Saturday, April 7, 2012

Broccoli and universal health care

During oral arguments before the U.S. Supreme Court two weeks ago Justice Antonin Scalia derisively compared the mandated insurance requirement of President Obama's health care law with a theoretical government mandate for Americans to buy and presumably eat broccoli. If the federal government can impose one mandate, why not the other?

It was supposed to be a ridiculous comparison, I think, a reductio ad absurdum, I believe it's called, though my  knowledge of Latin, legal arguments and the rules of logic may be a little weak.

But then it occurred to me that in the case of Mexico talking about universal health care coverage and broccoli isn't a non sequitur after all: The country has both, a surprisingly far-reaching health care system and more broccoli than anyone knows what to do with. It just needs to connect those two resources.

On Monday Stew and I gave Félix our gardener and his wife, two-year-old daughter and months-old boy a ride to the San Miguel General Hospital for a late-afternoon consultation for what sounded like rumbling chest colds in both of the kids. Two hours later we picked them up, a written diagnosis in hand (I couldn't read the writing) plus medications, all free of charge--at least to Félix.

During his wife's pregnancies she also received routine prenatal checks, including ultrasounds, and an eight-day stay at a hospital located two hours from San Miguel when complications arose during the first delivery. Both deliveries involved C-sections and transfusions because of his wife's hypertension and problems with epilepsy. Again, Félix didn't pay a cent.

Several months before, a young relative of Félix riding a bike got hit by a car on the road to Querétaro and was mangled pretty badly. So off the kid went to the General Hospital where he stayed for a few weeks and received what sounded like fairly spooky surgery involving metal rods and screws to mend his spine.

According to Félix, the guy is back on the street, not quite ready to do the samba yet but walking around pretty much normally. Did I mention all treatment and post-operative therapy were free of charge, no questions asked?

Closer to our ranch, neighbor Vicente's 15-year-old daughter--he has 14 children, mind you--fell off a horse and literally cracked her head on a rock. The ambulance showed up, plowed through a dirt road leading to Vicente's ramshackle house and took the girl away to a hospital in Celaya, about an hour away, where she stayed in a coma for about eight weeks. She's back home now, still unable to speak but slowly regaining some movement. She undergoes twice-weekly physical therapy in San Miguel, although this is not entirely free: Vicente has to pay for a taxi to take her back and forth to the clinic appointments in town.

Impressive, but you need some broccoli
The General Hospital is a three-year old facility that doesn't have the grandeur or five-story high atrium of many American hospitals consider necessary, but it is a comprehensive and modern facility, with a CAT scanner and other brand-new equipment. All services are free or absurdly cheap by U.S. standards.

Gringos and wealthier Mexicans who don't want to mingle with the smelly working classes at the waiting room of the General Hospital or other government clinics in town have the option of paying cash or buying insurance and going to private hospitals. The newest one in the nearby city of Querétaro, called Tec-100, in fact has all-new gizmos and facilities, including an American-style grand atrium with potted plants. So there.

Fees for medical services in Mexico are one-half to one-third what you'd expect to pay in the U.S. This seems like less of  a miracle when you take a closer look. Health personnel, including doctors, get paid only a fraction of what their American colleagues earn.

There are no such things as malpractice suits or insurance either, a mixed blessing because you have little if any legal recourse if your medical treatment goes South, so to speak. But that saves millions.

Since private health insurance is used by a relatively small portion of the population, you can also deduct from Mexico's national health care expenditures insurance companies' profits and their costs of marketing and selling policies and other wares.

Though I'm sure drug and medical equipment manufacturers actively hustle their products to doctors and hospitals, the consuming public is not bombarded by hundreds of millions of dollars' worth of direct American-style advertising and marketing for restless foot syndrome drugs and other potions.

Mexican hospitals often are first-class but they lack the edifice syndrome that has infected comparable American medical institutions, usually for nothing more than marketing and competitive purposes.

If Northwestern Memorial Hospital builds a billion-dollar medical temple on the North Side of Chicago, you can count on the University of Chicago Hospitals combine on the South Side to rev up its fund-raising jets shortly to build something even grander. All that fancy brass, marble and ferns adds billions to the national U.S. health care bill.

Of course, the Mexican public health care system--a huge bureaucratic maze partly paid by employers and state and local governments--in the end it's not really free. 

As a famous Mexican economist, I forget his name, once observed, "In this life there are no free enchiladas." That applies to Mexico's universal health care system. And given the Mexican government's legendary propensity for corruption and mismanagement, you can bet there are huge amounts of loose and missing change clinking around in the federal health care empire.

The weak link in Mexican health care, however, has to be the rampant poverty choking so much of the population. In towns just a mile from our ranch, many homes have no indoor plumbing facilities much less water treatment plants. Poverty also engenders health problems caused by lousy diets, with lots of starches, sugary sodas and sweets in the Twinkie section of the local convenience stores.

In fact, diabetes is one of the leading health problems in the country, with an estimated one in ten Mexicans affected by it. Dealing with it consumes more money than any other health problem in Mexico.

Our gardener Félix has a terrific touch for growing vegetables--beets, radishes, tomatoes, spinach, various types of lettuce, arugula, kale, chard, to name a few--but he treats them as if they were radioactive debris not healthy foods. "We don't eat that stuff," he finally admitted one day. Instead he will occasionally bring sweets or a large bottle of Coke to work.

So here's the irony. Despite all the kinks and squeaks, Mexico has something the U.S. is still debating--universal health care. What Mexicans need to do is eat more broccoli, something they have in abundance.

The government should seriously consider a Scalia-type mandate to force Mexicans to eat more broccoli, along with other greens, and perhaps drink less Coke. Mexico is one of the highest per capita consumers of Coke in the world, according to Coca-Cola Company statistics.

It's also one of the world's largest producers of broccoli. Semi trailers full of the broccoli are ubiquitous around San Miguel, except all of it--and most other produce grown locally--is exported to the U.S. I've never seen a broccoli  enchilada or a spinach chimichanga, have you?

The federal government needs to step in. There's a workable universal health care system in Mexico already firmly in place. What the country needs is to eat more of its own damn broccoli.




















7 comments:

  1. Very well-written piece. The only factor you left out is the American heresy that society owes us the right to live forever. Of course, as long as someone else pays for the medical bills. Our Mexican neighbors have a far more realistic view of life.

    ReplyDelete
    Replies
    1. Hey, you don't want to live forever but 98 is a nice figure don't you think?

      al

      Delete
  2. I distinctly remember the very first time I went to the Dr. at De La Fe clinic. At the appointed time, right on the minute, the door opened and the Dr., yes the Dr. was standing there. Not three or four intermediaries beforehand but the "real guy". When he decided I needed an x-ray, he walked down to take me for the x-ray, waited outside the door and then walked me and the x-ray back to his office. I was speechless (which for me is something). The cost of the x-ray, $30US, his visit $40 US. Great diagnostician too.

    Another time after 3 days in the hospital here, I was incredulous at the care and kindness of the staff. Equal, truly, to the care I have seen at world class hospitals in the USA. I think I'm qualified to say this since I spent close to 5 years almost on a daily basis at MD Anderson with my daughter!

    ReplyDelete
    Replies
    1. What I miss in Mexico is the lack of a primary physician or family doctor who keeps all your records and referees referrals to other doctors. I feel like I'm on my own here. We miss our Dr. Glynn in Chicago whom we've seen for about 20 years and has an inch-thick file on each of us tracking everything that's been wrong with us (even in Mexico, prescriptions, tests, treatments etc.

      al

      Delete
  3. Terrific Piece. Mexican health care system is not perfect but the American health system is corrupt to the bones. Carlos.

    ReplyDelete
    Replies
    1. And such corruption is what makes it so difficult to reform.

      al

      Delete
  4. Hmmm, sounds like my wife and I could be in good care in Mexico at what we will pay in the US. We are looking at approximately a grand a month in insurance rates upon retirement. And, of course, that does not include deductibles and prescriptions.

    ReplyDelete