My unique health care experience in the USA and Russia...
I was an active participant in the US medical 'system' for many years, putting in large claims for my child, and then myself after I was diagnosed in 1993 with cardiomyopathy. Seeing how chaotic and unfair health care delivery was in America, I gravitated towards selling an increasing amount of individual and group health insurance since 1983. Unlike some of my insurance peers, I worried about precondition clauses and lifetime limits which could burn my clients. Life insurance made the money, but my interest was with health coverage.
In Russia since 2000 I have been a patient in the Russian health care system in St Petersburg, with numerous hospitalizations, two surgeries, and the need to purchase cardiac drugs. So I have seen the full capitalistic answer for health coverage in America, and as an expatriate experienced what's left from the socialist system as it slowly slides towards a pay system in Russia. As Joni Mitchell says I've seen it from Both Sides Now.
Expatriate Fallback System
Many expats have a fallback healthcare system. They live as the locals, but if they have a medical problem they go to one of the private clinics that cater to foreigners, with the attention and Western courtesy that they expect, along with the ability to describe their symptoms in English. If an expatriate has a serious condition, he or she gets on a plane and returns to his home country for treatment.
How to become uninsured...
I was such an expatriate with a fallback system until I had been our of New Jersey for over a year. My eligibility to continue individual NJ Blue Cross coverage ended 12 months after our departure in June 2000. Having preconditions meant that I only could continue NJ Blue Cross, while eligible, and not shop for other coverage.
That first year I flew back to the States to have two tricky surgeries to fix my digestive system. The only way to continue adequate coverage was to again live in the United States before the 12 months were up. The Catch 22 was that we were unsure whether my wife would be allowed to live in the United States again.
Russian health insurance...
Since 2000 pay as you go health care expenses in Russia are much less than in the USA. But, it adds up. Now I am fortunate to have a passport with all rights of a Russian except I can not vote.
Much of my medical care is paid by a health policy which is attached to this passport... but not surgeries, and more and more procedures that were paid 100% are now platna, pay procedures. Today Larissa helped me make an every six month appointment to check and adjust my pacemaker. Starting the next visit in December they require an official 1000 ruble payment.
The USA and Russia have different assumption about healthcare. In the USA you've got to pay to play, while in Russia they will never turn you away.
US traumatic treatment...
My last trip to the US was probably my final trip there as, between the fun and beautiful scenery, there were some incidents that underlined unspoken attitudes that I don't want to be a part of anymore.
We had diner with friends in San Francisco after a long drive along the Big Sur. The next day we took the train from San Francisco bound for Glacier Park, Montana. I had received some negative email and legal information the day before which added to the stress of ordinary travel.
I woke in our compartment shortly before Glacier Park with a racing heart. We got off and found the Dancing Bears Motel. Here I rested except for two trips to the Browning Indian Reservation clinic. The Hagans, people we had just met, took me to the Browning Clinic and back just to be helpful to a stranger. I had no insurance and didn't qualify as a native American, so the best they could do was give me some palliative treatment and send me back to the motel.
The closest cardiologist was in Great Falls, to the south. We travelled there and twice I received treatment, enough to get me on the road before I incurred too many bills that they feared wouldn't be paid.
Larissa and I discussed whether to fly back to Russia then, or continue to my Duke University reunion in Durham NC. I figured as a Duke graduate, there for the reunion, they would give me better attention.
I was wrong. The reunion secretary coldly told me to go the the Duke Hospital and see what they could do for me. The big stumbling block for me was that I had the outcaste designation... Uninsured. After waiting for around three hours, the secretary still said there was no one to see me.
Larissa raised her voice and said she couldn't believe no one would look at me when I was so sick, as this would never happen in Russia. The ruckus she made got the attention of the head doctor in the back of the cardiology clinic and he came out to usher us into his office. He arranged for a teaching cardiologist to see me the next day.
The cardiologist saw me, with maybe five students in tow. He made a few changes to my medications and wished me well.
Please note... No one in Browning, Great Falls, or Durham ever suggested hospitalization. As they say in the States, if you want to understand something follow the money trail. They knew I needed rest, that I was in danger of having a thrombosis or stroke, and needed to be watched. But... economically they couldn't justify admitting another patient without health insurance!
Not just uninsured, but an expatriate!
In October 2004 on my 62nd birthday I began receiving retirement Social Security from the US. In October 2007 when I turned 65 I enrolled in Medicare, along with Part B for Medical Care Outside the Hospital. Part B costs $96.40 a month, deducted from my retirement pension.
Medicare and Part B are not payable outside the US (with very few exceptions). Why, then, have I paid in the last two years $ 2,313.60 for benefits I don't receive? Because, I never want to be caught in the USA again as an Uninsured.
Now, ironically, my health is weaker than before, which means I am less likely to make the difficult trip to my homeland. Being basically optimistic, it's unlikely I will ever accept the idea that I will never return for a visit, or even stay (if I win the Publishers Clearing House!).
Another irony, I voted for Barak Obama to get the US out of foreign adventures and so all Americans could have health coverage. Now it looks like extended health coverage for American expatriates won't happen, even for those of the 5.26 million non-military living abroad that are old enough to receive Medicare coverage.
In some ways it's better here...
In Russia, except for a very rare exception, medical care is never denied or rationed the way it is in America. True, you may have to wait a long time for treatment, and to get the top level surgeons you need to pay, or there are gifts expected, but initial treatment and hospitalization isn't routinely refused as it is in the United States. This isn't just a hold over from Soviet time, but reflects an attitude of the Russian people.
Much like propiska which guarantees everyone a place to live, the Russian assumption that naturally no one is turned away for treatment reflects what to them is a normal view of good human behavior. I have seen the kindness, intelligence, and often enthusiasm of the doctors in the Russian system, and I prefer it to the American one I experienced before.
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