Monday, April 19, 2010

A Medical Dilemma. (No, I'm not sick)

I must make a disclaimer at the start of this post.  I am going to be delving into politically dicey waters on medical care, medical insurance, and abortion.  Please understand that this post is not intended to skewer, lampoon, or pass moral judgment in anyway.

With our recently enacted (I should say shoved down our throats) health care overhaul (that's the only partisan thing I'm going to say) I think it is important to take a moment to study a case that is currently happening to one of my friends here in Korea.  Korea has socialized medicine, it is cheap, it is available to all, and it is a single payer system.  The government taxes you and gives you health care.  It is required by every single person to carry and have health insurance.  Foreigners working in the country are required by law also to purchase this health care.  Now there are several wonderful things about the health care system that Korea has.  For starters, it's cheap.  By cheap, I mean ridiculously cheap.  An uninsured person (i.e. foreigner who just arrived in country) can receive a physical that includes a urine test, blood test, and chest x-ray for 20 dollars.  You try and get that type of service done in the United States without insurance for 20 bucks.  Access is universal, if for some reason you do not have insurance, the prices are so low that you can still receive treatment.

Now, I have just given a relatively glowing assessment of the Korean medical system.  However, there are several drawbacks to this system.  For starters, Koreans have become so dependent on hospitals that when you have a common cold, it is expected that you go see your doctor.  In fact they think it crazy that when I have a cold I don't go to the doctor.  Now when I state go see your doctor, it is not your primary care physician that I am talking about.  We're talking about going to the hospital and seeing the first available doctor.  This has lead to an overburdened system which while, not rationing care, the sheer volume of business has reduced the quality of care given.  It has also led to the practice of issuing drugs for the smallest of ailments.  Now when you go to the doctor with the common cold you are given three days worth of anti-viral or antibiotics.  3 days only.  You cannot go back and get more without being seen by your doctor again.  While this cuts down on the surplus of prescription pills most of us have in our medicine cabinet, where is the fun in that?  The simple fact is that three days worth of pills doesn't do anything.  Even when dealing with Pneumonia you are issued three days worth of pills.  All this does is make the virus/disease/bacteria angry.  It doesn't cure you, it just makes you feel a little better for a few days then get sick again.

Now, with every medical system there are benefits and drawbacks.  However, the case of my friend is quite unique, and I think worthy of discussion or at least some prolonged thought.  Now I must say again that I am not passing moral judgment on these people, and I request that you do the same.  Ok, here we go.

My friend, who shall remain nameless, is currently married and the couple is expecting their first child.  Now I must state right now that neither of them are Korean, but both carry Korean medical insurance.  The couple was told for the first several months that their baby was fine and that it was developing nicely.  Then, in the 5th month of the pregnancy the couple found out that the child has a severely cleft lip, to the point where the nose has been completely disfigured, and a severely cleft palate which has potentially caused deformities going all the way into the child's throat.  This is their problem, and their issue, but I believe that it can be informative to the rest of us also.

Here are their options in no order of significance:

First: terminate the pregnancy.
Second: have the child and the give it up for adoption.
Third: have the child and keep the child.

These are the same options that everyone of us have when we are faced with a pregnancy, wanted or unwanted.  I must state that this was an unplanned pregnancy, but a wanted pregnancy.  Now every one of these options has severe drawbacks and risks involved.

The first option, which is incendiary and honestly I don't agree with, is really not much of an option.  Given the fact that the child is now in its 3rd trimester, the procedure would probably be a partial birth abortion which is just a horrific procedure.  Under Korean law abortion is legal, but restricted on a case by case basis.  For my friends, abortion has been deemed illegal because the defect is considered minor.  A government bureaucrat made this decision.  If the couple decides they want to have an abortion they will have to go to another country to have the procedure done, or try to bribe a doctor here in Korea to get it done.  China is looking like the best option for an abortion.

The second option is also not much of an option.  Giving up a child to be a ward of the state is one of the hardest decisions any parent can make.  Moreover, the Korean orphanage system is very much the same as what you find in the United States.  Only a small percentage of the children are adopted, and those that stay in the system are at a severe disadvantage.  It's a tough option, but it is an option.

Third, and this would seem like the only true option for this couple, is to have the child.  However, even with this, there are severe drawbacks.  The first problem is this.  The child is going to need at minimum 5 surgeries to fix and repair the cleft lip/palate.  These surgeries will cost at minimum 800,000 dollars.  The Korean medical insurance will only cover two of the surgeries because they deem every other surgery as cosmetic only.  These cosmetic surgeries include a bone replacement for the upper part of the palate because there is no bone there.  All in all the surgeries will cover two surgeries that only fix roughly 35% of the problem.

Now, I mentioned the cost being 800,000 dollars.  If you minus the two surgeries the total cost will still be roughly 500,000 dollars.  This does not include the years of speech therapy that will be needed, and how many other things will be required when this child is brought into the world.  Every choice is bad, and in reality there is no clear answer.

Here are some of the drawbacks to each option.

Abortion:  Regardless of your moral view of the option, the simple fact is that an abortion for this couple is illegal in Korea.  They are having to look at going to another country, with a far worse health care system if they want to pursue this option.  Also, this is not three weeks into the pregnancy, it's 6 months.  The child for all intents and purposes is alive at this point.  It may not be fully developed, but it is alive.

Adoption:  Giving children up for adoption happens here, just like it happens everywhere.  However, given this child's problems, there is little to no chance of  her ever being adopted.  Most people only want to adopt cute children.  They don't want to adopt a child with a cleft lip/palate, even with the two surgeries the child will still likely not be adopted because she is not a Korean product.  Moreover, the child will not receive the medical care it needs, nor the emotional/physical therapy that it will need as a ward of the state.  Life for the child in this option will be exceptionally challenging and the child will experience severe ridicule.

Having the child:  As I said this seems like the best option, however, it may not be.  Korea is a wonderful country and I have grown to love this place like a second home.  Yet, Korea prides itself on having a singular culture and being a singular people.  There is almost no space for the individual in this country if you are Korean.  This child, will experience severe harassment and will have a very tough time in school.  The child will experience this because it is a mix between American and Filipino.  The child will not be Korean, but will be attending Korean public schools.  The child will likely have a scar on its face will look different due to it's heritage also.  You remember how tough childhood was for the "different" students.  Also, the couple cannot qualify for loans here because both of them are foreigners.  If it was a marriage between a Korean and a foreigner then they could qualify for loans.  Simply put, on a salary of 24,000 dollars a year, you cannot afford 500,000 dollars in surgeries.

The question becomes, do you have an abortion and all that entails, do you give your child up to the state knowing that it will have a very tough life because of your choice, or do you have the child knowing that it will be disadvantaged and that you cannot take care of it in the way you want.  This is my friends dilemma.  They have no good option open to them, and are facing severe criticisms from their families with any option that they take.

The reason I'm bringing this up is because I believe it brings up some important questions.  This is where a lot of people want American health care to end up.  They want a single payer system where the government provides your health care and it becomes just another tax like social security.  These are the types of problems that people can run into with health care, be it through a private company, or a federal government.  The question that I think is important, is who should be making the decisions.  Should a government policy be dictating medical care, and making decisions on what is best for you and your family.  Should an insurance company be the ones making decisions stating what care you're approved for?  Should it be solely up to yourself and your physician?

There are no easy answers here.

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