Sunday, March 15, 2009

The Health Care Debate


I welcome the chance to talk about health care because it is so rarely discussed. Whenever the subject is debated, the argument always centers on access to health care, and not the care itself.

As far as access to health care goes, the US has some problems, but I don't think the system should be thrown out in favor of socialism. How to fix it? I can't tell you; ask someone smarter. But I lived there for 46 years and never knew anyone without some sort of health coverage; the rich could afford good, private medical insurance, the rest of us took what our jobs handed out, and some people (check the Internet: estimates range from 74% to 2% depending on your agenda) slip through the cracks. In Britain, however, we have universal health coverage provided by the State, which means the rich can afford good, private medical insurance, the rest of us take what the government hands out, and some people slip through the cracks.

Before I go on, I do want to stress that I like Britain's access to health care better than what I had to deal with in the States. There, I had to review policies every year and choose what I hoped was the best one, go to only certain doctors, etc. And you could never think about quitting your job and taking a little time off because your coverage would stop, so, yeah, universal health care has its perks. But the advantages stop once you actually get into a hospital; so if we're talking about health care and who is better at it, the US wins hands down.

I am told the NHS was once the flagship of Britain’s Social Engineering Armada. That may be so, but it's now a drifting wreck, foundering in a morass of governmental meddling. And I do blame the government for the state it's in, not the people who actually provide care. The rank-and-file NHS employees are dedicated people who sacrifice a great deal to remain on that sinking ship, grimly determined to keep it afloat even as the red tape pours in faster than they can bail it out.

Bloated bureaucracy, mindless management and legislative lunacy have made British hospitals dangerous places to be, especially if you are sick. Budget cuts mean losing a lot of useless managerial layers, um, I mean, scaling back on cleaning staff, orderlies, nurses and lower level clerks to the point that the hospitals are dirty, in disrepair and generally disagreeable places to be.

That's if you can find one. So many local hospitals are closing that if I break my leg in Horsham, West Sussex, I have to be trucked all the way to Redhill in Surrey to have it tended to. Soon, all the local hospitals in Britain will be closed and we'll all be sent to a central processing facility in Leeds.

In the hospitals I have visited I have seen dirty floors, ceilings with broken tiles and wires hanging down, a single, novice doctor having to cover an entire ward and ambulances queuing up outside the emergency room entrance.

When I asked about the latter curiosity, I was given this explanation:

The government, to track NHS efficiency, instituted a quota system. Any patient admitted to the hospital must be seen within a certain number of minutes. If the hospital falls outside the limits imposed by the government, they fall in the rankings and receive less funding. So, to stay within their quotas, they leave patients languishing in the ambulances outside the emergency room. When they feel they can see them in a reasonable amount of time, they admit them.

This way, the government gets to see nice, jolly figures, the hospital stays on target, the money (which is not enough to begin with) keeps trickling in, and everyone is happy. Right?

So, if in America, the perceived answer to their health care ills is to get the government involved, you can come take ours. Please.


Ah the “S” word - "socialism". President Obama asked recently, since when is taking care of your fellow countrymen "socialism"? When people call for radical change in the system, they are simply asking that everyone be given "access" to health care. (I’m sorry but to ignore the access problem over here is simply copping out.) At present it is proposed that, for example, self employed people be allowed to join together as one big insurance pool instead of having to pay over the odds for individual insurance. No one’s talking about free or socialist anything.

Times have changed in the USA. Because of the rising costs of insurance, the trend is for employers to pay less (eg. 60% as opposed to 100%) of an employee's health insurance, which can lead to hefty bills for workers. Many smaller companies are simply not able to offer employees any health benefits at all. As a result, there are more than 47 million uninsured people here, 37 million of whom are actually employed, which makes them ineligible for any kind of government assistance. And while I'm talking about Medicaid, the government program, it takes care of only 40% of America's poor.

So where do the uninsured go? Well, most of them don't go for any kind of preventative care, so by the time they are really sick/ill they are forced to use a hospital Emergency Room. If, as I did a year ago, you turn up with a kid and a badly broken arm, you get to sit in line with ear infections, snotty noses and conjunctivitis because these people have no primary care doctors. And guess who gets to pay for their care? No, not everyone else, (that would be socialism) but me. My hospital bill is approximately 45% higher than it should be because the hospitals lose about that amount caring for patients who can't pay. (In most states, hospitals must treat anyone who walks into the ER regardless of their ability to pay.) Even if it were being proposed that taxes pay for health coverage it would be a damn sight cheaper all round. Those of us who are lucky enough to have health insurance get to pay for everyone else who doesn't. What's the difference?

Interestingly, although the US spends more per capita on healthcare than any other country, (WHO stats) its use of health care services falls far below the OECD median. In other words, a small percentage of Americans are spending most of money. A family member last year, who was admitted to the hospital for tests, was so adamant about being tested for what he thought was wrong, that the doctors caved and ran all the tests. Hey, they weren’t paying. Because of rampant malpractice litigation, many GPs refer you on to a specialist anyway. I rarely bother with my GP as he’ll charge about $200 to tell me that I need to see an orthopedic doctor/allergy specialist etc. As I said, I’m lucky enough to have family health insurance, but I pay $12,000 per year for it, I have a $5,000 deductible before anything kicks in, AND I pay 20% of bills thereafter. Bargain. For that, I can choose pretty much any doctor I want. If you go for the cheaper premiums, you are told which doctors you can use, but in an emergency, there’s a high chance that someone outside of your plan will be involved in your care, and your insurance company won’t pay for that. It’s hard to ask everyone in a hospital whether they are in your plan – especially if you’re bleeding from the head.

Some people, even with health insurance, find themselves facing bankruptcy.

No one should be in this position.


  1. I just have to make one contribution, if I may, concerning the NHS. I hope you don't mind me chipping in... My very recent experience of the service has been, for me, an extremely good one. I found the hospital to be spotlessly clean, if a little run down in parts,(it is to be re-located and the site sold for property development), and the staff were, without exception, kind and compassionate, funny and caring, diplomatic and skilful.

    This was not what I had expected, given the constant bad press the NHS receives from the media, however, it was my experience and I cannot fault the various staff who dealt with me and the team who operated on me...

    I cannot talk about the US system, for I have not experienced it, but those who would fall through the net owing to having no insurance, for no fault of their own, would trouble me.

    I love your blog, and always find it to be thought-provoking and interesting. ~ Thank you so.

  2. WONI - Of course you can chip in, that's what we want! My story is that my mum had a hip operation diagnosed, scheduled and performed within three weeks a few years ago. She then had a physical therapist come to the house for ten days, then once a week. No complaints there at all. And more recently, when my uncle was dying in hospital, he was treated with care and respect at all times, the doctors kept the family fully informed and he had a nurse in his room round the clock.

  3. "Socialism" is a buzz word that Republicans throw around to scare the hell out of people. and they're pretty good at it. You see, they don't mind socializing the fire departments or the veterans administration because there is no money in it for them. But by offering "universal care", you rob them of their profit making opportunity, which is really what it's all about now isn't it? I also think that those fear mongers are really good at concocting horror stories about the NHS, just to prove their point. We are the only industrialized nation not to offer universal coverage. So, I guess we're the smartest kids on the block eh? Typical.
    I've said it before and I'll say it again...freedom, true freedom comes when I can choose to be or do whatever I want to do for a living without having to worry about whether or not my job provides health coverage. I can't imagine a worse lot in life then to work a job that makes me miserable because it's the only one that provides coverage. What an awful way to live. And I would like to add that I have experienced both systems myself and each of them has its problems.

  4. Sorry, but another thought came to mind. I think most Americans are under the illusion that they have good coverage. But when they suffer a catastrophe or a major illness they find out that their coverage is below par. There are dollar limits to how much treatment will be covered. A single hospital stay or treatment could wipe out that money. In many cases there is no allowances for alternative methods of treatment. Just because you have coverage doesn't mean you are truly covered.

  5. I don't know much about American health Insurance, but we are constantly reading, in England, of people who cannot afford insurance and some of the stories are really heart rending.

    Everyone should have access to basic health care.
    Yes, in England we are struggling because of all the new expensive treatments that are on the market now, especially for cancer. The hospitals are not as clean as they could be according to the media. I do know that some go in for a relatively small thing and fall ill with some serious infection that has been picked up there.
    However ..... we have always had pretty good treatment and I think the British way is very fair but is struggling under terrible pressure.

  6. Talking about capped health insurance. We have a family in our community whose two year old got cellulitis/staph from a small cut to his foot. Last year he had eleven surgeries and almost lost the foot. He stayed in hospital for seven months and the health insurance capped out after $1 million. The parents are both professionals therefore don't qualify for government aid; they have already remortgaged their house and are now being assisted by fundraisers so that their toddler's treatment can continue. AS I said, no one should be in this position.

  7. Ah, a subject near and dear to my heart. Unfortunately I've had intimate experience with both systems, including having a child born prematurely in each country. Not only is access different in each country, but the philosophy is different as well. Consider this:
    I developed severe pre-enclampsia with my first child while I was living in the UK. The NHS doctors handled it by putting me in hospital and watching me and not delivering until absolutely necessary (at 34 weeks). In the US, they delivered practically at the first sign of the disease (33 weeks), though it put my baby more at risk and she was in the NICU for FIVE WEEKS. Looking back, I think they were worried I would sue them. I also knew an OBGYN socially while I lived in La Jolla and she would often remark she had to offer delivery to “CYA”. It seems so many decisions are governed by the threat of lawsuits.
    And access is a HUGE issue. My sister has NO COVERAGE. She is highly educated but decided to start her own business and just can’t afford it. My parents (who live in the US) stress about their payments.
    Even if you have insurance, what about all the paperwork? After all our hospital stays, I would get piles of bills with codes I didn’t understand. Often these bills were incorrect, and then you spend hours on the phone trying to sort it out.
    When I first moved to the UK about 20 years ago I was highly skeptical. I am a huge NHS fan now. It’s not a perfect system, but better than what the US has to offer.

  8. I read the link Expat added and it was such a sad story. I think health care in the USA is 2nd to none for quality but OH MY, how expensive. The bill for my recent c-section was 20 grand!!! Thank God I have decent insurance and my co-pay is only $350

  9. I've been staying quiet on this subject, as I am the designated detractor ;) I do wish to point out that my argument was not in favor of US-style health care insurance in the UK, but merely a chance for the NHS to get on with being the NHS without all this government interference. Also, I think, from reading your comments, that it must have gotten worse in the US since I left (why aren't you taking better care of my country!?!?) My biggest beef with the NHS is, due to its stretched resources, it operates as a sort of National Emergency Room; you don't go unless you're really quite sick, so there is no concept of preventative care. Even a simple 5-year check-up would help but they simply don't have the capacity to do it.

  10. Mike's experience of healthcare in this country does seem to have been unfortunate. If it were more generalized -- for example if *all* hospitals were like the one(s) he's acquainted with -- then one might see this reflected in national general health indicators like whole life expectancy and infant mortality, and find that the figures were far worse in the UK than in the US. But so far as I can see the UK scores very much the same on both the aforementioned counts as the US (in fact, the figures are slightly better), or at least did so the last time I visited the statistics. And the UK spends per capita a far smaller amount than the US on healthcare!

  11. Americans who are anti the introduction of a National Health Service in the US seem to forget that we aren't talking all-or-nothing- its perfectly feasible to hang on to your private health insurance as well, as many Britons do. I do have private health cover to use if I need it - but could also chose to use the NHS. And at least I know that no-one in my country is without quality medical care just because they cant afford to pay for it.

  12. I'm about to move from Australia, where we have a publicly-funded universal health care system (Medicare) to the US. Coming from a country where - for the most part - I don't have to worry about basic medical care, it terrifies me that I will have no coverage for at least the first six months in the US - and very possibly much longer. It seems almost farcical that the most powerful nation on earth cannot do for its citizens what other nations have been doing for decades. I don't know how the uninsured in the US get by - I guess I'll find out soon enough.

  13. As if to prove how much of a national crisis the US is in, CNN have a new page on their web site "Empowered Patient" - set up to help people deal with their health care providers.

  14. This is turning in to a very thought-provoking debate, Expat mum - Thank you - Have a fab weekend!

  15. For me, the biggest difference is the impact on daily life of the anxiety of it all, whether you are healthy or sick. Lots of Americans live with a low-level anxiety about how they would cope if they got really ill. That is fuelled by endless advertisments and articles. And it is an anxiety based on genuine reasons. Being ill here, even if you're insured, is hugely expensive, plus there's all the paperwork to cope with too.

    In the UK, a lot of that anxiety is alleviated by the fact that the NHS is there. We love to criticise it, and I agree with Mike about the way it has been messed around with by government (I loved your "Bloated bureaucracy, mindless management and legislative lunacy", Mike), but at least it's there, and as Mike says, the staff do their best to see you right.

    So for me, it's as much a question of how it affects you when you're healthy as when you're sick.

    I've also found that when I go to the doctor in the UK, I'm watching out for whether I'm not getting what I need because the doctor is cost-cutting. Here, I'm watching out for whether I'm getting more than I need because the doctor is making money. Two sides of the same coin, perhaps? No, I prefer paying my taxes and having my health care free.

  16. Just one comment before we move on:

    I was at a party last night and a woman was telling about her son who, last year, had been diagnosed with cancer. She described the operations, the chemo, the care, about staying in the hospital with him during some of the ordeal (and, thankfully, the news that just recently he got the 'all clear' from the specialist). All I could think was, what a horrible, horrible strain that must be to have to hear news like that, and then to have to go through all of that. Then I realized she never once mentioned how much it all cost, which is always the central point in any story like this in the US. The extra burden of paying for all this and/or dealing with the endless paperwork would have made this terrible time that much worse for her and her family. So, yeah, I guess the NHS is pretty OK.

  17. > before we move on:

    Do we have to move on?

    There has been an awful lot about healthcare in the US versus the UK in the media in the last few weeks. Wouldn't it be contrary to the purpose of this blog to remain silent about it?

    For example: there are sources to hand that that suggest that Mike's assertion that:

    "Bloated bureaucracy, mindless management and legislative lunacy have made British hospitals dangerous places to be, especially if you are sick. Budget cuts mean losing a lot of useless managerial layers, um, I mean, scaling back on cleaning staff, orderlies, nurses and lower level clerks to the point that the hospitals are dirty, in disrepair and generally disagreeable places to be."

    ... are questionable. If what Mike says is right, how come Britain has a lower mortality rate than the U.S? How come the U.K. scores better than the U.S. in the OECD tables than the U.S. ? Are American hospitals *even dirtier* than the British ones he describes?


Note: Only a member of this blog may post a comment.