Tag: healthcare

Swiss Monsoon: Ashley Madison Leaks, Minimum Wage, And Healthcare [en]

[fr] Les fuites de comptes Ashley Madison et pourquoi je ne participe pas aux réjouissances concernant la mise à nu des infidèles. Mes petites théories perso sur le salaire minimum (fausse bonne idée) et le système de santé suisse (bon équilibre des pouvoirs).

After a tropical summer, the monsoon. It’s pouring all its worth outside. No, it’s not very pretty.

Swiss Monsoon

Ashley Madison leaks. Another opportunity to drag “nobodies” into the spotlight and shame them. Oh, the horror of the affair! I don’t have proper stats handy, but cheating is something roughly half of people do at some point, if my memory serves me right. If it’s not more. It’s a small crime. Yes, it’s ugly, it’s a betrayal, a breach of trust, and can even endanger your partner if you’re having unprotected sex. Lying is ugly (don’t I know it). But in the grand scheme of things, it’s a commonplace transgression. That usually has a story. Anyway, my purpose is not to discuss adultery in length or excuse it (go read Dan Savage again), but to invite those who may be perched there to descend from their moral high horses.

Does being on the Ashley Madison leaks list mean you should be outed to all those who know you as a cheater, maybe ruin your marriage beyond repair, and even damage your career? (And just sayin’ — not all those with Ashley Madison accounts are cheating scumbags.)

So, I will not gloat about these possibly lying and cheating people who are now outed to the world. Not because I think they have done no wrong, but because I do not think that the public square should be the one to judge their crimes. (Read my patchwork post from the chalet for some background.)

And then there is this:

Josh Duggar? I will allow myself some schadenfreude, given the guy has made a career shaming others for their sexual orientations, preferences, or even gender. He’s not a nobody. He’s a celebrity with a big PR machine. Different can of fish.

I didn’t just want to talk about Ashley Madison — I actually took notes of the various things I would blog about in my “next post, this week, oh next week, ouch another week has gone by”.

There’s a very interesting Planet Money episode on the birth of the minimum wage. It’s funny that for the US it is so obvious that there must be a minimum wage. Yeah, guys — it didn’t always exist. Here in Switzerland, there is no minimum wage. On the one hand I think it’s important to ensure people are paid fairly. But on the other hand it seems to me that setting a minimum wage makes us run two systemic dangers:

  1. The first is “tampering with the system” of offer and demand. This is not a very palatable point of view, and it’s certainly shaped by the fact Switzerland has a very low employment rate. I like to believe that if something is really underpaid, people will not take the job. But I know this is wishful thinking, to some extent. When you are desperate, you will even take a bad deal. But does artificially raising the bar for the price of labour solve the underlying issue, which might simply be that there is just not enough work for everybody anymore, which may call for much more radical solutions than a minimum wage?
  2. The second, way less far-fetched, is priming. When there is a minimum wage, this in a way sends a signal that if you’re paying that amount, you’re “OK”. What are you complaining about, you’re getting the minimum wage! I worry that if we do set a minimum wage, salaries which used to be just above might end up being “attracted” to that theoretical minimum. If everybody is paying minimum wage, you don’t have much choice but minimum wage. With no “reference point”, employers will probably be more free to compete to attract employees by varying how much they pay. I realise this is coming back to my first argument, and assuming a system in which there is “enough work”, so I’m not sure how things hold up when employees are competing for just any kind of employment.

Does anybody know of research around these questions? I’d definitely be interested in reading more on the topic.

This slightly “political” topic brings me to one of my little theories about the world. It has to do with healthcare. Healthcare has always been of a particular interest to me, probably because I use medical services quite a bit, and maybe also because I had heart surgery when I was a little girl and quite liked my hospital experience then.

I have people close to me in various countries, not the least my grandparents in the UK, and close friends in the US (and we hear enough horror stories about US healthcare, don’t we). I’ve lived in India (OK, extremes). I am in love with the Swiss healthcare system. And I have my little theory about why it is so good.

First, here’s how it works:

  • basic insurance (which actually covers a lot, determined by law) is compulsory; if you’re really too broke to pay for it (300-400 CHF/month roughly) your town will normally pitch in
  • when you go to the doctor, you pay the bill directly, then send it to your insurance which reimburses 90% of it; every year, you pay the first 300-2000CHF of your bills before getting reimbursed (you choose the “franchise” and your monthly insurance bill is reduced if you take a higher one)
  • for fancy stuff like alternate healthcare, private rooms in private clinics, etc, there are optional “complementary insurances”; they can refuse to take you on, but once you’re on, you’re on

So, it’s quite expensive, but the quality of care is really good. The reason I think it works well is that there is a balance between those parties who have a vested interest in costs being high (doctors etc.) and those who have a vested interest in keeping it low (insurance companies).

This means:

  • nobody can get dropped by their insurance because they get sick, or some “preexisting condition” BS
  • your insurance is not tied to your employer
  • “everybody” has insurance (quotes, because it’s probably not the case for a tiny marginalised fraction of the population)
  • you are free to see the doctor your want
  • no huge waiting lists for specialists, or hospitals, or doctors, or whatever
  • no quotas (your “GP” has more than 8 minutes to see you, and will just charge more if you end up needing a 45 minute consultation)
  • you get the bills, so you have an awareness how much your healthcare is costing
  • the quality of healthcare is high pretty much everywhere.

It’s not perfect. Ask Swiss people, they will complain about the healthcare system all day if you let them.

For me, the US is an example of a system where the people who have a vested interest in raising the costs have too much power. That’s how you end up with ghastly expensive bills for things like a drip, and insurances which have no incentive to defend your interests, as they can seemingly easily get rid of you if you become too expensive.

We see this in two areas here in Switzerland:

  • dental care
  • pet insurances.

Dental care insurances are not compulsory and not regulated. We are used to paying our dentists out-of-pocket. Having anybody in this country look at your teeth costs an arm and a leg, and insurances are commonly perceived as “not interesting” to have. Easier to drive to France (that’s what I do).

As for pets, we have seen insurances show up these last years. I got one for Tounsi as he was young enough, and it did serve me well as I ended up with thousands of francs of vet bills a couple of summers back. But the insurance has a clause for “chronic conditions” where they only pay for care during the three first months, and then they don’t cover it anymore. Sounds a lot like something one might find in human insurances on the other side of the pond?

As for the UK, it suffers from the opposite problem. As everything is state-run, and paid for by taxes, the parties looking to minimise the cost of healthcare end up having too much power. You end up with ridiculous quotas, sub-standard care, huge waiting lists. Sure, it costs less, but the quality of healthcare takes a dive.

What do you think of my “perfection in the balance of power” theory? Specially interested in your views if you’re an expat and have first-hand experience of different healthcare systems.

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Healthcare in San Francisco Experiences [en]

[fr] Expériences nettement plus positive avec le système de soins ici à San Francisco.

After my [trip to Walgreens in Austin, TX](http://climbtothestars.org/archives/2008/03/10/a-trip-to-walgreens/), I honestly hoped I wouldn’t have to deal with anything healthcare-related in the US, ever again. Oh well, I was wrong.

A few days ago I started having a sore throat, and went down to the Walgreens on First and Mission (I’m in San Francisco) to ask about some antiseptic spray or something. I had braced myself for another less-than-pleasant experience, and was positively surprised when a nice and smiling pharmacist listened to me, discussed options, gave me advice, and made me feel like she was happy to do her job. Quite a change from the grumpy guy in Austin, who maybe needed a job change!

A day or two later, I realised that one of my toe nails was starting to become way too painful (said toe nail was traumatized on the judo mats some 10+ years ago, and has been bothering me at times since then — but this was starting to be really problematic). I tried heading for the pedicure first, who politely turned me away after a few prods at it and a few yells on my part: it was already infected, and I needed to see a doctor. Oh, heck.

There was a Walgreens nearby, on 4th and Townsend, so I dropped by to ask about doctors. Where/how/what? A very nice and friendly pharmacist (wow, two of them in the same city!) told me to head for the clinic behind the AT&T ballpark (24 Willie Mays Plaza) to see a Dr. Zee (or Zak — short for Zacharewicz, and easier to pronounce). I found the clinic quite easily (between the ballpark and the canal), checked in as best I could (forms are clearly not designed for patients visiting from abroad), and waited — quite a bit, but hey, I was a walk-in.

A friendly nurse/assistant (?) showed me in, asked me a few questions about what brought me here (I got to tell her the sad story of my poor toe nail) took my blood pressure, and left me to wait a few minutes for Dr. Zee.

Dr. Zee was as nice as I’d been told. She listened to my story, prodded my toe nail a little, thought a bit, and gave me instructions for warm soapy foot-baths, keeping me toe out of the dirty San Francisco street-dust, and a prescription. A really lovely doctor that I heartily recommend if you’re in SF and in need of one.

I left, $90 poorer but feeling almost warm and fuzzy about healthcare in San Francisco, and decided to drop in at the Walgreens which had sent me to pick up my prescription. That’s where I learned that I had to wait 15-20 minutes to get my medication (some antibiotic cream) instead of just being able to hand in the prescription slip and walk out with my meds (as I expected, based on my — limited and Swiss — previous experience). I decided to drop in later that evening as I was going out.

Fast-forward a few hours. I’m back at Walgreens to pick up my prescription. I’m told they can’t give it to me, because the doctor did not specify on the prescription if it was *cream* or *ointment*. They’d tried to call the doctor’s office but it was already closed, so I had to wait until tomorrow. I said I really didn’t care if it was cream or ointment, they could give me either. They said they couldn’t, that the doctor needed to confirm if it was the cream or ointment. I insisted, arguing that the difference in between cream and ointment really wasn’t important in this case, that all I cared about was to be able to start the treatment for my toe as soon as possible. The pharmacist (who was a different one from the one who recommended Dr. Zee to me) kept on like a broken record, telling me they couldn’t make the decision or give me one or the other. I insisted more, saying that no insurance would bother them about this because I was from abroad and would be paying myself, that I wasn’t going to sue them, etc. No success: the doctor had to decide, **by law** they were forbidden from giving me the medicine without her confirmation.

I stomped out, feeling powerless and furious, then stomped back in to ask for my prescription. If was going to have to wait until tomorrow for my prescription, I would go to a pharmacy closer to where I was staying, like the one on 1st.

So, this morning, after 11 hours of sleep (!), I went down to the Walgreens on 1st to get my prescription. I also needed some other medication for my cough and eye. The pharmacist (honestly not sure if she was the same one as the other day) was lovely. She actually took the trouble to explain me how the medication I’d been recommended for my eye in Austin worked (basically, does nothing else than shrink the blood vessels, so that it’s less red). Checked that there was no discharge, and said “OK, so it’s not conjunctivitis then” (a contrast with “I can’t tell you, you have to see a doctor” or some other stupid by-the-book answer). Discussed the other drug I needed with me too. Nice and helpful.

And when my prescription arrived (less than 5 minutes later — and I don’t know if they called the doctor’s office, but they didn’t bring it up) she mentioned that it was quite expensive: $70. I told her I was probably going to back out then, because it was just for an ingrown toe nail which had already started to get better with the soapy water baths. She agreed with me that the cream was maybe a bit overkill given that, and that I’d probably be OK with over-the-counter antibiotic cream. *Over-the-counter antibiotic cream?!* Yes, that have that here.

So, overall, a much more pleasant experience of healthcare services here in San Franciso (despite one episode of “we follow rules, here” broken-recorditis).

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