Pharmacy in Cuba. (Photo: localsurfer / flickr)
New York – In Beijing, a 50-cent walk-in EKG determined my killer chest pain was no more than a strained muscle complicated by bad dumplings.
In Paris, six weeks of hospital tests and enough meds to choke a moose found an ugly lung shadow was only Balkan pneumonia. The bills came to $1,500, doctors included.
And if I'd been on Chinese or French national health plans, I would have been spared even those charges.
Nearly every society on earth — socialist, fascist or anything in between — regards not dying needlessly for lack of medical care as the most basic of human rights.
Some countries do a lousy job of health care, but most at least try. Saddam's totalitarian Iraq had a pretty good system, although it was no match for communist Cuba's. Only in America do people grow rich by deciding who gets to live or die. Nowhere else are costs so outrageously high or procedures so needlessly complicated.
"Health was not supposed to be an industry," Andrew Weil remarked on CNN. He traced the shift in America to the mid-20th century, when I started bouncing around the world.
Back then, a smug Tucson physician told me Americans want Cadillac medicine; his Coupe de Ville outside made the point. He just snorted when I asked about people who take the bus.
Decades of medical advances can now save countless lives at low cost, yet this profit approach grows more grotesque by the month.
Frederic Sarfati, a surgeon friend in Paris, has a different take on that automotive metaphor. He likes to think of the bulletproof little Citroen 2 C.V.
"Modern medicine is like car repair," he said. "You diagnose the problem and often you can just replace a faulty part. Meantime, preventive maintenance is crucial."
Parts and labor are priced on rational scales. Medical school is largely free and lawsuits are rare so most French doctors earn what American specialists pay for insurance.
U.N. figures rank France first in health care (United States is 37th, just above Cuba). The French live two years longer than Americans, with half the infant mortality.
France spends less than 11 percent of GDP on health compared to more than 16 percent in the United States.
Cancer treatment is free. When Genentech developed Avastin, Business Week calculated a year's supply at $48,000 in America. It cost patients nothing in France.
Yes, yes, employers pay high social charges on salaries, and some hypochondriacs abuse the system. But it all works.
Plenty of other models would serve as President Barack Obama's passionate appeals push Congress toward finding a national health plan.
Yet, as Weil says, none is likely to work if American medicine remains defensive, driven by insurance and drug companies. We pay for intervention, not prevention. "Rivers of money are going into a few pockets of people who don't want the system to change," Weil said. "There is a huge apparatus of parasites. This is unsustainable."
That, of course, is the main point. Obama is trying desperately to balance fiercely entrenched interests with intricate compromises that add to costs.
And people with much to lose, or gain, spend millions on confusing and frightening a badly informed public.
Systems that work are essentially simple. They cover the basics, assure safety nets, but also allow doctors to operate private practices on the side.
Government oversight prevents drug companies, hospitals and others from arbitrary, often stratospheric, prices. Sensible protocols cut back on unnecessary add-ons.
But, mostly, this is about underlying philosophy.
My most recent Paris mishap sent me feet-first to an emergency room. Doctors spent hours fixing my air filters and fuel lines before anyone asked what was in my wallet.
Dr. Michael Lavollay, a former science attache at the French Embassy in Washington, puts it simply: "Health is a basic right in France. In America, it's a market."