karakurt
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thread 1/14
The United States spends 18.3 percent of its gross domestic product — and more per person than any other country — on its state-of-the-art, sickness-focused system. Yet it is experiencing a decline in life expectancy to 76.4 years in 2021, the shortest in almost two decades.
04:06 AM - Oct 19, 2023
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karakurt
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thread 2/14
A tale of two sisters, two countries and their health systems
Two sisters, one in Lisbon and the other in New Jersey, show how Portugal provides a promising if imperfect model for improving a nation’s life expectancy.
04:06 AM - Oct 19, 2023
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karakurt
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thread 3/14
“Sometimes, I call her just to cry, because she understands what I feel in that moment,” Lucilia said.

They commiserate over the agony of swollen joints. They discuss the drugs both keep in boxes by their beds.
04:06 AM - Oct 19, 2023
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karakurt
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thread 4/14
And they talk over the treatment they receive to keep the cruel bouts of rheumatoid arthritis at bay.

That’s where the Costa sisters’ shared stories suddenly diverge.
04:06 AM - Oct 19, 2023
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karakurt
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thread 5/14
Almost all the care that Lucilia, 58, receives is carefully coordinated through Portugal’s Serviço Nacional de Saúde — the National Health Service — which puts a premium on universal access to primary care.
04:06 AM - Oct 19, 2023
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karakurt
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thread 6/14
Her sister Lurdes, 66, has cobbled together her treatment in the United States, paying some doctors out-of-pocket or showing up at the ER when her symptoms flare, and sometimes returning to her native Lisbon for more-affordable care.
04:06 AM - Oct 19, 2023
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karakurt
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thread 7/14
On trips she made there before the coronavirus pandemic, Lurdes stocked up on prescription drugs and scheduled routine screenings, including mammograms and a colonoscopy.

“I don’t know what would have happened if I couldn’t go to Portugal,” said Lurdes,
04:06 AM - Oct 19, 2023
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karakurt
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thread 8/14
The sisters’ experiences highlight structural and philosophical contrasts between the two systems — differences that put Portugal, a country of more than 10 million with a relatively small economy, among the nations with the best “population health” outcomes in the world.
04:06 AM - Oct 19, 2023
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karakurt
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thread 9/14
Portugal’s temperate climate, healthful diet and communal culture play vital roles in people’s well-being. There are also greater restrictions on guns. Personal drug use has been decriminalized, allowing opportunities to treat rather than stigmatize addiction.
04:06 AM - Oct 19, 2023
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karakurt
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thread 10/14
And there are more physicians per person than in the United States. In Portugal, as in other countries such as Chile and Costa Rica, advances in life expectancy have coincided with a focus on population-wide access to comprehensive entry-level care.https://t.co/cI7gT3A4x1
04:06 AM - Oct 19, 2023
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karakurt
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thread 11/14
The 1976 constitution established every citizen’s right to health care, regardless of ability to pay.
04:10 AM - Oct 19, 2023
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karakurt
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thread 12/14
In the United States, by contrast, Lurdes has had to navigate a patchwork system, leaving a trail of poorly coordinated medical records with different doctors at different hospitals, some even overseas.
04:12 AM - Oct 19, 2023
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karakurt
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thread 13/14
Lucilia recalls coming down with pneumonia and being admitted to a northern New Jersey hospital for a week, during which she saw countless specialists before receiving a diagnosis of RA — along with a bill for thousands of dollars, she said, which she could not pay.
04:13 AM - Oct 19, 2023
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karakurt
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thread 14/14
“They care about me. They protect me,” Lucilia said, shedding tears as she contrasted the skilled but short-term rescue care she experienced in America with the ongoing support she receives from her Portuguese doctors. “I feel when I am in bad shape, they give me strength.”
04:14 AM - Oct 19, 2023
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