I woke up in a rented room in London in the middle of the night, feeling like my eyes had been packed with hot sand and the lids were somehow glued together. When I pried them apart, the whites of my eyes were an angry crimson.
Maybe it was nothing. I’d been told that the pollen counts in the UK this summer are sky high. A raging heat wave in a city that doesn’t really do air-conditioning (like my gloriously fogbound town of San Francisco) didn’t seem to be helping. But when I squinted in the bathroom mirror, I saw a greenish-white discharge collecting around my tear ducts. This looked like more than a bad case of hay fever.
Then I remembered that one of the cognitive psychologists I’d come to London to interview mentioned that she’d recently had a bad eye infection. I Googled “conjunctivitis.” It dawned on me that the bottle of water I drank in her office may have been a mixed blessing.
But what to do? I was far from home with lots of work to do and no idea how to see a doctor locally. Thankfully, I didn’t have any appointments for a couple of days, and have health insurance from Kaiser-Permanente through my spouse’s employer. But I knew that getting reimbursed for treatment by a doctor outside the Kaiser network can be complex; what about an out-of-country doctor?
When I dialed the 800 number on my Kaiser card to find out what to do, an automated voice from AT&T informed me that I would be billed at the standard international calling rate of $1 a minute. After navigating a maze of call-center prompts, I sat on hold for 15 minutes.
The first Kaiser rep who took my call fired off a barrage of questions. Was I experiencing “blind spots, double vision, floaters, hallucinations, or any other problems” with my vision? Yes — the goopy discharge from my tear ducts was making it hard to see, and I said so. But that turned out to be the wrong answer. The Kaiser rep simply repeated her question in a more brittle tone of voice and added, “Just answer yes or no.”
Yes, I was having problem with my vision, but not “double vision, floaters, or hallucinations.” Judging by the structure of the question, I suspected that it was designed to fish for a different sort of problem than the one I had, such as evidence of entopic phenomena that might indicate something awry inside the eyeball, or even in the brain. I didn’t want to end up shunted onto the wrong track in the voicemail maze. “Floaters, hallucinations, and double-vision, no,” I explained, “but problems with my vision yes, because the discharge from my tear ducts…”
“Sir,” she cut me off sternly. “These are yes or no questions. Answer either yes or no or I will not be able to help you.” I furiously tried to calculate which falsely binary oversimplifications were the right ones.
Then back to limbo at $1 a minute. Finally an advice nurse picked up. She ran me through a nearly identical gantlet of questions — hadn’t my previous answers been logged into the database? — but unlike the previous insurance rep, the advice nurse could handle nuance. Given the severity of my symptoms, she told me, I should certainly certainly see a doctor right away — as soon as I had secured permission for an out-of-network exam with someone at the member-services line on the other side of my Kaiser card.
It was 2 in the morning in a strange country and my eyes were oozing green goo, but at least I was getting somewhere. I called the other number, navigated another maze of prompts, and waited. Tick, tick, tick.
Thankfully, the member-services rep was both efficient and sympathetic. Of course, she said, it must be upsetting to be having eye problems far from home. I should definitely go to a local clinic. But before she could give me permission to do that, she would have to talk to her supervisor, because she’d never dealt with someone having a medical problem outside the country before. Several minutes passed.
Then, good news from the supervisor — with one caveat. Yes, I should go see a doctor at a local clinic. But because this was all happening out-of-network, I would have to pay out of pocket. As long as I made sure to obtain all the necessary receipts and forms, however, I could submit them when I got home, and Kaiser would “open a case file” on me so I could be reimbursed.
I wondered how much the visit would cost me up front — $200, $500, $1000? The unfavorable exchange rate had already vacuumed out my wallet, just picking up Chunky Hummus Salad wraps and “flat white” coffees at Pret A Manger. But it didn’t matter. My eyes needed help now, and I was almost certainly highly contagious; I didn’t want to pass this mess on to anyone else.
The member-services rep then explained that a Kaiser doctor would be calling me within the next four hours to give me additional information. I asked her gently if the doctor could possibly call in the morning London time, because I was already sleep-deprived and had a lot of work to do the following day. Sorry, she replied, that was just not possible. The doctor would have to call within the four-hour window allotted for my case — even if that meant the phone ringing at 5 in the morning.
Still, I was grateful to finally have permission to seek the care that I desperately needed. I called a number I found on the Web for urgent care in Marylebone, the central London neighborhood where I’d found a semi-affordable place to stay for three weeks. Amazingly, a human being picked up the phone right away — an affable guy with a disarmingly chummy accent and an empathic manner. Yes, yes, of course I should see a doctor right away. Where should they send him?
What? This guy was offering to dispatch someone to examine my eyes immediately in my apartment in the middle of the night?
I couldn’t even remember the last time I’d gotten a house call from a doctor — was it when I had chicken pox in 3rd grade? I expressed my astonishment. The chap on the other end of the line just laughed: I assure you, it’s no problem.
Alas, there turned out to be a hitch after all. One of the amenities I’d traded away for affordable lodgings in Marylebone was a landline. The guy explained that the National Health Service couldn’t send out a doctor to see a patient who only had a mobile number. But he took my name and gave me the address of an urgent-care center in a hospital near the Latimer Road Tube that I could visit at 9 in the morning. I thanked him profusely and went to bed.
The physician from Kaiser who called half an hour later was brusque and reassuring as he told me everything I already knew. I almost certainly had conjunctivitis. I should go to an urgent-care center in the morning, get an examination and a prescription, collect all the receipts, and Kaiser would open a file for reimbursement.
A couple of hours later, I pried open my eyes, washed my hands, and headed out to the Great Portland Street tube. Unfortunately, because of maintenance on the Hammersmith and City line, the trip took longer than expected. Arriving in Latimer Road, I discovered that the London street app on my iPhone had been deceptively optimistic; I would need to take a bus from the station to the urgent-care center.
I started to worry. Had the nice NHS guy made a specific appointment for me at the clinic at 9am or not? Thinking back, I should have clarified that. If I missed the appointment, could I get another one promptly? Would I have to wait through an interminable queue at the hospital? Luckily I’d had the foresight to lug an afternoon’s worth of reading with me in my heavy messenger bag. I wouldn’t have to waste a whole day of work if I missed my appointment and had to start from scratch.
I didn’t expect top-drawer, American-style health care. I’ve been hearing all my life about how impersonal and inefficient the medical care in England and Canada can be — after all, it’s socialized medicine: a Kafkaesque, government-managed, bureaucratic nightmare. Surely I’d have to wait for hours in a dreary queue of ailing and indigent patients in a country with no freedom of choice between health-care providers. (Never mind that because my spouse is about to change jobs, we’ve been anxious about me losing my coverage for months, adding a sobering asterisk of reality to election-year buzzphrases like freedom of choice.)
Panting into the St. Charles Centre for Health and Wellbeing in Kensington half an hour late, I was surprised to see only one patient ahead of me. The nurse in the admitting window asked me a few basic questions; the fact that I was visiting from the U.S. didn’t seem to faze her. I don’t recall if I was even required to produce my passport. I explained to the nurse that after my examination, I would need to obtain various receipts and forms to file with my health-insurance company back home. She just nodded and waved me into the waiting room.
There were only a few people already sitting there: a pretty young girl with a sprained ankle, a middle-aged Rasta with graying dreadlocks, and a couple of prim-looking older women out of an Agatha Christie novel. The calm, tidy waiting room presented a vivid contrast to the huge Kaiser complex on Geary Street back home, where frail seniors shuffle from waiting area to waiting area, taking numbers from machines and clutching their all-important forms to deposit in seemingly unattended baskets, before they’re herded to an examination room to wait 20 minutes for their harried physician to make a brief appearance. Though most of the Kaiser staff I’ve dealt with have been pleasant and good at their jobs, they often seem beleaguered and exhausted by the sheer workload.
The subtext of nearly every interaction with a health-care provider in the U.S. is: You’re lucky to have this coverage. Don’t push it. There are thousands of patients waiting behind you who are in even worse condition than you are. Let’s get through this as quickly as possible so the whole bloody machine doesn’t come grinding to a halt.
My name was called after just a couple of minutes in the waiting room. An Asian doctor with a gentle, inquisitive face and a soothing, avuncular manner took my medical history, asked me if I was allergic to any medication, and examined my eyes. The diagnosis was indeed conjunctivitis. The doctor wrote out a prescription for antibiotic eye drops with steroids that would take care of both the infection and the discomfort, and pointed to a pharmacy directly across the street where I could fill it. Did I have any further questions?
Only one: Where could I get the forms and receipts that I would need to file with my insurance company back home? “The eyedrops will cost you about ten pounds,” the doctor replied, “but there’s no cost for this examination.” When I gazed at him with disbelief, he added, as if patiently explaining something elemental to a child, “This is the National Health Service — it’s free.”
I couldn’t believe my ears. Surely a freeloading American had to pay up front? The admitting nurse, however, had no forms to offer me. My prescription was filled at the pharmacy within five minutes by a Muslim woman in a colorful headscarf who also directed me to a lavatory where I could put the first round of drops in my eyes. I immediately felt better as the placebogenic effects of feeling well taken care of took hold. In a couple of hours, all of my symptoms were gone for good, though of course I continued taking the drops until the bottle ran out, as directed by the doctor.
Riding the Underground back to Great Portland Street, I felt an unexpected sense of exhilaration. I had experienced not just a visit to a new clinic, but an unfamiliar paradigm of medicine — one in which health care is abundant, easily available, and affordable, rather than scarce, expensive, and a hassle for both the patient and the doctor.
I’m aware that my little adventure in socialized medicine is no more than a trivial anecdote — one tourist’s experience with a minor affliction that was easily dealt with. I expect that many Londoners could furnish horror stories about their ordeals in the NHS. One renowned health-care expert who grew up in England recently explained the difference between British and American medicine to me by saying that if he was very rich and had cancer, he would rather live in the U.S. But if he was poor and had cancer, he’d rather live in the U.K. and be guaranteed at least B-minus care.
That’s the sort of nuance that gets lost when the framing of public debate on health care is socialized medicine versus free-market capitalism, the feds vs. private insurers, or the GOP vs. “Obamacare” — and when we allow the tone of that crucial national debate to be set by ill-informed voters yelling Fox News talking points in staged riots at townhall meetings.
Shortly after arriving back home, I read that GOP presidential front-runner Michele Bachmann — who brags of being a successful small-business owner because her fey “therapist” husband, boasting a degree from a defunct diploma mill, runs a network of clinics that take government funds to indulge evangelical fantasies of homosexuality being “curable” with enough prayer and self-loathing — had declared that President Obama must have been “not in his right mind” to pass the Affordable Care Act, which she has vowed to repeal if elected president. The GOP has been sounding the alarm about “socialist medicine” since 1961, when Ronald Reagan preached against the soul-sapping dangers of Medicare as a threat to American liberty.
The Koch brothers’ astroturfed Tea Party crusade against health reform can take the lion’s share of the credit for putting the GOP in control of the House in the mid-term elections, resulting in one of the most deadlocked, fractious, showboating, anti-labor, anti-middle class, and casually bigoted Congresses in history. With help from a president who often seems more eager to demonstrate his “post-partisan” reasonableness than to defend the lives of the American people against the ravenous appetites of corporations and lobbyists, the safety and security of everyone but the very rich — in the form of modest entitlements like Social Security and Medicaid — is headed for the chopping block.
It’s my generation that will end up ill and indigent in dank emergency rooms, without even the Medicare that my widowed mother depends on in her fearful hours, because we let quacks like “Dr.” Bachmann diagnose the myriad ills in our health-care system.
The specter of Americans paying higher taxes to prop up a bureaucracy like the NHS is a dependable stockyard of red meat for the right-wing base –though Americans already pay billions of dollars every month to support a system in which they’re too often treated like interlopers and malingerers, and from which they’re liable to be exiled for the sin of quitting a bad job to try to get a better one. That doesn’t sound like a “free market” to me.
“If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state,” GOP kingmaker Karl Rove rumbled ominously from the pages of the Wall Street Journal in 2009. “The public option puts government firmly in the middle of the relationship between patients and their doctors. If you think insurance companies are bad, imagine what happens when government is the insurance carrier, with little or no competition and no concern you’ll change to another company.”
Yes, imagine. Imagine a traveler from London coming down with a mysterious infection while on holiday in the States, waking up in a hotel room with burning eyes at 2am. Who does he or she call — 911? (You can imagine the response to a polite inquiry about a house call). Where does he or she go to find care with no insurance? I’ve waited in enough dingy stateside ERs with sick and injured people to know how being acknowledged after two hours in front of a blaring TV set can be the answer to a chorus of prayers.
Or imagine a society committed to providing access to health and wellbeing for everyone, rich and poor, rather than playing childish semantic games about “death panels” and “socialism.” The cost of calls to my insurance company to get permission to see an NHS doctor who didn’t charge me a penny will be six times what I paid for the medicine that cured my infection.
But that, I suppose, is the cost of living in a free country.