A Tale of Two Tuberculosis Tests

TB testing is the only medical procedure I have had in two different countries. So let’s compare a TB test in South Korea to one in the US.

Christian Patterson
2019-06-19
Underground Mall

When people talk about universal healthcare in the US, they always resort to “Norway and Sweden”. I consider this poor rhetoric for a couple reasons. For one, it’s a bit of a rhetorical trap, because Norway and Sweden aren’t unique. You could throw a dart at a map and hit a country with a more robust, socialized healthcare system than the US. Even countries that Trump supporters would call “shitholes” have medical systems that attempt to increase access to as many people as possible. In fact, two of the biggest issues for developing country healthcare systems are (1) brain drain, where doctors in places like India and Nigeria migrate to developed countries for work and (2) a general lack of national resources in general. The US, more than any other country by far has limited healthcare access, purely because of purposeful restriction of access.

But the bigger reason I’m opposed to “Norway and Sweden” diction isn’t because it’s a rhetorical trap, but also because it’s terribly Eurocentric. If you read the subheader of this article, you’re probably thinking “okay, well, what’s so special about South Korea’s healthcare system? I never hear about it.” Well the answer may surprise you (or will it?): South Korea has, by many measures, the best healthcare system in the World.

South Korea’s system is not universal insurance for citizens, but rather a universal right of the country, meaning my medical service, which required no identification, is (theoretically) the same service the Korean president receives. It is government-mandated, universal coverage. South Korea ranks number one out of OECD countries in terms of access. They have more medical devices and hospital beds per capita than most other countries (and depending on the device, all other countries). They have remarkably high survival rates from cancers, strokes, etc. Simply put, South Korea’s healthcare system is, if not the best, one of the best healthcare systems to compare to the US.

But, since we’re talking tuberculosis, South Korea’s only major health issue I could find, is they have the highest rate of TB amongst OECD countries. This probably explains why I had to be TB tested there to begin with. Even still, however, compared to most countries, not just OECD countries, South Korea still has relatively very low TB rates. Which brings me to…

Very similar to the Korean clinic where I was TB tested

TB testing in South Korea

First I will describe my experience getting TB tested in South Korea, then getting TB tested in the United States, and compare and contrast them.

About five years ago, I studied abroad in South Korea. It was a limited, summertime study abroad program, so I wasn’t there for six months or a year, but I was there long enough to get a pretty good glimpse into Korean life.

To live in the international dorm, I had to get a tuberculosis test within the first week of living there. An RA gave me a slip with directions, so I hopped on the bus, took it about 15 minutes to one of the more exterior neighborhoods of Seoul (which, is still much more dense than even the urban core of most American cities), up in the foothills that surround the city.

I walked into the clinic, pulled a number, then sat in the waiting room, which was several rows of chairs facing the front desk. It was similar to how the DMV (Department of Motor Vehicles) or DOL (Department of Licensing) works in the US. However, the clinic was much more clean, pleasant, quick, and well-organized than American counterparts. The number-pulling line system is a common form of waiting in South Korea. They also have it at pharmacies, and some post offices too, for example.

My number was called in a couple minutes. I went to the front desk, and due to the language barrier, I simply said “TB?” I showed them the slip that my university gave me, and they understood and directed upstairs.

I went upstairs and a doctor told me in English to remove my shirt and put on a heavy apron. They brought me into a small room, and did a bodyscan. They gave me a slip almost immediately verifying I don’t have TB. I went back downstairs, paid ₩4,000 (which, at the time was about $4, now it’s closer to $3.30). And that was that.

The room where I was TB tested in the US

TB testing in the United States

Now, let me compare that to being TB tested in the United States.

I used to work at a homeless shelter. It’s common for homeless shelters to require tuberculosis tests, because TB spreads through the air, making it very contagious, especially amongst people with weakened immune systems living in tight quarters. All staff members had to get TB tested too.

The way to get TB tested is twice a week, the county would send nurses to the Day Center, a place where homeless people could hang out during the day without being harassed by cops or asshole pedestrians.

The nurses would only be there for about 90 minutes. If you showed up towards the end of that time, you could wait, but you weren’t guaranteed to be tested.

The nurses set up little folding chairs and tables. People would form a line outside, waiting for the testing to start. I ended up arriving shortly after they started, so the line had been processed, and people dispersed throughout the conference room, waiting. A county clerk took my name, asked why I was getting TB tested, and some other basic information.

I sat in one of the folding chairs scattered around the conference room until they called my name about twenty minutes later. They brought me over to a table, and pricked my arm. The idea of this is that they inject a small amount of a substance under your skin.

Then, they filled out a slip for me, saying when I got pricked, and when to return. Then, a few days later, I left my other job a couple hours early, and returned to have the spot where I was pricked checked. If it developed in a certain way, it indicated I had TB. If I were to miss the returning day, then I would have to be pricked again, and come back, again.

Comparing two TB tests

Let’s compare the two. The test done at the Korean test costed $4 and the American test costed nothing. However, the American test wasn’t done through the conventional medical system. In reality, the only reason it exists is the county was funding homeless shelters. However, they know that in order to have homeless shelters, they need to make sure people who stay there aren’t spreading diseases. This means the only reason someone is able to get a free TB test is it’s a necessity when packing homeless people into bunks.

I conceptualize the government as an organ that maintains the economic system. Capitalist governments maintain capitalism. From that perspective, the cost of the county hiring nurses to provide free TB tests is worth mitigating visible homelessness. And while South Korea is certainly, also, a capitalist country, they have chosen to maintain capitalism with a different balance. So, not only does South Korea have significantly less homeless people than the United States, they wouldn’t need to work around the medical industry to provide very limited service, like TB tests, in such an ineffective way.

This shows that, not only is the American healthcare system prohibitively expensive, but it constantly has to do elaborate work-arounds to prevent healthcare crises. For instance, I googled around to find how much a TB test would cost if you’re uninsured. This isn’t information you can find for a conventional clinic, because it’s so inaccessible and unusual to just go to a doctor’s clinic without insurance, get TB tested, and pay. TB tests, however, are a basic procedure, so probably the closest equivalent to a clinic TB test in the US, would be getting a TB test at a pharmacy. At CVS, this costs $35 for the original test, and $39 for the test reading. So, it’s $74 total. Lord knows why someone would get the test without the reading, or vice versa.

So the closest parallel to a Korean clinic is a dirty American convenience store, where you go to the dark back corner, and pay over $70 more than you would in Korea.

Some other differences I could highlight is that the American version had a much longer wait. It also had a much more limited period of time where I could get tested. Another difference is I had to give information of myself to the American testers, because the government wouldn’t offer a service like that unless they’re keeping close tabs on you. For the Korean test, I don’t think I even gave anyone my name.

But perhaps the most major difference is that, in Korea, I had my body scanned, and in the US, I was pricked. This probably stands out the most, because it’s the most tangible difference. However, I wanted to talk about it last, because, all things considered, the difference in technology is a logical consequence of the other economic and systemic differences.

By that I mean, in South Korea, there’s no medical procedure (barring elective cosmetic surgery) that’s outside of their national healthcare service. Because of that, they can, and should, have the most high-tech, convenient, and best devices for TB testing. On the other hand, if most people who need TB tests are poor and/or don’t have insurance, then the incentive is to have the most low-tech devices for TB testing, to minimize sunk costs.

So while South Korea is clearly a capitalist society, we can isolate their healthcare system as an industry that is socialized, and compare that isolated industry to the for-profit, insurance model in the US.

What we learn is that healthcare policy doesn’t just determine how many people get access to healthcare, and how much it costs. We can also see that different systems yield different motives. The American healthcare system is motivated by profit, which causes lack of access and higher cost, but it also has other effects. And those other effects include using the simplest, retrograde equipment for procedures that aren’t profit-motivated.

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