“America has the best health care system in the world.” -many American politicians, both before and after Obamacare was ever law
[If you want to get a picture (satirical, of course) of the American health care system, check out this funny video from the Daily Show in 2014, even after Obamacare came into effect. Click CC for English subtitles. It shows how you could be deceived into believing the US is a “3rd world country,” considering low-income people in rural areas also benefit from emergency non-profit health care provider Remote Area Medical’s services.]
This is not just something American politicians believe. Many Americans will tell you, for better or for worse, they wouldn’t get their health care anywhere else. That they don’t trust anyone, and that for all that – to paraphrase Americans I know – “socialist universal health care crap” they talk in Canada, they still have to wait on long lines in the meantime. And this is a talking point which persists even outside of the US. Many people come there for health care because they trust the large number and education of our specialists, and because words and talking points repeated over and over are powerful.
When people ask me my opinion about CZ, one of my favorite things to discuss is health care – a universal problem with no single universal solution.
Americans are afraid of social systems because they erroneously equate the words “social” or “social democracy” with straight-up Socialism. And as I have written before, this is a no-good-very-bad-word in the US.
However, I now have experience with both the (private) American and (universal, socialized) Czech systems. So how do they compare? I would absolutely love to hear an expert opinion if anyone out there has one, but as I am only a health care hobbyist, I will give my anecdotal experience.
The first time I went to the doctor in CZ, it was to get a mandatory slip that stated I was in good enough health to work here. And I was shocked by the waiting room system. Keep in mind that I live in a small town, and that in cities like Brno and Prague, the system is certainly more modern. But in this small town-doctor’s office, you don’t make appointments. You come (as early in the morning as you can), take a number on a key ring off a board with hooks numbering up to about 30, and you can either stay to wait or come back later (if someone beat you to it and you have a higher number). You are called to see the doctor in the order of the numbers you’ve taken.
(I should also mention that the other doctor on the other side of this smaller waiting room has a more modern system where you press a button and get a ticket with a number on it.) And every time I get between numbers 2-5 (I’ve never gotten 1), I’m like…
If this wasn’t surprising enough, there is no secretary or nurse in the waiting room. This person is on the other side of a door which can only be buzzed open from the inside. So if you urgently need to speak to her, you have to knock and wait in an awkward little group outside the door until she has time for you.
Why is this strange? In the US, every waiting room has a little desk or window for the secretary. We call ahead to make appointments for doctor visits and these appointments are taken very seriously. The secretary should be the friendly face and PR person of the office – if we wait more than 10-15 minutes for our appointment, we need someone to complain to.
However, I’ve gotten used to the waiting and it’s really not as bad as it sounds. If you come sharp in the morning hours, you usually don’t wait longer than 30-45 minutes. Bring a book.
One more note about secretaries
In small town doctor’s offices, there are usually a grand total of two people in the doctor’s office – the doctor (doktor or doktorka 😉 ) and the nurse. This usually means the secretary is usually also the nurse. Yep, she takes your blood and she knows everything about you.
In American offices, secretary is often, but not always, a separate job from nurse.
Small Town Hospitals
I’m lucky to live in a town that has a hospital, and what’s more, to live a three-minute walk from it. When I go to the doctor to get blood drawn, but for example I have missed the once-a-day pickup from the doctor’s office (which takes place no later than 8am and usually earlier), I can walk my own blood sample to the hospital. Depending on where you’re from, this may not sound weird to you, but it will definitely sound weird – and perhaps even unacceptable – to Americans (and my own mother HI MOM).
Here’s the crucial part.
In CZ, health insurance is a universal right – another legacy of Communism. An employee, employer, and the government all work together to ensure the employee gets health insurance. So health insurance is not free – I put money towards my plan through my monthly wages.
In the US, most employers with 50+ employees offer subsidized, employer-run group plans, while workers contribute to the cost through premiums, co-payments and deductibles… lots of health care terms Europeans don’t have to care about. Self-employed people in both countries are responsible for buying their own health insurance.
My American experience: Under Obamacare, I am eligible to be on my parents’ insurance until the day I turn 27. Health care costs are shared between us the insurance company. This means that when I go to my primary care physician, I have to pay a “co-pay,” which under my plan is $50. So if I want a yearly check-up, or if I need to get blood drawn regularly for my medical issues, I pay $50 every time I see my doctor, and slightly more ($60) when I get a recommendation to see a specialist.
My Czech experience (Czexperience): Czech patients used to pay 30 CZK ($1.30) per doctor visit, a requirement put in place to discourage them from abusing their ability to see their doctor whenever they wanted. This was highly unpopular, and public pressure caused politicians to eliminate this rule, so… when I go to the doctor, I pay nothing. Insurance covers all my visits.
This is true elsewhere in Europe as well, especially former Soviet satellite states. A quick story – last summer I was in Romania with my boyfriend. I developed a painful, burning rash on the back of my neck which, after one day, I realized was not actually sunburn. We were lucky to be in Brasov, where pharmacists spoke excellent English, and one very generous one (to whom I will be forever thankful) called a local dermatologist to make me an appointment. The dermatologist – who, funny detail, spoke every language except English, it seemed, and needed the help of another patient in the waiting room to communicate with us – determined it was an insect bite and prescribed antibiotics and creams without expecting payment. *Huge sigh of relief.*
A couple of crucial differences between American and European systems:
The Supreme Court has debated, and Americans continue to debate, the legality of an employer having a say (based on religious freedom) in what health insurance can cover, and this has mainly focused on birth control and abortion coverage, leading many to conclude that politicians and employers want to legislate women’s bodies.
Coverage choice: If you get health insurance through your job in the US, you often must accept the plan your employer offers. If you need coverage for extra services, you pay more money for health care “riders.” Health care costs in the US are usually extra expenses. On the other hand, health insurance plans in CZ are chosen individually by the employee and all costs are simply funneled through taxes on monthly wages, which the employer takes care of. Plan options are more similar to each other than in the US and cover a wide range of things, and most or all of what is now being called EHBs (Essential Health Benefits) in the US; for example, pregnancy and childbirth, mental health care, prescription drugs.
The Czech health care system guarantees rather long-term PAID sick and parental leave (and every European state does too, to varying lengths). The American health care system allows for only short-term UNPAID sick and parental leave. (More below.)
Pharmacies and Medication
In the US, generic drugs can be bought cheaply, but many companies take advantage of the system and charge very high prices, depending on what the drug is for and its market availability. I remember paying about $20-25 for antibiotics when I was younger, and this varies wildly. In CZ, I’ve had my fair share of throat issues and have never paid more than $4 for 10 days of antibiotics.
However, it’s also true that more things are available in the US over-the-counter (you don’t need prescriptions for them), and most things you need in CZ, you’ll have to talk with the pharmacist before getting your hands on them.
Here’s one very interesting and highly-publicized example about how one American family went to the emergency room and were billed $629 for a Band-aid (plaster).
“He tells us that Colette is okay, that the reason it’s bleeding so much is because there are so many capillaries at the end of the finger,” Bird said. “Then he literally runs the finger under the tap, dries it, puts a Band-Aid on it, and says that’s it. We’re very relieved, we go back to the car, and the Band-Aid falls off. But it was fine because it had stopped bleeding.”
Everything about the visit, he says, seemed fine — the doctor, the nurse, all of them were reassuring and provided appropriate care.
Then the $629 charge arrived. To Bird, this seems nuts — in his view, the hospital wanted him to pay $629 for a Band-Aid. Even though his insurance had negotiated the price down to $440, he was still incensed by that initial number.
This was John Murphy, who is the chief executive of the Western Connecticut Health Network, which owns the hospital where Colette was seen. He wrote back to share “a different perspective” on the emergency bill.
First, he points out that the Band-Aid didn’t cost $629; it was actually just $7. The other $622 was the cost of seeing the doctor and using the emergency department itself.
[…] “The remainder of the charge,” he writes, “was associated with the use of the facility and staff. We staff the emergency department 24-hours a day, every day of the year, and stand ready to treat whoever walks through our door, be it a gunshot victim or a patient with a stroke.”
I can see both sides of the issue here. A similar thing happened to me when I was younger, when my family had to pay about $600 for an unexpected visit to the emergency room for me when all I received was a painkiller. However, Murphy has a point – it’s the doctors’ job to be there around the clock. We can debate it til we’re all blue in the face.
Not just a figure of speech.
How does the Czech system subsidize these costs, can anyone tell me?
All I know is that here in Tišnov, when I go to the emergency “pohotovost” services, I pay 80-90 czk ($3.5-4). On the spot.
You may be asking yourself – if you pay so little for health insurance, how can you be sure of the quality?
Again, this is only my anecdotal experience. I can say there have been one or two experiences where I didn’t feel the Czech doctor was as attentive or open to my questions and concerns as an American doctor would be, but mostly, doctors are friendly and willing to listen to you. However, they are also firm about what they believe.
All of that said, I personally have not noticed a significant difference in the health care I’ve received. (Then again, I have not needed any serious attention like surgeries in CZ.)
Meanwhile, I could spend hours talking with you about…
In CZ, when you’re ill for more than a few days, doctors will give you “neschopenka” papers (literally “not approved”) that allows you to stay home. And especially when you are on antibiotics, everyone wants you to stay home at least a week. (There are three papers with three different colors which are to be given to three different entities, but how confusing that is, is a different story.)
On the other hand, Americans do not generally have paid sick leave and are taking a pay cut if they stay home. That means they are antsy to get back to work and often return before they are truly better.
In CZ, current law states that after staying home for three days, you start to receive 60% of your salary. In the US, it’s so far only a good employer that pays.
and Parental Leave
In CZ, mothers can take up to THREE YEARS of maternity leave per child, with her job guaranteed upon return. Fathers can choose to take the leave instead of the mother. As of this summer 2017, the parent staying home receives 70% of their salary (Czech-only link) and can choose to receive more money per month and stay home for a shorter time, or receive less money and stay home longer.
Here’s a list of European countries with the best parental leave policies. (Czech isn’t on there probably because all things considered, salaries are low for Europe and it’s difficult to take care of babies with the daily/monthly salary options available.)
In CZ, parents can also take paid leave from work to go to the doctor with their child or care for a sick child.
On the other hand, the US is one of the worst countries in the world for maternity/parental leave policy. The US does not mandate paid maternity leave. It only guarantees up to 12 weeks of unpaid maternity leave with the same job upon return, under certain conditions. A handful of very progressive companies like Amazon, Netflix, and Google offer paid maternity leave.
Overall, I really believe that in CZ, doctors and everyone on the street believes that health is the most important thing. We have to take care of ourselves to take care of our society, and employers are very understanding of this. In the US, we may say health is the most important thing, but we are lucky even to have it based on the philosophy of our system.
How is the health care system where you live? Any opinion on the Great American Health Care Debate? What about universal health care?
Extra information for consideration:
We can all agree that Obamacare was, at the most basic level, an attempt to extend health insurance to all Americans by creating public health insurance markets that would, in theory, drive down health care costs and make insurance affordable for uninsured Americans. It required Americans to buy health insurance or face a yearly penalty. It also aimed to protect Americans by requiring certain minimums of coverage by insurance companies. The system is imperfect, but it has until now provided millions of Americans with health insurance coverage. The currently proposed Republic health care plan (which is unvetted, unpopular, and vindictive towards Obama-era policies) is estimated to kick 22-24 million Americans off of their health insurance – NOT to make insurance better for Americans.