I think that it can be a good idea to examine best practices of other countries. However, most countries' problems are so unique as to require a local approach. So while BG can examine various countries' health care systems, ultimately, reforms need to happen in the context of the country's current situation. Ideally, BG will find it's own solutions, which could potentially be more innovative than just doing what someone else does.

"First of all, the U.S. has 50 different states, and there is this perennial problem of state vs. federal in all things."

I think that this is the core of the problem, although not many realize it. This is a major conflict of interest in that you have a locally elected officials in charge of the Federal government. It really is like putting the costumers in charge of the bank - probably workable 100 years a go, but in today's setting is extremely dysfunctional. This is why the Americans keep talking about their "broken government" but [...]

Read the full comment no one would dare to bring up the real culprit - the fact that the US has the oldest, unchanged and hardly reformed, form of governing still in use in the whole world.

This is why I find it so stupid when some folks push for "Americanizing" our system. "Locally elected and accountable" officials is just a code word for conflict of interests between two different Gods - that of your party and National government, and that of the ones that actually send you there - your home voters. BG is better off with MPs loosely associated with various locals and not being terribly dependent on local electorate.

This is among the reasons why little can be meaningfully reformed in the US, including Health Care with all of its competing players that I pointed out below. People bitch about the slow progress of reforms in BG, and while I too wish that things can go faster, one has to stop and think about the staggering amount of changes that we had witnessed in BG in the last say 15 years. It's really nothing short of attempting to change EVERYTHING we know.

Not a small feat at all...

Well, I think that in regards to the U.S., there is a rather large amount of innovation, research and advanced techniques that can provide truly outstanding care to those who can pay for it. Of course, there are huge problems with our health care system. I agree with Valeri in that what Obama has proposed is in no way going to reform the system, and in my opinion, will only make things worse. Free health care isn't free.

It's very tough for a large country to revamp it's entire way of doing business. First of all, [...]

Read the full comment the U.S. has 50 different states, and there is this perennial problem of state vs. federal in all things. The medical and insurance industries are heavily regulated and as noted earlier, it's a very complicated system for all involved.

I was hospitalized in another western country outside of the U.S. and while they thought they had the best "free" government health care system in the world, I had a very tough time agreeing with them and I was even paying for private insurance.

Stefcho note how you say:
"while it's true that our system has it's problems, it has continued to be the best system in the world."

and that Brit below says:
"Thank goodness for the British N.H.S."

What is it with the Anglo speakers and their outmoded patriotism? Most Europeans are much more realistic and pessimistic about their countries. We all have problems and we in BG just have different types of problems. Obama is a lefty, but there is an issue with the US health care and it's [...]

Read the full comment structural. Nothing Obama is pushing for will solve it.

No system where the consumer isn't the one paying for the service can survive for long, because it lacks the basic laws of human economic interaction. Remember, a Third Party, means that someone is getting screwed - that's always the case! Three people doing business - there must be a designated fool - Murphy's law.
You have more than three in the US. You have the hospitals, the doctors, the insurance companies, the corporations paying the premiums, the government (medicare and such) and only then the patient with his meager co-pay. It's almost impossible to know who's doing whom. That's where the $28,000 for problem free delivery comes from - two days in the hospital...

Extortion is a way of life for the US health system and everyone is extorting from everyone they can... 300 leva for the BG doctor, under the table, is nothing and in some ways, it brings back some market normalcy in the relationship between patient and provider.
That connection is completely lost in the US. The patient is but an extortion tool for the doctors, hospitals, lawyers and others, and yes, it doesn't solve our, Bulgarian problems, but it does put things a bit in perspective. Our problems are ones of quality, which is dictated by the general productivity, which is pretty low, hence the health care buying power. Yours are systemic.

Valeri, while it's true that our system has it's problems, it has continued to be the best system in the world. Is there finacial corruption to Drs to purchase expensive machine's? Sure, however they are used for the benifit of the patient as well as the Drs ability to make money. I feel bad for the Bulgarian Drs, while undereducated they still deserve to be paid more for what they do, I didn't mean to make a blanket statement about "all" Bulgarian Drs but most are extorting patients in order to survive. I'm sure there are many very dedicated Drs [...]

Read the full comment that try to do there best in the work they do but they are limited in their ability to properly do the testing they need in order to treat the patient properly. I'm not just saying these thing to upset anyone or to start a scandal, I've seen it first hand with my own eye's. I worked very closely with the medical system in Bulgaria. I can tell you some stories believe me. But what bothers me the most is that you always ignore facts and turn the situation around to point out the bad things in other systems, does this justify the system that you have in place? NO it does not. While the state has its problems and our friend Obama is trying screw it up even more as we speak, we are the one's that do most of the research for the drugs and procedures that are used around the world, this is why the cost is so high. These drug companies while greedy, spend billions on R&D that are shared around the world for everyone to benifit from, for example and just a simple one, Plavix, a drug used to smooth out the lumen of blood vessels to prevent the built up of plaque in the heart and surrounding vessels, took years to develope and is now on the shelves in Bulgaria for a fraction of the cost that we Americans pay for the same drug, we pay the cost of all of this research. So, while you took your eye off the ball and are in denial about the condition of your health care system, don't always just come crashing down on the American system as you always seem to do, it has it's problems and we will survive them, as always. because that's what we do, we find the problems, we try to fix them even if they are corrupt. Now the libs in Washington are trying to make the goverment the largest insurance company in the world, people here are not happy with the goverment in our lives. Our feeling is anything the goverment touches turns to crap and just ends up costing more and doing less. This issue is so hot here now that this will be the reason Obama will only be a one term President and in November we Rebublicans will gain several seats in the house and in the senate. People see how they screw up anything they touch. It will be interesting the next 8 months. But with all of that said, no matter what or how they do what they do in Bulgaria and even if they are under educated, I give them respect for working in this field and under such circumstances. They make due with what they have available to them and they work long hard hours, I know this as I've done it myself in Bulgaria.

Cosmos:

"These stories are scary I think I would rather use the vets."

Not all that surprising, Cosmos... Say I hear that some of those K9 cookies aren't that bad either;)))

What say you?

These stories are scary I think I would rather use the vets. Thank goodness for the British N.H.S.

Stefcho, all that is certainly true, but as an American, please - your system is in dubious shape as well, and certainly threatening to bankrupt your country. The US system is structurally unsustainable, because of one simple fact - the costumer in not the consumer and cost is going off the charts. I had a good friend who was a "financial consultant" for doctors, meaning he was advising them how to rip off the Middle Man (insurance companies), who in turn get their hands on anyone that can pay - meaning the insured.
He was advising them on [...]

Read the full comment what test machines to invest in, and (his words) - if you have that machine, guess what - you do many more tests with it;)
That's why you have 30% annual premium increases and $500 for two aspirins in the hospital (I swear that's what they charged my insurance company when my wife had the baby).

Our heal care is just poor - it actually corresponds to the average Bulgarian ability to pay and personal productivity as well.
Yours is on its way to bring you down.

First of all the reason BG Drs. are not poor is they extort their patients at a time when they are the most desperate, for example just before surgery the Dr will ask if you want to have this done and not feel any pain or would you rather pay an extra 300lv or more to have extra attention from us? This is the truth, I've seen it with my own eye's. At the same time the pay that Drs get is a joke, yes they may not be very good Drs but they still put in the time to [...]

Read the full comment do what they can with limited resources. The whole system is bad, first of all the education of Drs in BG is also a joke, 6yrs and your a Dr? This is at least half of the training time for Drs in most other countries. IN the USA Drs are in training for at least 12yrs and if you want to specialize in something like surgery, it's another 4 yrs. The thought of Drs only getting paid 300 to 400lv per month is an insult for people trying to take care of more patients then they can handle. The system needs a huge bandaid, it is broken badly. The horror stories I could tell you would shock even some Bulgarians. My advice is to take as good care of yourself as you can and avoid needing a Dr. in Bulgaria. But there are always some that are very dedicated and are trying to do their very best but the "fund" will not even pay them for what they do. I would say to increase private insurance companies into Bulgaria to not be at the mercy of this corrupt "fund" it is normally bankrupt by April anyway the conditions in most hospitals is horrible, I actually saw a litter of kittens in one hospital if you can believe that, I was shocked, this was at Queen Giovanna. Pirogov is just a condemmed building that is used to treat emergency cases and a lot of times you see someone coming in and then coming out 15min later because I suppose they couldn't pay the bribe to admit some poor old lady. It is as if I was in a third world country. Something needs to be done and the Ministry of Health should require that Drs get continuing education every year in order to maintain their licence. But you have much more to do to brig these hospitals up to some standard. The vet clinic near me takes better care of animals then some of the hospitals in Bulgaria.

I have also seen many incompetent doctors. As well as politicians. Hell, I am incompetent myself! But I didn't swear any oaths.

then your doctor skills are on equal par with my space-shuttle flying skills.

God save us all from BG doctors.

Nekadurni izmamnici!

Yes. In Bulgaria we are many, ivan. Doctors deserve to be paid.

ever seen a poor doctor???