Unlike popular belief, direct democracy started long before politicians associated with the military wing of Brazilian politics lost its battle over the hearts and souls of locals. But in the late 1980’s, the last vestiges of military rule had been wiped out. But not their policies of hyperinflation. But as a new constitution was drafted, certain positive rights were added to the final document, prompting “public health” to play an important role in the building of a new nation.
“Health is a right of all and an obligation of the State,” the documented guaranteed.
By late 1990, a law had been added to the books, prompting the launch of Brazil’s “Unique Health System,” or SUS in Portuguese.
As a child born into a family of doctors and healthcare providers, I remember the conversations around the dinner table. The worried tones and the discussion revolving around the growing demand for health service providers and the government’s chronic lack of understanding of the medical profession. In the beginning of his career, one of my uncles — a surgeon — was often forced to work for 48 hours straight without rest. At the time, he was employed by the publicly funded health system, having to travel from one hospital to the next without pause. When he finally fell asleep at the wheel and found himself pinned under a truck, breaking every single bone in his body, he knew it was time to go to the private sector.
Like present day America, Brazilians were largely reliant on the publicly funded system. “It’s a right,” they said. But a private system was also available. Not without having to abide by strict and oftentimes burdensome regulations that artificially pushed the cost of care and insurance up.
When I moved to the United States, the last thing I expected to experience was difficulty in finding affordable care. I thought that even if I couldn’t afford seeing a top-notch physician in a reputable hospital, I could still take solace in the fact popular community clinics were still around. But as the Affordable Care Act rolled in and private charity organizations began suffering greatly due to the new demands, the publicly funded — even if partially — health care system in the country became the go-to place for most low- and middle-income Americans and immigrants. The result? An unsustainable reality.
As mandated and heavily subsidized health insurance becomes unaffordable, more people crowd community clinics, other partially funded institutions, and emergency rooms. The overcrowding leads to worse care, which in return, leads to lowered life standards.
During one of my last visits to one of these crowded community centers, I experienced first-hand a reality I’m already well-acquainted with: Total lack of attention to what the patient is saying.
As I waited for three hours to be seen by anybody for a simple blood test, I was taken aside by a social worker, asked terribly private and unrelated questions, and then urged to take the government’s money to pay for my $35 “exam.” Once I explained all I needed was a simple blood test and that I was ready to pay for it (with money!), they sent me back to the waiting room where I waited for another 40 minutes to be taken to another room where they asked me for a urine sample.
“How about my blood test?”
“We’ll see what the doctor says.”
“But all I wanted was a blood t–”
“Here’s the cup and a couple of hand wipes. That‘s the restroom.”
After another hour in the waiting room, I was finally able to talk to a physician. “He’s the doctor,” I was told. No name, no introduction. During the entire exchange, he asked the same questions I had been asked a couple of hours earlier. And like the nurse before him, he put all of the information I repeated to him in the computer. But whenever I brought up a concern, he interrupted or moved on to the next item on his list. It was only after he left the room that I was told he was not coming back. But the nurse was nice enough to come by to let me know they would, after all, let me have my blood test.
Toward the end of the ordeal, the nurse approached me. She needed to schedule an appointment for an exam I never requested and was never brought up during the “conversation.”
As I walked out of the clinic — nearly 4 and a half hours later — I overheard another patient discussing with the receptionist.
“I didn’t set an appointment for a test, I need to talk to a doctor.”
“It should take a few more hours.”
“But my appointment was 2 hours ago!”
As I stepped outside, I saw a dozen more people waiting around the entrance of the clinic. “Too crowded in there, makes me sick,” a Hispanic lady told me in Spanish. “What are you here for,” I asked. “A blood test,” she murmured.
While I’m lucky enough that one of my employers may soon be able to help me get health insurance, I’m still in awe that, unlike the many choices of restaurants I have to choose from, I’m still not able to pay for the care I need à la carte. But because health became a right, it also became a burden instead of a competing service. Now, people who need it the most, are suffering. Because someone up there told them that health care was a right.
If you visit the Yelp pages of these popular clinics, the reviews are the same: “Worst service I’ve ever had.” And these are not rich kids writing these comments. They are low- or middle-income individuals, who are often Latino or black. How is it that when we are forced to go with the “free”option, we admit that health care is a commodity, but when we cast a vote for a popular candidate promising everyone more free health care, the service all of a sudden turns into a right?
It’s still a mystery to me.