Tuesday, July 28, 2009

How to talk to Finnish people about American health care

"You've been brainwashed. Your American husband has brainwashed you." So said a casual acquaintance in Helsinki after I had tried to assert that I, in fact, do have some semblance of health care in the United States. Finnish people like to believe that nobody in the United States has any access to doctors. They think that Americans are all fat, sick and dying, except the ones who are on crack, skinny and dying. This may be Darwinistic wishful thinking. Finns don't have a very big talent pool, so keeping as many people as possible healthily competing in the global marketplace is an attractive proposition, especially if the Americans are failing on that front. Finland has free healthcare and education, and Finns must put some hope in Americans messing up their people as well as their economy. I mean, how else are small countries going to compete? Luckily, Americans put their wet clothes in electrical driers bought with credit cards even though the very air itself dries laundry for free, and drive cars the size of tanks just so they can say they do it, even if it bankrupts them, while eating and medicating themselves into oblivion. So there is hope for Nokia. This I am told by all the Finns who know America better than I do, because they see these things on television all the time where things are made very clear and dramatic. When you live in the US, like me, it tends to be more confusing, and brainwashing is a definite risk, so it's a good thing they set me straight on this stuff.

Finns learn about American health care from incredibly popular American television dramas. They see crowded ER waiting rooms where dying children and raging crackheads commingle as they wait hours and hours for treatment, and that's what they think everyone here has - not just a fifth of Americans. When I tell them about the employer-funded insurance system, they shake their heads in disbelief. A bureaucrat in an insurance office decides what care you are eligible for? That's crazy! Do the bureaucrats even have medical training? Shouldn't this be a decision between a doctor and a patient, like in civilized countries? Finns' bureaucratic nightmare vision of American health care is exactly the same vision right wing Americans have of "socialist" health care. It's a perfect mirror image: left is right, right is left, but otherwise everything is the same. When I show people my elaborate, expensive dental work, paid for mostly by my employer's insurance, Finns point out that my poorer neighbors in this famous West Oakland I am supposed to live in probably don't have access to the same level of dental treatment. How can I smile with my new, white teeth in the 16th best country in the world in good conscience? I don't know what to tell them.

So I do my best to entertain Finnish people with the kind of health care stories they want to hear. I tell them about hospitals with wall to wall hallway carpeting, and they shudder in horror. (Finns regard wall to wall carpeting sort of the same way as amphetamine diet pills: fashionable in the sixties, but fundamentally toxic and dysfunctional.) I tell them about moldy waiting rooms. (Really. I've sat in a waiting room with wall to wall carpeting AND mold on the window panes.) I tell them about doctors who are not so much interested in getting you healthy and out of there, as they are in trying as many expensive diagnostic methods as possible to "eliminate possibilities." Of course they don't want to find out what's wrong with you, because then you would get cured and stop needing their care. This is how I ended up with X-rays, an MRI, medication, and an elaborate treatment plan for my knee before a physical therapist figured out the problem was in my hip and fixed it. The doctor had me convinced that my mild but consistent pain could be caused by any number of serious, life-threatening illnesses that could only be diagnosed using an MRI machine, which happily his clinic happened to have, for a special price only for your insurer my friend. I was worried, so I agreed to the tests. This was a doctor. He's supposed to know what he's talking about. But he never even took a look at my body alignment, which was off so obviously even I could see it when the P.T. pointed it out. Did I mention this physical therapist was not covered by my insurance? Finns love that story. They laugh and laugh and laugh.

I also tell them the story about our (insurance-provided) family doctor who refused to prescribe progestin for postponing my period. Why on earth would I want to do that, he wondered? Because menstruation was incompatible with my weekend plans. What were those plans, exactly? I didn't feel the need to specify - what business is it of his? - so he became increasingly suspicious. He wanted to know if my husband and I "even have sex." Here we have a medical professional who is unable to discuss a woman's reproductive system without thinking about, and demanding information about, her sex life. The doctor seemed entirely confused about birth control pills and low dose progestin pills, and about a woman's right to choose when she goes surfing. He assured me this procedure is entirely unheard-of in all of American medicine, and refused to prescribe the medication. He also refused to give me a referral to a female ob-gyn in the insurer's network, when I said I was not comfortable getting examined by a male doctor. I don't know to this day why the doctor behaved in this fashion. Maybe he felt I was being preposterous for suggesting what treatment I wanted, instead of letting him perform multiple diagnostic analyses with expensive machines and labs. Maybe I needed an MRI to determine that I in fact do have a uterus, or lab tests to make sure I don't have some chemical imbalance that causes frivolous surfing on the weekends.

Undeterred, and by now, quite mad, I booked an appointment at Planned Parenthood. It was the only reproductive health care that was available to me on the kind of schedule I was working with - and besides I'm used to same-day or next-day appointments back home so it never occurred to me that I needed to plan my menstrual cycle months in advance. Planned Parenthood, I tell my Finnish audiences, is a type of organization that provides free or nearly-free health care for people who can't otherwise afford it, so naturally those who can afford health care stand outside the clinic calling themselves "pro-life" and protesting. I exaggerate wildly and describe ducking rotten tomatoes, gunfire and hand grenades to get to my appointment with the female doctor. (In fact, at the Northern California Planned Parenthood I visited, there were no protesters. But Finnish people have seen the near-riot anti-abortion rallies on television and they would call me a brainwashed liar if I claimed there were none, so what do you expect me to do?) I describe talking with a nice doctor whose voice kept being drowned out by gunfire and angry chanting. I describe her tinkling, fairy-like laughter when I told her about our family doctor with the moldy waiting room. "Your doctor is crazy," she said, "in America we postpone our periods all the time! We like to be efficient and productive, and we're not going to let a little menstruation get in our way." Planned Parenthood had ready-made, five-pill period-postponement packets ready to go for clients. I didn't even have to go to a pharmacy. Finnish people sigh in relieved astonishment when I tell them that in America sometimes, cutting edge, modern health care is only available to those who can afford nothing else, and to those desperate enough to visit the pregnant teenagers' clinic. I say I was annoyed, yet proud to pay the full, non-insured price for my health care in support of Planned Parenthood's brave work in the war zone that is American reproductive medicine.

I get a lot of my health care when I'm on vacation in Finland, because it is simpler and faster than begging the insurance company and calling around looking for a doctor who will take me in a few month's time. The Finnish, "socialist" health care is much less Soviet than that, and also there are no wall to wall carpets. The Finnish doctors I go to listen to my cautionary tales about American medicine with what can only be described as train-wreck fascination. I do my best to confirm their existing impressions of the third world state of American health care, and they promise to never ever vote for politicians who want to hurt our imperfect, but basically sane, "socialist" system.

1 comment:

outi said...

so true, well written!!!

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