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PNHP RESOURCES

The advantages of getting sick elsewhere

By Louis Balizet, M.D.
The Pueblo (Colo.) Chieftain, Jun 17, 2017

Last month, a Pueblo woman, while on vacation far from home, developed chest pain, cough and shortness of breath.

She had had blood clots in her lungs previously, and feared a recurrence of this potentially deadly condition.

An ambulance was called and arrived in 20 minutes, having been dispatched from the local hospital. This was soon followed by another vehicle carrying a doctor, who assessed the woman inside the ambulance.

Her physical examination revealed severe bronchospasm (tightening and narrowing of the air tubes in the lungs). Medicines to reverse the bronchospasm were administered via nebulizer; an EKG was done; and the ambulance driver was directed to proceed to the emergency room, where another doctor assumed care. Blood tests, a chest X-ray, and a follow-up EKG were performed.

The emergency room doctor concluded that the woman's condition was due to severe asthmatic bronchitis, with recurrent lung clots ruled out by one of the blood tests. Intravenous steroids, intravenous antibiotics and additional nebulizer treatments were administered.

After seven hours in the ER, the woman's condition had improved, but not enough to permit discharge. She was admitted to an adjacent six-bed observation unit, where a third physician (like the first two, a woman) took over, and continued the regimen started in the ER.

After 12 hours in the observation unit, she had improved enough to be discharged, with prescriptions for oral steroids, oral antibiotics and asthma medicines to be administered by nebulizer.

After she was settled back in her hotel, the woman's husband went to a nearby pharmacy and walked out 10 minutes later with her medicines and a rented nebulizer. The woman gradually improved and after four days was able to resume her vacation schedule.

The bill for the ambulance and hospital services, including all tests and physicians' fees, was $137. The pharmacy bill came to $38; for locals, there would have been no charge.

In what fantasy land did this episode take place? It was no fantasy -- it was Italy. I know, because the woman is my wife.

Why was my wife's care not accompanied by a backbreaking and complicated bill, as it would have been here in the U.S.? Because Italy, along with every developed country except ours, has made a societal decision that needed medical care should be provided to all residents without crushing financial consequences to the sick person, and that the national government should guarantee, finance and organize this care.

The efficiencies that result enable Italy to cover everybody for a fraction of what we pay with equal, if not superior, outcomes.

Italy spends $3,272 per capita for medical care; we spend $9,471. Italians have a life expectancy of 82 years; ours is 79. At an individual level, my wife's care in Montepulciano, Italy, was at least equivalent to what she would have received in Pueblo.

Since a system like Italy's (or Canada's, or Australia's, or Germany's) is so superior to ours, why don't we change?

Despite the perils for individual patients, there are some that are doing very well under the status quo -- chiefly medical insurers and pharmaceutical companies. These entities enjoy privileged and protected status in the American system that they don't elsewhere. They also have the political, financial, and public relations resources to thwart any move to a system that favors them less.

With Obamacare threatened by internal structural weaknesses and external political attacks, we should be looking for alternatives. Other countries, like Italy, offer guidance about how to achieve universal, economical and effective medical care.

Our health care debate would profit from "A Taste Of Italy."

http://www.chieftain.com...