This article was published in the Global Times on December 23, 2009, here.
It’s hard to miss: in America, a nation-wide debate about healthcare is dominating the headlines. President Obama has proposed revolutionizing the healthcare system, including providing health insurance for millions of Americans currently without coverage.
However, the plan’s detractors have labeled “ObamaCare” an unwanted step toward socialism, arguing that America already has the best healthcare system in the world.
So when a minor accident recently forced me – an American living in China – to visit the emergency room at Beijing’s Chaoyang Hospital, I was eager to see what healthcare in a real socialist country was like – and how America’s system compared.
To my surprise, I found a number of similarities.
After the doctor determined that I needed stitches, I had to pay before receiving treatment. In America, the situation is similar: the first thing a patient receives is a clipboard of forms that ask, among other things, one’s health insurance provider. Hopefully they have one.
Both China and America’s systems resemble that of a fast-food restaurant, where customers pay before they eat. This stands in contrast to the U.K.’s National Health Service (N.H.S.), exemplified in Michael Moore’s documentary “Sicko” when wanders the halls of an N.H.S. hospital searching for a cashier that doesn’t exist – except to refund transportation costs incurred by patients. I’m not aware of any restaurant like this.
Luckily, even though I had to pay up front, the whole process at Chaoyang Hospital was extremely fast. I was able to see a doctor immediately and was on my way in a Beijing minute.
Another similarity is insurance. In urban China, people’s health insurance is provided by their employers, not by the government (though China does have a government-supported safety net for people in poor, rural areas.) So just like I would in America, I had to file a claim to get reimbursed.
So what are the differences between the two countries’ healthcare systems? In a word: cost.
In America, a few stitches could cost someone without insurance several hundred U.S. dollars. Even if they have insurance, they would probably have to pay a deductable. But at Chaoyang Hospital, the whole cost was only about 350 yuan, or approximately US$50 – which included a tetanus shot and week’s worth of antibiotics. No wonder the insurance company did not give me any hassle.
Though it is true that even such a relatively low cost could present an obstacle for people in some segments of society, I believe it is at least within the realm of reason, while in America we balk at the US$100 bandage on our hospital bills.
Another difference between China and America’s healthcare systems are the facilities. Though Chaoyang Hospital is a modern, well-maintained medical facility, it is not representative of all hospitals in China. In fact, even on the campuses of China’s top universities I have seen poorly maintained clinics that looked as if they were built by barefoot doctors.
The final difference is bedside manner: how a doctor relates to his or her patients apart from the actual treatment. There are always exceptions, but I have noticed that whereas American doctors generally take time to counsel patients about their options, sometimes Chinese doctors prefer to take the “tough love” approach. I’ve seen a doctor laugh at one particular American patient for nearly passing out when being stitched up. “Foreigners are weak,” said the doctor with a smile.
A friend who has worked at hospitals in China and America shared his view: “Chinese doctors are actually more experienced, because they see many more patients every day and can make a diagnosis much faster.” So the difference is not the level of care but the level of personal attention.
So the question is: are America’s nicer facilities and more personable doctors worth the extra cost? To answer that, let’s examine what that extra money buys in a U.S. hospital.
Once, I took a Chinese friend to the emergency room in America. He had acute back pain that could have been caused by a slipped disk or pinched nerve. However, we had to wait in an overcrowded emergency room for several hours before a doctor could see him. During this time, my friend’s pain was nearly unbearable – as was the concern about how much it would cost.
Sadly, on that occasion he did not receive the same level of care in America that I have since received in China.
To be sure, China’s healthcare system could be improved. To borrow the language of China’s leaders, it needs to be more “harmonious.” Greater emphasis could be placed on bedside manner, and many medical facilities could use a fresh coat of paint.
But there’s nothing “harmonious” about the status quo in America’s healthcare system either. The system is sick, the entire insurance scheme has slipped a disk, people’s wallets are bleeding, and there is an incredible amount of pain. America is waiting in the emergency room.
At a time when these two superpowers, China and America, are vying for economic superiority, let’s see which country can become a healthcare superpower first.
10 Comments
Great article Tim! Misty and my mother enjoyed it to.
Very good Tim, your description of American healthcare is very accurate. I would also add that the wait for a scheduled visit with a doctor in the US can be almost as horrible as an emergency room. Even when you have an appointment it is not uncommon to sit in a waiting room for an hour or two and even then the personal attention you get might be questionable. In addition to that, there’s also the often wasteful practice of what’s called a “follow up” visit. For example, after many routine tests a patience is ask to come back for another office visit even when it’s known that the test results indicated no problems.
agreed
Are you kidding me? You make it sound as if the quality of Chinese hospitals is even approaching anywhere near that of its American counterparts. I have lived here for five years in all parts of China and been to the hospital on multiple occasions. In Shenyang and Xiamen, I have been to the “best” hospitals where it smells like pee, kids defecate into garbage bins (although bathrooms are readily available nearby), doctors routinely order unnecessary tests to boost revenue, and almost every patient, regardless of ailment, is prescribed a drip of lactate and sodium chloride.
I do admit that if I had a minor injury or ailment, I would opt for the Chinese hospital due to cost and overall speed; however, the high costs and waiting times we are subject to in the States guarantee quality of care and treatment. If I am ever seriously injured or affected by some grave ailment, I pray to God I am in the good old United States of America, whether or not Obama has made reforms.
I have 30 years experience in the American Healthcare system and although what you say about the Chinese hospitals may be true, the current healthcare system in the US is broke, to say the least.
Not only is there abuse and excessive waste but the out of control costs and stacks of red tape do not equate to quality healthcare. Should we settle for “pretty good” just because we believe anther countries healthcare system may seem inferior?
I agree with you that, by American standards and norms, our system may be broke. Trying to compare the Chinese and American systems, however, is like trying to compare filet mignon wrapped in bacon with cube steak. No matter how broke our system may be, the quality is higher all around.
Thanks Chaz and Hanyman for your contributions. “To be sure, China’s healthcare system could be improved … But there’s nothing “harmonious” about the status quo in America’s healthcare system either.” It pains me that some politicians have actually said the US system does not need improving (http://tinyurl.com/yzl8g6u).
Perhaps my article didn’t spend enough time chastising China’s healthcare. I can certainly validate Chaz’ description of some medical facilities/services. But my point here is just how ridiculous it is that — particularly when it comes to the payment scheme — America’s system shares more in common with China’s system than the system of many post-industrial, developed democratic countries. No more excuses; we need to reform healthcare.
Glad i found you on Twitter.
I have had two US hospital experiences in my 70 years:
1. On Christmas Eve I had a bursitis attack in both my shoulders. Walk-in private emergency services closed, I went to a hospital. A cortisone shot at that time in the private walk-in service would have cost $25 each. The Emergency room bill came to $1065. Yet the conservatives advocate that we have “universal health care” because anyone can go to a non-profit hospital and get care. Then they complain about the cost of health, which is swollen by unnecessary visits to ERs.
2. I had an operation. Went home, got a blood clot in lung. That is, I figured that was the problem, took a shower, called doctor, he agreed and said to get a cab and rush to the emergency room (he had a surgery scheduled). He called to say they should admit me. I went to the desk, gave my name, doctor’s name, and said I had a blood clot in my lung. Problem: I looked really healthy, no bleeding, felt just fine as long as I did not lie down. Four hours later I was asked, in a sarcastic tone, “Why are you here?” I said “Blood clot in lung.” The person snorted with skepticism, “How do you know?” “My doctor said so.” Finally they let me see a doctor, who informed me that I probably just had a touch of pneumonia. I said, “No, not this pain, Very different, only there when I lie down, very localized and deep, not that I’ve ever had pneumonia.” Tests were run, then doctor in a scolding tone: “Do you realize that you have a blood clot in the lung, and that you could die any second?” “I answered cheerfully, “That’s what I’ve been saying for the last five hours.” Then the brouhaha: forced onto a gurney (thus causing huge pain), rolled off to room. Blah blah. Everything turned out fine.
I have never been to China. In the U.S the waiting room in the E.R is always over crowded and 5 hours if probably standard for any minor E.R Visit. There are no upfront payments and I have never been denied coverage for lack of insurance or otherwise.
My Buddy has a wife from China and their experience in China is that Health-Care is free paid for by the additional taxes. So I was suprised when you mentioned insurance in China, but possibly this is only for E.R visits. Also their belief that you cannot be turned down for treatment or coverage in China like you can here in the U.S for the most serious of issues like in the well known movie “John Q” where his son is denied a heart transplant because lack of insurance and money.
My issue with Government Health Care is that I don’t believe I should have to pay the same taxes when I go to the Doctor maybe once in 5 years as someone who may go 12 times a year. That doesn’t seem like a fair way to do it, but at the same time I don’t think the right to live and die and treatment should ever be determined by the amount of money you have and nobody should be refused treatment when a treatment is available.
Maybe a fair way to do it would be to calculate all your doctor visits over the year and deduct your tax return and modify your personal income tax rate by how much you owe. “Just one possible solution”
Thanks for your input. This is such an important issue for any society, and I wish the public debate in America had been characterized by people sharing their honest opinion and constructive ideas like you have — rather than resorting to name calling, which is how it turned out unfortunately. Anyway, just to set the record clear, China does not have universal healthcare. The system in China is very much the way America was/is: you pay cash unless you have insurance that you purchase or is provided by your employer. It is other democratic countries in Europe where tax payer money supports universal healthcare. That’s why I think it’s inaccurate when people claim universal healthcare is “communist” or “socialist” or whatever — the fact of the matter is that most post-industrial democracies other than America have some form of universal healthcare, and America does too in the form of Medicare/Medicaid. There’s nothing more “communist” about that than public libraries. Also, I think that the Chinese healthcare system has a long way to go, but I’m just saying that a CAT scan costs US$50 here, so even if you don’t have insurance it won’t cause you to lose your house. Anyway, thanks again for your comment. This has been a hot topic!