Socialized medicine – dangerous to your health?

Health care is probably the testiest issue in Bernie Sanders’s campaign to pull America in the direction of a welfare state. The Danish single-payer system, like its counterparts in rest of the developed world, costs only about half as much as health care in the US as a percentage of GDP. Do Americans get twice as much or twice as good care for the expense? Hardly. According to the WHO, the US system ranks 37^th in the world in 2016, just below Costa Rica (in this department Denmark is little better, at No. 34).

Nevertheless, the US political establishment as well as many citizens demonize universal health care systems as dysfunctional communism, even as people complain about higher fees under Obamacare. This perception must owe something to lobbying and PR clout of the insurance-pharma-hospital corporation cartel that is so solidly entrenched it can’t be meaningfully reformed without a severe dislocation in the economy. I’m not advocating any specific changes because I wouldn’t know where to start. But as the boomers become increasingly feeble, the number of diabetics accelerates, and inflation in the price of services in the sector continues at double the core rate, somethin’s gotta give.

 How the European system works

I don’t understand how the new US system works because I’ve never had to use it. But I can describe the single-payer system in practice and give you an impression of whether it’s really impractical, annoying or dangerous.

In Denmark, everyone selects his or her own general practitioner. If you need to see a doctor, you book an appointment on a website, and one is usually available within a week or two, sooner for urgent situations. When you arrive at the office, you swipe your health insurance card in a terminal. If you need tests or treatment by a specialist or in a hospital, your GP books the referral online and you make an appointment. You can renew prescriptions online and see all your medical records from a secure centralized database.

You never get a bill from the public system. You don’t need to make a bet on the size of copays and deductibles. You do have to pay for prescription drugs, dentistry and glasses. But you can get generic drugs and can also a partial refund on other services from a nationwide cooperative health insurance plan that most people subscribe to at modest premiums.

Susceptibility to abuse

People don’t seem to become hypochondriacs or abuse the unlimited services as much as you (and the Freakonomics guys) might expect. As I understand, 30 or 40 years ago, when unemployment was very high, there was a wave of disability diagnoses that removed a segment of burned-out hippies and alkies from the labor market statistics. They’ve cracked down since then.

If you’re really determined to exploit the system, though, you may be able get validation for less visible ailments like stress, depression and back pain, and the rules for salary compensation are generous. With a doctor’s recommendation, you can take up to 120 days off before your employer can fire you. But blatant indulgences are frowned upon, at least in polite circles.

Those waiting lists

The main questions about the system concern the infamous waiting lists and the quality of the care. Although they aren’t as long as many Americans seems to think, waiting lists do prompt many complaints. Operations and procedures that are categorized as not being urgent may be scheduled several months off, and there may also be delays in testing or treating threatening conditions. When people start dying on waiting lists, Parliament sometimes intervenes to adjust the “guarantee” for treatment within a certain period or to allot emergency funds to shore up resources. My impression is that few people are seriously hurt by the delays, but that’s little comfort if you happen to be one of them.

There is an alternative to waiting lists – private insurance, which is provided to a certain number of people by their employers. My most recent referral to a specialist set the difference in stark relief. The appointment at a public hospital was in more than three months. I got immediate approval for private treatment from the insurance company and an appointment the same day at a private hospital with one of the country’s leading cardiologists. With the insurance, there’s no copay for treatments that can be referred to public facilities. There is a small copay for other things covered by private health insurance such as physical therapy and psychotherapy.

But are they proficient?

It’s difficult to judge the general quality of care, but I’ve had enough contact with the system to form an opinion. I’ve had several good experiences with knowledgeable and capable physical therapists. But the competency and conscientiousness of GPs seem to be uneven. The great majority are probably fine, but some seem bored and blasé. I’ve heard of several instances of a misdiagnosis or lack of diagnosis of a serious illness; they seemed disturbingly common among patients in the oncology ward.

This deficiency may be partly owing to the system. Danish GPs earn a good salary, but nothing like American doctors’. They’re not as ambitious, nor are they as motivated to order all possible tests and other precautions against malpractice suits. Hospital doctors are apparently more ambitious. A complaint that gathered steam a few years ago during a waiting-list debate was that some of them had second, more lucrative jobs at private hospitals that they seemed more interested in.

The perils of bureaucracy

One drawback in the hospital system is that patients are not assigned to a specific doctor. Department or team members takes turns making the rounds, and each new one has to familiarize herself with the patient’s journal again. That can be annoying, especially when their opinions and recommendations are inconsistent, and it makes the overall experience less personal and assuring.

There have also been instances of insufficient oversight, occasionally shocking. Last year a psychiatrist who was brain-damaged himself was found to have prescribed the wrong medication for several patients, with fatal consequences for one of them, and the Board of Health had apparently not acted upon complaints.

When the stakes are high

I must say, however, that altogether my experience with serious illness in Denmark has been positive, and that covers two RFA treatments for arrhythmia and my late wife’s five years of oncology care. There were a few problems – a strange lack of resolution to operate on an abdominal adhesion and a seemingly prejudicial dismissal of an application for alternative cancer treatment in Germany, which was supposed to be available to EU citizens.

There was also a tendency to follow the usual practice of recommending new chemotherapy treatments that offer only a slight chance of a significant increase in the survival period. I think big pharma funds most clinical trials here too. But generally the specialists, surgeons, technicians, nurses and other personnel seemed capable, thorough and eager to use all the resources at their disposal to obtain the best outcome.

As with the waiting lists, lapses are rare, but that’s what you remember. If money is not an issue, you can be more certain of getting the best possible care in the US. But I doubt that the overall quality of care is worse in Denmark than in the States, and no one is financially ruined by an illness or accident that can bring plenty of suffering in itself. Or burdened by the ongoing premiums.