A Tale of Three Cities: Istanbul, Athens and San Mateo, San Mateo County Medical Association Bulletin, September 2007, By James R. Missett, M.D., SMCMA President

From Gocek, a small seaport town of about 2,000 in southwestern Turkey on Republic Day, Monday, October 29, 2007: the 84^th anniversary of the 1923 Proclamation of the Turkish Republic.

Istanbul is a city of 17 million that straddles both of the eastern and western shores of the Bosporus (or "cow crossing") that flows south from the Black Sea to empty eventually into the Aegean Sea.  Almost one in four of the 76 million citizens of Turkey live within greater Istanbul. All Turks are covered by one of three general health insurance plans for which everyone (theoretically) pays out of his or her income. Tax collection remains a national problem to which the current government is energetically addressing itself, but with mixed results.

In fact, it is the government's level of confidence in its health care contribution collections that determines the level of benefit that an individual in a given class of employees will receive. In other words, the more certain the government is that the individual class has paid its complete premiums, the higher and the broader the range of benefits are for recipients.

The best and widest range of services is made available to government employees. These include the employees and instructors in public schools, colleges, and universities.  Some might look askance at government workers getting the best deal and the broadest coverage with respect to their health insurance, but government workers are also a class of employees whose income is best and most accurately known to the tax collectors.

Better health care coverage means that a Turkish government employee is permitted to receive covered medical care in any private or public university medical facility without any co-payment. . .

Turkey is currently applying for membership in the European Economic Union (EU). The widespread belief is that the real reason for the postponement of their acceptance into full membership by the EU is based on the fact that Turkey is not a Christian country. In contrast, Greece is a member of the European Economic Union.

Like the Turks, the average Greek worker contributes approximately 40 percent of his or her total income to a combination of health care insurance and social security insurance. Approximately 15 percent of an individual's total income goes for health care coverage, while approximately 25 percent of an individual's total income goes for social security cuts.

However, unlike Turkey, Greece does not allocate benefits based on a government versus non-government basis. Nor does Greece give any of its 11 million population access to the better public university health care physicians, clinics, and hospitals.

Greece, however, does continue to struggle with EU demands for retirement eligibility age to be raised from its current levels of 30 years of work for a man and 25 years of work for a woman, to approximately 40 or 45 years of work for a man and 35 to 40 years of work for a woman.  The current retirement schedule allows for retirement as early as age 45 for some people.

The EU wants to increase the age of eligibility for retirement benefits to at least 55, but the Greeks are resisting. Of the 11 million Greeks, half live in Athens.  This means it is largely the Athenians that are resisting the demands of the EU for raising the retirement age. 

This is taking place at the same time that the Turks are beating plaintively and fruitlessly on the doors of the EU to subject their citizens to the same restrictions that the Greeks do not want. . .

To read San Mateo and the rest of the article, go to www.smcma.org/Bulletin/BulletinIssues/Oct07issue/BULLETIN-0710-President.pdf.

Can You Believe People Are Paying Medicare And Social Security Taxes Of 40 Percent?

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Lessons from Sweden's Universal Health System: Tales from the Health-care Crypt
by Sven R. Larson, Ph.D., JAPS, volume 13, No 1, 2008.

You cannot buy a new Lexus for $20,000. Small budgets cannot buy first-class medical care either. Yet one of the most persistent arguments for single-payer health insurance is that it will somehow give everyone gold-plated care at little or no cost. 

There are a lot of dry statistics to prove just how wrong this notion is. But there is a side of this issue that rarely is told, especially not by advocates of a government medical monopoly. It is the story of those who pay the price for the serious rationing in a single-payer system.

Universal Rationing: Real-Life Examples

Rationing of care is a reality under universal health insurance.  Yet, its advocates seem universally oblivious to it. In an effort to unmask the reality of "universal coverage," here are some actual case histories of real people with real experiences. They were reported by Swedish news media, in some instances numerous times. Sweden has longer experience with socialized medicine than almost any other country in the world.

In October 2003 Mrs. A., who lives in Malmo, Sweden, gave birth to a baby boy. She was signed out from the hospital after delivering the baby. There are not enough beds, so delivering a baby "without complications" is an outpatient procedure. Budget cuts have eliminated beds and medical staff.  The next day Mr. and Mrs. A. noticed that their baby was weak and did not want to eat. As is common in Sweden, they did not call a doctor. Instead they called the tax-paid "TeleMedicine" service.  Nobody advised them to go see a doctor right away. The following day their baby died of pneumonia. 

In May 2006 another couple lost their three-year-old son to the budget-starved medical system. When Mr. and Mrs. B.'s son suffered from diarrhea and had been vomiting for almost two days, they took him to the emergency room at the nearby university hospital. A doctor ordered a supply of intravenous fluids, and the boy was sent on to the pediatric clinic to have them administered. When he arrived, the nurses had no time for him. Mr. and Mrs. B. repeatedly called on the medical staff to ask why nobody was coming to give their son the intravenous fluids he so desperately needed.  Every time they got the same answer: nobody has time. They have too many patients and too little staff.  Six hours later the three-year-old boy died of heart failure.  You do not have to be a child to die from denial of care in Sweden.

In April 2005 Mr. C., 61 years old, became concerned about an unusual feeling of fatigue. He went to see a doctor at the local government-run clinic. The doctor sent him home with some encouraging words. Mr. C. came back a while later with worsened symptoms. Again he was sent home after a superficial examination and with more reassurance. Over the next year and a half Mr. C. visited this tax-paid local clinic a total of 14 times. He had no choice - all Swedes have to go through a government-run primary care physician at a tax-paid clinic in order to see a specialist. He developed blood in his urine. But the doctors refused even to take a blood test.  They told Mr. C. and his son that they were denying him the blood test because of budget restrictions imposed by government bureaucrats. When, finally, Mr. C.'s son convinced the doctors to do one blood test, they found out that Mr. C. had cancer. He was referred to a regional hospital. There they established that his cancer, originally curable, had spread throughout his body. There was nothing left to do. He died shortly after.

Even those who do not die from encountering denials of care suffer considerably under Sweden's universal coverage. Mr. D., a multiple sclerosis patient, lives in Gothenburg, a city of 500,000.  His doctor told him about a new medicine that is considered a breakthrough in MS treatment. But, when the doctor put in a request to have Mr. D. treated with it, the request was denied. Reason: it would cost 33 percent more than the old medicine, and that was more than the government was willing to pay.  For most Swedes there are no longer any subsidies for prescription drugs. People with exceptionally high pharmaceutical costs get some subsidies, but they have to pay the greater share themselves.  When the government denied Mr. D. the new medicine on the grounds that the subsidies would cost too much, he offered to pay the full cost of the medicine himself. He was denied the option to pay full cost out of his own pocket because, the bureaucrats said, it would set a bad precedent and lead to unequal access to medicine.  In Sweden, there is no way to obtain access to medication outside the government-run system.

There are other absurd examples. How many times have you gone to see your doctor only to find security guards posted in the waiting room?

This is reality in Malmo, Sweden's third largest city. To see a physician the 280,000 residents of Malmo have to go to one of two local clinics before they can see a specialist. Except during business hours, only one of the two clinics is open to serve all the city's residents.  As a result the clinic is severely overcrowded. The security guards serve two functions. They keep patients from becoming unruly as they sit and wait for hours to see a doctor, and they keep new patients from entering the center when the waiting room is considered full.

Opening the second clinic during off-business hours is considered too costly.

Government control over medicine also leads to government arrogance. In Gothenburg, a hospital was blessed with having a talented orthopedist on its staff. Dr. Leif Sward worked part time for the government-run hospital, part time for a local soccer club at its private orthopedic clinic, and part time for the British national soccer team.

You would expect a man with such credentials and experience to be considered a prized asset in a tax-supported hospital. But the government bureaucrats were unhappy with the fact that Dr. Sward was not working full time for them. They considered his work for the private health clinic "competing employment" - the soccer players should come to the tax-supported hospitals instead so as to increase their revenues. So they gave Dr. Sward an ultimatum: quit the private sector or leave us.

Dr. Sward chose the latter.

By giving Dr. Sward this ultimatum, the medical bureaucrats showed that their priority was to control and stifle competition and choice, an action contrary to the interests of patients. . .

Conclusion

If we implement a universal, single-payer model in America today, the negative effects will reliably occur about a generation from now. The question that we need to ask ourselves as we enter the election season is this: Are we willing to send that bill down the road for our children to pay?

To read more about Sweden's Health Care and the taxes required to pay for it, go to www.jpands.org/vol13no1/larson.pdf.

Sven R. Larson, Ph.D., is founder and president of The Hill City Skunkworks, a public policy research firm in Saratoga Springs, N.Y. www.hillcityskunkworks.com/
Contact: valfardresearch@yahoo.com.

Single-payer medicine does not give Access to Healthcare, it gives access to a Denial of Service.