On the mend

As I was leisurely handshaking my way out of a goodbye party for a friend recently, I grabbed a couple of macadamia nuts out of a dish to munch. Within minutes, I noticed that parts of my gums were starting to swell. Before I got to the lift, the swelling had travelled around my whole mouth and my tongue was swelling as well.

I was joining the thousands who go off unexpectedly to the emergency room every day. But my allergic reaction - my first - was taking place in Hong Kong, a city that, according to the conservative Heritage Foundation, stands No1 at the global epicentre of fang-and-claw capitalism. For perhaps a dozen years, it secured the top of the foundation's Index of Economic Freedom World Rankings, except when it changed places 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 per cent to 17 per cent on income adjusted for deductions and allowances - or a flat 15 per cent of gross income, depending on which is lower, not higher. This is not a place for socialistic approaches to societal well-being. Nonetheless, what happened to me over the next three hours ought to inform the debate over health insurance that is now wracking the United States. Despite Congress' vote on Sunday, the Republicans, saying the plan amounts to socialism, vow to continue their opposition and to clean out the Democratic stables in November's elections.

The Heritage Foundation is one of those right-wing lobbying organisations that waged the last-ditch fight against US President Barack Obama's plans. Yet, of the top 10 countries on the Heritage Foundation's index, every single one has some system of universal health care except for the US. After Hong Kong, they are Singapore, second, Australia third, followed by New Zealand, Ireland, Switzerland, Canada, the US, Denmark and Chile, in that order. Freedom of universal health care obviously does not figure in the Heritage Foundation's definition of economic freedom. Leaving my friend's flat, I could feel my hands and feet swelling. I started to feel like I was being bitten from head to foot by fire ants, and to onlookers I must have looked like a man in the most painful stages of heroin withdrawal.

As my throat started to constrict, I jumped into a passing taxi and asked to be taken to the nearest hospital. That was the nearby Ruttonjee Hospital, a one-time tuberculosis sanatorium that was turned 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.

Only 10 per cent of Hong Kong's population have health insurance or receive health benefits from their employers, according to a study by two Queen Mary Hospital specialists. The other 90 per cent go to the public hospitals. The government spends 2.97 per cent of gross domestic product on public health services, covering 92 per cent of all hospital admissions. Private care is about as expensive as it is in the United States. Private patients spend 1.8 per cent of GDP on private care - or 40 per cent of total health spending - which covers just 8 per cent of all hospital admissions. In the US, by contrast, health care spending amounts to 17 per cent of GDP and triggers 62 per cent of all personal bankruptcies, according to studies by Harvard University and the American Journal of Medicine.

Although 92 per cent of the public get their health care from public institutions, Hong Kong is one of the healthiest places on the planet. Early public-health education and professional health services give the city the second-highest life expectancy in the world, at 85 years for the average female and 79 years for men. Its infant mortality rate, 2.94 deaths per 1,000 live births, is the world's fourth-lowest.

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's computer chip gives my age, digital thumbprints and other information.

Admission also features payment of HK$100 - US$12.88. That was all it cost 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. It also covered five days of free medication including Piriton (chlorpheniramine 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 routine. There was no need to hand over a credit card, or fill out a series of forms by hand. In the US, such treatment is simply unthinkable. According to Consumer Health Ratings, a US-based website, a typical emergency room arrival in the US costs US$1,038. An electrocardiogram 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, she asked me if I wished to spend the night. Since I live near the hospital, I got up and walked home minus a HK$100 note, 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