Brasilmagic\’s Weblog

Venting to the World

Health Insurance in the US vs. Brazil

I am not an expert on how governments can provide universal healthcare to its citizens.  I agree with Barack Obama that health is a right, not a privilege. But if I agreed with those extremist libertarians, healthcare would be an “individual choice”. Health would be a privilege of those who have money; for those who are dumb enough not to have money, just rot and die. 

However, it is very very expensive. It is almost impossible for a country to provide quality free healthcare coming from only taxpayers’ money.

The US already provides good free public schools for elementary and secondary education. In Brazil for example, public schools are not reliable, so most parents pay for private schools from kindergarten to high school.

I think the best way is to have clinics for those who cannot have private health insurance. These clinics would charge very little, but would not be free. The doctors who would work there would be younger doctors or retired doctors or doctors who do not mind making less than they would in private practice for a guaranteed 40 hour week and a feeling of satisfaction that comes from helping people (I have a pediatrician aunt who donates one or two days of her working week to work in a free city clinic which caters to the very poor population. My grandfather, also a pediatrician, would always see patients who could not pay).

Lines would be longer, waiting periods for non essential surgeries longer, but everyone would have access to it. For all others who require a better insurance, they could continue paying more through their employers or privately. This is a bit how it works in Brazil, although there are many complaints about long lines and deficient infra-structure in the Brazilian public health care system.

In the years I lived in Brazil, I always had private health insurance. I also do not remember ever receiving bills at home. I would pay my premium, my monthly payments and when I went to the doctor I would be covered. Any exam or test woud be covered by my monthly payments. It annoys the hell out of me to receive bill after bill sometimes months later after any doctor’s appointment here in the US. The communication between health providers and health insurance companies is dismal, and many claims are refused for misinformation. So the patient ends up with the bill.

I am tired of fighting insurance companies and trying to rectify bills that are wrong. I do not remember ever having to do that in Brazil.

So, besides teaching Americans how to deal with electronic voting and alternative fuels, should Brazilians also teach Americans how to have both public and private healthcare for its citizens? Or is the British/Canadian/French model better?

This is a very complex matter with no easy solution. Comments?

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October 15, 2008 - Posted by | Difference between cultures, Health, Politics

7 Comments »

  1. Very interesting post. Personally, having spent some years researching the medical systems of various countries, I think A LOT can be learned from Brasil, in order to BETTER our healthcare here in America. I’m not saying that the healthcare in Brasil is perfect, in fact I haven’t yet found a country that would meet my standards of GREAT healthcare, but I’ve said many times, while battling a very rare Endocrine disease, that I’d rather be in Brasil for testing, and treatment, including brain surgery. The testing protocols in Brasil for certain diseases are FAR ahead of the testing protocols in the US. Here, it is ALL about making the most money, milking patients for money most of them don’t have, and then in the end, not helping them due to the need for more testing, which can take years. I had to test for two years, although suffered since I was a young child to diagnose my disease. I had the classic, textbook symptoms, although doctors here in the US wrote them off. Had I been a citizen of Brasil, Italy, France, or even Cuba, I would have been treated, before I suffered from the greater, more severe symptoms of the disease. WHY?! Because, in other countries, the epidemic of obesity isn’t as great, and so when a child presents with symptoms such as weight gain, it isn’t automatically ASSUMED that it’s from overeating and little physical activity. The doctor’s actually find a CAUSE for the problem, instead of blaming the patient and/or parent. Also, in some countries, including Brasil, “rare” disease are just that, RARE, but NOT impossible to have. The mindset of doctors here, because of the caution of rare diseases drilled into them in Med school is that they’ll most likely never see that many, if any “rare” diseases. It’s not that they don’t see them, it’s that they don’t DIAGNOSE them! Now I know this isn’t always the case, but most often it is. Another thing, Brasil, being a “third world country” had diagnosed the first case of MOMO syndrome, which currently just 4 people have been diagnosed with. 2 in Brasil, 1 in the UK, and a “unconfirmed” case in Florida. Why is this case still “unconfirmed?” Testing, that’s right, more testing, which if in Brasil, would probably have been completed, which would put a stop to the ENDLESS worry and wonder of the parents and patient, and they could go on to learn how to live with this condition, and figure out a PLAN.

    I truly hope that President Obama will look to other countries, hopefully not the UK or Canada, as they arent’ the best examples of a Universal Healthcare system.

    I also think your idea of a small fee clinic with younger doctors and retired ones is a good idea.

    Great BLOG by the way, it’s always an interesting read!

    Obrigada!

    Comment by Nicole | December 19, 2008 | Reply

  2. Nicole, yours has been one of the most intelligent comments I have received. Your portray of what happens here has also been my experience. I was severely disappointed with the commercialism surrounding health in this country, something that, along with education, I considered being above greed and profit. And I am not saying the public health system in Brazil works beautifully either, it has many holes, such as long lines and wait, but my brother had a double transplant (he had diabetes Type 1) done in 2001 totally funded by the government. He did not survive long because it is still a very risky procedure, but the surgery was a success, done at the Albert Einstein hospital in Sao Paulo, one of the best in the country. I also had a procedure totally paid by public health funds in 1988, even being “middle class”.

    I also like the way Brazilian doctors spend time with their patients. I call American doctors “5 minute doctors”. You wait for 30 minutes or more to be seen and they spend 5 minutes with you and have NO interest in any other information that is not pertinent to the problem they are seeing you for. If you are coming to see the doctor because you have a pain in your left arm and then say you also have a pain in the right arm, the doctor will ignore you. They want you to pay for another visit. And since doctors do not see you after hours or on weekends, you usually have to take time off from your FEW American vacation days to go to the doctor.

    Comment by Grace Farrell | December 19, 2008 | Reply

  3. Hey guys let me share my impressions of the US heath threats.. oops system.
    Being a Brazilian living in here for almost a year now (I’m on college where in California) the impression I have of the American commercial health system is really cruel. Me as a foreigner have to pay 600usd per semester to have the most BASIC health care which doesn’t cover that much.

    In Brazil like Grace in Brazil i never had bills at home I used a lot the public health system for long time, now that the economy is better my family has insurance, but even when we did not have the private insurance my 2 sisters that like my mother had uterine cancer where treated and cured not having to sell a house or being billed for life. Even medicaments that we couldn’t afford at the time were provided by the government, my brother recently had a stroke and was in the line for heart transplant fortunately before the surgery could happen the treatment was enough to remiss the situation that now he doesn’t need anymore the transplant. He’s being watched regularly by his doctor in the military hostipal in Sao Paulo.

    I think that here in the US the government closes the eye of the population, most my friends in college had no idea that a South American country could have such developments like free universal health care, advanced state in fuel independence and well established democracy. I still get the same old questions if we are free enough in Brazil to say whatever we want about the president.

    I would like to talk also about the educational system in Brazil. Unlike Grace I had to study I whole life in the public system. And I agree 100% that the public educational system is very deficient with a few exceptions. In Brazil mostly the high school is really deficient but the federal high schools in which I studied despite the lack of budget to keep the laboratories working fine still has great results. But the best example of the Brazilian educational system is the public Colleges and Universities.

    Here in the US I learned that there is NO free superior education. You might win grants from governments and institutions but most people still have to pay to study in Universities and Colleges owned by the Government/State in Brazil no.

    I studied in a public College in Brazil, the requirements to get a position were incredibly hard because the number of students per position. Which is normal because it’s free. The number of free Universities and Colleges still has to grow a lot to provide free universal superior education but compared to many countries we are ahead also on that.

    Although today the number of free Federal, State, Military, Municipal Universities isn’t enough the government came with a good idea to make easier for the most needy population to have access to superior education. If you pass the test (in Brazil you have to take a test for placement in college called “Vestibular”) in a University that is enlisted as institution you get 50% off your monthly bill, plus if you apply to FIES which is the government student financial system the government pays the other 50% and you make social work on weekends like help kids in school at sports, math, languages and others on weekend school, this way you don’t have to pay back to the government the loan and you leave school without debts. Most Americans leave school with a huge debt, having to pay it back, on top of other ridiculous expenses. The requirements to apply to FIES is that you have studied in public school most of your life (like most of the Brazilians), which makes sense because most of the Brazilian middle class can afford better high schools which give you a better preparation to take the free public colleges tests. Also the quotes system was based on a economic status not in race(which is very hard to determine in Brazil because of the racis mix. I’m part Portuguese, Japanese Black and Brazilian Indian)depending on your economical status you can apply also to the number of positions dedicated for the quotes.

    I think that Brazil could be a model for many countries the big problems we still have there are:

    *Corruption, too much money is stolen by corrupt politics, in change but still long ways to go;

    *Low self-esteem, Brazilians still think that most of what is done outside Brazil is better;

    *Payback to society although we have a lot of public services, college for instance the institution asks you to payback to society working in Brazil, but most of us seeing “better” opportunities abroad come to work in other countries seduced by the promesses of more money, well thats very subjective, here in the US for instance the prices of house and health care(the 2 most important needs of a human being)is insanely high, US has easy access to House Loans but it seems like a life-time commitment due to prices of housing here. Not to mention the lack of work rights(or the non-application of them), in Brazil all registered workers(the non-registered depend on the contract between employee and company) with no exception have right to vacation and absence time depending on the occasion(like I’ve heard here in the US by law for the Mother is about 30 days, and none to the father(although many bosses may allow it for the man) in Brazil by law the Paternity leave is 5 days(or until the mother “genitals” are back to normal) and 180 days for the Mother(public and private workers) and no discount on the pay check during these periods).

    *Safety, I’m one of the few cases that have never had anything stolen (I lived in São Paulo and Guarujá south coast of São Paulo). We still have problems like kidnapings and a corrupt police(with exceptions I happen to know lots of people in the Brazilian police. My brother is a inspector of the São Paulo police, and most are really honorable people but the few crooks stain the name of the corporation).

    *Money distribution, due to the lack of education a big part of the Brazilian population still can’t enjoy the benefits of this economic boom we see today. Althought it is changing I myself am a example of this change. My family was poor we lived in the lower middle classes areas of Guarujá Sao Paulo’s south coast me and my brothers all studied in public school some of us studies in public colleges and other’s had to work in the business hours and go to college at night. Today we have a very confortable life and achieved the status of middle class B (Brazil has the classes: poor , middle class A(upper),B(normal),C(lower)). But the opportunities is there. Everyone can do it as long as you have the will to do it.

    I’m not saying that Brazil is perfect, far very very far from that, but we are in the right direction, I’m not saying also that everything is wrong is US here the money distribution is FAR FAR better then in Brazil, I love here and there in Brazil. Every country has its particularities.

    I can’t say I know a lot about the US because I’ve been here for 1 year so far, but one of the things that I most admired in Americans is the fight for the rights… which today I have some regards about. Me being here since Feb 2008 got US in the Election time and Prop8, here in California. And I’ve seen the fight to make a simple right be given to the gay population. In Brazil gay rights exists for long time, ultimately giving the civil union rights in 2007. In words of the current president Luis Inácio Lula da Silva “Acho que nós temos de parar com hipocrisia, porque a gente sabe que existe”(I think we have to quit the hypocrisy, because we know that it exists(gay relationships)).

    In Brazil every “marriage” has 2 steps: the civil marriage(the one by the government is called CIVIL UNION) and the religious(in the church or temple or what ever the religion have). Straight couples always had to have a “CIVIL UNION” in the civil court and then whenever they want have the religious marriage in their church.

    Today the gays have the same rights to have CIVIL UNIONS(rights to pension, inheritance, hospital visits etc) and depending on their religion and church acceptance have their religious ceremony, its becoming more and more normal gay marriage in liberal churches, and thats a choice of the church to accept the ceremony not obligated by law.
    Having all that said, I intended to give my perspective of the Brazilian health system and ended summing up a little of several aspects about my country, sorry have gone a little out of the subject.

    Comment by Gilmar Lima | February 7, 2009 | Reply

  4. Wow Gilmar, very good post. Thanks for the contribution.

    Comment by Grace Farrell | February 7, 2009 | Reply

  5. I’m from the UK and after having lived in Brazil for several years (went with my parents when they decided to retire) assure you that anybody that has to rely on the public health care system in Brazil is doomed. I myself cannot afford private health care, which I consider exorbitant, as I am self-employed. I have spent hours and hours in queues, only to be told there was only one doctor on duty (and not the specialty I needed). The clinics are absolutely filthy. If you’re not already ill you’re bound to catch something there… and the doctors are harassed and often downright rude. Also, except for very simple viruses and such, I have received several wrong diagnoses (once nearly losing my life after having been misdiagnosed when I had what was clearly an ectopic pregnancy), been pumped full of antibiotics (anyone that has used this health care system knows the doctors ADORE to prescribe antibiotics) and wasted long hours waiting to be seen, often having to turn round and go home in disgust. I also suffer from BPD, and have been waiting for THREE whole years to be seen at all… I have just about given up hope of ever receiving any help. I have no idea how the country’s public health care system compares with the US, but I cannot honestly believe it can be any worse than in Brazil.

    Comment by nicola shellard | March 3, 2009 | Reply

    • Nicola, great to hear your perspective. I am sure there are many horror stories like yours, especially in hospitals near the “periferia”, where the slums and poor population lives. Very litle respect for human life. My daughter, who is a medical student at UPenn, is going this summer to Brazil to volunteer in a public hospital. I seriously hope she does not catch anything. I still think it will be a great experience for her.

      Comment by Grace Farrell | March 3, 2009 | Reply

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