Someone Else’s Pain

This morning, I was reflecting on the role of healthcare systems around the world and, inevitably, on the fact that healthcare costs in general are rising. If we look at a semi-private healthcare system like Germany’s, we realize that these health insurance funds automatically need to make a profit, just like in America. And that makes me wonder why a constitutional right — the right to health, the right to healthcare — has to be mixed, if you will, with the need to make money.

The economic crisis that awaits us in the coming years, one that we may not yet be able to see, will most likely cause costs within the healthcare system to rise as well. Inflation in the energy sector is a whip, because it will always bring additional costs into other sectors. It rarely remains confined to energy alone. Just think about how many hospitals depend on electricity and heating to keep their buildings warm and to operate the equipment they need. And when I really think about it, I cannot even remember the last time a healthcare reform was carried out in a European country that was actually in the patient’s favor.

Merz says that doctors in Germany are “Nutznießer” — beneficiaries. It is an expression that has already gone viral. That is the view from his ivory tower in Berlin, where he has lost all contact with reality on the ground. Of course it is easy for him to think that way. The moment he gets a little hemorrhoid sticking out, all he has to do is show up at Charité in Berlin, and they will immediately shut down at least three departments for him and summon every head of department. They will wake up at three in the morning, come to the hospital, and personally measure Mr. Merz’s hemorrhoid.

The reality for the rest of the population is very different. Most patients wait months or even years to get an appointment with a specialist. And these are not the disadvantages of a public healthcare system in which you have universal healthcare. These are the results of policies that are deliberately aimed at reducing healthcare spending. If healthcare is a Grundrecht — a fundamental, inviolable right of the patient — how can you, as a politician, tell people to use healthcare services less simply because you would like to save money? You cannot afford to do that. It is an act that would automatically lead to lawsuits. And so the only truly logical, objective solution available to you is to somehow make access to healthcare more difficult.

If fewer patients are examined by doctors within the same amount of time, costs within the system will fall. Regardless of whether those patients eventually present in much more serious conditions because they will most likely be diagnosed later. The reality is that treating a patient with terminal cancer, in a palliative situation where there is nothing left to do except give them painkillers and wish them a pleasant life, is, economically speaking, much less of a burden on healthcare services than diagnosing three patients with early-stage cancer who will then undergo chemotherapy, radiotherapy, different operations, and afterwards medical rehabilitation, where, in some situations, the outcome remains uncertain anyway. So the logic is, most likely, that the financial policies surrounding healthcare systems are deliberate. Our politicians in general — and here I think I am speaking for a good part of Europe — want to reduce the population’s access to healthcare.

In France, for example, there is a universal healthcare system with essentially one public health insurance system, unlike Germany. However, the system has been changed so that, for certain specialists, patients can no longer simply go directly to the specialist. Instead, they first need a referral or recommendation from their general practitioner. Fine. But then, considering that general practitioners have the right to refuse patients and say that they are no longer accepting new ones, you can create a situation in which certain patients are deprived of the services of a GP and, as a result, cannot gain access to certain specialists either. So how do you solve that problem?

Do you think anyone cares? Do you think the politicians in Paris care about this? Do you think that when one of them gets sick, they have any problem getting a doctor’s appointment? It is exactly the same problem. When Macron’s hemorrhoid swells up, he goes to Paris, to the finest hospital, where even the water they use to wash his ass around that hemorrhoid is probably scented with roses. Now go and tell that to a French farmer living near the Pyrenees, where healthcare coverage is appalling. And if we look deeper into France, at these so-called medical deserts, the situation becomes even worse.

So somehow, our society in general — globally, across the world — is in decay, and you can see it by looking at the state of healthcare. When healthcare begins to collapse, when healthcare begins to stop functioning, when people lose access to medical care and become increasingly sick, that is the moment when everything is getting close to imploding. I am very curious to see how healthcare systems will develop over the next 30 years. I do not want to be pessimistic in any way. In my own naivety, I am still an optimist. An optimist. I still hope that everything will get better. But I also hope that, even if it does not get better, those of us working within the system will still have the necessary resources and, perhaps more importantly, the strength and patience to try to manage the situation as well as we possibly can for the benefit of our patients.

But I am quite skeptical about the direction things are taking right now. Because in the 14 or 15 years that I have been part of this system — and if I count medical school as well, I have spent more than 20 years of my life doing this — I have seen no improvement. I see no political will to improve the system in any meaningful way. And everything always comes down to money. Money. Everyone, everywhere, whenever they talk about healthcare, talks only about money.

I do not remember anyone talking to me about money when I was in medical school, when I went to lectures and listened to different professors. Everyone talked to me about my role as a doctor, about what the patient needs, about what we are supposed to do for them, in a complete utopia. Nobody talked about money. Nobody talked about the financial limitations of healthcare services. And yet the reality we live in today could hardly be more different.

I will end this post with something that has stayed with me over the years from one of my lectures in medical school. As a side note, I studied medicine at the University of Medicine and Pharmacy of Craiova, Romania. There, during one of our lectures, one of our professors asked us, as young medical students, what the easiest kind of pain to endure was. And everyone started coming up with answers: a headache, pain in your leg, pain in your ass. None of us really knew what to choose. Then he smiled, looked at us ironically, and said: “Someone else’s pain. Not yours.”

When a patient comes to you and tells you that they are in pain, it is the easiest pain in the world for you to tolerate, because you are not the one feeling it. And it is incredibly easy for you to brush them off, send them somewhere else, and not take them seriously. But what that professor did not tell us back then was what we are supposed to do when the entire system is in pain. What do we do when the healthcare system itself comes to us with a pain that, apparently, everyone chooses to ignore? What do we do then?