Sunday, September 27, 2009

The big box in the sky

In the summer of 2006 we visited Innsbruck Austria. When in Europe, it's obligatory to visit the local cathedral. One of the big attractions in Innsbruck is the HofKirche - built in the 1550's by the Holy Roman Emperor Ferdinand I.

Just above the altar, I noticed an interesting architectural detail. There was big glassed-in suite with a great view of the proceedings - it looked kind of like a luxury box (sky box). I guess it makes sense, after all, you can't expect the emperor to sit in the pews. I'm sure it was catered, had a bar, and probably a couple of big screen TV's. I kind of expected to see George Steinbrenner peering down imperiously from the windows.
In the USA our cathedrals are dedicated to sports.

In 1965 the city of Houston built the Astrodome. The architecture wasn't ornate, but the effect was stunning. Huge indoor stadiums are commonplace today, but when it was built, the Astrodome was considered the eighth wonder of the world. These structures aren't Chartres or the Kölner Dom but they sure are big.

Actually, the most important innovation of the Astrodome wasn't the indoor stadium, or even artificial turf, it was the the luxury box.

Since then, sports franchises have turned the luxury box from a VIP perk, into a major source of revenue. The New York Yankees reportedly charge up to $600,000 a season for some of these suites.

It's comforting to know things haven't change all that much.

Wednesday, September 02, 2009

My encounter with 'socialized' medicine

In December 2006 I visited the Emergency room in Toledo Spain. The visit was precipitated by a recurrence of inflammation in my left eye - a condition that I have experienced several times over the past few years.

I took a bus to the Hospital Virgen de la Salud (Toledo municipal hospital) first thing in the morning. My Spanish isn't very good so I took Eva as translator. The ER didn't look all that different from a US hospital, but the experience was very, very, different. There was a crowded waiting room and an admissions desk.

"The experience was very, very different."

We explained my problem at the window, and they collected my name, address, and other information. They didn't ask about insurance or a credit card. They sent me immediately to the specialists office inside the building. Eva went to the crowded waiting room, which was for relatives only - patients are admitted right away.

The ophthalmologist was busy with another patient. I waited in the hallway next to a very sick woman on a gurney. After a few minutes she was taken into a room and I was left alone. I waited for 10 minutes.

The doctor did not speak much English. I wrote out on a piece of paper "HLA-B27", which is the genetic marker for my condition. He seemed to recognize this and he examined me with a Baush & Lomb slit lamp that is identical to the one my ophthalmologist uses at home. The doctor wrote me a prescription and sent me om my way.

I checked out at the ER discharge desk. The bill was about 90 euros ($110 at the time), and as a non-citizen the hospital would bill me later. "I live in the US, let me pay now," I suggested. They looked confused. I couldn't pay now - the ER didn't have a cashier. The sent me on my way with directions to the pharmacy.
"My visit to the emergency room took 45 minutes - total."
Eva and I got lost, but a local woman showed us the way to the pharmacy. It was a small room with a pharmacist behind a big white counter. They only sold medicine, no soft drinks and bateries and makeup. The pharmacist gave me a bottle of brand name Pred Forte, the price was printed on the bottle - 3.50 euros (about $4 US). My pharmacy at home lists the identical drug for around $50 - I get it for a $20 copay.

Same drug, 1/10 the cost.
Other than the (lack of) waiting, the examination and treatment was identical to the care I get in the US.

Here are the differences I observed between socialized medicine in Europe and private medicine in the USA:
  1. I was not asked me for insurance or credit card on admittance.
  2. I did not have to wait in the emergency room.
  3. The doctor saw me quickly, and had the first-rate equipment in his office.
  4. They discharged me without asking for payment.
  5. The hospital bill was about $110.
  6. The identical prescription cost 10% of the US price.
© 2008 Raoul Rubin