Can we all agree, there's something wrong when a person who's reluctant to drink a frozen margarita in Mexico City can rationalize getting a root canal in Tijuana? Or, that it's weird for a 24-year-old to consider the idea of scheduling her IUD implant surgery during a summer trip to England?
It's called medical tourism, traveling abroad to receive free or reduced healthcare. Sound crazy? It shouldn't, at least not to Lowcountry residents. One in six South Carolinians do not have health insurance, according to U.S. Census Bureau data. Yet, roughly, 90 percent of the state's residents have internet access at home. Add those stats together and the answer is simple. Forget Medicaid, Charlestonians — Expedia yourself to better health. All you need is a passport, a plane ticket, and some gauze. We hear Bahrain is great for bypass surgery this time of year.
Of course, that would be funny if it wasn't true.
The United States healthcare system is in limbo. The Democrats' reform bill is on life support. And for South Carolinians who are sick, it's all about the Benjamins, baby. According to Cover the Uninsured South Carolina, 74 percent of our state's uninsured list affordability as the reason they have not purchased health insurance.
That's hardly a revelation. Michael Moore's controversial film Sicko said the same thing three years ago. What is different is that as Obama's reform effort flatlines, the healthcare grass has never looked greener in other countries than it does right now.
Tray tables up, it's time to fly with a few local guides on a medical tour to see what the world has to offer.
Bed Rest in Bratislava
"I got sick all the time," says Charleston native Sara Power of her two years living in Slovakia. Blame it on the rolling hills or the gypsy kids — whatever the case, the highly susceptible Power discovered that as long as she had a translator, getting treated was easy.
"Once you get a visa, you're automatically entered into the system," says the CofC grad. "I didn't have to pay for anything, just a very small amount for prescriptions."
Pharmacy visits usually cost Power $3-$4, but there was a catch. "I couldn't get simple things, like Advil or Tums, over the counter," she says. Everything required a prescription, even for a minor cold, and the inevitable week's bed rest, doctor's orders.
"I loved that!" says Power, "They're really conscious of spreadable diseases. If you were sick, no one wanted you at work."
Send you home for bed rest? What? Here in America, we sit in cubicle pods next to Typhoid Tinas all day long as they sneeze bubonic plague-laced snot rockets onto our keyboards, and you don't hear us complaining. You're weak Slovaks, weak!
Slovakia pays for its socialized medicine with a 19 percent flat tax, which may sound high to some, but Power says she wouldn't be opposed to tax hikes to enjoy the same level of security. In fact, she says, "I would say it outrages me that a former communist and Second World country can provide healthcare for everyone and that America, the greatest country on earth, can't fix our situation."
Now living in Asheville, Power pays her own insurance. "I am eligible for it through work in a bit," she says. "Right now, I pay $100 a month."
Her policy covers the basics and, for the time being, that'll do. That said, she can't help but lament the loss of the Slovakian system. "The difference is, in Slovakia the state cares for you."
And it's that safety net she misses the most.
My Big Fat Greek Fungus
Vikki Matsis, who City Paper readers know from the recent Not So Hostel article, was enjoying a day on the beach in her family's native Greece when her brother noticed a swollen bump on her shoulder. "I thought it was just a huge mosquito bite," she says. It turns out the bite was actually ringworm, which quickly spread to her knee.
"In Greece there's a pharmacy on every corner," says Matsis. "I just walked in, didn't have to show insurance or anything, explained in Greek my problem, and they gave me a high-powered anti-fungal cream." After shelling out three Euros and undergoing four daily applications, the ringworm was gone. In the U.S., a much weaker over-the-counter cream would have cost Matsis around $14, while anything stronger would have required a prescription.
Greece was recently rated by the World Health Organization as having one of the best healthcare systems in the world, not to mention the cheapest in the European Union.
But the Greek healthcare system is not without its faults. "My uncle and cousin both have heart problems and have had to fly from the town of Kos to Athens for surgery on their own dollar," she says, which one could argue, is domestic medical tourism in and of itself.
For now, Matsis feels fortunate to have insurance through her work, but she believes that "healthcare is a right, not a privilege." She would love to see some kind of universal coverage in the U.S. Until then, there's always cheap ringworm meds to be had abroad.
Medical tourism had been on the rise in India until the 2008 Mumbai attacks, according to the International Medical Travel Journal. Now the industry looks poised to take another hit as a recent U.S. advisory has asked citizens to review their travel plans to the nation. Sorry, Chennai-bound gastric bypass-surgery patients, that rules out a final pre-op gorge on authentic Tikka Masala. Guess a bucket of local KFC will have to do.
But don't cry over your chicken legs just yet. According to Tanveer Singh, a senior engineer at Bosch, the state-operated healthcare in his native country isn't so hot anyway. In fact, medical treatment is only "good if it's private," Singh says, adding that it's "not so great if it's government run."
Singh has spent the past 14 years living in the States, seven of those in Charleston. He says, "I know of Indian doctors who shuttle between the U.S., England, and India doing procedures, so the talent is there. It's just the question of finding the right hospital or medical institute." Typically this means going private, as the government hospitals are extremely overloaded.
In India, healthcare is the responsibility of each individual territory within the nation, similar to state-run Medicaid. This creates wide disparities from region to region. Having seen firsthand India's problems providing quality universal healthcare, Singh is split on his feelings about creating a similar system in the U.S.
"It seems like some people would take advantage of it," he says. "On the other hand, healthcare is so damn expensive, it should help a good part of the population."
Singh makes an excellent point: medical fees are high, but, some would say, they have to be. Often with government-operated programs like Medicaid or Medicare, doctors are treating patients at a loss.
Take Dr. Scott Evans, of Lowcountry Medical Associates in Mt. Pleasant. Evans, who's been in practice since 2002, says, "Over the past 10 years, the cost of practicing medicine has increased at a rate much greater than the reimbursement from insurance carriers, especially from programs like Medicaid and Medicare."
The result: Evans finds himself cramming patients in to cover his costs. "I have to see 18 patients a day just to break even for my overhead, and that does not include my malpractice insurance," he says. "Medicare doesn't pay as well, so I would have to see even more patients each day to break even if my schedule is heavily weighted with Medicare patients."
This is especially troublesome for Evans, since he's a geriatric specialist. A lot of his patients are older and have more health concerns, which require more attention and, of course, more time.
"I went into family practice and geriatrics because I wanted the opportunity to spend time with my patients and get to know them," Evans says. Instead, to compensate for a decrease in payment, practices often must adjust from scheduling patients every 15 minutes to every five. "In my opinion, this limits the patient-doctor relationship and increases the chance for poor overall medical management of the individual. Medicine should be practiced as an art, not rushed like fast food."
Speaking of food, the irony is if someone on food stamps, another socialized service, went to Harris Teeter and couldn't cover all their groceries, the Teet wouldn't hand them a free box of cornflakes. However, with Medicaid and Medicare, some doctors argue they're being asked to give away treatment for free.
So who has the answer?
United Kingdom or Magic Kingdom
British expat Robert Grant doesn't claim that the U.K. has a perfect healthcare system, but he says his home country isn't that bad. "They're doing the best they can with the resources they have," says Grant.
Growing up in Cornwall, the Plasq Software owner experienced the usual stitches and scrapes, but says, "As far as my family was concerned, there was never a worry about going to the doctor, never a worry about cost. Just worry about the injuries themselves."
The National Health Service, or NHS as it's commonly known, works as a kind of giant triage system. "People with urgent needs are seen immediately. People who can wait and be scheduled for a later time are put into that system," says Grant, which he feels is fair.
Dr. Evans disagrees. "I had a good friend of mine who lived on the west coast of England who was in his 80s and suffered from terrible chronic neuropathic pain," he says. "After months of waiting, he was at last able to see a neurosurgeon who confirmed that he needed surgery to correct his problem. They put him down on the books for surgery 11 months out. Granted the surgery and all his care was free, but had he been in this country I could have picked up the phone and had him in a surgical suite in a week."
Instead, Evans says, the gentleman was put on bed rest until his operation. "By the time that his surgical date rolled around he was too weak to have the procedure. He died a month later."
Long waits are a challenge, but there are pluses to the U.K. system. The biggest benefit of NHS, Grant says, is that there's no such thing as a preexisting condition. "I can't believe that does not have a huge resonance with Americans," he says.
According to HealthReform.gov, in the U.S., 12.6 million non-elderly adults — 36 percent of whom tried to purchase health insurance from an insurance company — were discriminated against because of a preexisting condition in the previous three years.
"There is no easy way to communicate the weight that is lifted off an individual's shoulders when they realize that there will not be a bill for medical services," Grant adds.
Self employed in Charleston, Grant receives medical care through his wife's insurance, but worries about what he'd do if he contracted something serious. He says, "It's actually quite depressing and unbelievable and makes me wonder for the future of this country when such an obvious benefit to the citizenry is unable to be implemented."
Grant is frustrated with the bureaucracy facing Obama's healthcare reform bill. "I've given up hope of any major change happening during this administration. The entrenched interests and general fear of change in a large percentage of the population have effectively hampered the effort," he says.
Dr. Evans is frustrated too, but for different reasons. "The idea that the government will be able to fix the American medical dilemma with one gargantuan bill is insane," he says. "If the government wants to show the American people that they know how to best run our medical system, then why not start by repairing the system that they already control?"
Perhaps nowhere else is the lure of socialized healthcare so palpable and yet so out of reach than on that frozen tundra to our North. Damn you Canada, you get to host the Olympics and deliver babies for free? Pour me a Labatt Blue, I'm immigrating!
All kidding aside, for some former Charlestonians, like Natalie Lapish, it's no laughing matter. Canada is saving her life.
"We moved to Vancouver in 2006 when Chris got a job at the University of British Columbia," recalls Lapish. Her husband, a post-doctoral research fellow, works at UBC's Department of Psychiatry. Upon arrival, the couple discovered that not only were they now enrolled in Canada's publicly-funded national healthcare service, but also given bonus health insurance paid through Chris' work.
"Extended benefits cover dental and optometry," says Lapish of the perks. In Canada everyone can get a tooth pulled or a pair of specs for free until they're 18, then they have to pay for extras. Lapish says bonus insurance is standard for the country. "Anybody with a real job has extended benefits," she says. "It comes out of your paycheck."
The family was especially appreciative of the cushy benefit when Lapish was pregnant. Rather than being admitted into a three person room, she had her own birthing suite.
Life was good in Vancouver for the family until this past November. After giving birth to her second child, Lapish noticed a few odd symptoms that she thought were post-pregnancy related. They weren't.
"I was diagnosed with Hodgkin's lymphoma," she says, the same disease she'd been treated for and purportedly cured of at age 15.
When her mother heard the news, she asked, "How much is your treatment?" Remembers Lapish, "I said, I don't know, I've never seen a bill. You get treated for cancer, and you leave."
Lapish says her care in Canada has been excellent. Sure, it's a bit weird when you have to wait a few days for a hospital bed, but she says, "I'm comfortable with that because I don't have to pay." At the time of this interview, she was preparing to enter the hospital for a month-long stay for chemotherapy. When we spoke to her, it was day three of waiting, and she'd just received a call from the hospital telling her a bed still wasn't available. "That's okay, because I'm not an emergency," she says.
Yet, continuing her chemo and care is urgent and factors into the family's future. "We'd always planned to live here only a couple years, and we were going to move back to the states this summer," she says. Due to concern about her preexisting condition, those plans are on hiatus. The couple realizes whatever job Chris takes back in the U.S., it will have to provide first-rate insurance.
"Chris was interviewing for one job and asked a woman working there about the insurance coverage. The woman said, 'I'm the wrong person to ask,'" says Lapish, sounding discouraged.
"There needs to be a complete overhaul," she says. "American people are too scared. They hear socialized anything and put up these big red flags."
Dr. Bob Freeman, who founded Charleston's Harvest Free Medical Clinic, advocates for change at a grassroots level. Freeman's clinic, on the old Navy base, is focused on helping the roughly 60 percent of Lowcountry poor who don't qualify for Medicaid or Medicare. "We've shown how inexpensive healthcare can be when you have basic protocols in play," says Freeman.
Harvest manages to cut costs by prescribing 99 percent generic brand drugs to its patients, and Freeman would like to see local physicians do the same.
"Take a drug like Lipitor. It costs $125 a month, but you can prescribe a generic brand that's only $1.50," says Freeman. "Nothing's been proven to say the generic brand doesn't work just as well as Lipitor."
Freeman suggests a reform wherein a state-governed yearly bonus would be given to doctors who prescribed the most generic drugs. Though innovative, some would argue his plan risks giving doctors an incentive to prescribe to patients' pocketbooks rather than their real health problems, not that some doctors don't do this already.
"The truth is, people flock to our country without any insurance coverage and pay cash out of pocket for care because they know that in America we have the premier medical system in the world," says Dr. Evans.
And therein lies the rub — whatever reform changes, no one wants to forego excellent care. That said, a socialized option doesn't have to offer the Cadillac of health insurance, but it needs to be quality, because when it comes down to it, this is your uterus, pancreas, or gums we're talking about!
Bottom line: Slovakia may have your back, and Canada may never show you a bill, but that doesn't mean their systems are perfect. From Bangkok to Botswana, every healthcare system has its problems. It's choosing the right plan for the U.S. that matters. And that's exactly what's going to be decided at the Feb. 25 healthcare summit.
Psych! It could be years before our constipated Congress receives the atomic colonic it'll take to get something done! Until then, Rio's got a blue light special on gluteal implants. Keep your passport handy.