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I am going to continue the talk about different health care systems I have seen in my travels. I will start with Germany because I was able to observe many features of the system over many years. For those who want a thumbnail sketch, look at:
http://www.howtogermany.com/pages/insurance.html
However, I would like to approach the issues from a completely different angle. In 1983 (or thereabouts), a German medical student visited Santa Fe in order to organize her research on Native American medicine. Astonished, I asked a lot of questions. She said it was very normal for medical students to sign up to study acupuncture or homeopathy or Ayurveda during their summer holidays. She said that these forms of alternative medicine were mainly studied by medical doctors rather than "alternative" practitioners who were not MDs. There were two hospitals specializing in really unusual medicine, the Anthroposophical one that offers training in the modalities first propounded by Rudolf Steiner (of Waldorf School fame) and another that features the methods of St. Hildegard of Bingen. The demand to intern in these places is so great that students put their names on waiting lists the moment they are accepted into medical school.
I have this "information" from a variety of reliable sources but someone like Michael Moore could check the particulars. If you are skeptical, call it heresay and wait to corroborate the details.
This doctor, the one studying Native American medicine, brought a patient with her, someone who had an autoimmune disease that resembled gangrene. She had been hospitalized numerous times, and the story is very complicated and probably too long for an email. Suffice it to say, during their travels, the condition erupted. They were in Big Bear, California, at the time and the patient had to be air lifted to Long Beach for emergency treatment that, unfortunately, included amputation of her leg. She ended up with hundreds of thousands of dollars of medical bills, at a time when even the cost of bandaids was covered by insurance in Germany. This has changed since 1983, but at that time, it was very difficult for her as a student to realize that in this country, we buy our own bandaids.
I was tangentially involved in this very dramatic story, but it sensitized me to many differences between our countries. In terms of the formal medical training, the doctor told me the curriculum in Germany is the same as here. She actually went on to take the exams here and the last I saw her, she was in private practice in this country.
In 2003, I gave a seminar in Bavaria and met an Anthroposophical doctor and a year or so later, I met a Hildegard doctor. Both considered themselves to be more or less "normal" medical doctors except for their special training and it was perfectly legal for them to use their expertise in the context of a licensed medical practice. Moreover, no one was afraid of backlash from regulatory agencies or lawsuits initiated by patients.
For me, these aspects of the system were infinitely more flexible and comfortable than what I have seen here. I found most doctors to be quite relaxed (in comparison to doctors in this country) and their material needs were also well met.
In addition to medical doctors, there are naturopaths in Germany and they are also well regarded and permitted to offer a wide variety of services.
On the patient side, there are essentially two types of insurance, and I found that the basic insurance covered nearly all conventional treatments but those who had private insurance were covered for practically anything and everything a doctor might recommend, including herbs and the uniquely German "kur" at special clinics offering almost exclusively natural treatments.
The language itself covered the spectrum well. There is a term that translates "school medicine" and practically everyone knows that these treatments are less congenial and that they sometimes have terrible side effects. However, there are also the natural treatments that are offered at places with names like Kurhaus, or cure house, and the traditions are very entrenched in the culture. If you remember scenes from Amadeus, you will recall Mozart's wife going for the cure with the healing waters and marvelous music. The tradition is alive and well today, covered by private insurance, and modernized to include a lot of treatments such as ozone and oxygen infusions, Iscador injections, natural supplements, and perhaps even Ayurvedic massage or pancha karma.
In the situation in which I found myself, a presenting cancer patient might have already had surgery and a lot of chemotherapy, but often as not, the patient signed up for a "cure" that was to start the day the chemo ended. So, whether talking about the private practice of a holistic doctor in Bavaria or one of the many German clinics or another clinic in Switzerland (which is not part of the European Union), I found German patients were covered for a surprisingly wide range of treatments, often including hospitalization in foreign countries.
How is this possible? It's possible largely because the people have more or less agreed to a view that as citizens of a progressive country, no one should be in want. Frankly, it's very hard to disagree with this view because it is so equitable.
As a practitioner, I found German patients to be less stressed than American patients. Obviously, everyone with serious illnesses has to face serious issues: life and death, priorities, trust in the recommended treatments, attachments to belief systems, people, and work. Basically, this is the same, but without financial worries, I found patients were generally calmer and less distracted by issues such as the hardship of the medical bills on themselves and their families. I have to say that I have seen patients in this country who chose to die rather than saddle their families with debt, and this, of course, is outrageous in the 21st century.
I very much enjoyed working in Germany. I don't speak German, but I understand it fairly well. I found that it was easy to work in a system and a culture that was permissive rather than paranoid, and I would, if the truth be known, be happy to return to Germany.
That's one side of the story, but the other side is whether patients were actually getting better treatment, and I cannot honestly say this was the case. A resourceful patient in this country may go around the world several times in search of a cure. I believe these journeys are always important. In times past, I used to meet patients who had been to clinics in Mexico and then to faith healers in the Philippines and perhaps later to surgeons in Thailand. There is a huge business of medical tourism in countries that offer treatment similar to what one would expect in the best hospitals here but for a tenth of the cost.
Nowadays, I meet patients who have gone to Brazil to see John of God and more and more people are looking into stem cell research in China. So, my professional opinion is that tighter restrictions force people to search when their prognoses are poor. I do not believe that there is nearly as much medical fraud as often claimed, nor is there false hope. From my perspective, there is as much false despair as there is false hope. For every person who was disappointed in the Philippines, there is another who was benefited in some way, and the same is true for countless clinics all around the world.
People often ask me for guidance about how to manage their illnesses. I never make a decision for anyone; but I explain options. For instance, not long ago, a man called about his son. He's Australian and health care in Australia costs patients nothing, absolutely nothing. However, his son was getting worse. He surfed the net, called me about some options in Mexico. I suggested that since the stay might be long that he'd be more comfortable in Germany. He is extremely happy with the decision and his son in improving. However, for every story like this, there is one about a German going to Brazil or Canada because he or she could not find what was needed.
A part of me is in total agony over these crises and I really believe I take on some of the desperation of the patients, but another part really loves the idea of a world without borders where one can go to Tibet or Peru and find the mystery and magic that was lacking in the hospital at home. Therefore, I am in favor of 100% freedom. Sure, there are risks that people will misrepresent their abilities, but this occurs in every profession so until we are all perfect, it is a buyer beware world.
However, America is going to make some very big decisions about health care and so I am hoping each of you will do everything in your power to make sure we keep all options on the table and that we do not allow the scope of what becomes "standard" to be reduced. It would be much better, in my opinion, to be 100% unregulated than to be overregulated by a dysfunctional system. Think about it. What's the worst that could happen if someone purported to have cures that turned out not to be cures? A few people would be burned but the word would spread and the situation would self-correct in no time.
We are getting used to voting online, scoring our eBay experiences, rating our books on amazon.com, it is not impossible to imagine patients commenting on their prescription as well as over the counter medicines as well as their medical experiences. In an open system, there is scope for true scientific and spiritual inquiry, not to mention tolerance.
At the moment, we live in curious times. Personally, I find it irritating that one the major differences between our two political parties is their positions on abortion. I do understand that a government has to decide what is legal and what is not, but I have watched this debate for 30 years now. I watched Hawaii legalize abortion, I watched Rowe vs. Wade, and I listen to Guiliani and Romney and Obama and Clinton harping away on what is ultimately always a highly personal choice. Regardless of faith or politics, the final decision is made by a troubled woman and the surgery is performed by a doctor or someone in a back alley. It was always that way and would not change if the laws changed. So, this is one of those cases where I think separation of church and state is such that the decisions need to be left to priests and pastors and their patients and the patients' psychologists. If we got this out of the national debate, we might hear what the candidates would do about the problem of health care for those who do not even have a choice about treatment or dying. This is a bigger dilemma. The other issues can be resolved on the local level and do not require federal intervention.
In the meantime, if you have comments you want posted, you can add to these discussions.
Copyright by Ingrid Naiman 2007
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