The Health Care Debate

Mike:

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.


Toni:

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.

Shoot 'em Up!

This is a tiny video, but hilarious


Toni:

Let me start by saying that I’m not against ALL guns. I recognize that some people handle guns safely, don’t use them to harm other people etc. etc. However, in the USA, the problem doesn’t really concern these people. Let me give you some statistics**:

     - 80 million people own guns in the US
     - In 2005 30,694 gun deaths occurred in the US
     - Of this statistic, over 3,000 kids and teens died. That’s over 8 per day, and compares with about 20 (per year) in the UK
     - US kids are more at risk from firearms than any other industrialized country
     - In 2005, 477,040 victims of violent crimes had been faced with a firearm
     - The percentage of homicide victims killed with a gun increases up to age 17, and then declines
     - A gun in the home (usually intended for self defence) is 4 times more likely to be involved in an unintentional shooting, 7 times more likely to be used to commit a criminal assault or homicide and 11 times more likely to be used in a suicide

And so it goes on. There’s no doubt that there is an “inalienable” right to own guns, in the minds of most Americans. This is based on the 2nd Amendment to the Constitution, which states, somewhat confusingly, “A well regulated militia, being necessary to the security of a free State, the right of the people to keep and bear arms, shall not be infringed”. Since it’s almost hopeless to argue whether this referred to individuals or the people en masse, all I can say is that the writers of this Amendment could not have envisioned convicted felons and would-be terrorists getting hold of such firearms for harmful purposes. Nor could they have predicted that so many innocent children could be killed by stray gunfire, and gang-related drive-by shootings, as happens all too frequently here on the south side of Chicago.

There needs to be some heavy restrictions, many of which are already in place but not enforced. Although gun control is different in every state, there are some ridiculous loopholes. In Illinois, where it’s actually fairly well controlled, a waiting period (between buying and taking delivery of a firearm) does not apply to non-residents of Illinois who attend legitimate gun shows. Great. Pissed off with your neighbour in Indiana? Just pop over the border while you’re still in a rage with him. In other states, the gun show loophole is even bigger, where unlicensed, private sellers are not currently required to conduct background checks on their customers, nor ask for a Firearms ID. Big problem, leading to guns getting into the hands of criminals and would be terrorists (which has happened).

I could write a book on this. Suffice to say that Americans need to get their collective head out of the sand and acknowledge the correlation between gun ownership and gun deaths.

** All stats come from reliable sources such as the Centre for National Health Statistics, the Department of Justice etc. Trust me.



Mike

Let me start with some statistics of my own (I mean ones I looked up, not made up):

     - There are 255,748,000 of them registered in the US
     - In 2005, 43,510 people were killed by them
     - Of those, 14,754 were innocent bystanders

Am I talking about guns? No, the family automobile. The difference is, no one is suggesting that we restrict them or take them away.

My point is, people are killed by lots of things (incidentally, the death toll from blogging stands at two and rising) and guns, being inherently dangerous, get their fair share. But is this any reason to curtail them? I don't believe so, and even if I did, it wouldn't make much difference.

America is a gun nation. Our country was founded, not with words, but guns. Our freedom has been secured, not with words, but with guns. Owning a gun is seen as a basic, American right and anyone trying to change that attitude is looked upon with suspicion (and reminded that the first thing a tyrant does is attempt to disarm his victims).

I owned guns when I lived in the States. My family still owns guns. We were taught to respect them and use them properly as, I would argue, are most people. Certainly there are accidents, certainly there are killings, but removing the guns would not significantly halt this.

In Britain, where guns are outlawed, there are an average of 5 fatal stabbings a week. During the year, it is estimated that 130,00 people are threatened with knives. And that doesn't include the unfortunates who are killed with metal pipes, kicked to death or, my personal favorite, set on fire. You can't even argue that guns promote impulse killings because two recent murders in our town involved an argument, the aggrieved going back to his home to fetch a weapon (in one case a nunchuck, in the other a kitchen knife) and then seeking out the other person and killing him. If a gun had been available, they would have undoubtedly used it, but the results would be the same.

It is unfortunate that a minority of gun owners get all the press when the vast majority are responsible people who promote gun safety. Almost everyone I knew in the States had guns of some type but, as far as I know, not one of them ever tried to shoot anybody. Even those with the sorts of weapons that might be used to successfully invade a small country weren't raving gun maniacs, they simply liked to go down to the local gun range and spend a relaxing hour or two on a Saturday afternoon popping away at targets.

So I think guns are regulated enough, and that gun owners are getting a bad rap, and Americans as a whole are unfairly portrayed as pistol waving lunatics.

And another thing, if you believe…wha- Ow! Umph!

Sorry, I just fell off of my soapbox.

On a lighter note, I did get a real kick out of a Little Britain in America skit that showed a man running a gun safety class and, as he handled each of the weapons, the front of his trousers began pitching a noticeable tent. It was highly amusing and, I figure, just about spot on.


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The World of Work

How does working in the US compare to working in the UK?

Before we dive into this week’s topic, we would like to welcome "Big Apple/Little Britainer" as our first Guest Blogger.


Mike:

I have always maintained that my move from a US to a UK work environment was not nearly as much of a culture shock as my move from a public sector job to private industry. To quote a famous line from Ghostbusters: “You don’t know what it’s like in the private sector; they expect results!”

Also, I fell into a good job almost as soon as I landed here and have stayed with the company ever since, so I don’t feel qualified to comment on the nuances of the British corporate ethos (where, if rumours are to be believed, you work a standard 70-hour week) opposed to the Americans (who look upon a 70-hour week as a sort of vacation).

I think both countries share a similar insanity when it comes to work/life balance; mainly that your work is your life and, therefore, they balance. What is very different, and what I do feel qualified to comment on, is the amount of holiday they receive.

I was truly shocked when I was offered an entry level position at my current company and they told me it came with five weeks vacation. In the States, most jobs I had offered a week to start, and then upped it to two after a requisite number of years. Not that it mattered; I, like many of the people I knew, never really went anywhere anyway, at least not on a regular basis. My annual leave was mostly used up a day at a time as a legal method of skiving off, and if I took a full week, I often just stayed at home.

In the UK, the five weeks I am allotted do not carry over into the next year, so using them is mandatory, and not frowned upon as it sometimes is in the States. And when Brits take a week or two off, they GO somewhere. I have been to more places in the past seven years than in the 47 that preceded them, so even though they still expect a lot from you here, there are some added perks.

Another thing that is very different in the UK, and which also took me by surprise, is the way they treat birthdays in the office. In the US, you could happily forget your birthday and if someone in the office did know about it, they might offer to take you to lunch or buy you a beer after work. Here, it is up to YOU to supply birthday goodies for everyone in the office. This, as you might imagine, makes it much harder to forget your birthday because there are any number of people waiting for you to supply their morning Danish.

It seems an odd tradition, but if you think about it, the purchased/freebie goody ratio evens out over the course of the year, and you almost always get to have an éclair or a slice of cake with your tea.

So, more holiday, marginally less hours and a sporadic supply of free cakes; to my thinking the UK wins this round.



Big Apple/Little Britainer:

I have done a fair bit of global office tourism in recent years. I’m a Brit who started my working life glamorously in Buenos Aires, working for a tiny American-owned company staffed by a rag-tag bunch of expats and locals. When the Argentine economy and multiple presidents spectacularly dive-bombed in late 2001, the American owners bailed and our motley crew was left out in the cold. After a year finishing my degree and relying on several student jobs for support, I returned to my home county - Hampshire - and a brief (two months) stint with an English company in an English town. From there I took an offer for more money and less holiday and landed at an American company in London, which was then bought by a European company that moved me to New York. And now I work for a once-British multinational, recently acquired by a Canadian company. As the Yanks say; go figure… but this much I have learned:

-- While Brit working life revolves around the electric kettle (or, in larger offices, the electric urn), American working life centers on the water cooler. If you're a lucky expat Brit, you'll find the water cooler has a 'hot' tap providing lukewarm dribble that is the focal point for all the expats, who hopefully dangle Lipton teabags and reminisce about PG Tips and water at boiling point.

-- As Mike said, Americans don’t do holidays and instead I conclude they must spend many more hours a year surfing the internet and chatting at the water cooler about how lazy their European colleagues are because they get, like, 36 days vacation….
I admire much about the U.S. work-ethos, but face-time culture seems to pervade American offices. Maybe I’ve just been unlucky, but I’ve witnessed management that rewards time spent in the office over quality of time spent in the office, and I’ve seen colleagues raise eyebrows at those who have to take sick children to the doctor, or schedule a dentist appointment in the middle of the day. It’s institutionalized. After nearly three years here, I feel very lucky to have as much as 10 days holiday and I’m even beginning to wonder what I’d do if I had more…

-- I’ve also found it’s very hard to persuade American colleagues to socialize out of work. Working in a fairly youthful office in London, a quick drink after work was pretty common. Some even enjoyed a not-so-quick drink at lunch. I think this is about more than the different cultures’ approach to alcohol (which is another subject entirely) – I think Americans see work truly as ‘just work’ and find it odd that anyone should want to hang out with their office mates when they’re not being paid for the privilege.

To sum up, I do think the quality of working life is better in the U.K. Financial conditions may have changed that for now, but it’s not really the tangibles -- holiday, salary in a (once) strong currency -- that I miss. I miss the social interaction of English offices; getting cups of tea for colleagues, chatting over a beer after work, or celebrating all those birthdays that Mike has suffered through!


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