Doctors & Dentists

[El Perro]

Excellent post by Moore. I don't believe I have the international coverage with my Swiss Medical plan, so I'll double check. I do remember something about alerting them prior to a trip abroad and paying at that time for some coverage.

[Thomaso276]

I have had the Swiss Medical for 1.5 years, with universal coverage, which I have not had to use. Good to read that it is decent coverage.

Jackson, I pay about $150 monthly, I think it was about 50 dollars less without the universal coverage.

I am very happy with Swiss Medical here for me and my dependents!

[Moore]

Last week I returned to Sex Prison to serve a relatively short sentence. Two days after I arrived I came down with a nasty flu (?) and decided to visit a doctor since my throat was pretty ragged. I called my major (Cigna, Aetna level) platinum US health "plan" and found out that the city/state I am currently staying in (city and state both in top 10 largest of USA) are not covered by my "plan". They are not in the proper "network". How shocking. I had a similar "network" problem 3 or 4 years ago but got around it by changing my US address with my then-employer - as a result they had to give me an "indemnity" plan for the bullshit state/address I listed due to employment regulations. It's pathetic that one has to resort to fraud in the USA just to see a doctor. The whole industry here (at least the insurance/administration part) seems about as shady as the towing business.

Knowing that I was about to travel to a shady medical country, I kept my Argentine plan (Swiss Medical/Docthos) just in case. I activated the international coverage, which lasts for 1 year and can be renewed indefinitely, right before leaving wonderful Argentina for the USA medical quagmire. When I became ill, Cigna confirmed once again that the primary service they provide is ensuring that I am never covered by their "plan". So I called Docthos in Buenos Aires and told them I'd like to see a doctor here in USA. They gave me the US 800 number and I was talking with an agent in Miami 2 minutes later. She took my data (including basic symptoms) and called me back 1 hour later with a doctor's appointment set for the next morning at an excellent medical center about 10 miles from where I'm staying way out in the suburbs. I never said US doctors/facilities were bad, I just said that my US "plans" never let me use them.

Docthos prepaid my appointment and I pay nothing. The US doctor gave me two prescriptions which I do have to pay out-of-pocket but Docthos will reimburse 100% of the receipts when I return to Argentina (I could maybe fax/scan them but its not so much money for the medicine). About 8 hours after my appointment, I received a call from the Docthos agent in Miami. They wanted to know how I was feeling and also advised me to call them again if I needed to see any more doctors, which they would arrange immediately and pay 100%. It's unbelievable that I receive excellent, prompt, and FULLY PAID care/attention from my insurance carrier 5,000 miles away in BA but get nothing but bullshit excuses, exceptions, and rejections from my US carriers - "that's not covered, you're not in the proper network, there are no doctors in that state, blah blah blah."

I need to clean out my thick wallet and will throw away either my Cigna health insurance card or my 100 Austral bill. So I need to determine which item is the most worthless. The Austral went out of circulation in 1991 upon being replaced by the Argentine peso. At the time, 1 Argentine Austral was worth about .00003 US Dollars. Here are all the uses I can think of for the Austral 100-bill and the Cigna card:

Austral 100-bill:
1) Keep it for collector's value. I've seen them framed and displayed on walls in BA restaurants.
2) Keep it for emergency toilet paper.
3) Try to scam a tourist in BA by claiming that it's worth 100 pesos. Taxi drivers get away with this occasionally.

Cigna Health Plan Card:
1) Keep it for emergency cocaine lines.
2) Keep it to swipe/open certain locked doors.

It's a close call, but numbers never lie. The Cigna card is the most worthless waste of space in my wallet and I'm trashing it.

So it is now confirmed – Argentine health insurance (SMG/Docthos at least) worked like a charm in USA. Now I will be testing other Argentine documents. It is only a matter of time before I get pulled over on one of the local expressways and I'm going to see if I can get out of speeding tickets with them. I know an American guy that has lived in Germany for years, he may even have his citizenship. When he gets pulled over for speeding here, he'll sometimes give the cops his German documentation and pretend to speak little English. They usually let him go with a warning and slowly explain that there are speed limits in USA, unlike the autobahns "over there". It is especially funny that many cops fall for the act since his birthplace is listed on his German ID, which is often the city that he is pulled over in. In Argentina, I sometimes give the cops my AAA International driver's license which says on the front page that it expired in 2002. They never catch it.

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Hi Moore,

What was the additional premium for the one year rider for the international coverage?

Thanks,

Jackson

[Moore]

What I do not understand is why corporate American doesn't push the politicians into public medicine. Given that they own the corrupt politicians and that they (corporations) complain that having to provide their employees healthcare creates an uneven playing field with companies from other countries who do not have to provide it, I just do not understand their silence.

A decent point, but either way the corporations would probably pay a huge part of it whether it be via private health premiums or social taxes. Most Euro/other countries dont have anywhere near the rock bottom employee tax rate of about 8% (6.2% Social Security, 1.45% Medicare, plus some pennies for state unemployment tax) that USA corporations enjoy. The question is, would it be cheaper to pay the higher social taxes than the ridiculous cost of private health care/insurance that we currently have. Its hard imagine anything being more expensive than the current system.

[Stowe]

Moore.

I agree that generally speaking privatization usually is better unless it becomes a monopoly as cable, telephone, et al. have become. I also read the article where it had our upper class less healthy then the UK's lower and middle class.

Even with all that evidence, politicians still refuse to accept the reality.

What I do not understand is why corporate American doesn't push the politicians into public medicine. Given that they own the corrupt politicians and that they (corporations) complain that having to provide their employees healthcare creates an uneven playing field with companies from other countries who do not have to provide it, I just do not understand their silence.

Dirk.

I did not say that TODAY our education system is only available to the rich. I said that with the way the cost of both medicine and education are spiraling out of control (well beyond the means of average Americans) that 20 years from now, it will only be a luxury for the rich. And given that government grants are dwindling (because of deficits) and the middle class shrinking, I see absolutely no evidence to indicate that it is or will be an improving commodity for the middle class.

I know this from personal research for my son.

Suerte,

Stowe

[Hunt99]

One of the reasons that medicine in the US is the MOST expensive in the world (by a factor of 2 or 3) is because it is privatized. There are so many layers and each layer requires paperwork and profits, it is considered much less efficient than government controlled medical-granted not the US govenment, which tends to mis-handle everything.

Both Canada and Englands (both of which are lambasted by politicians here as terrible) public medicine is actually cheaper and rated better then ours based on a UN analysis (now I realize there are some out there that just because it came from the UN, they consider it invalid)

The health care system in Canada may be cheaper, but it is not better. One need only look at the thousands of people who come from Canada to the US to seek treatment for their medical problems.

Do you need a hip replacement in Canada? I hope you're ready to wait 18 months. That MRI appointment you spoke of making will be coming right up next December. Just about the only way Canada has been able to maintain the system is by making private insurance plans illegal. That's now breaking down along with the inefficient weight of the system.

Medicine in the US is more expensive in large part because of the socialization of the system that has been advancing since 1965. In the areas of medicine where there is no government-controlled insurance coverage, prices and services get cheaper and better as time passes, through the system of free enterprise which does not operate in most areas of the medical market. Examples of this are vision correction and plastic surgery, neither of which are covered by 99% of insurance.

[Hunt99]

Hi Hunt99,

Again, I would disagree with you, especially given that a lot of doctors and surgeons in Argentina have studied and trained in the USA.

Thanks,

Jackson

Let me put it this way, Jackson: If medicine in Argentina was so advanced, wouldn't it be the other way around, with American doctors going to Argentina to study and train? Think about it.

Hi Hunt,

I didn't say that Argentina medical training was more advanced than in the USA, I said that Argentina medical services were closer to the quality of medical services commonly available in the USA, and one indication of this was the fact that a significant number of doctors here in Argentina had gone to school and otherwise trained in the USA.

Thanks,

Jackson

[Mpexy]

I have quite a few opinions regarding the general topic of healthcare, especially the state of such in the United States compared to elsewhere. However, I generally refrain from participating in conversations like this simply because like discussions of politics, there is often no right and wrong - simply two camps of people with opinions that will not change because again like politics, there is enough truth on both sides to have reasonably formed those opinions (whether I agree with them or not)

I will merely point out though that often people confuse which issue they are discussing when one compares how "good" healthcare is in the United States versus somewhere else. When conversations like these come up, how "good" healtcare is actually boils down to the completely separate qualifiers of:

A) How "good" the availabilty or accessability to that healthcare system for Non-Elective procedures is for the general population.

B) How "good" the availabilty or accessability to that healthcare system for Elective procedures is for the general population.

C) How "good" the actual quality of care received in a technical sense.

D) How "good" the cost burden is to the patient vs. The state.

I don't want to get trapped into trying to discuss a topic that honestly people really aren't going to change their minds about. So all I'll say as my opinion is that when discussing ANY countries healthcare system, it is possible and even probable that they excel in one or more of these separate qualifiers, but NO country excels in all of them.

So in my opinion, when you, I, or anyone says Country X has a better healthcare system than Country why, what is really being said is that whatever aspect you care about might be better in that country versus the other. Are there countries that rank miserably on all of these areas? Sure. But when conversations come up, I rarely hear United States versus Somalia, it's always between two countries that do legitimately have claim to be "good" in one or more of these areas but not in others. Just my opinion but it only takes just one of these areas to not be "good" for someone to legitimately say someone else's system is better.

For example, take Canada and the United States. I really don't want to stir up any pro-Canadians here but an objective reality is that one reason Canada excels at the ability to offer near 100% availabilty to Non-Elective healthcare is because their availability and access to Elective healthcare is miserable compared to the grand-daddy of them all - the United States. Is this right, wrong? I'm not going there - we'd then be discussing the worth of differing political systems and social values. Just as the cost basis to the patient for Non-Elective Healtcare is immensely favorable on the general average in Canada vs. The United States. But then it goes into the vortex of discussing whether the state supporting that cost basis, and the means they need to implement to support it, e. G. Higher taxes, is "good" or not.

I'm just saying that if you're a person wanting say an elective MRI done to avoid a more invasive procedure (an example of a highly useful procedure in a medical sense) or a non-major obesity related abdominoplasty because frankly you just want to look good (an example of a procedure that frankly doesn't have much medical value) and told you have to wait two years under the Canadian system, it's not unreasonable for that person to think the United States has a much "better" system. A single major metropolitan area in the United States has more MRI machines and access to that procedural time than any entire province of Canada.

However, equally valid is the reverse of this - if you're son needs a certain specialized procedure but you're HMO tells you that is 'not covered', what the hell do you care how grand the elective system is in the United States? If you're lucky enough to be Canadian in this case, you'd be thanking your lucky stars you're in Canada.

Last couple of completely random order thoughts -

- it's not perfect, but no public healthcare system or hospital is allowed to refuse treatment for medically necessary treatment based on the ability to pay in the United States. The issue is availability of bedspace and limited county resources, not whether that access is not technically there for all. Next time you're in Los Angeles, not to stir up an immigration Pro or Not discussion here, but ask any healthcare professional there what illegal immigration does to the availability of public services that were originally sized and factored for the legal citizen population.

- Doctors in the United States undergo a fairly bizarre transition which admittedly is a hot topic even within the medical community. During medical school training, rotations, and residency - a significant period for some up to 11 years - doctors in the United States are trained that medical decisions come first. In short, you run every single test and procedure to accurately diagnose and treat the patient (which also means you ignore the useless ones) This teaching hospital system basically ensures the doctor is well trained, but in my opinion also reinforces the more socially "good" value of putting patient welfare in the hands of the actually trained to make that call - the doctor. However, the minute you leave residency and enter private practice - either solo, in a privatized group or hopspital, HMO, Medical Group - the legal profession takes over. You now run tests you completely don't think under that specific situation and patient are even called for but you do, because to not run them means huge liability risk if you're ever sued. But you also frequently don't run various tests because some non-medical professional tells you it's not 'policy' or 'covered' or would incur great legal liability even if you're right.

-Look into private Medical Groups. It's a hybrid between an HMO type system and PPO system. You can choose a main GP, but you don't need to go through that GP, can choose or elect specialist referal at will, and essentially within that group can hop to any doctor you want. Basically, it's the freedom of a PPO private care system but technically listed under HMO status with most healtcare insurers so that you can elect to take that group as your "HMO" network.

- Yes, legal issues and liability coverage is a huge factor for any doctor or medical group / hospital, both in terms of negatively influencing healthcare decisions as well as the actual costs, direct (malpractice insurance) and indirect (too long to list but indirect liability coverage can cost as much or more than the actual malpractice premiums) President Dubya can quote whatever he wants - the total cost is way the hell more than 3%. Perhaps when you factor an entire large system budget, say like Los Angeles' County hospitals, it's 3% of that multi-billion budget because that bloated budget also includes aggregate spending for social services, admin, etc. But on the real end of the stick - you're average small to mid-size clinic, group, or independent physicians collective that serves the majority of real patients every year, it's a killer.

[Moore]

Dirk,

Correct me if I'm wrong, but the educational "boosters" like scholarships you refer to don't really become a factor until university level, which is WAY too late. Unless things have changed recently in USA, you're likely going to get a shit public education (primary, secondary, high school) if you live in a low income/tax district regardless of your ability.

I can't disagree with your comments about US health problems. The article I mentioned did not imply that medical care was the root cause of the US/UK health differences. Thing is, the UK "diet" has got to be as bad as USA. As artificial and processed as US food may be, at least it partially qualifies as food.

[Rock Harders]

Moore-

I think we are in agreement here that in general the USA needs a more equitable health care system and that Argentina's health care system is more than adequate and provides free / almost free medical care to all that need it. However, I find some faulty logic with some of your other arguments.

I firmly believe that education is not only available to rich, white upper middle class and higher US citizens. That may have once been the case, but now it is not. The fact is that in the USA, if you have the intellectual ability, and you exhibited this ability through grades and test scores, you will attend the finest schools regardless of financial status. There are billions of dollars of public and private grants / scholarships / aid available to students of academic merit. If a student is from an underpriveledged or underrepresented group, even more scholarships / grants / aid are available. In addition, academic standards for admission are enormously relaxed at top universities for applicants from underprivledged / underrepresented groups. I understand that it is easy for rich, white, upper middle class students to succeed, however the opportunity exists for everyone, some just have to work harder than others to achieve it.

In terms of health of US citizens versus citizens of other countries, this has everything to do with the disgusting and foolish nature of the US diet and the IMO ridiculous nature of the US pharmaceutical industry, and little to do with the actual medical care available in the US. The food the typical US citizen eats is truly appalling, its like putting 45 octane fuel in the gas tank of a Ferrari requiring 93 octane and expecting it to run smoothly. Synthetic refined Sugars, hydrogenated fats, nitrates, food dye, preservatives, all those things are like poison for the body. If people ate more natural, unprocessed foods (like the rest of the world) they would be much leaner, healthier, and more attractive. In addition, the pharmaceutial industry is to blame for this to some extent. Feel a little off, pop 3 advil, you'll feel better. Hey, why not do it everyday? If US citizens ate correctly, they would not ever feel the need to take pharmaceuticals.

Suerte,

Dirk Diggler

[Moore]

Stowe,

I believe in mostly free markets and that they generally make products better and cheaper. What you write affirms that the US med industry has become kind of a shady/corrupt business (enter attorneys?). The lawsuit factor must be a huge cost, though according to Dubya it only accounts for about 3% of the total cost going by memory of the 2004 pres debates. It seems to me that in many countries like Argentina, good medical care is correctly viewed as a right and necessity for all, whereas in USA you're essentially only entitled to it if you can afford the country club membership dues. I'm referrring to mentality and not socialist or pure capitalist systems. The US attitide toward education seems similar, which probably explains why we have masses of ignorant, sick people.

I read an article just a few days ago about a comparison made between US and UK health. US/UK differences have often been attributed to racial/income factors. But this study showed that after adjusting and comparing white US middle class to white UK middle class, UK was much healthier - shockingly so by several measures. The kicker was that even the white UK lower class was healthier than the white US upper class!

If Im not mistaken, there are about 20 countries with life expectancy rates higher than that of the USA and there are urban areas in the US with rates (life, infant mortality) comparable to the those of the worlds poorest nations in Africa. Kind of hard to claim "we're number one!".

[Stowe]

One of the reasons that medicine in the US is the MOST expensive in the world (by a factor of 2 or 3) is because it is privatized. There are so many layers and each layer requires paperwork and profits, it is considered much less efficient than government controlled medical-granted not the US govenment, which tends to mis-handle everything.

Both Canada and Englands (both of which are lambasted by politicians here as terrible) public medicine is actually cheaper and rated better then ours based on a UN analysis (now I realize there are some out there that just because it came from the UN, they consider it invalid)

I had an MRI in January and the doctor has billed it to my insurance company 4 times and each time the insurance company rejects the claim because of some very minor error. He is still waiting to get paid.

For an epidural for a neck problem, I have received perhaps 30 bills for the 1 epidural (sent to my insurance company and copied to me) from so many doctors, hospitals, and medical offices, most of whom I did not know I used for the procedure.

I have had to make 3 payments for the same bill because the insurance company claimed they lost the payments. Only later to have to reimburse me for the double overpayments.

In 20 years, medicine in the US will becoming much like a college education-only available to the rich. And that is nothing like any other country.

Yeah, tons of people rush to this country for our medicine. That just shows it is great medicine for the rich of any country. The average US citizen will neer have access to that quality of medicine.

Suerte,

Stowe

[Moore]

Having been to dentists, eye doctors, GPs, ENTs here, I'll take a WildAssGuess and say that machinery used in Argentina is about 10 years behind the cutting edge used in USA. But I'd choose an excellent doctor using perfectly maintained 1996 equipment over a half-ass doctor using 2006 tools any day.

With complex medical conditions, I believe that the crucial element of the MDs job is to determine exactly what the problem is and how to best treat it. Knowledge/training must be more important than machinery in most of these cases.

One time an ENT here used an instrument that I thought was quite neat. It was a long, remotecontrol, stringlike tube with a tiny camera on the end that he stuck several inches "up" my nose and took pictures of sinuses, etc. I wouldnt think that its been around forever.

I'm surprised that Mpexy hasnt chimed in here. Most of us dont have any medical training.

[Rock Harders]

Mongers-

I agree with Hunt to a certain extent about not wanting to have very-serious, potential life altering procedures done in Argentina if one could afford to have the same procedure done in the United States. I do not doubt for one minute the training and education of Argentine doctors. What I might doubt is the presence of the most modern, up-to-date equipment and techniques. My aforementioned LASIK eye surgery is a perfect example of this. I definetly could have gotten LASIK preformed in Buenos Aires for a mere fraction of the $4000 USD I paid to get in done in the USA; however, I've only got one set of eyes, and I KNOW that the opthamologist (sp? In the USA is very well compensated and therefore is able to use the most modern and up-to-date equipment available. Based on the medical equipment I see in dentists offices and the state of certain medical facilities I have seen, I am not sure of the presence of ultra modern equipment here.

Suerte,

Dirk Diggler

[El Perro]

What are you basing this on Hunt?

And Jackson is correct, many doctors (lawyers too) here studied, trained, etc in USA, which is of course a very highly regarded place for advanced / specialized education. Of course the basic education offered to the general US population sucks balls (semi illiterates graduating high school) Lots of parallels between education / health systems of a country.

Recurring sinunitus, while not cancer, can be fairly serious and sometimes involve serious surgery. I should mention that my ENTs here in Argentina were the ones that finally whipped it with treatments, high tech exams / tools, and medication. Mayo and the rest of the bozos I saw in various states were a waste of time and space. The various ENTs I saw there, exluding the one at Mayo, really didnt seem to give a fuck. When the docs entered I got the feeling "ok you got 3 minutes pal".

Again, agreeing with Moore here regarding ENTs in the states. Not to say there haven't been a few decent ones through the years, but the majority are drudging through their mile a minute day with the idealism of med school way back in the rear view. I had a real good one years ago in Virginia who did my deviated septum work (there's a fun time)