Medical Care in Socialist Hong Kong

On Friday night, March 13, as I was leisurely handshaking my way out of a goodbye party for a friend, I grabbed a couple of macadamia nuts out of a dish to munch. A few minutes later, I noticed that the gums surrounding my right upper molars were starting to swell. And, before I got to the lift, the swelling, in an odd trajectory, had travelled around my whole mouth to the left and my tongue had started to swell as well.

I was joining the thousands who probably go off unexpectedly to the emergency room every day. But my allergic reaction -- the first I had ever had to nuts or anything else for that matter, was taking place in Hong Kong, a city that, according to the conservative Heritage Foundation, stands No. 1 at the global epicenter of fang-and-claw capitalism and has for perhaps a dozen years, secure at the top of the foundation's Index of Economic Freedom World Rankings except when it changes place with Singapore.

This is the city with the famed flat tax so beloved of the Heritage Foundation and of Conservative guru Steve Forbes. Effective tax rates here can either be progressive – from 2 percent to 17 percent on income adjusted for deductions and allowances, or a flat 15 percent of gross income, depending on which is lower – no higher. This is not a place for socialistic approaches to societal well-being.

Nonetheless, what would happen to me over the next three hours ought to inform the debate over health insurance that is now wracking the United States Congress and threatening Barack Obama's presidency. Despite the Congress's vote Sunday, the Republicans, saying the plan amounts to socialism, have vowed to continue their opposition and to clean out the Democratic stables in the November election.

The Heritage Foundation is one of those right-wing lobbying organizations that are waging the last-ditch fight against the President's plans. Of the Heritage Foundation's top 10 countries in its index, however, every single one has some system of universal health care except for the US. After Hong Kong, they are Singapore second and New Zealand third, followed by Ireland, Switzerland, Canada, the US at eighth, Denmark ninth and Chile 10th. Freedom of universal health care obviously does not figure in the Heritage Foundation's definition of economic freedom.

Back at my friend's flat, by the time I got to the street, I could feel my hands and feet start to swell. I hopped onto one of the city's rattletrap trams to go the 15 or so blocks home, thinking I ought to get there fast and go to bed. But on the tram, sitting on the top at the front with the windows down, I started to feel like I was being bitten from head to foot by fire ants. My hands were writhing together and my fingers looked like sausages except that they were redder than I had ever seen my skin in my life – except for my knuckles, which were stone white. I had the momentary thought that to the rest of the passengers on the tram, I must have looked like a man in the most potent stages of heroin withdrawal.

I alit from the tram, intending to walk the three blocks home in the city's Wan Chai district, when I could feel my throat starting to constrict. This is not good, I thought. I jumped into a passing taxi and asked to be taken to the nearest hospital – which happened to be about 400 meters or so away. It is Ruttonjee Hospital, a 140-year-old onetime tuberculosis sanitarium that was redeveloped into a 600-bed general facility in 1991 and remains partly government funded.

Ruttonjee is emblematic of Hong Kong's parallel medical infrastructure, which features 12 private hospitals and more than 50 public ones. Polyclinics also offer primary care services, including dentistry. Most of the universities offer free or affordable health care to students.

According to a paper by Kar Neng Lai and Wai Kei Lo of the Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, only 10 percent of the population have health insurance or receive health benefits from their employers. They go to the public hospitals. The government spends 2.97 percent of GDP for public health services, which cover 92 percent of all hospital admissions.

Private care is about as expensive here as it is in the United States, with private patients spending 1.8 percent of GDP on private care, or 40 percent of total health spending, which covers just 8 percent of all hospital admissions. By contrast, US health care spending amounts to 17 percent of GDP. Health care spending triggers 62 percent of all personal bankruptcies in the United States, according to studies by Harvard University and the American Journal of Medicine.

Despite the fact that 92 percent of the public get their health care from public institutions, Hong Kong is one of the healthiest places on the planet. That is partly – at least according to the government -- because early public health education and professional health services mean the city has the second-highest life expectancy in the world, at 84 years for the average female and 78 years for men. Its infant mortality rate of 2.94 is the fourth lowest in the world.

Within minutes after the terrified taxi driver dropped me panting and gargling at the doors of Ruttonjee, I was on a gurney, being given medication. The check-in procedure involved handing my permanent resident identification card to the admissions counter. The card features a computer chip loaded with data including age, picture, digital thumbprints and other information.

Admission also features payment of HK$100 – US$12.88. That was it for three hours of care including an electrocardiogram, saline drip with antihistamines and steroids, the expert care of Dr Karen Wong Mei Kam and three nurses, and five days of free medication including Piriton (chlorphenramine maleate), Phenergan (promethazine HCL) and Prednisolone, plus a couple of hours of enormously sound sleep.

While for me it was an emergency, for the hospital it was probably utterly routine. There was no need to hand over a credit card, no need to fill out a series of forms by hand. In the United States, such treatment is simply unthinkable. According to Consumer health Ratings, a US-based website, a typical emergency room arrival in the US is US$1,038. An EKG can run to another US$1,375. Anyone who has ever been to a publicly funded emergency room faces hours of waiting unless they suffer from an immediate life-threatening condition.

There were no bills for me to sign at Ruttonjee. When the nurse awoke me from the oddest of gentle dreams -- that I was sitting in an antique Cris-Craft woodie speedboat, gently bobbing up and down at a dock while the engine burbled quietly away – she asked me if I wished to spend the night. Since I only live perhaps half a kilometer from the hospital, I got up and walked home minus a HK$100 bill along with HK$20 for the taxi ride in. So take your pick. Does the Heritage Foundation's raw capitalism have a dose of socialism?

John Berthelsen is the editor of the Asia Sentinel, a regional internet-based magazine of news, comment and analysis based in Hong Kong.