Medical Mysteries

One thing you can hardly avoid in life in the US is the prominent role for medicine here.




It starts when you just walk around. In Europe, hospitals are large and obvious, but other medical practices tend to cluster and be rather discreet. Here they are everywhere. Almost every apartment block seems to have rented out its ground floor as medical surgeries, and quite a few private homes have a medical office as well. There are general practices, large and small, but also an astonishing number of specialities, for things I have sometimes hardly heard of.



Then turn on the TV. Fully 20-25% of advertising is for some medical remedy. In Europe, you see the odd advert for non-prescription medicines like cold remedies, but here these are dwarfed by speciality drugs which require prescriptions.



The industry certainly have money to advertise, but don’t seem to pay a lot to creative agencies, judging by the formulaic and unimaginative adverts. The whole advert usually has people walking around, with an extensive voice over. The walking around tries to convey some sort of discomfort, but never explicitly. Perhaps that would be considered bad taste. An example is a hilarious ad where people seem to spend their lives walking past toilets (rest rooms, in American). I guess we are supposed to discern that sometimes they also walk inside too, and need to do something unpleasant. As the voice over progresses, the actors still walk around, but start to smile more, as though their symptoms are alleviated. Now they walk past the rest room with purpose and a spring in their step.



Meanwhile the voice over has three distinct parts. Part one often starts with the phrase “imagine life without” continued by a description of a symptom and a named ailment I have rarely heard of. Having established a product name (for some reason usually three syllables with the last one –a) can alleviate the symptom, the voice starts to speak more quickly and reads a disclaimer, while the poor actors continue to walk around in the background, unsure whether to act in pain or cured.



The voice over disclaimer is hilarious, and is enough to put anyone off almost any product. For example, it might say that the product can lead to side effects of depression, suicidal tendency or death, before launching on a long list of other potential problems. OK, maybe that one isn’t for me then.



Finally, the happy walk starts and the voice over reverts to the slower tone. Ask your doctor about product X, we are implored, if we really want to walk around all day avoiding rest rooms, and don’t care too much about the suicide risk.



I do not exaggerate, this comes up virtually every break for something ending in –a. After a while it just starts to wash over you.



Not quite so common, but still a major advertising category, are legal compensation chasers. We knows these ones in Britain too, thanks to the lovely banks and their lovely mis-selling. But here, they are everywhere, and usually relate to a medical product which has had bad side-effects. Seemingly, I should be looking out for people who took all these three syllable products and then died or became suicidal, because then I could replace rest rooms with banks and investment products in my own walking life after picking up my compensation bonanza.



So what is happening here, and is it all bad?



After coming to the US, eventually we got around to registering with a GP and a dentist. In Europe, that might involve a quick visit, and never seeing them again in years. Not here.



The first part of any medical visit is the legal and financial part. All surgeries have as many people handling that as the actual medicine. You fill out form after form, with two purposes. One purpose is to tell them we won’t sue. The other is to establish who will pay, usually the insurance that comes from my wife’s work.



Then you make it to the actual physician. They have wonderful equipment and take a lot of time with you. They give lots of tests and send you to other places for more tests. And then they find things to treat. Expensive things.



So I tell the GP I am a bit deaf. In Europe that would lead to a quick inspection for wax and a shrug of the shoulders. Not in the US: I am referred to an audiologist, who turns out to have a financial and legal firewall, followed by impressive assistants and equipment. He sends me for another scan at another place, just to make sure.



The result is that between the four of us we must have made over twenty medical visits in three months. Some are regular, some are following up issues, some are preventative. All lead to a bill for the insurance company, and most lead to a follow up treatment.



And the bills are massive. I have a direct benchmark, since I happen to have had blood tests in Portugal, the Netherlands and the USA during 2012. The USA cost is between ten and fifty times higher, for what I perceive to be similar tests. They probably use more modern equipment, used by more highly paid and plentiful staff, backed by finance and legal overheads and still making good margins.



So now I understand a bit more why so many businesses here are medical. I suppose I can even understand the economics of the advertising, since if I do visit my GP and suggest the three syllable product for my (real?) rest-room problem, she will undoubtedly have the time and inclination (and financial incentive?) to follow it up. In Europe, it would take me two weeks of misery to get to see the GP, who would look at me askance for wasting his time, and probably need to look up the ailment himself.



Much of this is good. I can now sleep easier, secure that I don’t have various ailments that I never thought I had anyway. It is good I am not a hypochondriac, as I would then lose sleep from having so many extra ailments to worry about. But also if I do get something, they will discover it and treat it well – which in some cases must also save the system some money.



But the expense feels horrific, and uncontrolled. The federal government pays for the elderly and the very poor. There is a layer who previously lacked any insurance (and therefore would stay away), but Obamacare will remove that. And for the rest of us we have insurance, paid for by our employers.



Individuals have no real incentive to complain, and generally will not question any recommendation for treatment. It is a brave government which cuts back on expense for the elderly, though one day they will have to. Employers complain, but are not organised enough to make an impact. And big pharma, the many medical professionals, and their friends in finance, insurance and law, will say nothing and quietly get rich.



What can be done? The European systems are far from perfect, and, it now becomes clear to me, are way behind the game in preventative measures and timely checking for common illnesses.



But here things are out of control. Apparently some brave insurance companies are starting to challenge some recommendations, based on statistics. It feels good to me that the payment system rewards them for this, but of course the medics find it an insult that someone sitting in an office with no medical qualification can question their advice. In the end, the government will need to make the same challenges for medicare (older people). It also feels right that individuals should have some incentive to question a treatment.



It will take a long time to fix. Meanwhile, some advice. First, if you have a child, they could do worse than go into medicine in the USA. Second, don’t bet on the USA sorting out its deficit anytime soon. And lastly, if you manage to visit the USA, don’t miss the wonderful TV adverts.