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.  

Super Tuesday

The Republican presidential race took a great leap on Tuesday when my home state of Georgia, along with nine others, all held primaries or caucuses on the same day.  Against my better judgment, I stayed up to around 3:30 to watch the returns come in.  Georgia was declared a win for Newt Gingrich within minutes of the polls closing at 2:00 a.m. Helsinki time.  No surprise there.  Not even Newt could manage to lose in his home state. 

Gingrich got 47% of the vote in Georgia, to Romney’s 26%.  What surprises me is that Santorum, favorite of hard-core evangelical Christians was only able to reach 20%.  Ron Paul got a pitiful 6%, which I guess shows there really isn’t much of a libertarian streak in the Peach State after all.  Republicans in my home county in North Georgia went for the native son in an even bigger way.  They cast 51% of their votes for Gingrich, giving him a whopping 28 points lead over Romney.  And this despite support for Romney from some of the county’s more prominent citizens that was enthusiastic enough to draw attention from national TV, though not exactly in a good way. 

While Gingrich took Georgia by storm, you have to wonder whether the hurricane force of his personality (read, “blow-hard”) is strong enough to carry him much beyond his home state.  It begins to look like he doesn’t have much of a natural base outside his native south, if even there.  In northern and western Super Tuesday states, like Massachusetts and Idaho, Gingrich didn’t make it higher than 8%.  In Ohio, he did better (15%), but still came in third. 

Even in the South, Gingrich wasn’t a shoo-in.  Neighboring Tennessee, just up I-75 from Atlanta, went overwhelmingly for Santorum, leaving Gingrich in distant third place.  With a less-than-stellar showing like that, it’s no wonder there’s lots of talk that Gingrich should do everyone a favor and quit.  Of course, he won’t.  Not yet.  He’s betting that Georgia and South Carolina weren’t just flukes and is putting all his chips on Alabama and Mississippi, two other Deep South states that vote next Tuesday. 

I have a feeling that the baffling allure of Newt Gingrich does not extend much beyond the Georgia state line, and he’ll lose next week, especially when God-fearing voters in Alabama and Mississippi have the option of Rick Santorum. 

If you ask me, Santorum’s allure is just as baffling as Gingrich’s.  He is not only conservative, but also a true believer.  He’s a deeply religious Catholic with an antiquated worldview that has apparently prompted him reopen a debate that many of us thought was settled over 50 years ago. 

Everyone recognizes that abortion is an incredibly emotional and tangled issue, and one that is still controversial for many Americans.  I don’t doubt for a moment that Santorum, like many conservatives, would like to see abortion disappear.  But what is surprising is that he also seems to feel the same way about birth control, decades after the Pill made planned pregnancies easier and a way of life for most Americans. 

Maybe that’s what bothers Santorum.  He is currently riding the wave of controversy over birth control that would have been hard to predict a year ago.  He has talked about “the dangers of contraception” in America, which he sees as not only unleashing sexual freedom outside of marriage, but also igniting too much sexual pleasure within it.  In Santorum’s mind, sex between a husband and wife is sullied by contraception.  Without the possibility of creating a baby each and every time, matrimonial sex is diminished, reduced to just an act of pleasure stripped of its true purpose, procreation. 

I’ll hazard a guess that most married couples in America kind of like it like that.  In ordinary times, I would say that Santorum is way out of step with his fellow citizens.  But these may not be ordinary times.  Just witness the uproar surrounding Sandra Fluke. 

Fluke, a 30-year-old law student, tried to testify before Congress in favor of forcing church-supported universities, such as Fluke’s Georgetown, to pay for birth control as part of their health-care insurance coverage.  (It was a White House proposal along these lines that first awoke the apparently long-simmering animosity of conservative Republicans to birth control.) 

Fluke told an informal panel of Democratic lawmakers that the lack of insurance coverage for birth control pills could cause hardship for low-income students at Georgetown.  She explained how a fellow student with an ovary condition treatable with birth control pills eventually lost an ovary after she was unable to get the medication through Georgetown University’s insurance. 

Now, some conservatives might simply argue against the policy Fluke was advocating.  (By the way, the public health system in Finland pays when women visit a clinic for birth control prescriptions, but not for the medication itself.  Women here have to cover the cost of the pills, unless they need them for a medical condition.)  Or conservative critics might question Fluke’s objectivity or accuse her of exaggerating the severity of the issue.  Fair points.  But that wouldn’t have been vicious enough for conservative radio host Rush Limbaugh, a gasbag of historic proportions. 

On his nationally broadcast show, Rush launched into a personal attack against Fluke where he called her a “slut” and “prostitute” for expecting taxpayers to pay her to have sex.  Rush’s twisted (in every sense) logic was that Fluke was having so much sex that she could no longer afford to pay for birth control herself.  He continued his on-air attacks for four days in a row, at one point suggesting that if taxpayers had to pay for Fluke to have consequence-free sex, then she should provide video tapes of the encounters so everyone could enjoy. 

Even by Rush Limbaugh standards, this is simply unbelievable.  Not to mention totally inaccurate.  Besides being incredibly insulting and juvenile, his rant bore no relation to what Fluke’s actually said, to the issue at large, or the reality of birth control itself.  For example, it would be private insurance paying for the pills, not taxpayers.  Limbaugh also seems to think a woman needs to take a birth control pill each time she has sex.  Chances are he’s confusing birth control medication with Viagra, something he apparently does know quite a bit about. 

Limbaugh finally issued a lukewarm apology when sponsors started leaving his show, but hasn’t faced much real criticism from the right over his comments, least of all from the GOP presidential candidates, who all seem afraid of him.  I would love to think that something like this would force him off the air for good, but the way things are these days, I wouldn’t get too hopeful. 

Happy International Women’s Day?