(My mother, who is an avid reader of my blog, is a native of Greece and while a fierce partisan of that country is never-the-less perplexed at the love so many of my readers have for socialized medicine of the kind which is the rule of life over there. I offer this brief description of a typical socialized system in a modern European country.-PB)
The hottest new career in Greece, a country with socialized health care and my family’s ancestral homeland, is the Apoklistiki Nosocoma, or “Private Nurse.” Because the public hospitals are so understaffed families routinely hire one of these trained nurse to watch over their relative while the low-paid government nurses do whatever it is they do for their small salary, a salary which is just enough to convince them to come to work but not enough to actually get them to do anything.
These private (or “elite” nurses) are brokered through the public hospitals in a tacit admission that the socialized system cannot provide decent medical care to the people.
But that’s how it is when nurses (or anybody else for that matter) are employees of the state and have jobs from which they can be dislodged only by the apocalypse or another Persian invasion. They will certainly not be fired for ignoring the patients. Not only is the pay low but, with the exception of a few zealots, there isn’t exactly a long line of Greeks waiting to work for those wages doing the kind of work that our well-compensated nurses do automatically. There are no incentives to work and no penalties for not working. The results are predictable. Not only are Greek public hospitals understaffed but the staff in ‘em are not exactly chugging away efficiently.
Of course, if you want anything done in the Greek public medical system you can always pay extra for it with a well-placed bribe. Maybe a couple of hundred Euros in a fakelaki (envelope) to the general surgeon to put your father at the head of the line for a colectomy. Perhaps some well-placed Euros to the charge nurse to make sure she watches your sister. My mother, who lives in Greece, relates to me that this system of bribery is endemic and almost institutionalized. In a country where doctors who elect to work for the state barely make what a garbageman makes over here, not only are there shortages of trained doctors in the public system but they have very little incentive to make the system work and the fakelaki is necessary and expected.
In our country a homeless wino can be brought in for gastrointestinal bleeding and within 24 hours have everything including a sigmoid colectomy and a kitchen sink thrown at him while he is cared for no differently than the paying customers. No bribe is required and the concept of expecting one is unthinkable. In fact, our system, although expensive, provides such good care to everyone that the VIP and the wino are indistinguishable as patients.
In Greece on the other hand, enjoying as it does the bounty of socialized medicine, there is a three tiered system. In the first tier are the private hospitals which are the equal of anything we have in the United States. Unlike our hospitals however, they are in no way charity institutions and only cater to the wealthy. In the second tier is the public hospital system where those who can afford it bribe doctors and nurses and even hire maids to clean their relative’s otherwise filthy rooms. In the third and bottom tier are the poor who lay in cots in the hallways of the crowded public hospitals relying on their relatives for the basics of life and nursing care.
No relatives, no care. Greek public hospitals provide only the rudiments of services to their patients. The condition of the food service in most of them, for example, would be a scandal in the United States. Patient are fed indifferently from rat and roach-infested kitchens and the concept of nutrition seems to be unknown. It would be a national embarrasment except, in typical European fashion, the Greeks take great pains to criticise the United States while their own post-operative patients slowly starve to death. An ironic state of affairs in an otherwise modern European country.
Even getting admitted to the hospital is a difficult process requiring the ubiquitous fakelaki. We would find it hard to believe accustomed as we are to almost instantaneous access to the full panoply of medical resources but in Greece if you have a life-threatening condition, say colon cancer or PORT-score maximizing pneumonia, and you rely on the socialized system you are probably out of luck and could die before you are admitted. The waiting list for what we consider to be routine medical care is hopelessly long.
And things like hemodialysis or Critical Care? Not if you are elderly or poor. You are going to die, just like Darwin intended, because in Greece as in most socialized countries they do not keep the weak and the helpless alive when they become a burden to the state. That’s the secret of socialized medicine. It’s like Logan’s Run. When your life-clock runs out you are done. Finito. Buh-bye. So sorry. Appreciate the taxes and everything but now it’s time to pay the bazouki player.
What’s my point? Nothing really, except you get what you pay for. Providing the high level of medical care that is expected by the American public is not cheap. Attempts to nationalize, socialize, quasi-socialize, or we-swear-we’re-not-going-to-socialize will do nothing to lower costs unless medical care is strictly and severely rationed. Oh sure, you can get yer’ stinking ineffectual primary care provided by a poorly-trained Nurse Practitioner but when your heart starts to give out or you need a new knee, well, you will see the truth to the adage that free health care is great as long as you don’t need it.