I've always liked my dentist. She's professional, competent, friendly and she once called me a "medical miracle" because the only cavity I've ever had in my life was during my first pregnancy.
But a blurb in her recent newsletter, along with a recent minor but annoying debacle that was me trying to find dental insurance, finally put me over the edge. Any other time I'd have rolled my eyes and let it go, but I've had it. Enough is enough. Nice or not, such uninformed perpetuation of fear and lies as you'll see below is putting the well-being of this country in grave jeopardy.
Follow me over the fold.
This is what set me off:
In her last newsletter, my dentist included a blurb entitled "So what about that 'free' nationalized health care program?" She proceeded to make the following claims about socialized health care in Europe, according to her relatives who live there:
- Local anesthesia (numbing) is never used for any dental procedure other than surgery (extractions). This means all fillings, and even root canals, (yes, really) are done without any painkillers, due to the additional cost of novocaine and the extra time it takes to use it.
- It is difficult to get good replacements for missing teeth. My cousin sent me his dental models from Europe and asked if I would make him a partial plate because he could not get any in his home country. He is 45 years old and is missing almost all of his upper teeth due to decay. Of course, this is the quality treatment he received for free. He only went to the dental clinic (there are no private offices) when he had pain, and then he could get novocaine and get his teeth pulled.
- If a patient is lucky, they may get an actual cap on their teeth, if the waiting list is short. Some better quality dental care is available if a person is willing to pay cash. Of course, then, the treatment is not free after all.
Still want “free” dental care?
Well. I lived in Europe for almost 14 years, and this is, in my experience, simply not true. I had excellent routine care that included novocaine as needed, and still have two porcelain crowns I received there almost 15 years ago, painlessly, which are still in excellent condition.
I am frankly sick of the lies I keep hearing about the quality of care (or lack thereof, or the real bugaboo: but you have to pay taxes!).
So first, I emailed one of my German friends. He began his reply by laughing out loud:
Hahahahahaha . . . well, of course Europe is the most backwards third world country you can imagine . . .
Maybe it’s not so great in Eastern Europe? Czechoslovakia or so? But no anesthesia? I can’t imagine that. I personally can only speak for Germany, England and France, and the medical care here is completely humane. In any case better than in America, where cowboys get only a shot of whiskey before they remove the bullet, hahaha . . . see, there are clichés everywhere.
Yeah, I think somebody wants to scare you because they can make more money on individual private patients. The doctors are trying that here too lately . . . we are watching in horror as our health care system goes down the drain . . . I’d say, they’re moving toward an American-type system, in which people who don’t have money simply aren’t treated.
But still, HERE every public patient gets a heart, a kidney, or whatever expensive thing they need. I remember how your grandmother [dying of cancer] had to leave the hospital every 6 weeks, spend 6 weeks at home, go to the hospital for another 6 weeks, etc. That couldn’t happen here; even someone who is unemployed, on welfare, gets the entire spectrum of health care AND he has a right to a roof over his head and to having his basic expenses covered. It’s not riches, but no one starves to death. . .
I think if the Americans weren’t so terribly insulated in their own world, and if they could see our socialized system, they would be envious.
By the way, I have public health insurance, and I pay a fee to insure my whole family. The fee is calculated according to income—I have a good monthly income and therefore I pay the highest level, which is 600 Euros a month. A regular worker pays about 300 Euros. That is for all the legally prescribed benefits-- all benefits are prescribed by law. If you want more than those, you have to pay more.
Yeah, but they rip out our teeth without anesthesia . . . got a shot of whiskey? I have to go to the dentist . . .
So, my dear, I have no idea what your dentist is babbling about, except that it’s about fear-mongering and probably about making money, not about your health . . .
Kisses, yours--
The really funny thing is, the newsletter came right as I was in the midst of another (typical, in my experience) insurance mess. I thought I had signed up for the same dental plan as my son's in a process that sent me through a labyrinth of confusion on both the internet and the phone. It took me several weeks, and I didn't realize we had different plans (and thus different providers) until the bills came in. My dentist, whom I've been seeing for several years, was in my son's plan, but apparently not mine.
I explained all this to her, and then added the following. I tried to be polite:
I am telling you all this because I find this (admittedly relatively trivial but to me aggravating) situation especially ironic in light of your recent comments in the newsletter. There, you claimed that you had it on good authority that the health care system in “Europe” is frighteningly primitive and that decent care is available only to those with cash.
I've heard such claims a lot lately, and I disagree in the strongest possible terms. No health care system is perfect, but I suspect it differs from country to country in Europe, (e.g. France, Germany, or Scandinavia might well look different from Spain, Portugal, or Hungary). I find it disingenuous to make broad claims about the (supposedly inferior) health care in “Europe.”
Secondly, having lived in Germany for 14 years, I can tell you that, while the quality of care I experienced in Europe is similar to that in the United States, access to good care and, above all, to adequate and affordable insurance, is far, far superior there compared to the maze of confusion, headaches, and surprises—many of them nasty and some fatal--that we currently have here.
Everyone living and working legally in Germany, for example, has affordable health, vision, and dental insurance: no exceptions. Millions here go without. Here, health care costs, according to a recent Harvard study, are the leading cause of bankruptcy. In "Europe," this is unheard of. People get the care they need at a price they can afford--and in my experience, more holistic and equally humane care with a greater emphasis on prevention. As with traffic tickets, public day care, etc., all fees are set according to your income bracket.
This is how it worked when I lived there: 1) you signed up for insurance with a company of your (or your employer's) choice. 2) You received a booklet of proof of insurance certificates; every quarter you used one if you needed to, normally for a primary care physician who then wrote referrals as necessary. 3) You picked a doctor or dentist of your choice, made an appointment, and showed up.
That’s it, period. There are no in or out of network complications, no demands that patients make predictions about the kind of care they might need in the future, no crap shoot with choices of deductibles. My out of pocket expenses for a one week hospital stay when each of my sons was born were the rough equivalent of $50, and that included 10 in-home visits afterwards from a pediatric nurse. No one there is dropped, ever, when they get seriously ill, or denied if they have been.
My mother-in-law's terminal cancer did not bankrupt her (as it easily could have here), but on the contrary made her last few years as stress-free in myriad ways as possible. Her insurance even paid for her lab work during her last visit to the States, making it possible for her to see her grandchildren one last time. And we got to pick the hospital. Above all, I remember her telling me that in Germany, it is mandated by law that doctors are not allowed to leave their patients in pain. Whatever pain management needs to be done, in whatever situation, is done. At no additional cost.
No one claims such care is “free,” but what I experienced in Europe was high quality, well-coordinated health care that was available and affordable to everyone who lives and works legally in the country. We made less than we did here but we lived well--with better, more comprehensive health insurance than we've ever had here. In Hamburg, over time, I was able to create—and stay with--a stable of doctors I liked and trusted. Here, even with insurance (which for me has been intermittent), it has not been at all unusual to have to start over, finding new doctors every year, as fortunes and circumstances change, often for reasons (such as divorce, employment, employer decisions) I have little or no control over.
I am frankly appalled at the unsupported claims, ridiculous sweeping generalities, and blatant untruths (there is FAR more choice there than here) that are currently being spread around about the “inferior” or supposedly overly expensive care in other countries, countries that may or may not be as rich as we but whose systems are designed to place a very different emphasis on the health and quality of life of all its people, and not just for those who can afford it.
Affordable care for all is doable. I have no doubt we are capable of creating a system in which we actually take care of each other--if we so chose.
But beyond my own experience and the experience of countless friends and family all across Germany, as well as the experiences here of seriously ill close friends who cannot afford the care they need (some who actually have insurance but are time and again denied care or expensive medications), a recent study reveals the gravest problem:
The United States places last among 19 countries in deaths that could have been prevented by access to timely and effective healthcare, a new study finds.
If the United States had performed as well as the top three countries out of the 19 industrialized countries in the study, there would be about 101,000 fewer U.S. deaths in the per year, the researchers estimate.
The top performers: France, Japan, and Australia.
Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine compare trends in deaths that could have been prevented by access to timely and effective healthcare. Specifically, they looked at deaths amenable to healthcare before age 75 between 1997–98 and 2002–03.
They found that while other countries saw these types of deaths decline by an average of 16 percent, the United States experienced only a 4 percent decline.
"It is notable that all countries have improved substantially except the U.S.," said Nolte, lead author of the study. (www.livescience.com)
101,000 unnecessary deaths a year? That, apparently, we can afford. I for one find it untenable.
Please cancel my December appointment. And please be aware that however much I disagree with your newsletter, that is not the reason I will not be returning to your practice. If we had a system such as the one I experienced in “Europe,” I would be able to go to the dentist I choose, and that would be you.
Unfortunately, here you are apparently not one of my network providers, and that makes you a luxury I can’t afford.
Thank you for your time and for the excellent care you have given me. All the best to you.
Sincerely,
A last comment: I don't believe my dentist would knowingly lie just to ensure that she maxes out her money-making potential --although enough of the big guns in the health care debate are arguably doing so--but I do think the debate is poisoned by a mix of ignorance, fear, arrogance (we're America, so any other system must by default be inferior), and a deliberate manipulation of all three.
I do know, however, that there's a lot more choice involved in nationalized health care than we have here. Including the choice of whether to live or die.