Many welfare states, like the Scandinavian countries, and even others like Canada and the UK believe that health care for the population is a right. Everybody needs to have access to, and be assured of, reasonably good treatment. They pay high taxes to cover the cost of universal single payer coverage. The US believes that health care is expensive, taxes should be low, individuals need to pay for high quality care, and companies and doctors should have a high return to motivate them to provide the best in the world. Some assistance is provided to the aged and indigent. Many get excluded in the process.

Case 1: A sliver of wood from the floor entered the sole of my foot. I yanked it out but a few days later, realized I had left a piece behind. It was parallel to the sole, so did not pain or pinch, but could be clearly felt when the area was pressed. Work made me put away attending to it. A week later, I called my primary care physician, who I have been seeing for about 18 years. His front office informed me that this requires intervention, and his office is not covered by insurance for that. I need to go to the walk-in clinic at the hospital.

I did that a week later.  The nursing assistant listened to my story and said they do not do interventions, and she would have to send me to the Emergency Room side of the hospital. I demurred, asking if that wasn’t expensive? She said yes, and then offered to speak to the doctor in attendance at the clinic. A short while later, the doctor walked in, examined my sole with a magnifying glass, and said that if I had come right away, it may have been possible to remove it. It was now embedded and the area was inflamed. He did not recommend digging around and said that if it was a metal or a glass sliver, it would come to the surface on its own. Being wood, of cellulosic material, the body would absorb it and I need not do anything. I asked how long I should wait, and he said to visit the Emergency room after a week if it is not gone! I was charged $198 as my share of this consultation.

A week later, the sliver was still bothering me, more mentally than physically. I looked up the web and found an AFC Urgent Care unit in Arlington, near me. I went there. The front office comforted me by saying that their charges are more reasonable than the emergency room. I was then attended to by a ‘physician’s assistant’ who looked not older than about 22. She breezily announced that yes, we can deal with this. A short while later, she returned with a longish needle, and after poking about in the spot, removed it with a pair of forceps and displayed it to me. Done! What my sister would have done with a safety pin, had she been around. I received a bill for $236, being my share of the costs. So my share of the expenses to remove a wood sliver from my sole was $434, under the high deductible health insurance plan that I was on.

Case 2: A year ago, I had my cataract removed from one eye, involving one ophthalmic surgeon consultation before, lots of tests, surgery, and three follow-up visits. I was under a different health plan with higher premium and lower deductibles, and my costs were nil.

My two eye drops to treat glaucoma, in the US, costs me (my co-pay) $40. The same medicines are available as one (same manufacturer) in India, and it costs me Rs. 850, or about $12, retail, no insurance.

Case 3: While on a visit to Chennai (India) during the summer of 2019, I felt the need to visit an ENT physician to check on my vertigo and my suspicion that my hearing was dulled. (Students in the last rows were not audible.) I visited the doctor, who sent me off for a hearing test (Rs. 700). I went back to the doctor, who examined me, saw the report and said there was nothing wrong with my hearing, he did not want to medicate me for the vertigo since he thought it was random and not serious, and to return if and when I really had a problem! His consultation fees: Rs. 500. Total costs: Rs. 1200, or about $ 17.

These are random experiences of two different health systems! I am not offering any solutions for the health care of the world!

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