Thursday, December 29, 2005


A reader writes:

I read with much interest your blog on Socialized Medicine today about the Canadian system of health care. I can say, from experience, that there are good and bad things about socialized medicine.

I live in Costa Rica where everyone is guaranteed medical treatment. They have a system called the "Caja" that allows medical treatment to everyone and a family plan costs very little, but if you have an income you are required to pay. My wife and I, being from the United States can take advantage of this system and we pay about $US12 per month for a voluntary plan. We don't pay the additional amount for retirement as the Costa Ricans would pay but that would only add an additional $3 or 4 a month to the payments. Where the minimum monthly income is around $200 per month this is quite reasonable and those who can't afford to pay can apply to receive the service gratis. They make up much of the difference between the cost of medical care and the amount charged by charging employers approximately 30% of their workers wages for a complete plan where the employer is obligated to pay 21 of the 30% and the employee 9%. Being that the 9% is somewhat more expensive than the voluntary amount many workers prefer to have their own insurance and the employer doesn't mind considering the savings and usually will give the worker the additional money to pay for the voluntary plan. This doesn't help the financial status of the system and is against the law but being very hard to control is a common practice. Insurance with the Caja also doesn't insure for instances of injury on the job, this is another insurance!

In addition to the "Caja", an employer also has to purchase insurance from the national insurance company (INS) for any work related injuries but for each worker this is only about $80 a year and is well worth the cost. Treatment is given at an INS clinic and medications are provided by private pharmacies at no cost to the insured. Private pharmacies carry a much wider range of medications than those available through the Caja hospitals. Private health insurance is also available through INS for individuals and for my wife and I, both being in our early 60s the cost is a little more than $500 each a year. With this insurance we can obtain full coverage at any private facility in the country.

With the Caja you can elect to use a private physician who can prescribe treatment and medications through the Caja so you can bypass the long waiting lines at the Caja clinics, receive immediate medical attention and then any extensive tests or medications can be received from the Caja at no cost. A regular doctor's visit to a private physician who is recognized by the Caja usually costs about $15 per visit. To be recognized by the Caja a Dr. has to give a certain amount of time each week to the local Caja hospital and mine gives two evenings a week of four hours to the emergency room. All doctors who work for the Caja also have private practices so this benefits all.

The major problem with the Caja is much as it is in Canada. They try and keep all costs low and this is only detrimental to the patient. The system is slow and the waiting rooms are packed with patients waiting for appointments. The Caja hospitals truly resemble third-world facilities and the people working there care little about the discomfort of the patients. There is also little communication between the hospitals and the referring physicians!

In October of 2004 I was experiencing severe chest pains on an intermittent basis and went to my doctor for an examination in the nearest town of Turrialba. He discovered that I had acid reflux and within a month of taking medication the problem was resolved. Unfortunately, an x-ray taken for the examination revealed a spot in the upper lobe of my right lung that was of considerable concern. I was admitted to the local hospital and taken to another hospital some distance away in San Jose for a cat scan in early December of that year, having to wait for a slot that was available to my local hospital. I then waited until February for the results of the cat scan to finally be forwarded to my doctor who then referred me to a pulmonary specialist in yet another town, Cartago, in another hospital. After being examined by this doctor I was scheduled for a bronchioscope and as this doctor performed the procedure it was relatively timely, only a few days after the original appointment. Then, I was referred back to the hospital in San Jose to speak with a surgeon about having a biopsy on the suspected nodule. It was now April of 2005 and I was told that as soon as a bed in surgery was available that they would call me.

In July the hospital in San Jose had a fire and the surgical recovery facility was destroyed! Being with the Caja this was the only hospital that was authorized to admit me due to the location that I live, although several others could have performed the biopsy.

In August I had a follow-up appointment with my pulmonary specialist and he was considerably belligerent that nothing had as yet been done towards having the biopsy. I should note at this point that all prior tests were proving negative as to having a malignant nodule but nothing was positive. There had also been no notable growth in the nodule. He immediately made contact with the hospital in San Jose and they no longer had me on the list for a bed as they were only taking emergency patients so had purged all other lists. Then he contacted another surgeon with whom I received an appointment with in just a few days and I was given the option of continuing with the Caja (where he guaranteed me that I would get immediate treatment) or going to a private hospital for the procedure. The difference was that through the Caja, which is severely restricted on available equipment, I would have had to had open chest surgery and with the private clinic the procedure could be done with a probe and only would require open chest surgery were the nodule malignant. Also, with the Caja the biopsy results would take fourteen days, possibly requiring another surgery to remove the lobe, and with the private clinic the results would be immediate. I didn't know about the private INS insurance at the time and would have to absorb the total cost of the operation but elected to go the private route.

Two weeks later after a one week trip to the US, and at the cost of $6, 034, I was home recovering knowing that the nodule had been benign. The surgery, food, and care provided by Clinica Cima was without parallel. For this instance it was a bit late but we now have the private insurance through INS!

Socialized medicine has it's place in poor countries where many can't afford even remedial care but in affluent societies it just creates more bureaucracies and the actual cost to the taxpayer should be seriously evaluated before any country embarks upon such a plan. It should also be considered if you wish the government to have control of this much of the counties GNP which was estimated at 14% when the Clinton government was trying to institute Socialized medicine in the US.

I won't even elaborate on the graft which diminishes the available services for which one past president of Costa Rica is now under investigation and house arrest.


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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