Thursday, July 25, 2013

A Cursory Look at Health Care Costs and Services

Health care costs in the United States are a common topic of conversation among expatriates here in Peru. Many of us in our group are getting up there in age and visiting clinics more frequently. And most of us know of Americans who come to Peru when confronted with major surgery or treatment for a serious illness or disease. In every case the story is the same…the cost of transport, hotels and restaurants added to the cost of medical treatment is still significantly below the cost of medical care alone in the United States.

Not too long ago out of curiosity I contacted a well-known major insurance company and asked for information for a middle of the road health insurance policy for Maribel. The quote was $375 per month with a deductable of $3,000. The agent added that the monthly premium could be reduced if we would consider a larger deductable such as 6, 8 or $10,000. Have we really reached a point where we can casually talk about a $10,000 deductable without going into shock? According to the latest census the median income in the United States is $50,054. A $10,000 deductable is 20% of that income, and for the so-called lower middle class blue-collar worker with an income of $30,000 or less it’s at least 33%. Who can afford that cost; beside a monthly premium of $300 or so?

Let’s leave the realm of generalities and look at some medical services and expenses that I recently incurred in the United States and Peru.

A week prior to a visit to the United States I pulled an upper back muscle while doing weight lifting exercises. The occasional stabs of pain were uncomfortable but bearable until the strain healed itself – so I thought. Two weeks later I awoke in a Wisconsin hotel room literally unable to move even a finger without triggering excruciating waves of pain. Twice in my life I’ve experienced pain that I rated a 10 – appendicitis resulting in an emergency operation, and nerve pain from shingles. This pain equaled them. It took an hour just to get dressed and into the car of a friend, who drove us to a hospital emergency room. There I was given a muscle relaxant injection and a 5mg diazepam pill. The doctor also wanted upper body X-rays to rule out causes other than a muscle strain. Verbal and written instructions called for diazepam to be taken three times daily as needed and for 800mg of ibuprofen three times daily for pain. Costs amounted to:

Emergency room services…$409
Diazepam -10 pills…………….12

The pain gradually disappeared over the next two days but resurfaced three weeks later in Chiclayo.  Maribel phoned a doctor friend who recommended a clinic and orthopedic doctor. In Chiclayo, in private medical clinics, you pay in advance for an appointment. To see this particular doctor, who is both an orthopedic surgeon and traumatologist the consultation fee is $36; about three times the fee of a general practitioner. The doctor concluded I have a severely contracted muscle and prescribed Arcoxia (etoricoxib) and Tensodox (cyclobenzaprine) for seven days. He was critical of the doctor in the United States for prescribing ibuprofen. He also said therapy was necessary to “teach the muscle to relax” and recommended a therapist, whom we phoned and visited the next day. After an examination and some discussion the therapist said I would need at least five sessions consisting of fifteen minutes of muscle manipulation (I call it muscle mangling) and twenty minutes of electrotherapy. The cost for each session is $7. I’m through four sessions and am vastly improved, though even as I type this I can feel that muscle pinching me, as if to say, “go ahead…make one wrong move and I’ll contract again like you wouldn’t believe.” Anyway, the cost of treatment in Peru has been:

Therapy ($7x5).......35

I am not suggesting that costs can be compared because the services are different, but I think conclusions can be drawn. I know that in the United States you're not going to find an orthopedic surgeon/tramatologist who will consult for $36, nor a physical therapist for $14 per hour. The only remaining question is the quality of health care and I'm sure those Americans and others coming to Peru for treatment would join me in saying that health care here seems to be comparable to that in the United States.

Tuesday, July 16, 2013

Been to Hoosick Falls lately?

If not you’d better hurry because the village is seriously considering dissolving itself as a unit of government. The problem as I understand it is that the village has been experiencing negative growth for a long time (the present population of 3500 is half of what it was in 1910) and there is no longer enough revenue to provide basic services. Don’t know what affect that would have on the physical village or its inhabitants but I hope it wouldn’t change because it’s a fun place to visit.

We were in Hoosick Falls because we’d driven from Brattleboro Vermont to Berdnardston Massachusetts for an early breakfast, then drove to Bennington Vermont to check out the museums and the Battle Monument after which we had brunch, and decided that it would be cool to eat a late lunch in New York. We chose Hoosick Falls mostly because it was close, but also because we’d learned it was the home and burial place of Grandma Moses (more on that later).

Approaching Hoosick Falls from the east on Route 7 will take you past the Big Moose Deli. We didn’t stop, but there were a ton of cars parked outside and lots of photos on the internet so I assume it’s a popular tourist attraction. What it does is create the expectation that maybe Hoosick Falls is a fun place to be. And we did enjoy our visit though I think we brought most of the fun with us.

While eating lunch at the Falls Diner on the outskirts of town we inquired about the location of the tourist information center: a sign on route 22 indicated there was one, and about the location of the grave of Grandma Moses. We pretty much got blank stares for responses. Undaunted, after finishing lunch we set out in quest of Grandma’s remains.

The Hoosick Falls downtown area presents a pleasing appearance. Streets and sidewalks are clean and the building exteriors are well maintained. It doesn’t at all look like a dying town. But where was Grandma Moses? People on the streets were familiar with the name but nothing beyond that. Having driven through the town twice we were about to give up when I spotted a senior center. Surely seniors would know about Grandma…after all she died in 1961, not all that long ago. I asked the woman at the desk if she could direct me to anything in town related to Grandma Moses. After a few moments of hemming and hawing she admitted she vaguely remembered hearing the name. But she was young. She more than made up for her lack of knowledge by taking me into a large room where a group of about a dozen seniors were engaged in various activities. The young woman announced that “…this man is from Peru and looking for anything to do with Grandma Moses.” Silence. Everyone was searching the faces of the others, apparently in the hope that someone would know something. After a few moments Paul stood and volunteered that he knew where she was buried because his parents were “….only a few plots away.” That broke the ice and there followed about 10 minutes of warm conversation. Finally Paul offered to show us the way to the cemetery and we turned to go. I will never forget the comment a woman shouted out as we were leaving…”Come back and visit us sometime! We don’t know much but we’re friendly!”

We followed Paul to the Maple Grove Cemetery where he led us to the grave. Both the headstone and a commemorative plague had accumulated a coating of mold and were difficult to read. We happened to have a brush in our car and used it to remove the mold as best we could.  The cemetery is located on a hill and Grandma’s grave appears to be on the highest point. Paul used the view to point out various buildings and places and to talk about the glory days of the town.

Just one block from the cemetery is the Ice Kreme Kafe. It was a hot afternoon and after the work of cleaning Grandma’s headstone (I wonder how many people can say that) we stopped for a cone. Maybe it’s the clock, or perhaps what looks to be an old railroad station sign. But for whatever reason this photo is one of my favorites. Hoosick Falls was a memorable experience. 

Saturday, July 13, 2013

About Bellows Falls Vermont

We began to notice the difference shortly after entering Bellows Falls from the south on highway 5. We had left the town of Brattleboro, where we were based during our recent visit to Vermont only a brief 30 minutes ago. Though the towns are only 20 miles apart, it is much more than distance that separates the two.

Brattleboro, like most small New England towns has its history and has attempted to capitalize on that history while encouraging modern growth. That it has done that successfully is shown in the downtown area where the old stands alongside and merges with an eclectic, urbane, cosmopolitan atmosphere reflected in its buildings and inhabitants. Much of the literature available at the welcome center and chamber of commerce stresses the existence of a “sizable and hip artist community.” Walking the streets it’s not difficult to equate the town’s culture with parts of Boston located only 100 miles to the east. Brattleboro speaks of a past and a present. Bellows Falls whispers only of the past.

We were in Vermont both to pursue our ancestors and to explore the offerings of the state. This photo of the Bellows Falls ‘square’ circa 1908 is what our grandfather would have seen when he arrived in 1910, having decided to leave forever the tiny village of Jaskiewicze in what was then Russia and today is Belarus. Grandfather Michael was coming to join his brother John who had arrived a year earlier along with hundreds of other immigrants to work at the huge International Paper complex. In 1910 the economy of Bellows Falls was growing quickly and was based on largely unskilled labor. Beside the paper mill there was the Vermont Farm Machine Company…a world leader with patents on several types of farm machinery, and many other employers eager to hire the immigrants arriving daily at the train station.

The new arrivals needed housing which resulted in an explosion of three, four and even five-level square multi-family buildings being erected throughout the town. Most of these still exist today in various states of repair or disrepair. In this photo is a house where our grandparents lived in 1917 - 1918.

Bellows Falls was a healthy and vibrant if somewhat raw community but all of that changed abruptly when the paper mill decided not to deal with a labor strike and instead closed its facility. That closure had a mushrooming effect and before long the Bellows Falls immigrants were forced to look to other communities for employment.  In our grandfather’s case he moved to Windsor to work at the Cone Machine Company, and it was here that our father was born. For reasons we can only guess at the family moved back to Bellows Falls two years later.

Beside the economic woes in 1918 an influenza epidemic ravaged most of southern Vermont. Our grandmother Teofila was one of its victims. She died on October 26, 1918 at the age of 25 but not before giving birth to three sons. For me one of the biggest highlights of this visit was the moment we discovered her grave marker at St. Charles Cemetery in Westminster Vermont. We were also able to locate most of the houses they lived in; the church they attended and the factories grandfather worked at.
This is the Bellows Falls square today. There is a different clock tower; the streets are paved and the hoop skirts and horses are gone but our grandparents would have recognized it. And they probably would have noticed the lack of activity. Walking main street in Bellows Falls is like walking through a museum. It feels like a representation of what used to be. There is an occasional person on the street and a car passing by. There is a Subway restaurant and a couple of other small businesses open, but the feeling is that they are the reluctant ‘last blooms’ on the tree among the many vacant store fronts and are waiting to fall. The welcome center was closed on two consecutive days and no one we asked could tell us when it would be open. Even the people in the businesses we entered seem to be just going through the motions; showing little interest in their visitors.

There are many things of interest to see and do in southern Vermont and we spent many enjoyable moments discovering them. Some of them I would like to revisit and spend more time exploring. While Bellows Falls was a necessary and enjoyable stop on our tour it is not on that list.