Being sick in America:
Fleet, Robert
BEING SICK IN AMERICA ROBERT FLEET TRY THE POLISH CURE During the two-year-long, largely futile, debate on health care one heard with growing alarm the horror story that "socialized medicine"...
...From this admittedly noncasual observer's perspective, the stories to tell about socialized medicine in Poland are generally positive...
...Yet it is anecdotal terrorism that is used by American health-care providers to denigrate socialized medicine...
...Yes, this cliche did happen to us, almost laughably had not Alina's life been at stake...
...At the Warsaw Cardiological Institute this professorship is held by the world-renowned author of many medical texts, Dr...
...He scheduled surgery for the next week and was more than a little surprised that we declined the "very necessary operation...
...After all, we have "the best health-care system in the world...
...Ironically, we returned to the U.S...
...Warnings of long lines and lowered standards prevailed: If medicine were socialized, Americans would lose the "right to choose" their own physicians...
...We endured a half-year's grueling existence of scraping together funds for individual tests that-since American doctors don't consult with one another-seemed to contradict one another...
...The final indignity came at check-out...
...When push came to shove, American "health care" failed miserably and the still-socialized medical system of Poland came to the rescue-saving my wife's life along the way...
...gifts-a.k.a...
...BEING SICK IN AMERICA ROBERT FLEET TRY THE POLISH CURE During the two-year-long, largely futile, debate on health care one heard with growing alarm the horror story that "socialized medicine" would be the end result of tampering with "the best health-care system in the world"-to quote a popular TV ad featuring a handsome doctor-spokesman...
...This contrasted starkly with the American hospital, where Alina was wheeled into the financial bureau before being examined by an admitting physician...
...in fact, every cent was tied up in film and theater productions...
...Still, the cost has been about a third of what it would have been here...
...One wrote up a "detailed" examination that had lasted less than a minute and involved no physical contact at all...
...The doctors, then, were unaware of Alina's iffy liver condition-although each of the medications prescribed in the hospital contained specific warnings against use on liver-sensitive patients...
...Alina's doctors admitted that several colleagues had returned to the U.S...
...Instead, these were men and women who sat down on the edge of a bed and said to the old babcia, "Oy, pani, I'm sorry but I can only give you a heart that will make you live another fifty years, not a hundred, so you will have to come back to me again then...
...Still another put down a room visit for a day when he was very specifically absent...
...under a system where socialized medicine still prevails, it is a vocation...
...Desperate, we were in no position to disagree...
...Perhaps she would still qualify for their free socialized medicine...
...I had the opportunity to discuss this attitude with various doctors at the Warsaw hospital...
...Andrzej Biderman was Alina's surgeon-and both of them were under the supervision of a professor...
...Docent Borowiecka arbitrated conflicting opinions...
...Administrative officials were kept at a distance--the philosophy being that patients and their families supporting them must not be put in stressful situations...
...Cowed by the weakness of illness, Alina was unprepared for the haphazard way in which the "American system" works...
...We still owe several thousand dollars to the Polish hospital where Alina had her successful heart operation last summer-it was not a socialized freebie for us...
...Coming into a few thousand dollars, repayment of expenses on a past film, we decided on a desperate tactic: go to Poland for testing...
...As an example, it was suggested Alina have an "electro-version" treatment to alter her postoperation heart filibrations...
...Poland is not a cheap country: prices have been rising steadily and are comparable to those in Midwestern America...
...A compromise was reached-apparently to the benefit of the hospital, since we had no voice in the matter: Alina would remain in the hospital for observation for the maximum number of days allowed by Medi-Cal for "discretionary emergency" patients...
...Oh, and yes, they make house calls...
...Oh, and yes, they are paid by the hospital-so there is no separate billing from the doctors, radiologists, anesthesiologists, and every third hospital person who talks to you-as there is in the American system...
...Socialized medicine...
...One symptom involved excessive burping...
...There was group horror at how finance dictates treatment in the U.S...
...But these are generally on the "give what you can" scale, flowers and wine being the most popular gifts...
...Our family physician prescribed a medication to improve heart beat- apparently unaware of tests indicating a failing valve, and that a strengthened heart beat quickens that deterioration...
...All charged their services to Medi-Cal separately from the hospital bill, which was clocking in at $1,300 a day...
...No one could deny the lure of the high incomes American physicians earn...
...It was a very kind letter, concerned...
...Thanks to the conflicting opinions of self-interested and half-assed doctors, at that point we did not know if she suffered from valve damage, epiglottal ulcers, or liver cancer...
...Nothing was demanded...
...Specific costs for medical expenses changed even as Alina was treated, but it is important to note that she was able to have over $10,000 worth of pre-operation testing and examinations for less than $1,000-a savings primarily attributable to the fact that a hospital room in Poland was charged at $40 per day (raised to $75 per day while we were there...
...Our family physician, miffed, would qualify Alina for only a month's disability insurance...
...There were other fun surprises...
...The humane doctors providing the "safety net" of public welfare had neither treated her condition properly nor did they bother to tell us the extent of her heart damage...
...The doctors were not holier-than-thou, upper-middle-class, smarter-than-you-can-imagine specialists with a cellular phone constantly ringing in the latest real-estate mortgage rates...
...No problem: we were covered by insurance we had purchased for the film employees...
...to find a message from one of her American doctors...
...Poland consistently produces a fine pool of talented physicians, exported worldwide...
...bribes-were the bane of our existence, as greedy apparatchiks demanded off-the-books "gifts" for services already officially paid...
...She was terrified: at her L.A...
...Without a final examination she could not be released and I left in the late afternoon for a far-away business meeting...
...We were in limbo...
...Alina was visited frequently each day by a primary cardiologist, Dr...
...We should have...
...Kept in the hospital for six days, Alina waited on the seventh for either our family doctor or the hospital's "attending" physician to check her out and advise what the next steps would be...
...None of these were administrative positions...
...A gastroenterologist, discovering that Alina was covered by insurance for nonheart symptoms, dispensed with X-rays and physical exam completely-but decided she had an epiglottal ulcer...
...Some of those attending Alina had practiced in American hospitals as visiting physicians, ostensibly to learn more modern techniques...
...Anecdote, of course, should not a policy decision make...
...Given no choice in the matter, Alina was visited by numerous physicians whom we neither knew nor particularly wanted to see...
...As well-intentioned as the clerk handling our case was, we did not fit any of her required profiles for coverage: nowhere on the list was a category "needs life-saving treatment immediately...
...On our own we explored the American health care "system" to discover a number of specialists who insisted that Alina's condition was probably serious, but refused to consider testing or treatment unless payment was received upfront in lieu of insurance...
...But that was not the point: everything was incredibly human in this "socialized" hospital...
...For Polish citizens these costs were covered by state-sponsored insurance...
...More than one doctor refused any gift at all until surgery was over and they would be certain that Alina was on the road to recovery...
...Wanda Sadowska...
...With a per capita income considerably lower than Americans enjoy, Poles have approximately the same patient-to-doctor ratio-and actually have fewer patients-per-bed than in the U.S...
...All aspects of diagnosis were discussed thoroughly with the patient...
...It was a painful, groaning experience we witnessed...
...One could-and most patients did-supplement their daily services with gifts to the doctors and nurses...
...At the very worst, we concluded, medical prices were so low there as to allow us to afford making all of the tests we already knew were out of our reach here...
...for Alina it was a pleasant, invigorating process...
...I had forgotten that "personality" is an individual characteristic...
...telephone calls from the financial office had outnumbered doctor visits two-to-one...
...We had a simple choice: pay cash or die-no insurance carrier was going to cover a pre-existing condition that needed immediate, expensive treatment...
...No one bothered to check her medical history...
...It was to that level of medical service that Alina was recommended then: the Warsaw Cardiological Institute...
...This is a direct result of their socialized education system: ability, rather than financial resources, is the arbiter of who goes to medical school...
...however, as doctors pledged to the Hippocratic oath, Polish physicians and hospital administrators felt it their obligation to treat the patient first and then worry about payment...
...As in American Health Maintenance Organizations, the Polish system of free socialized health care begins at a local clinic...
...I feared the dreaded "impersonality" of socialized medicine...
...We assumed that the doctors coordinated their efforts...
...This approach resolved the problem of conflicting opinions we had been given in America by independent specialists, as each Polish physician discussed in daily clinic meetings his or her interpretation of test results...
...rather, they were hands-on professionals whose interests in the patients were medical only...
...On paper we were quite well off...
...No, thank you...
...Medi-Cal is the California state "safety net" for low-income individuals...
...An American cit- izen for years, Alina is Polish by birth...
...The expected "gifts," for example...
...Our family physician suggested an ingenious solution: he would check Alina into a local hospital as an "emergency" and force them to care for her under Medi-Cal provisions...
...We expected worse in the hospital, since medical services in Poland are virtually free and medical professionals are paid on a scale not higher than the national average...
...One of America's pre-eminent cardio-surgeons, credited with important refinements to the artificial heart valve, was schooled in Poland...
...or, for a small fee, one can go to a physician of individual choice anywhere in the country...
...Clinical teams of consulting physicians are assigned to each patient in a hospital...
...Yes, there are boors among the Polish medical profession...
...Having lived in Communist countries for extended periods of time, I am certainly not in a position to argue for the "freedoms" afforded by those thankfully dead regimes: it is definitely more pleasant to live in a democratic, capitalist-oriented Eastern Europe, despite the uncertainties of the current times...
...Problem: the insurance company decided the condition was pre-existing...
...In Poland the anesthesiologist is a part of the team, regardless...
...Which means that our medical insurance coverage sometimes lapses, and we must also constantly seek out affordable premiums rather than stay with a single carrier...
...This came to be appreciated ever more greatly as operation day approached...
...The Warsaw doctors shook their heads, familiar with the payment-dictated policy: They could not understand how American doctors could do this to a patient without anesthesia...
...Smoking is banned in hospital, but who is going to stop a doctor in an elevator...
...This hit home in a number of small ways...
...R.' s cigarette hanging out of his mouth every time he emerged from an elevator...
...Other clinic cardiologists came daily-and all were overseen by a docent, Dr...
...But, then, until this past year I had not experienced a serious family illness...
...Later, as it was decided that an operation was needed to replace Alina's damaged mitral valve with an artificial one, the cardiology docent coordinated arrangements with the cardiosurgery clinic's docent-Dr...
...We offered her medical records every time-one doctor went so far as to proclaim with his refusal, "I don't need to look at those, I know what I'm doing...
...Last winter the stress of an armed robbery and the Northridge Earthquake induced an arrhythmic condition in Alina's heart...
...The financial situation turned out to be somewhere between our best and worst-case scenarios: as an American, Alina was ineligible for Poland's free medical services...
...Yes, as Bill Clinton conceded in January, health-care reform in America is a dead issue...
...My wife, Alina, and I are filmmakers, entrepreneurs in the finest capitalist sense...
...perma- nently...
...Few bothered to look at her medical records...
...health care works fine if one is regularly employed by another: I'm not...
...I certainly did not like Dr...
...Besides, Alina's condition was deteriorating daily...
...Perhaps U.S...
...It reminded us that Alina's condition was serious and that, as soon as we could make financial arrangements, she should come to him for treatment immediately...
...We had made a film in Poland eight years earlier...
...Elzbieta Borowiecka: she examined each patient at least twice weekly...
...Neither one came to the hospital that day...
...The hospital administration, however, knew that Medi-Cal would not cover another day-so, while I was on the road, Alina was bundled off to a taxi by nurses, given $10 for the fare, and sent home...
...They did, however, bill the state of California $17,000 for their services-including absentee examinations...
...That, however, was also why so many elected to stay in Poland: in the United States, medicine is a profession...
...hospital the woman in the next bed had been given the treatment without anesthesia-an anesthesiologist was not covered by her Medicare insurance and she was too poor to pay his fee...
...Miroslaw Kowalski...
Vol. 122 • June 1995 • No. 12
