After experiencing frustrating problems with two doctors at a Cary, N.C. medical practice, Oksana Zhirnov decided to take some radical steps to get medical care.
Instead of finding a new local doctor, Zhirnov packed her bags and flew off to Russia to see a physician, she writes in an opinion column in today’s (Raleigh) News & Observer.
Apparently, Zhirnov had a very positive experience in the private Russian medical system—and paid only $250 (plus airfare) for several diagnostics, a diet consultation, and even French herb-based gall bladder tablets.
She believes that her private Russian doctors were so good because they face competition from Russia’s government-run universal health care system.
Based on this conjecture—and the fact that her mother, living in Russia, pays $1,200 a year for medical care—Zhirnov concludes:
My experience with these two health care systems leads me to believe that the American health care system is not as patient-focused as the private Russian system. Maybe a two-tiered system for medical coverage would improve the quality of health care offered to all Americans, like me.
There are excellent arguments being made for the creation of some kind of universal health care coverage in the United States. But Zhirnov’s column is not among them.
While Russia’s private health care system—where doctors are paid in cash by patients—may, in fact, be quite good, Russia’s public system is a corruption-filled mess.
As Alex Rodriguez writes in the Chicago Tribune, “Russia is an unhealthy nation, and its health-care system is just as sick. Its hospitals are understaffed, poorly equipped and rife with corruption.”
Rodriguez goes on to describe how bribery often greases the wheels of remarkably poor medical care, and cites an Open Health Institute statistic that 35 percent of money spent on health care goes to corruption.
A 2007 article from a Moscow Times correspondent published in the New York Times lays out how this corruption affects ordinary patients:
When Karen Papiyants lost his leg in a road accident last year, his medical nightmare was only beginning.
Although like any Russian he was entitled to free treatment, he says the doctors strongly suggested he pay $4,500 into their St. Petersburg hospital’s bank account, or be deprived proper care – and perhaps not even survive.
Faced with that choice, relatives of the 37-year-old truck driver scrambled to scrape together the money. But Papiyants said that did not stop the nursing staff from leaving him unattended for most of the night and giving him painkillers only after he screamed in agony.
“It’s nothing but blackmail and extortion on the part of doctors,” Papiyants said.
Beyond corruption, the Chicago Tribune article notes that in 2006, the state-run system ran low on prescription drugs due to bureaucratic problems. Only those with money to buy drugs elsewhere could afford to stay healthy. In 2007, a state hospital in Eastern Russia ran out of syringes. Again, only those with money to buy their own could be treated.
Given the dismal state of Russia’s public health care system, it’s shocking to see a call for universal health care based on this nation. A two-tiered system of the Russian sort might be good for those in the top tier, but relegating everyone else to bribery and poor care is not something any government program should ever do.
Israel has a two tier system in which everyone gets virtually all needed medical care for free after paying 5% of their income into the system. Insurance provides special things including earlier access to therapy and expensive cancer drugs. As in all single payer plans, Doctors are set up to be motivated to order less rather than more diagnostic and treatment options and more than 90% of medicine works pretty well. Doctors also don’t get paid for piecework so they don’t contribute to useless costs by overordering.
In the U.S. you get paid more by doing more. You can protect yourself from lawsuits by doing more. Patients are encouraged to desire more by direct-to-consumer ads and those who are ensured want us to go all out. If you are lucky, you can get the last few percents of accurate diagnosis and best treatment at the cost of many more adverse outcomes. Going this far up the asymptote is very inefficient on a population basis and greatly drives up the costs of care.
The best systems in the US may be Kaiser and perhaps the Mayo clinic where the physicians are salaried and therefore not motivated to overorder. At Kaiser, their bonus (as you know) depends on the efficiency by which care is delivered.
At one point doctors were very much against being salaried because it would vitiate the entrepreneurial spirit with which they are theoretically endowed. However, they are a beleaguered species now and have many more women. A comfortable salary and relief of the incredible paperwork might be the most desired outcome of reform.
Truly, how the care is paid for is much less important than the motivation of the physician pool. The physician’s pen is the mightiest weapon increasing the cost of medical care in the U.S.
Hey man, nice article. It’s amazing that people continue to make this fallacy, namle that a single personal experience is somehow indicative of a general pattern. Anyways, the economist ran an interesting article about Healthcare in India that you should check out. Here’s the link:
Basically, India’s healthcare system offers a market driven alternative to the way we look at healthcare. Instead of poorer individuals being driven out of the market due to increased costs, India has seen the emergence of a private, two-tier system of its own- hospitals with better conditions and more expensive equipment for the wealthy (including the “medical tourists”), and simpler, result-driven facilities for everyone else. The multitude of rival hospital chains throughout the country keeps prices honest and doctors up to par.