American v. Brazilian Healthcare, a Continuing Series
by Mike Kimel
American v. Brazilian Healthcare, a Continuing Series
I spoke to my sister on Skype last night. She’s been in Natal, in Northeastern Brazil, for the past few months. Last week, she noticed a couple small warts growing on her leg. So she wandered down to a government run hospital and and had them removed. The hospital was low on supplies, and the doctor asked her to contribute a box of Q-tips (since Q-tips would be needed in the procedure). The total cost of the whole thing: 12 reais, or about $6.60 American, plus a box of Q-tips.
This isn’t the first time I’ve had a post that dealt with my sister and the Brazilian health care system. A few years ago I wrote about the time she had emergency open heart surgery in Brazil, and how it compared very favorably with her experience with (planned) open heart surgery in the US.
Now, on the subject of the US, my wife also has an interesting healthcare story to relate. She got a letter from Aetna, her insurance provider, indicating they didn’t know why they were being asked to pay for services when she doesn’t have health insurance through them. Interestingly enough, money is withdrawn from our bank account each month to pay for her health insurance, and a call to Aetna indicated that she did, in fact, have health insurance. A number of phone calls back and forth between my wife, Aetna, and her doctor resolved the issue (I think) – the doctor is being paid, etc. But it isn’t the first time this has happened, and it serves to follow up our family’s earlier experience with health insurance. All told, I would estimate my wife and I have spent about 40 hours – that would be a workweek – dealing with health insurance since July.
Brazil is a poor country, and I don’t think anyone has ever suggested that the Brazilian health system is the best in the world. On the other hand, we often hear precisely that about the American system from certain circles, despite the astounding cost (which doesn’t seem to include the waste of time dealing with the paperwork or fighting with health insurance companies) and ho-hum outcomes. I’m starting to think a lot of Americans are absolutely insane. Lord knows it would explain a lot.
I had open heart surgery a few years ago at 29 to correct a congenital valve problem. I found a world-class surgeon who could do the procedure without breaking my breastbone (minimally invasive).
I wanted to do my homework to make sure I didn’t get hit with any crazy and unexpected charges, coinsurance, etc. I had never been hospitalized for this length of time before.
It turned out that my surgeon was out of my network, and his office had planned to bill though another cardiac surgeon in his group that was in network, but in my calls with the insurance company I tipped their hand. My surgeon was the only one who could really do the procedure in the minimall invasive way, although he was training others to do so.
His office actually yelled at me and asked my why I would ever be talking to the insurance company. I said that I would have to see what my options were with other surgeons. Luckily my surgeon was a saint and he called me personally to tell me to come in to talk to him. He offered to perform the surgery as planned and to waive anything beyond what my insurance would cover for him as an out of network surgeon.
In the end I had a very favorable outcome, but only because I had a surgeon who wanted to help a young person (since most of his pateients are 50+) and because he was wealthy, both from his work and from a large inheritance of New York real estate, and could easily affort to waive the fees (and he had enough standing with his office / hospital to get them to agree on their part).
We have the best healthcare AVAILABLE in the world, but to ACCESS it involves gamesmanship and/or the kindness of strangers.
Oh come on Mike. Don’t you feel the power that come from the freedom to independantly manage your risks that come from living via the market place? Isn’t it gradifying to know that you, through your keen intellect solved this issue by taking on the insurer? Don’t you feel the high that comes from knowing you too are playing in the big leagues? Getting help from a community of people known as the US government? Not for you man (cue the unshaven man in his pickup truck, straight highway in the desert with the delta blues playing).
It’s the American Dream. NOT!
Erik,
I think it is safe to say the US has the best medical technology in the world. But not the best healthcare… read the post on my sister’s opinion having had open heart surgery here v. in Brazil. Care was better there, even if it was lower tech.
You are correct. “Healthcare” was the wrong word. We have the best technology, the highest count of cutting-edge doctors, and some of the most bleeding edge research. These are also reasons why we spend so much money on it. We also have the fastest access to care if you can get it / afford it.
We don’t have enough intelligent doctor-pateient dialogue. All patients want maxiumum treatment, by nature. Most doctors want to do right by their patients. There is also the specter of defensive medicine that inflluences some. The end result is that we MRI every twisted ankle. In the end it adds no benefit to the overall care except that you sidestep the stress of not doing someting that you COULD do.
Add in our splintered patient record information and it’s a nightmare. I had two specialist visits in one day last year. Both wanted me to have an MRI and both wanted me to get blood work done. I informed the second doctor about the tests ordered by the first, and I was able to consolidate. Unfortunately the MRIs could not be consolidated because of the nature of the tests. in the past, thoguh, I have hand-delivered X-ray films to doctors from tests that I had had previously rather than following their orders for a new one.
I am very proactive (I do project management), but how many people can we expect to be so, especially with the bulk of care going to the elderly? And one the price / cost management side – the favorite theory of the GOP – it’s impossible. I’ve tried (see my prior comment). If I can’t manage my own healthcare it cannot be done. The price points are unintelligible and different for individuals vs. different plans. Everyone keeps all the information opaque. It’s not possible.
My wife encountered a rather harmless but amusing expression of the paperwork insanity of the american private health insurance system with a previous insuer. Every time she went to the doctor she would recieve 1-6 bills for $0.00 each month for several months. No notification of anything being covered or paid, just a straight up “please pay nothing”. She notified them of this odd behavior. It continued for the next couple years until she switched insurance.
We’ve had two more annoying but ultimately inconsequential billing disputes with health insurers so far.
“…especially with the bulk of care going to the elderly?”
Well, yea, but the gubmint provides their insurance. Pretty sure I’ve had more billing problems and coverage disputes in my still very healthy existance than my grandmother has through multiple rounds of complicated health problems and medical procedures for her and my, recently deceased, grandfather.
Don’t forget to factor in iatrogenic diseases when judging quality of care. Over prescriptions of drugs, unnecessary procedures, etc. play a part in for-profit systems, at least for those who have robust insurance. Ask Michael Jackson.
My recent experiences with healthcare for my parents have been horrible – and I though with medicare it would be the opposite. The system itself has been confusing, and they let their gap insurance lap due to their dementia. Well they cannot get that back, so I had to sign them up for an advnatage plan to get it. I do like the simplicty of Advnatgae on the surface, but who knows what lurks there as a surprises. Fun adventures.
However, that is not the main thing. It is long-term care. This was the component of Obamacare that CLASS tried to deal with, and was scrapped. I now understand why.
The regulatory, rent seeking labyrynth that controls assisted living and nursing care, by state, is horrid. For example, with a dementia diagnosis in Rhode Island, you must go to an expebnsive memory care wing. The cheaper option would be my mom living in regular assisted living with my dad (he is pretty functional for the most part). He can handle her with occasional help. Neither of them can live at home any more, and they need that availble help 24-7 but not the level provided in memory care.
For any health care to work in this country, silly rules that drive up costs need to be ended quickly. I am terrified of the building long-term care crisis that is brewing woth boomers. I feel this ignored cost will will blow-up medicare and medicaid. That is why CLASS was there, but at the same time scrapped because the costs are so massive. These costs do not need to be, but it will require sensible long-term care facility policy and options. Then an option like CLASS might be workable.
My parents are paying it now, but the money will be gone in 2-5 years – then the medicaid process hits. All comes down to their life expectancy – and they are relatively young.
So I do not necessarily see this solely as a finance problem, but a problem of supply in LTC options/solutions from seniors. The lack of options is caused by rent seekeing for the LTC industry. Now if I can find a state where it is not so onerous, maybe Florida or Georgia.
When my grandfather accidentally hurt himself, a routine check of his chest revealed early stage lung cancer.
It took the doctors months before they could schedule all the “necessary” tests with their FRIENDS… and of course they couldn’t operate without the “necessary” tests. Which had to line the pockets of their FRIENDS.
The cancer was considerably worse before they could be arsed to finally operate.
My grandfather sat there through this whole process like the slack-jawed obedient moo-cow he was. Let them kill him.
Didn’t stop him from pointlessly lecturing me about “maturity”.
The insanity with Blue Cross in MA on the variabilty of rates based on multiple kinds of plans is even nuttier and time concuming.
Hi, I’m a Brazilian living in Texas for about 10 years, i got used with everything here, except health insurance!!! I can not believe how a rich Country can have such a poor health insurance, and believe me, my husband is an engineer and has a very good job,i also have a good job too. but it kills me all the time a have to go to the doctor, first of all, i always have to wait, then the nurse gets me, put me on a other room and takes my blood pressure and put me on hold again, if I’m lucky after 20 minutes the doctor comes.spend 5 minutes with me and prescribes a lot of medicine(i never buy, just if I really need it )and I’m free to go.
After 2 to 3 weeks a get a bill because my insurance has this deductible that until now i don’t know how it works. Do I need a insurance if all the time we go to the doctor we have to pay??? The only time we don’t have to pay is for our physical once a year, and if i say check up not physical they’ll try to charge me. What do people without health insurance do in this Country? Is there such a thing as public hospital? Now talking about Brazil, i spend most of my life there, my husband used to work for IBM and of course i had the best health insurance. I had two daughter there, stayed in a private room and left without paying a penny. Most private health insurance in Brazil you don’t pay to visit the doctor or when you are hospitalized, this happened with my Mom and father, my mom has Unimed that she pays about $100 dollar a month, my father has a petrobras insurance that is even better, after staying at the hospital they send him home with hospital bed, nurse 24 hours a day, because his insurance provides this kind of benefits. i was comparing my private insurance here with Brazil private insurance.. Now lets talk about public health insurance, we do have a real public insurance in Brazil, it calls SUS that means Unified Health System.its a FREE health insurance for everybody, poor, rich, foreigner, nobody is left out, but it used by poor population. Is it perfect? No its not, there are so many thing to be improved , that’s why Brazilian are going to street to change this and many others thing that is wrong in . Brazil. Brazil is a such a big Country and not all state are the same, if you leave in Sao Paulo the chance are you”ll get a very good public hospital, but if you leave in Northwest of Brazil, they will be not as great.
I go back to Brazil once a year since I moved here, and had two times experiencing with public health there. First it was in Barao Geraldo(Unicamp) Campinas, SP, where I’m from.
I woke up with a bad earache, my head it was about to explode,. I was going to schedule a visit to a private doctor, since i don’t have insurance in Brazil anymore, my sister suggest me a public one, i wasn’t sure at first, all my life leaving in Brazil I never used public hospital, but my sister convince me. I got there for my surprised there where just 4 people in front of me, since I forgot my Brazilian ID here, the person helping me said any document with my picture would be ok, i gave her my American driver license, she made no question about it.
before 30 minutes i was seeing a doctor, that treat me very nice, actually talked with me, saw what my problem was, prescribe me a medicine, and told me to get it for free at the public pharmacy they have at the hospital, he just told me if they have the medicine here they can not deny it for me.
The other time I was when I was visiting a small city ( Itacare ) in a state called Bahia. The trip offer me insurance, i accept and paid a little bit more for my trip.
Getting there since they have a lot of sea food place( they have a lot of beaches there ) I could not resist to eat shrimp(its my favorite sea food) but after eating, i notice that my voice it was changing, i got worry and call the number on the insurance card that i bought, they help me with the closest hospital there, for my surprise i was told that they don’t have private hospital in Itacare, just public( I should have saved my money with insurance). I went there, it was a very simple hospital, so different from USA and the ones I’m used in Sao Paulo. It was so empty , first thing that came in my mind it was , people don’t get sick here or its closed. I walked a little farther and saw this lady, explained her my problem and she took me to this just one doctor that was at the hospital. I just fill this paper with my information, and the doctor helped me right away. He gave me some medicine and asked me to stay there for a couple hours to see how i would respond to the medicine. After three hours I got better and he let me go. The same afternoon I was enjoying the beach.
I know a lot of people that had to wait much longer then me, and I know if you need a surgery you probable have to wait the one to a year, it depend where in Brazil you are. Of course Brazil do not have all the technology we have here in America( even Europa doesn’t have) but believe me, we do have good doctor.s, our technology are in our doctors hands, they are as good as American doctor with one exception, they are so human, they talk to you. In Brazil you don’t spend time with the nurse but with the doctor. They have a office and you go there and seat and talked with them as long as you want to.,
Oh, other thing, you can findr free dentist in Brazil too , believe or not. And we do have such a thing as public university too, actually they’re better then private, i went to Unicamp one of the best one in the country. Its hard to get in, but if you really want to, there’s nothing that is going to say no to you, it really depend on you.. Now they have the cota for poor and negro (we used the word negro in Brazil, not black, black is consider offensive)it gives priority for those classes to get in public university. Brazil is not perfect and I think it will never be, but for a poor country its doing very good comparing to USA.. Don’t be mean and tell me if I’m not happy go back to my Country. Here is my Country too, I’m an American citizen now. and pay as much or more tax then everybody., and i love here too, just don’t like going to the doctor here. Sorry about my poor English, I feel that with all my time here I still have a lot to learn.
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