Thursday, September 01, 2005

Imagine that

Not that it has happened, or it definitely will happen, but the Greek government is looking into the possibility of a heating benefit in Greece, due to the fact that most folks use petrol to heat their homes and apartments here and oil prices are rising so high.

Such things really blow my mind here. Sure, there are plenty of bad things about Greece, but this is a government that actually thinks about its citizens now and then. Greece is struggling financially, but its people have health insurance. Even I have health insurance here (well, thanks to being married to a Greek citizen). Yet, 45.8 million Americans lack health insurance, according to the U.S. Census Bureau. Tennessee alone recently dumped over 200,000 from their state insurance program, TennCare (and dumped is the correct terminology here, if you read the stories of the affected people).

Sure, there is a big difference between Greece and America. There are only about 10 million people in Greece. Is it easier to manage health insurance for 10 million? Perhaps. Of course, the Greek budget is considerably smaller too. But there are controls on how much profit doctors and hospitals and pharmaceutical companies can make here, too. These controls help keep costs down and make health insurance more manageable for the government. When I buy my prescriptions, and pay anywhere from 3 to 9 times less for a drug than I did in the U.S., I have to wonder why. The pharmaceutical companies are all the same. Can it be that Americans are paying the cost of research, while Europeans are getting a free ride?

Ironically, the Iraqi people are getting health insurance written into their constitution. Will the servicemen and women who are fighting for Iraqi "freedom" have health insurance when they get home? Will they have it in the future?

I suppose I should quit beating this dead horse, especially since there is no insurance to cover its revival.

9 comments:

The SeaWitch said...

Personally, I am not a fan of the Greek healthcare system at all. Many doctors demand and receive bribes from their patients for their services. The public hospitals are substandard and I've been misdiagnosed by doctors so many times here that it's hardly worth the trouble to sit for hours outside an IKA doctor's office while he spends most of his time with pharma company reps. As for the government caring about its citizens with a heating allowance...that doesn't even begin to cover the amount of money they waste on paying underskilled and inept public servants, mismanagement of EU funds and public money, the monstrous debt incurred from the Games and the list goes on and on. America's healthcare system needs a lot of work too but I never had half the problems with healthcare there as I do here.

Thanos said...

You probably didn't have any problems, because you had health insurance. It is inconceivable to me, that an employer may have people on his payroll but not offer them insurance. It is mandatory in Greece (and most of Europe), that the employer pay health insurance for the worker. And people who are unemployed get basic coverage by the state. And how can it be different? What are these 46 million americans going to do when they can't fork over 5000 dollars for a simple gallbladder operation or 250 for a $5 X ray or 50 bucks for 10 pills that cost 50 cents to make? Die? Kill? Go underground? I don't know. Capitalism in its truest form I guess, but it still sucks. Even affluence is no safeguard, something like cancer can deplete even the fullest wallets fast.

Greece? Sure, the hospitals are overcrowded, but that is because of lack of primary health care (small "kentra ygeias", small regional clinics). Sure, the hospitals aren't all wide and bright and carpeted, but then no one (or very few people) die in the streets. As for the bribes, I'm sorry, but it's primarily the patients' fault. The bribes are offered so that the doctor "take better care" of them, rarely extracted by the latter. When it happens (and it does, don't get me wrong) it's so that the patient may skip the order of things and have his or her surgery now instead of in 5 months (as scheduled). Is it right? No. But it's up to us, the patients. If we stop offering, doctors will stop taking. As for misdiagnosing, it happens everywhere, but I will say that greek doctors are among the very best - something that cannot be said about americans. Of course it does matter that the american population is 25 times the greek - thus the "rotten apples" are more prominent. But my personal opinion - a little tainted by "guild" feelings perhaps, but backed by statistics - is that greek doctors are really good.

Can things be done to improve things here? Of course. Many. But health care is the one sector, the only one, that I can say is better here than in the U.S. Now if you want to talk Scandinavia... different picture :)

EllasDevil said...

I too used to think public hospitals in Greece were bad and always thankful that if I needed treatment, I had the insurance cover to go to any private hospital.

My view changed when after suffering a heart attack, my father was taken to a public hospital in Athens. Now my initial shock of the condition of the hospital (peeling paint, a door hanging off its hinge, huge cracks in the marble floor) were made insignificant by the absolutely fantastic treatment he recieved from the doctors and nurses who were ALL very proffesional and obviously very dedicated to their work. Those people saved my fathers life. I cannot think of enough words to praise them and I will not let anyone call a public hospital to me any more.

As for the bribe, we actually offered the doctor money on the day my father was discharged and he refused to take it. We offered it because my uncle told me to do so.

The only time we did have to pay a bribe was when my father had to have a follow up operation in a private hospital a few months later. We were told that "your insurance covers everything except the doctors fees" (the envelope). We payed the money and even though I agree with everyones comments above, for me it was money well spent.

So could a patient expect the same high level of care in a US public hospital?

The SeaWitch said...

I'd rather NOT be covered by IKA, TEBE or any of the various health funds in Greece and pay for my own health insurance because I want to control who will ultimately make the difference between life and death for me. And yes, I was covered by my employer for health insurance in the US...but that's exactly why I chose to work for one employer over another...even though my pay was less per month, health insurance was more important to me. So yes, my experience with US healthcare is definitely different from someone who has the misfortune to be uninsured and unable to be insured. For a First World country, it's a disgrace.

As for the bribes...I definitely agree with you that patients are just as responsible for giving the bribes as the doctors are for accepting them. There is a big difference when it comes to culpability though...doctors are professionals, bound by a strong code of ethics...patients are not. Just because a bribe may be offered, does not mean it's ever OK to accept it. Why should someone who can afford to pay $5,000 for surgery take priority over one who cannot? Of course not all doctors subscribe to this abhorrent practice but far too many do. My friend's ob/gyn asked for his "fee" before he even discussed the delivery of her baby. My mother-in-law was hounded by her doctor every day while recuperating from her surgery in the hospital after she smashed her knee up to pay his "fee" of 5,000€ after her surgery. She, too, was covered by private and public health insurance. It's so common here that it's become an accepted practice rather than the contemptible system it has become.

With regards to the conditions of the hospitals...I wasn't talking about pretty pictures on the walls or colourfully painted floors and fancy nurses uniforms. I'm talking about hospitals which have chipped paint on the walls, rusted beds and cots in the children's ward, and downright nasty hospital staff. A lot of people praised the Paidon hospital where I had to take my son two years ago but I really can't say I was impressed. My son did get the treatment he needed but he I felt so guilty about the overall depressing experience that I vowed to my husband that I will pay whatever it costs just so he doesn't have to share a room with 7 other very sick children--from infants to 10 year-olds and the fear he had of the hospital staff.

I have found great doctors here...but none of them through the public health insurance system. That could simply be because they're overbooked and therefore cannot spend the time necessary to make proper diagnoses as private physicians can.

And please don't assume I've included you in my diatribe here. As I said, I have been very lucky to find some wonderful doctors as well and wouldn't change them for the world.

Vol Abroad said...

I know nothing about the Greek health care system, and hopefully I'll never have any first hand knowledge. (No offense, but I'll probably only ever go to Greece on holiday, so I wouldn't want it ruined by illness or injury). But I do know something about the NHS in the UK and I know something about health care in the US.

Here in the UK, yes there are problems, but you know what, anyone can get access to health care. It may not be the access or the cushiness that some of us experienced as priviliged Americans all the time, but sometimes it is.

Melusina, don't stop beating that horse, and I've got to pick up a stick and start beating it. If there's one thing us expats can do it's try to talk some sense into our home country about health care.

melusina said...

Yes, I have to admit the first time I walked into the Army Hospital in Athens (since my husband is in the military, that is where I have to go) I was a bit shocked. I was used to a pristine and glistening hospital (Vanderbilt) and what I saw looked more like the general hospital in Nashville. Ok, so, it wasn't going to be fancy healthcare anymore.

I have to admit I was impressed with the doctor I saw there, he seemed very knowledgeable, quite amiable, and took time with me that my American doctor never did. But I am sure, as with any system, doctors in some places are better than others, and it is just as easy to have a bad experience as a good one. Still, people here have health care. Too many Americans do not. If I was still living in Tennesse, I would have been one of those thousands who lost TennCare insurance, and I would have been up shit creek without a paddle.

Anonymous said...

"As for the bribes, I'm sorry, but it's primarily the patients' fault. The bribes are offered so that the doctor "take better care" of them, rarely extracted by the latter. When it happens (and it does, don't get me wrong) it's so that the patient may skip the order of things and have his or her surgery now instead of in 5 months (as scheduled). Is it right? No. But it's up to us, the patients."
I am confused Thanos. You admit that the bribes are used so that the patients
a. get better treatment, and
b. get to get operated before they actually die waiting for ever.
Is it only me that sees the oxymoron here? You put the blame into the hands of the ones offering the bribe desperately trying to save their own lives or their beloved ones, and on the other hand you praise the system that doesn't actually work properly so that these people wouldn't result to it?

"As for misdiagnosing, it happens everywhere, but I will say that greek doctors are among the very best - something that cannot be said about americans."
I have no opinion about the americans. The only thing I can safely assume, is that their equipment is far too advanced compared to ours. Electronics is my thing, so I wonder...
Would I trust a skilled person with a hammer and a screwdriver to repair my plasma TV or a less talented person with the right electronic equipment to do the job? In general,Greece is left behind technologically and naturally, the medical equipment at the public hospitals are older than Kolokotronis.

Ellasdevil, I am glad to hear your father received the best treatment possible in a public hospital. It is my understanding that for serious heart conditions, the public hospitals send you to Onasio that is a private hospital for "more sophisticated and better treatment". So I suppose your father's condition, as serious as it might seem to you, wasn't serious enough based on the above fact. On the other hand, I believe your judgement would be more accurate if you had another person of yours that was actually treated at Onasio and then you could make the comparisons. After all if all was that good here why did the following people leave Greece to be hospitilised abroad:
a. Andreas Papandreou
b. Melina Merkouri
c. Giorgos Genimatas
D. Aliki Vougiouklaki
..and many others

In conclussion, we may have good doctors but then again we are in no position to evaluate them really. We think they are good because they managed to do what is expected from them...to treat us successfully. We appreciate the personell of the hospital, because in our agony, we were so pleased that we only had to "hire" an outside nurse aka "apokleistiki" only for the night and not for the whole day, to look after us and make sure we are not left to die without anyone finding out too late.
We don't mind really the dirt because we can't always see it (most hospitals have dark colors like dark green that dirt and blood don't show that much, this is a fact).
We totally ignore the mental state of the patients that have to live in miserable rooms with 20 other people, not getting sleep when the visitors of the person next bed visit at 4pm and talk as loud as they would at the soccer field.
We don't care that the windows are closed, most of the jammed, and the nurses say that you don't need fresh air, you have the oxygen apparatus as an alternative.
We don't care that the public hospitals don't have Air Conditioning and that the patients have to bake in 40 Celsius and above in summer...
But at least we are greatful that if you get a prescription from IKA let's say, your medication is cheaper....might not be the one you really need because it is either not in the list of the cheap ones that the goverment allows you to take or the doctor just received a bribe from this or the other pharmaceutical company to promote their drug over the competitor's one...and the latter my friends, I know it to happen for a fact from having 2 close persons to me working as pharma reps!

Costas

melusina said...

Kostas, I highly doubt they would schedule a surgery in 5 months if it was life threatening sooner than that. The bribe is to push your case through the door faster, not to get "better" treatment. This is the same exact thing as people in America who have tons of money offering 1 million for a kidney to save their dying child when a poorer child is due for that kidney first. And of course, the doctor takes the bribe, because who pisses off people with money?

It still amazes me that Greeks complain so much about their healthcare. Lets see Greece switch to the American way and see how much they like it. A lot of Greeks would be without health insurance, especially the old and the chronically ill. $100 for a 5 minute visit with a doctor who barely pays attention to your problem, just sends you for $50 worth of tests that end up costing you $500, because of the mark up. Medicines that cost $100, $200 and up for a month's prescription.

As with any system, some things are good and some are bad. Some doctors are good and some are bad. The Greek system isn't perfect, but at least you have it. There are people who are dying in Tennessee because their governor cut off their health insurance, and they can't afford to pay for it themselves.

I suppose the solution, then, is to find some middle ground. But damn that is hard to do. Especially in America, when all the doctors and pharmaceutical companies there want to make 2000% profit, and the conservative government wants to keep the rich getting richer.

Thanos said...

Just adding a couple of comments to Mel's, since we're having a good discussion:

"I am confused Thanos. You admit that the bribes are used so that the patients
a. get better treatment, and
b. get to get operated before they actually die waiting for ever.
"

I assume you're greek, Costa, so I will answer in reference to the greek mentality, which you understand. In 99% of the cases they won't get better treatment, they will think that by greasing the doctor-pasha's belly, he will pay more attention to them. It's clearly a remnant of 400-500 years of turkish mentality, which (some) doctors are of course exploiting.

"You put the blame into the hands of the ones offering the bribe desperately trying to save their own lives or their beloved ones, and on the other hand you praise the system that doesn't actually work properly so that these people wouldn't result to it?"

I put most of the blame with the patients. Simply put, if no one offered bribes, no one would demand them. Now, I don't condone the behavior of either parties and I do think it should stop. If the system were left to work on its own, the patient would be scheduled for when there would be an opening and - perhaps - die before he had a chance at a cure. That is the system. Is it perfect? No, but it's the one every country around the world uses. So, the bribing-to-get-ahead-of-everyone-else is not a weakness of the system, but of the people.

"The only thing I can safely assume, is that their equipment is far too advanced compared to ours"

A common misconception and one that, being a doctor myself, can assure you can be deadly. Machinery makes a doctor lazy. When you depend on a machine, you don't brush up your knowledge and your skills. You don't take the time to listen to the patient, touch them, examine them... the machine will take care of it. Except machines do nothing on their own. They need experienced diagnosticians, good doctors. Personally I'd rather be examined by one of the old timers, who could listen to a heart through a stethoscope and recognize 7-8 different conditions. One that can touch an abdomen and distinguish between cancer and gas. Our training, thankfully, is still clinical. We don't use many machines. We get taught about the patient and the use of our ears, nose, hands. That is what makes a good doctor, not a 20 million dollar MRI machine. Sure, machines help, but at the hands of a bad doctor, they are not useless, but dangerous.

"After all if all was that good here why did the following people leave Greece to be hospitilised abroad:
a. Andreas Papandreou
b. Melina Merkouri
c. Giorgos Genimatas
D. Aliki Vougiouklaki


Yes, all these people were hospitalized abroad and spent - no doubt - exorbitant amounts of money. Shall I remind you what heppened to each of them?

a. Dead. Life prolonged by operations that could have been performed easily in Greece.
b. Dead, cancer. Nothing was really done to prolong life.
c. Dead, cancer. Nothing was really done to prolong life.
d. Dead, cancer. Nothing was really done to prolong life.

So? It's true, you can get a better room with a view of the Thames in London, but I seriously doubt you can get better care. Now, paying some top dollar to fly to a specialist of international renown, sure, you can do that. But a) it's a privilege of the rich and b) the domestic specialist is not much worse than the international man of wonder.

" We think they are good because they managed to do what is expected from them...to treat us successfully." That is the definition of a good doctor... someone who treats you successfully. The rest, the niceties, the room, the flowers, the how-do-you-do, the smiles, it's all fluff. It's all personal relations and business relations.

As for the rest of your post, I agree completely. Health care professionals need to invest more of their personal interest perhaps, the hospitals do need to upgrade their facilities, just as you said.

I will leave you with a post script about bribery. A doctor, someone who works on your health, on your very life, someone who works 24 and 36 hour shifts, someone who is on call all day every day gets a salary of 1500 euro here in Greece, IF they are lucky. Just to compare, the lowest in the rest of europe is 4500 and the highest (note: PUBLIC service, general hospital doctor, not private companies) reaches 9000. At the same time, the NOVA person asks 75 euro for 15 mins work, the plumber wants 55, the electrician 40, the private tutor for your child makes 40 an hour (tax free usually) and I could go on and on. This is not to excuse the doctors' behavior, but you can see the inequality. Not to mention that for private consultation (which is usually 15 to 30 minutes) the state pays a doctor 3.5 euro. That's nice, isn't it?

All respect for the medical profession has been lost and I will be the first to admit that doctors have played a major part in that. But don't believe everything you hear on TV. Greece has good doctors, people who care. Think about that, the next time you're about to spout some copy-paste filth you heard on STAR channel.