I need to refocus – to push myself a bit – to try new things
– to sharpen my observation. Push myself
to learn about our Health Care System before I can have an intelligent
conversation with my students – adults – here in Spain. So I asked.
There is a great program by Frontline that tells some pretty ugly
realities but without the sensationalism of Michael Moore. That is what I needed. I needed to know why, while working as a
professional – most of the problems people faced never effected me. I learned and now I know why some things are
broken. But, I can also keep to my
original theory that insurance companies that work for a profit – as any good
businessman does – are really the problem.
That, and their lawyers.
But what about in a system with quote un-quote universal
coverage, with standardized pricing and access to the latest technology? Where does it fail? Or, does it?
It seems that given the choice, most Spaniards opt for private health
care (at around 60 euros a month) because of convenience and quicker access to
appointments and non-emergency surgeries.
(Two weeks for a hernia as opposed to six.) When I asked my professional adults if they
would be willing to take that same 60 euros and hand it over to the government
to improve the State system – no one was.
This is the exact same parallel as America asking us to fork over more
taxes to pay for a system that may or may not improve by throwing more money at
it. They understood and agreed. Americans pay 16% of their GPD on Health
Care. So what gives? It is obviously highly inefficient. Or, the insurance companies have a nice
take. ( I just read El Cid and can draw
all sorts of parallels there, too).
And what happens when you receive free Health
Care in Spain? Why, after three
years of “coverage”, you decide to take advantage of the system and get those
annual checkups that you’d been missing.
You call up for an appointment on a Monday. The doctor can see you on Thursday. Not bad.
No long queues, nothing messy.
They clinic is beautiful and clean.
The staff professional. You get
to see the inside of your uterus live for the first time in your life and you
are free to go. Drop off the sample for
the lab on the way out the door.
Wow. They didn’t weigh you, they
didn’t take your height, or your blood pressure, or anything vital. But, you got to see that there aren’t any
cobwebs in your fallopian tubes, as you suspected, so you are happy. Downstairs, the receptionist asks for 80
euros. What? I thought this was free. Look, I have my insurance card. Here.
Newly minted. No, no. Step over here. We get charged for the lab and we use a
private lab. Fine. Can I take it to the public lab? Yes, it is well, over there. Oh, I have a map. Where is it?
Um, somewhere over here.
Right. So once you have the
results, mind you, you have to bring them back to this clinic. Fine.
Here’s my insurance card. Well, I don’t
really want it, but I will scan it anyway.
And, remember, you cannot come back here ever, for anything, as long as
you shall live. Or something to that
effect. WHAT? I got your name from the book for crying out
loud. This town is a freaking baby
factory and this is the only freaking gynecologist in town. WTF?
So, the next day, I venture to the dentist. Same insurance card but this time they accept it. All rosy smiles and welcoming. Watch the news on the flat screen next to your head and your teeth are given a cursory review for cavities. None. Good. Cleaned with raspberry paste and you are good to go. At this point you are elated to have received better treatment than at the gyno's, so you proceed to checkout and are on your way. Wait. I know you don't really speak Spanish or really know the system, but shouldn't there be an XRay or two? Nope. Fluoride? Nope. Recommendations of toothpaste or toothbrushes? Nope. Six month check-up? Por supuesto no. Do people even really clean their teeth in this country? Well, I do see more missing and rotting teeth here than I should when 'everyone is covered'...
But, what about emergency care? When you go out and about exploring the environs of this beautiful paisaje, you tend to run across a cold or two and if you are extremely lucky - it may either develop into or weaken you enough that a stomach flu comes along. It's not actually called that here. But I have finally come to find out that I do not indeed, have a Social Security Card. Nice as it is that the Junta de Andalusia gave me private insurance by Mapfre on top of the 'universal coverage' - it doesn't really mean shit when the receptionist has no idea how to fill out the resulting forms or whether she needs to turn me away. Fortunately, after waiting an hour for the doctor to return from siesta (in a clinic with presumably 20 doctors), he accepted my diagnosis, listened to my belly and gave a prescription. He asked if I had the magic prescription paper from my doctor - uh, no, I have an emergency situation - if I had a doctor - I would have gone to him. Sin magic paper - prescription is paid out of pocket until I find a doctor to provide it. Hmm. Wasn't the guy with the prescription a doctor? Well, in the end, maybe not. It seems I was just given a script for diarrhea. Vamos a ver.
In the end, I prefer to be sick in America. At least I have confidence that a temperature will be taken, blood pressure, weight - something that provides a baseline or an indication other than that I can pick up my head and speak in a halting second language. Fighting the insurance companies has never compromised my faith in our doctors. Here, that element's gone and I still ain't confident.
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