U.S. vs. Europe: Health Care
Posted Tue, Jun 7, 2011

As I have tried to make abundantly clear the United States is the only country in the industrialized world that does not provide universal health care for its citizens. We have preferred crisis management to preventive medicine and we use emergency rooms of hospitals as triage units and primary care offices for the poor. In my judgment the reason for the lack of consensus on the need for universal coverage is the self centered attitude of patients. They want what they want and they want it now! Anecdotally this is nowhere more evident than the selfish and immature attitude of senior citizens.
Two vignettes, please.
I asked 10 female senior citizens a hypothetical question. Your husband needs a liver or he will die. A 4 year old child needs a liver or he will die. Only one liver is available. To whom will you reward the liver? In all cases the women chose to give the liver to a husband in his waning years rather than a child with the potential for a full life ahead of him.
A male senior citizen came to my office complaining of a benign growth on his face which he requested be removed. I told him I would comply but that since removal was not medically necessary the procedure would be considered cosmetic and he would have to pay for his care out of his own pocket. He responded with some anger saying that several years ago he had a similar growth and the dermatologist down the block charged Medicare. I explained that the doctor probably falsified the diagnosis to justify the procedure and questioned if his physician would lie to the government was he comfortable that the physician would not lie to him. He was not assuaged.
So we are in a deadlock where voters want everything for themselves and do not want to pay for it. At least they do not want to pay so that someone else can get care.
Another problem: State after state has voted down itemizing basic health care; that is, listing diagnoses that would be covered for all Americans. The presumed worry is what if my diagnosis is not on the list? This is the same sentiment that prevents tort reform in medicine. What if I have a medical injury? I want to collect the big bonanza too!
The conundrum: Technologically health care in the U.S. is superior to any in the world.
The last vignette: My wife’s was back in Sweden a few years ago and had a physical check-up. I advised her to request a routine colonoscopy. The doctor denied the request advising that the Swedish health care system only provides colonoscopy for patients who are bleeding. My wife had her colonoscopy paid for by our health insurance in the United States. Three years ago my wife’s best friend moved from Sweden to France. This year her French physician insisted she receive a routine colonoscopy. Her friend was found to have colon cancer! We believe successful surgery followed.
Conclusion: The health care system in the United States is technologically superior for those who can afford the system and know how to access care. The health care system in the United States in inequitable and even if you can afford it most patients have no idea how to evaluate care. The social care system in Europe is often inferior and inadequate given the knowledge we possess today. One would think it would be possible to merge the advantages of each.
Health care in the United States is schizophrenic; we have the best quality and poor distribution. Those of us on Medicare don’t have to worry. The politicians are too scared of us to change the system.


Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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