Cheap healthcare. How do they do it?

Recently I published a post about my visit to the ER. After some thought, I decided this deserved follow up.

The experience I had and the high quality yet extremely low cost of treatment Jim and I have both had here in Belgium does seem "too good to be true". We also haven't experienced anything life-threatening or terminal so I can only speak about what I know.

Thankfully we've not had to test the system on either continent.

I'm no healthcare expert, I know very little about socialized medicine, and actually even those who are healthcare experts will tell you there's no magic bullet.

Common sense will tell you that nothing is free and caring for the sick is expensive.

It does seem physicians here do not demand or receive the high wages that physicians in the States do. Having said that, I think doctors should earn a good salary. They spend half their life in school and the other half saving ours. I can't think of many things more important or more deserving than that.

Is it fair?

Does nationwide healthcare make it more fair?

I have actually had people from Belgium ask me if it's true that some Americans cannot go to the doctor or receive the care they need when they're sick. They seem to find it astonishing and unbelievable.

But we don't.

They grew up in a system where everyone is cared for. Equally.

We didn't.

We, the lucky ones, who do have access to good healthcare - are we willing to do whatever it takes to care for those who don't?

Current debate indicates that answer may be "not really".

The whole thing is just incredibly complicated.

For one thing, take a look at a tax comparison. This alone provides part of the bigger picture.

Tom T. Texan				Bjorn K. Belgian
$50,000		Salary		€50,000
8,700	<>	Income Tax	42% >	20,800
41,300		Net		29,200
4,130	<>	Sales Tax	21% >	6,130
~$37,000				~€23,000

Tom T. earns $50,000 a year. After standard exemptions he'll pay about 17% of that in income tax.

Tom gets to keep and spend $41,300 every year. Everything he buys will be taxed at about 10% so he ends up with around $37,000 after taxes.

Now, Bjorn K. earns €50,000. With standard exemptions he'll pay about 42% of that in income tax.

Bjorn gets to keep and spend €29,200 every year. Everything he buys will be taxed at 21% so he ends up with around €23,000 after taxes.

Is that fair?

Here's another comparison we found particularly interesting.

Gasoline here is over $7.00 per gallon compared to less than $3.00 in the States.

That's a lot, but motor oil really is black gold.

Yeah, that's €22.75. This exact same motor oil in the States is about $5.00 per quart.

(For you non-metricists like myself, a quart is very close to a liter so that's pretty close to "apples to apples".)

That liter of oil we purchased is the equivalent of about $31.00 in the States. So your trip down to Jiffy Lube would run you about $150. Tire rotation and new filter not included.

Belgians do have one of the highest tax burdens in the world. Only Denmark and Sweden pay more.

All Belgians pay some income tax. Even the lowest wage earners pay 25%.

Nearly half of Americans pay no income tax.

Wablief?

All Belgians pay some income tax. Even the lowest wage earners pay 25%.

Nearly half of Americans pay no income tax.

I know it's not all about money. When the world's health systems are ranked, Belgium isn't the best, but it does fare better than the States. Remember fair and equal access to care is most certainly a factor in ranking.

It's also not all about money or healthcare. What about quality of life?

Belgium and the U.S. are in the top ten countries worldwide and usually run neck-and-neck in quality of life accounting for things like cost of living, freedom, health, safety, culture. Our neighbors (literally) France, Switzerland, Germany, and Luxembourg rank even higher.

But back to healthcare. I've always wondered where you draw the line. Of course I want every effort made to save the life of my loved ones. Every innovative treatment known to man to be pulled out when me or my family needs it. Who doesn't?

When Randi was a toddler, Jim was a self-employed cabinetmaker, and I worked as a part-time secretary. The only insurance we could afford at the time (and it was hardly affordable) was for hospitalization in the event of an emergency. It had an extremely high deductible and truly was for emergencies only. Randi got sick and her pediatrician wanted to put her in the hospital. Along with being worried about her, unfortunately we were also worried about how we'd come up with that extremely high deductible. She stayed overnight in the hospital. Got better, thank goodness. And we found a way to pay for it.

I've never forgotten how it feels to know that every penny you spend at the doctor's office comes out of your own pocket. We've been fortunate for many years to have excellent healthcare coverage through Jim's job, but we have never, not once, spent the company's money or the insurance company's money as if it weren't coming from our own pocket.

There's really only one way to learn that lesson.

The U.S. spends about 17% of GDP on healthcare. More than any other industrialized nation. Switzerland, France, Germany, Belgium, and Canada spend about 10%.

It's the most expensive benefit paid by U.S. employers. The word "outsourcing" comes to mind.

I once worked closely with a geriatric physician who studied in Romania, then studied and practiced in Canada, and then came to the U.S. to study and practice. She had a world of experience and an interesting perspective on healthcare.

Is it prudent to give a 90-year-old alcoholic a liver transplant? At what cost?

How far do you go to save the life of a 12 oz. "crack" baby?

Is there a double standard when it comes to abortion?

Is their life worth any less than your loved one? What is the cut-off age for transplants? What is the cut-off for saving the baby? Do we consider their quality of life after we spend a fortune saving them? Did saving them jeopardize the funds that could have saved someone else? Does that "someone else" have more value?

I can't make that call.

Can you?

Shouldn't somebody?

To be clear, one cannot lump Europe together as one can Canada and the U. S.

Every country in Europe has its own healthcare system governed within its own country. Results in treatments, availability of drugs, survival rates cannot be compared using "Europe" as one entity.

For example, U. S. women have over a 60% survival rate of more than 5 years after a cancer diagnosis. Well, in Sweden, Belgium, and Switzerland it is also over 60%.

There are 27 countries in the EU. They are not all the same.

Believe me, from what I hear, Belgium, France, . . . have as many issues as the U. S. when it comes to government and politics, but that's a whole other story for another day.

It seems to me that the one benefit of healthcare for everyone is that it's healthcare for everyone. The attempt to be fair to your fellow man.

Should we, the privileged do without?

Is healthcare a right or a privilege?

Maybe therein lies the problem. How much do we really care about that guy down the street whom we don't even know, doesn't go to our church, hasn't had a steady job in a decade, smokes a pack a day, whose kid just had a "crack" baby?

I can't make that call.

Can you?

Should somebody?

Perhaps if we, the lucky ones, with access to the best medicine has to offer, did have to make that call, considering everyone equally - the 90-year-old alcoholic, the 12 oz. "crack" baby, the deadbeat smoker down the street, and your very own precious loved one - healthcare for everyone would take on a whole new meaning.

I'm pretty sure it would.

And I'm glad I'm not the one who has to make that call.