could say I fell off the roof, since I was still at roof height when the ladder slid out from under me, dropping me like a rock flat on my back onto our porch. The fall fractured one of my shoulder blades, and it hurt like hell. Considering the kind of health issues some folks have to endure, it was no big deal. Still, it required a hospital visit and, just to be on the safe side, an ambulance. And did I mention, it hurt like hell.  

To go into a bit more detail, my latest little episode of careless ladder usage required:  

• a forty-minute ambulance ride, during which I got three doses of fentanyl (once again, it did hurt like hell)  
• a CT scan of my head in Malmi Hospital  
• seven X-rays of my back and shoulder in Malmi Hospital  
• blood test in Malmi
• a cross-town ambulance transfer to Töölö Hospital for more specialist examination  
• two more CT scans in Töölö, including a full-body scan to rule out internal injuries  
• another blood test, before being discharged from Töölö around one in the morning 

Luckily, the cracked scapula was the only body part damaged. My pride, from once again falling from a ladder like a klutz, is another matter.  

And the point of me talking about this at all now is the costs. The accident resulted in two medical bills. The ambulance bill was €25 ($28). The bill for everything done at the two hospitals, all the examinations, X-rays, CT scans, came to €32.70 ($36). Total. 

This is the kind of health care system we have here in Finland. I did not have to fill out any forms. I do not have any kind of private health insurance. I do not pay insurance premiums. I did not have to worry whether the doctors or radiologists treating me were “in network”. I did not have to worry that the hospital where the paramedics took me had some prior arrangement with my insurance company, which doesn’t exist anyway, since I don’t have insurance.  

I did have to give my Kela number, equivalent to the Social Security number in the States. This allowed the paramedics to access my medical records already before the ambulance ride. It is also proof that I am part of the Finnish health-care system and entitled to its highly subsidized services.  

Private insurance does exist here, as do private clinics and hospitals, but I’ve never seen the need to use them except when they were provided as part of my employer’s health benefits for routine doctor visits.  

The public system here is fine with me and is typical of European-style universal health care, or “socialized medicine”, or Medicare for All, or whatever you want to call it. Some variation of this kind of public health system is what Democratic candidates for US president have been discussing in recent debates. Universal health care should be a winning issue for the Dems, since it sets them apart from the Republicans, who are doing their level best to dismantle the imperfect, but needed, reforms in the ACA (AKA Obamacare). 

Listening to the debates, it’s clear Democratic proposals for changing US health care are still taking shape, like whether private insurance should be banned (in my opinion, no). But, if you ask me, the Finnish system would be a good model.

Affordable Care

Yesterday, I got up at 4:30 to take my youngest son to the airport for a trip to Spain. While he was stuffing the last of his gear into his backpack, I switched on the TV and happened to see a bit of CBS Evening News.

Here in Finland, we naturally don’t see a lot of American broadcast news. At our house, our satellite service provides international cable news channels like the UK’s Sky News and BBC, but only CNN from the States and nothing from old-school American TV networks, like NBC or CBS. 

Except, as it turns out, at 4:30 in the morning. Apparently, Sky News rebroadcasts some programming from American news shows, but only in the dead of night. So, by chance I caught the tail end of a CBS News story about health care in America – which has been a huge story this week anyway as the Supreme Court begins deliberations to decide the fate of the Patient Protection and Affordable Care Act, otherwise known as Obamacare. 

The CBS story told about a health-care provider in Texas, a nurse practitioner named Melissa Herpel, who has set up her own “walk-in” clinic to offer quick medical aid without the need of an appointment. (A nurse practitioner doesn’t have a medical doctor’s degree, but is qualified to do many of the same tasks, including prescribing medicine.) Herpel’s clinic doesn’t charge as much as a doctor would and is more convenient than a visit to a hospital emergency room, making it ideal for the nearly one out of four Texans who don’t have health insurance.

What got my attention, even as I was half-wake and in bad need of coffee, were the figures being quoted in the story. Herpel was shown treating a little girl who had a large wooden splinter in her foot, for which Herpel changed her standard fee of $50 (€38), plus $15 for an injection of antibiotics. This, according to the CBS report, compares to the $900 (€680) that the same treatment might cost in an emergency room. For removing a splinter?

The $15 ($11) that Herpel charged for the shot of antibiotics might seem pricey considering that the medicine itself reportedly cost only two dollars a vial, which must be enough for several doses. (There’s, of course, also the cost of the syringe, etc.) But, that’s a bargain compared to the $100 (€75) that Herpel says the same injection would cost in an emergency room. 

If that’s the case, then having a splinter treated for under a hundred bucks probably seems like a good deal to the girl’s mother, who has to pay for it out of her own pocket because she says she can’t afford the $400 (€300) monthly cost of health insurance.

I find these figures somewhat mind-blowing, which I’m sure shows that I haven’t had any direct experience of American health care for a very long time.

I can’t say how typical $400 a month for insurance might be, though I have seen a figure of $5500 ($4100) a year for a family policy bought on the individual market, so it seems to be in the right ballpark. Nor can I say how these figures compare to Finland, where health care is based on the single-payer model. I’ve never bought health insurance here, and the only charge for visiting a doctor is a nominal office fee. Last November, when I saw a doctor about a bad cough, the office fee was €13.70 ($18). (For people under 18, it’s completely free.)

Of course, the girl in the CBS report could have had her foot treated without her mother having to pay a dime, if she had visited the local emergency room, which is required by law to treat uninsured people. And it can be argued that it's this requirement to occasionally provide free health care for 25% of the population that forces Texas hospitals to recover their costs by charging everyone else $900 for splinter removal. If it sounds like an odd system, it is.

Living here in Finland, it’s easy to forget how American medical care, which is mostly based on private health insurance, works for most people. Those who have insurance get their care from their regular physicians; those without it, go to the emergency room. And, as we all know from TV, emergency rooms aren’t the nicest of place to spend much time.

Like I say, I can’t vouch from personal experience whether the high costs reported by CBS of having a splinter removed is representative of medical care in the States. But, something tells me I’d rather not ever have to find out for myself.