America's Exceptional Medical Care

Is anybody else getting sick of hearing how America's medical care is the best in the world? Does anyone still believe that it is? Yes to the former means you're paying attention. Yes to the latter means you believe all of the American Exceptionalism lies that are still going around. Don't get me wrong, I love America, and there was a time, within human memory, within my own memory, when America was the most exceptional country in the world. The best! The best by far in almost every category. That time, unfortunately, has passed. America has been overtaken by events. The democracy, the rule of law, the standard of living, and yes, the standard of medical care, have all been overtaken by most of the developed world and quite a bit of the developing world as well.

Here's an example from today's New York Times:

Some guy is mowing his lawn, wearing shorts. He feels a sting of some kind on his right foreleg, front side. When he looks down, he can see the puncture wound. He finishes up the lawn and goes inside to clean up. Before long there's a red area around the puncture. It doesn't hurt, so he puts on some Neosporin and forgets about it.

After a couple of days, it does start to hurt, and the red area is larger. Guy goes to “the doctor,” which today is some kind of clinic or “medical center” or something. Something corporate, where all of the care providers are underpaid employees.

Ooooops! No doc today! So he is seen by a nurse-practitioner. I love those people, but they're not doctors. She gives him a bottom rung antibiotic. His symptoms worsen.

Second visit! Ah! There's a doctor here today. Well, a resident, anyway. An internist! By now the red mark is large and has bumps in it, and there's a line running up his leg. He goes home with more antibiotics.

Third visit! This time he is seen by a real doctor, but this doc is also an internist. Forgive me, but doesn't “internal medicine” still carry its traditional meaning? What the hell is “internal” about an angry skin rash? This doctor, like those others before him, has no idea what he is looking at, and is considering a course of one of the strongest of our current antibiotics. Luckily he got a brainstorm. I'll see who else is here today! By total coincidence, there's a real dermatologist leading a bunch of residents around, trying to teach them something.

The real dermo takes one look at the guys legs (it's bilateral now, did I mention that?), and asks, “are you using a triple-antibiotic-ointment on it?” Like Neosporin for instance. Guy says yeah. Case fucking closed! Dermo doc says, “you're having an allergic reaction to the ointment. It rubbed off onto the other leg while you were sleeping.” (Turns to his resident assholes and says, “this is Allergic Contact Dermatitis.”)

Guy discontinues Neosporin, it all clears up, and thank sweet baby Jesus in the manger the guy doesn't get his legs cut off because some internist is sure that it's the fucking flesh-eating virus.

I get better care than this in Thailand. And when I ask to see a dermo, without an appointment by the way, I'll see a dermo, and I'll be sitting with a real dermo within twenty minutes or so. These are most often experienced doctors who know what they're doing. They get out the big light and have a good look around, and generally they get right to the point. Then, if they're not busy, they like to chat a bit and practice their English. It's all very chummy.

I have no idea what they charged that poor guy with the bee sting, or whatever it was, but it was three visits with two Rx's for antibiotics. My one dermo visit would cost me, for the visit alone, about $35. I don't have outpatient insurance, so that's the full charge. They like to prescribe things here too, but I discourage them, or refuse antibiotics all together. They all like to write scripts, wherever you live. They make money on it, let's face it. They do the same thing in America. Usually, even with scripts, I get out for $60 or $70 bucks.

My doctors are as good as yours, and my providers are for-profit hospitals. Mostly, anyway, I keep a working relationship with the best government hospital in case I need something expensive, like open-heart-surgery. Want to laugh? Two years ago I had an angioplasty with two stents installed at my local, “expensive” hospital. The bill was under $10,000, my junk insurance paid one third of that, and my doctor had an MD and post-doctoral angio training in America. His English was as good as mine. (The bill included one night in the cardiac ICU.)

So, how's that “Shining City on the Hill” thing working for you?