Sunday, October 9, 2016

Notes from My Socialist Hellhole: Healthcare

We just wanna go our own way,y'all. 

By the time I had lived in Sweden for only two months, I had gone to a women’s health office, the normal doctor’s office, an emergency dentist, the normal dentist, the emergency room, and the weekend urgent care clinic. Aside from having a surgery or cancer or intensive rehabilitative care after a catastrophic accident (no, really, universe, I can do without that) I have already experienced every aspect of the Swedish healthcare system.

Seeing as how many people are concerned about what might happen if America adopted similar socialised medicine to Scandinavian countries like Sweden, I thought I would let y’all know my firsthand experiences (spoiler alert- they were all great).

First off, as a worker in Sweden I am treated exactly like a Swedish citizen in terms of all social benefits. There is nothing a Swedish citizen receives that I do not receive. I was given a Tax ID number as well as what is called a “personnummer”, which is basically the equivalent of the American Social Security number. This personnummer and all my relevant information are stored in a main database. This database is accessible by every single health care provider and pharmacy. This means that anywhere in Sweden- if I show up to an ER in the south, or a doctor’s office in the north- I have a complete and accessible medical record. It also means I can fill a prescription at any pharmacy in the country, because they will have my prescription from my doctor.

As to payment: you pay 200 kronor anytime you see a doctor, which is about 24 USD. This is for any doctor’s visit, from a regular doctor to a weekend urgent care clinic to the gynaecologist to my vein specialist center- 24 dollars. This is all you pay, even if during that visit they perform tests or draw blood or take a urine sample- 24 dollars, you are done. And after you have paid 1,000 kronor out of pocket, or about 120 US dollars, you don’t pay anything out of pocket the rest of the year.

Here are my experiences with healthcare in Sweden thus far:

My first visit was, characteristically enough for me, to the ER. Only my second time out in Sweden with my friends, I went to an after work event and was knocked out on the dancefloor. A very tall and very drunk Swedish man got *really* excited over the huge balloons being tossed around the crowd, and decided to clock one with an uppercut. I turned around right as he did so, and he caught my jaw instead, which threw me back in a cartoonish way, laying me out on the ground and knocking me out for a second or two. I came to in my friend’s arms, as he carried me off the dance floor. We took a taxi to the ER, which is where I found out that I had been issued my personnummer (this was right after I got to Sweden, and I was waiting on the letter to arrive, but I was already in the system). The receptionist took me straight back to see a nurse immediately, who took all my vital signs, talked to me, did a test you do when someone gets knocked out, and then gave me a stretcher with clean sheets to lay on while I waited. She also gave me ibuprofen and water. I waited, yes, for three hours- but I have waited far longer in the ER in the U.S., I had been triaged as soon as I arrived, and like anywhere, had I been in immediate danger I would have been seen immediately. 

I was seen by two doctors who performed extensive tests to check for concussion and any problems, they took my full medical history to update the system (since I was brand new) and they allowed me ample time to ask questions. They were professional, kind, nurturing, and helpful. When I checked out the ER bill was 400 kronor, total, for everything, which is about 48 USD. I left knowing there would be NO surprise bill coming later to shock me.

My second visit was for my annual well woman exam with the local midwife. I called in on a Friday and asked to set an appointment; they told me to come in on Monday anytime after 3:30 for a walk in appointment. I admit I was skeptical that I would be waiting for hours. I showed up at 3:30 on the dot, took my number… and waited for less than 20 minutes. Many times I have waited double that WITH an appointment in America. I was taken back and seen by a nurse midwife in a cheery and bright office/examining room, where she took a detailed medical history, let me explain any concerns I might have, and then took the time to explain the medical system to me, how to make appointments, and where to call in an emergency. She performed the exam, drew my blood, and took a urine sample. I asked her how much I owed and where to pay, and she laughed. For a full consultation, a pap smear, a blood test, and a full STI screening I paid 0 dollars. I didn’t even have to pay for the office visit, because every woman in Sweden gets free pap smears/well woman exams. 

My third visit was when I was lucky enough to get strep throat. I woke up on a Saturday morning with all the symptoms, and this was when I discovered another useful aspect of Swedish healthcare: the 24 hour hotline staffed with nurses who will answer questions, triage you, and give you numbers and addresses of healthcare providers. I called the hotline and was given a number for an urgent care clinic late Saturday afternoon, and since I didn’t have a fever I accepted an appointment for the next evening. I went in the next day five minutes early and was seen right on time. I was given a strep throat culture test and a full examination, and a prescription for antibiotics. Again, I only paid 24 dollars, flat, for the office visit, because all tests are included in that. My antibiotics were 20 kronor- about 3 USD.

Unfortunately, my strep throat lingered and did not go away, so for my fourth experience with Scandinavian socialised healthcare I headed off to my vårdcentral, or local health center. This is where my midwife office is located as well. The vårdcentral is like the main health building for your local area, and a variety of doctor’s offices are housed all together in a big building. And no, it is not austere and cold and made of concrete blocks. It looks like a nice government building, the main reception is staffed by friendly people, and the main waiting room has lots of comfy chairs and magazines and a kids’ play place. You can walk in at any time, without an appointment, and be seen during normal office hours. 

Again, I was worried about how long I might wait. But again, I walked in without an appointment and was seen by a nurse practitioner, alone, in a private, bright office with a window and plants and the cliche doctor’s office cheesy nature posters, within 20 minutes. She triaged me, took all my info, and ordered a blood test to check for infection and told me I would see the doctor. I was given a red laminated card to take down the hall, walked right in, and got my blood test immediately. The results were processed within the 15 minutes I sat waiting to see the doctor, and he gave me a thorough check-up and asked me how I was adjusting to Sweden and where I had been before. He prescribed me new medicine and gave me a note for my employer. He also scheduled my appointments for a referral to a vein specialist. I paid my 24 dollars and left, knowing there would be no bills following me for the blood tests, because it was all covered.

My experiences with the dentist were similarly fantastic. I chipped a filling on my first day of work in Sweden, and after I got over strep I went to the emergency weekend dentist, where anyone can just walk in. I still hadn’t learned my lesson, and went in expecting horrendous wait times, frankly based on experiences I had had in America at dental offices. Instead I was given a number and told to come back in an hour and a half. I came back in an hour and twenty minutes and was seen right on time. The dentist looked at my tooth, poked around in it, tapped it, and gave me an x-ray. She declared the filling was just chipped, but was still sealed, and it would be fine to wait to see a regular dentist. I asked her how much I owed and she laughed. “We didn’t do anything, you don’t owe anything!” I was seen by a dentist, a dental hygienist, given an exam and an x-ray, and that was all free.

I went back to my vårdcentral, which also houses the dentist, and made an appointment for a full check up and dental cleaning for three weeks in the future. I went in on the set date, was seen right on time, had a thorough mouth exam by the dentist, had my teeth cleaned by the hygienist, and had an appointment set to fix the filling. Dental prices are different from other health services, but for all that I paid about 120. My filling will cost about 100. 

Finally, I recently had my appointment at my vårdcentral with the doctor concerning my legs, so he could refer me to a specialist. I showed up on time, was seen right on time, and he spent over half an hour listening to my history of symptoms, giving me various tests, and asking questions. I was referred to a vein specialist, he ordered a blood test, and he ordered an appointment with the nurses to fit me for new stockings. The order for the blood test is in my file in the database, so I can show up at anytime the vårdcentral is open, tell the receptionist I am there for my blood test, give her my personnummer, and they will do it at my convenience.

To make a long story short, I have received nothing but thoughtful, qualified, and timely care from friendly health care providers in comfortable and enjoyable offices and examination rooms. I can say it has been better than the healthcare I have received in America, from the environment/cleanliness of the offices and exam rooms to the consistently positive bedside manner and thoughtfulness of the providers. There is often some fear that you will be treated like a number, mindlessly pushed through a bureaucratic nightmare of cinder block grey prison cell like examination rooms, with austere and somewhat dingy surroundings. People often wring their hands about waiting times, or death panels, or whatever else. No, y’all, just no.

Most of all, I love the peace of mind that when I leave the doctor there is no waiting for the other shoe to drop, wondering how much a random follow up bill will be. Due to the vårdcentral system, I have seen the same doctor and the same nurses in my local community. I recognise the  receptionist ladies, they remember my name and face, they ask my how it’s going adjusting to life here, it all has the pleasant feel, almost, of going to your local library. However, just to clarify, I can go to any doctor, anywhere in Sweden, whenever I want. 

I also want to add that for anyone under 18, anything to do with health has no payment at point of service- from dermatologists to dentists (yes, even braces) to all immunisations to anytime you go to a doctor- no one under 18 has to have money to see a doctor for anything, ever. This means that as a teacher, I know that all my students are taken care of, from their bodies to their teeth to sexual health to their mental health. I cannot put into words the peace of mind this gives me, as someone who is in a position where I need to constantly think about my students on so many levels. Not having the stress of wondering if they are taken care of health wise is incredible.

I have now lived and worked in two countries with exceptional health care- Japan and Sweden- and I have far preferred both experiences to anything I have received in America. It is extraordinarily difficult for me to listen to the outright lies that are told about socialised healthcare by people who have never lived abroad and have never experienced socialised healthcare firsthand. I have friends all over the world, I have traveled extensively throughout the years and met hundreds of people in hostels, and I have never met a single person who envies the American healthcare system. 100% of the time when we talk about it they express outright pity and disgust. We are all entitled to an opinion but when you have an opinion that is totally not true about a system- socialised/public option healthcare- which every other country in the Western developed world has, it is very frustrating. 

Any system created or run by humans will have inherent flaws, and I am certainly not saying socialised healthcare is perfect, or that people in Sweden never have bad experiences with the system. But when the flaw of the American system is that people can be financially destroyed or die if they get sick, I think that is a fundamentally irreconcilable flaw. When the richest country in the world has citizens crowdfunding for medical bills, or putting plastic jars in convenience stores begging for help with a child’s chemo, we should be ashamed. Frankly it angers me that other countries have taken better care of me than my own. I showed up in Sweden and was taken care of with no questions asked as soon as I had a visa and I was in the country- in America, I worked and paid taxes from the age of 14 and could not afford medical care until a decade later when I finally was lucky enough to have a job that gave me good benefits- a privilege millions of Americans don’t have. 

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