How Not to Fix the Healthcare Mess

Devra Torres | Apr 5, 2017 | 3 cmts

For better or for worse, healthcare is in the news again, and I have a story to tell. You can draw what political conclusions you like, but the moral of the story is more about how to treat persons than about which kind of vast, national structure to erect.

Our family had a long, intimate and mostly painful experience with government-controlled healthcare. During our decade in Barcelona, we endured everything from the extraction of a stray Q-tip to the delivery of a nine-pound son under their system..  

When we first arrived in Spain, we were only eligible for public medicine (since my in-utero son was deemed a pre-existing condition). Later, we qualified for private healthcare, so we had a basis for comparison. (Spain had both, and all the doctors who worked within the private system put in a certain number of hours in the public one. I don't know if that's still the case.) The difference was dramatic. Particularly eye-opening was my delivery of two different babies, with the very same doctor, one under the public regime, another through private insurance. But let’s begin with the Q-tip.

Early on, my husband got the end of one lodged in his ear canal (not his fault: Spanish Q-tips are pretty flimsy). He walked to our assigned neighborhood clinic, took a number, and sat down among a crowd of people who clearly had bigger troubles than his own, judging from the time it took to attend to them.  When his number was finally called, his relief was short-lived: the government had not supplied that particular clinic with the instrument required for Q-tip extraction. The doctor sat down, filled out a referral slip, and explained to my husband which two buses would take him to the larger, more lavishly equipped establishment on the other side of town. 

On his eventual arrival, my husband asked directions of the functionary at the information desk, rode the elevator to the appropriate office, took another number, and tried to get comfortable. His patience was rewarded: after more waiting, two more bus rides, and a short walk, he was back home, clear-eared once more.  His day was shot--but not a peseta had changed hands!  Free medicine!  Who was he to complain?  In America, there would have been at least a co-pay to cough up.

A few months later, there I was, in active labor with our second child.  When we arrived at the hospital, my husband was called away to fill out impressive quantities of forms.  I was briskly dumped onto a gurney in a dim basement chamber with the laundry and left alone with my thoughts. For a long time.

Eventually they rolled me upstairs. During the next seven hours, I was held down and injected with something (they wouldn’t say what) against my express wishes, ridiculed for expressing pain (“Thought you said this was your second baby!”), and then wheeled into a quadruple-occupancy recovery room (or octuple, counting our four newborns).  I spent the next four days being reprimanded for incompetent swaddling technique, walking the halls without permission, and wanting to nurse my son.

Now, can every facet of this lamentable scenario be laid at the door of socialized medicine?  Of course not.  After all, lots of medical systems are riddled with bureaucracy, paperwork, disgruntled and ill-tempered nurses, overworked and harried doctors. And weren’t there plenty of cultural issues at play, too?

The funny thing was, though, there I was, a few years later, ready to deliver my daughter. Same culture, same city, same doctor. I arrived at the hospital. They’d allowed me to do all paperwork earlier, so I was welcomed right away into the delivery room. This time my doctor was allowed to work with Carmen, a midwife he’d delivered babies with for 25 years. Because of their expertise and the leeway the private system allowed them, we could forgo most of the invasive technology mandated, one-size-fits-all style, under the public system.  Of my eight deliveries (seven hospitals, two countries), my public-option son’s was the most traumatic, my private-medicine daughter’s the least—yet the doctor was the same.

It’s just one woman’s impression. The way it worked in Spain, the privileged got to go private and the less privileged had to go public. The privileged got treated with dignity, the rest like cattle. In America, too, patients on government assistance often end up with substandard care. Women on Medicaid have to sit in waiting rooms plastered with unsubtle birth control propaganda. The message is clear: just enough of my kind, way too many of yours.

I used to tell this story, way back when the "public option" was first being discussed in America, as a cautionary tale against socialized medicine. I was (and still am) frustrated at how people who've never lived under it hold up "soft" European socialism as a utopia for patients. But it could just as well be a warning about how people get mistreated and disregarded when the problem is not an overreaching government, but the impersonal forces of Big Pharma and Big HMO muscling their way into everybody's treatment, trumping all concern for treating patients like persons.

The worst of all worlds is the kind of crony socialism you get when an overweening government entwines itself with the most corrupt of business moguls, usurping every possible level of personal decision and vetoing away every last instinct of common sense. That's what we seem to have now. Whatever we replace it with, I hope we get over the tendency to mistake bureaucracy for efficiency and standardization for care.