This may start like a bar story, but it may end as a rant: one day, a Canadian colleague, an American colleague and I (Chinese) were having lunch, and we were talking about the health care problems each face in our countries. In Canada, you pay high tax, but health care is free. In America, you pay relatively low tax (according to the Canadian), but healthcare is ridiculously expensive. China’s medical system is so diverse and constantly changing that I don’t know where to start. Generally, for the civil servants, most have medical coverage for a relatively low cost. The cost goes up for those working for businesses, which are required by the Labor Law to provide for medical coverage. Some, though, cover common treatments, but treatment for serious illnesses such as cancer are covered only to a point, beyond which you have to purchase other types of commercial insurance. Then there are those farmers and laid-off workers who have little, if any coverage. They are out there basically watching out for themselves. In any case, it is prohibitively expensive to treat major diseases, hence the saying “You may work hard for decades to build a decent life. But it takes only one major illness to take your life to the pre-Liberation days”(辛辛苦苦几十年，一病回到解放前).
The good part, though, is that you really don’t need to wait a few days to see a doctor. For that you tolerate a little inconvenience of waiting in lines. But in the US you wait too, for days to go to your appointment, and then you often have to wait in the waiting room in doctor’s office, sometimes for hours. There is a reason why sick people are called “patients”.
Comparing these healthcare systems is a difficult task. But what I am observing is that in China, the looming problem is the lack of specialization. Hospitals operate pharmacies, which is a fertile soil for corruption, because doctors are then motivated to prescribe expensive drugs to boost the profit of the hospital. Doctors can also accept “kickbacks” from medical vendors too. All such hidden costs raised the costs for medicine. For decades, there is talk of separating the two, but it is going nowhere. It is frustrating. I don’t why there are so many frivilous “proposals” at the recent National People’s Congress sessions when issues like this deserve more attention from policy makers.
In the US, I noticed the problem is overspecialization. Everybody is watching out for their own little niche of work that they sometimes fail to see a patient as a human being. This is shown even in the paperwork you get after a doctoral visit.
Let’s say I get sick. I go to the doctor’s clinic. Doctor ordered me a test. Then I go to the lab for a test. Doctor prescribed some medicine. I then leave the clinic to go to a pharmacy. Do I have to have the tests? Maybe not, but doctors want to make sure so that they do not get sued if their diagnosis is proved wrong. Keeping your expenses at a minimum is not their games to play. And there is little patients can do about it.
Then I started to receive bills, from the hospital, from the lab or labs, and from the doctor. Then I started to receive paperwork from the insurance company explaining “benefits” I received. Then the doctors, clinics and labs sent second rounds of paperwork to get what I still owe after the insurance company has paid their due. Any minor error in this process can make my life exponentially more complex in handling all the paperwork. I tried to keep track and then I gave up. A person has to be very organized in doing this. And there is an association that can help you to be like that, NAPO (National Association of Professional Organizers).
What bothers me really is the fact that one doctoral visit can lead to an average of seven or eight mails from various places. Sometimes this is so stupid that you’d wonder if robots are running some operations that you get the same mail three or four times a month asking for the same thing. I ususally paid as soon as I got the first bill to prevent these avanlaches of paperwork as much as possible. But when there is an error, you have to straighten this out. That’s when it is getting nasty. Who pays for these, the postage, the printing, the call centers that handle all inquiries? Eventually me, through increased insurance premium, increased tax, if not directly through doctors or hospital’s charge. Expenses have to come from somewhere, including all such unnecessary expensese. That’s where it gets unfair for a patient. Somehow the system is messed up somewhere. And this is just a minor issue. Not to mention the many holes and cracks in the system that tax dollars are going into.
I am fairly healthy now. I cannot wait to see what this mess is going to be like when I get older, with more health problems. That is why I am eating more and more apples now.
In addition, the healthcare plans do not cover dental and vision problems. This may have been taken for granted. But it is weird if you really think about it. Aren’t teeth and eyes body parts? In all countries there are specialists treating dental or vision problems, but I am wondering why insurance has to make exceptions to these two. Again, I call this overspecialization. But that is a presenting cause, deep down, the root causes are the quirks of human nature that even Obama cannot do anything about (such as greed.) He may help to make things worse, for instance, by creating an entitlement mentality that future generations will not be able to undo.
Naturally the ideal answer to the title question is that you’d better not to get sick anywhere. But that does not seem to help much. It is a condition that we all eventually face and we expect the systems to be more efficient in taking care of the problems, yet both the US and the Chinese healthcare systems are deeply flawed. I am wondering what other countries do to keep healthcare less of a pain?