An Eye-Opening Adventure in Socialized Medicine

Karl Marx, M.D.

Dr. Marx will see you now (image by Keith Karraker)

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.

Great Portland Street station

Great Portland Street Tube station

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.

Conjunctivitis

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.

iPhone London street map

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.

St. Charles Centre for Health and Wellbeing

St. Charles Centre for Health and Wellbeing in Kensington

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.

GOP candidate Michele Bachmann

GOP front-runner Bachmann describes Obama's Affordable Care Act as "Frankenstein"

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.

Related Posts Plugin for WordPress, Blogger...

Creative Commons License
An Eye-Opening Adventure in Socialized Medicine by NeuroTribes, unless otherwise expressly stated, is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

This entry was posted in Bacteria, Ethics, Health, Politics, Science, TV and tagged , , , , , , , . Bookmark the permalink.

149 Responses to An Eye-Opening Adventure in Socialized Medicine

  1. Dana says:

    For the first 25 years of my life, and especially from 1992 til 1999 when I was no longer covered by CHAMPUS (an old-style form-submission type insurance program which sometimes turned you down for reimbursement), I had experiences similar to yours all the time. Why? I was a Navy brat, then an Army soldier, then an Army wife. That’s why. I didn’t even have to pay the U.S. equivalent of ten pounds for eyedrops. I simply took my prescription to a military pharmacy. No co-pay, no nothing.

    When was the last time you heard a Republican refer to the military healthcare system as “socialist”? Never, I bet.

    The Heritage Foundation, I think it was (or maybe the Rutherford Institute, though I think it was the former), has a page on their website that discusses how much of the DOD budget is spent on healthcare. They had it pegged at about one-fifth. That’s coverage for EVERYONE eligible, by the way, not just active-duty servicemembers. That includes premature newborn infants, fat and diabetic Army wives (I was the former, though not the latter–gotta love pregnancy-related hormonal changes!), retirees, elderly parents, and in-laws.

    With all that in mind, the HF still wanted to see the government come up with ways to cut costs. That was the closest I ever got to seeing conservatives implying there was anything wrong with military coverage. Since it hasn’t become a major talking point with the GOP rank and file, I have a feeling the HF was overruled someplace.

    If you kill people and break things (even for honorable reasons), or if you are closely related to someone who does, you’re worthy of saving. Everyone else can go hang, I guess. It makes me wonder for what exact purpose the military is killing people and breaking things, if there will be nothing left worth defending here at home.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • M E DuPrey says:

      Thank you.

      I am now covered by Medicare & Tricare for Life.

      I receive splendid medical care from the doctor of my choice and referrals to specialists are not required. Moreover, my prescriptions are paid for. I really DON’T see what the problem is.

      USAF D/W (Ret.)

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  2. paul says:

    What’s missing from a lot of the “debate” over universal access to health care (since that’s actual under consideration, not the provision of care itself) is the potential for savings both in dollars of GDP/wages spent and in reductions of lost work time. For a country that seems increasingly focused on the bottom-line, it seems that low-cost accessible preventive care or early treatment, as in the conjunctivitis suffered by the author, would be desirable, in terms of lower costs (what would this cost if it weren’t treated for a week or more?) and in better productivity. Of course, any service or commodity that has low access barriers is likely to be abused but those details can be dealt with in the implementation. We don’t even have an agreement that universal low-cost/free access is worth doing.

    Consider the cases over the past few years of people dying from dental infections that could have been treated with antibiotics but instead became terminal infections. Imagine if a young boy came to an ER and it was determined that his treatment would cost $2 million, all uninsured, and he would die anyway (as actually happened in one case). Why admit him? If, on the other hand, he had seen a doctor 2 weeks or so earlier and been prescribed antibiotics that would have cost infinitesimally less, he would have lived and the state would not have had to eat those costs.

    As it happens, he had insurance, of a sort. But no dentist in his area would accept it as the government plan he was on had too low a repayment rate. If anyone says we don’t ration healthcare in this country, they are lying. Pundits accuse universal care systems of rationing based on need (which actually has a name: triage) but we ration based on a ability to pay. Which is the most fair or equitable?

    How many deaths due to untreated injuries or infections are acceptable, so that we don’t somehow enable people to steal access to medical care?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Dana says:

      And everyone does triage, not just universal-coverage systems. Every. One. You have to. You can’t put a lot of resources into caring for someone with a knee scrape when there’s a patient dying of a stroke just down the hall.

      These yo-yos don’t even understand how health care *works.*

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  3. Marcus says:

    Great story, and a reminder of why we love the NHS!

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  4. NICHOLAS MCGEORGE says:

    Life expectancy for men and women in the UK is six months longer than USA, with 40% lower costs per head in the UK than in USA.

    NHS is clearly doing something right at less cost than private insurers in USA.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  5. rpg says:

    David Dobbs told me this story last night at the pub. Fair brought a tear to my eye, it did (forgive the inappropriateness of that remark, won’t you?)

    There’s a lot of things wrong with Britain, but by God I don’t want to live anywhere else.

    VA:F [1.9.22_1171]
    Rating: +1 (from 1 vote)
  6. Pingback: links for 2011-07-24 « Embololalia

  7. Flora Steele says:

    We had excellent care in New Delhi and Chiang Mai in 1989, which I suppose was socialist as we never got a bill for either (weekends overnight in the hospital, dignosis, treatment). We also have good experience with Medicare in the US now.

    I wish there were socialized medicine in the US, or at least Medicare for everyone, with less or no co-pay. But what does Obamacare have to do with socialized medicine? Obamacare just gives Kaiser more customers; it doesn’t make Kaiser less of a hassle.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  8. Richard Noble says:

    One aspect of the U.S.A’s. uncivilised and cruel healthcare (or lack of healthcare) system that has not been mentioned is its effect on wages and salaries. Because of the high cost of medical insurance that the employer provides wages and salary levels are inevitably reduced. This sometimes affects the company’s international competitive position as their competitors in other countries do not have similar costs, healthcare being provided by the state. General motors made much of this point during their recent troubles. A further aspect is the resort to surgery and other expensive treatments when a more conservative approach would be equally or more effective.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  9. Pingback: What You Can Get Away With (Nick Barlow's blog) » Blog Archive » Worth Reading 46: Two conspiracies for the price of one

  10. Pingback: links for 2011-07-20 « Thagomizer.net Thagomizer.net

  11. Mary Branscombe says:

    glad to hear the NHS did what the NHS does well; treat the patient rather than handing out the bill. There are problems in the NHS and things that could improve, but the general level of care is good – and that fact that everyone gets treated without forking out cash at the point of treatment means everyone gets treatment. If you earn, part of your taxes fund the NHS. We don’t think of it as socialist until the right wing parties try to dismantle the system, but it is a welfare state. I know the philosophy of US independence is opposed to that, which is a shame – and I’d note that we call ‘ObamaCare’ insurance reform rather than healthcare reform. In many ways I’d love to live in the US and work there, but we’d never move there as freelancers because the health costs would be beyond our means. I have friends who’ve held bake sales to pay for their liver transplants in the US which I find appalling…

    Incidentally, while there are few jobs in manufacturing in the UK and there are depressed areas where unskilled workers find it hard to get jobs, employment is pretty good, especially in small businesses. Like needing a green card or job offer to move to the US, there are immigration requirements ;-)

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • A. Marina Fournier says:

      Your occasional hostess here, Mary.
      I too would call Obamacare insurance reform rather than healthcare. I do worry about you two, now and then, when you’re over here. I suspect you buy travel insurance, as other British citizens responding here have said they do.

      If it were truly healthcare reform we were attempting here, what would it look like? What are some of the elements like to be?

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Dana says:

      As an American, I don’t understand why so many of us think of publicly funded medicine as anathema to independence when we have no trouble with the concept of publicly funded police or firefighter coverage. I only know of a couple areas of the country where firefighter coverage is by subscription rather than tax-funded, and most of the country agrees that’s a barbaric practice. Yet we cannot extend that thinking to medical care. I don’t understand. You’re just as likely to need help from police or fire department for negligent behavior, if not more likely, than you are to need medical care for that reason. Arsonists and other criminals abound and plenty of people are ignorant of the law.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  12. Lisa says:

    Oops I mean I did NOT pay one cent. Also they gave me a CD of all the scans to show my orthopedist back home.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  13. Lisa says:

    Lying here in my guesthouse in the Austrian sud tirol with a thigh to ankle cast on my right leg due to tibia fracture yesterday. Service at the hospital in the Bolzano region of Italy: Slow but professional. Physical exam followed by CT scan followed by diagnosis and meticulous application of the cast, plus two days’ worth of heparin injections, a prescription, an authorization for air travel back home to the US, and finally, a pair of crutches adjusted for my height. After the technician wheeled me out to the waiting room, I mentioned I needed to pay the bill. He patted my shoulder. “it’s okay” I did pay one cent, except for the prescription.

    Viva Europa !

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  14. M. says:

    My wife and I were traveling in Serbia when she came down with weird abdominal pains. We went to a doctor, who sent us to a kidney specialist, who took ultrasounds, and recommended a CT scan upon finding weird things. It turned out to be a tumor, which they diagnosed as probably benign.

    The whole diagnostic process took three days, and cost about 250 dollars, mostly in fees we paid to jump the line (since our vacation days were running out). We went back home expecting that we would go straight to surgery, and get the problem taken care of.

    How foolish of us.

    Once back in the US, the doctors here would not accept any of the findings. Instead, we had to reschedule and re-do everything, the US way. Which means schedule a CT scan in a week; get results a week later; get the specialist to actually look at results another week later… etc.

    It ended up taking three months. Our insurance was billed $12,000 for all the tests and visits. That was in addition to the $10,000 they billed for the eventual surgery itself.

    Yes, it was benign. If it wasn’t, treatment would have been delayed by three months.

    I’m seriously going back there if I get seriously ill. The cost of ticket is nothing compared to the pain one has to deal with during the infinite delays, and the cost of the treatment itself is approximately the same as the cost of copays here.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  15. Brent Eades says:

    Oddly, I had almost the identical experience a few years ago, waking up in a London hotel with badly inflamed eyes. The concierge referred me to a nearby clinic where I was put right within an hour or so. No charge other than for the drops.

    This didn’t surprise me as much as it did you because I’m Canadian and take it for granted that I’ll receive free medical treatment when and as I need it, within reason at least.

    I’m fifty-five and have never encountered care that I’d consider “inefficient or impersonal”, or at least no more so than I imagine I’d would find in hospitals and doctors’ offices anywhere else. (Though I acknowledge that the experience of Canadians in more remote areas may be different. Again, that would apply anywhere I’d think.)

    My dad recently lost a four-year battle with cancer which involved several surgeries, chemo, the lot. He had nothing but good to say about the numerous specialists he dealt with during that time. They were consistently competent and compassionate. He never had to wait unduly for important procedures. And he didn’t have to pay a cent from his pocket.

    The Canadian system has its flaws. But the bottom line is that if you’re sick and need help you’ll get it, regardless of your income, employer or social status. Doesn’t sound like a lot to ask for.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  16. Dave says:

    In July of 2010 I was bitten on the finger by a viper in Costa Rica. Bites by this particular snake are not generally life threatening but may result in local tissue damage and in my case potential loss of a finger. So through the whole ordeal I wasn’t really worried about dying; I had some concerns about damage to my finger but I was definitely thinking about the bill. I was in the emergency room, had blood tests and then anti-venom administered. I spent almost 48 hours at the hospital and received two prescriptions at my discharge; the total cost was $50. I received excellent care and my finger is completely healed. When I tell people about my ordeal there response is almost invariably “It must have been horrible to have had that happen in a third world country”. If that is health care in a third world country then I guess health care in the US is equivalent to that in a “fifth world” country at best.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • A. Marina Fournier says:

      When Limbaugh claimed falsely that, if the Obama Health Care Reform passed, he was moving to Costa Rica, a number of us wondered if he realized that the country already had “socialized medicine”.

      I still wish he’d kept his word.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  17. Pingback: Balloon Juice » The Sad Long Life of David Brooks

  18. Pingback: The Sad Long Life of David Brooks | Sarah, Proud and Tall

  19. Jo says:

    While I realise you can only recount your own experience, as a British person (who lives in the US) the tone of this article does come off as being rather naive. A couple of things that jumped out at me:

    1 You *should* have been charged for treatment, as you are non-EU – the only reason you were not is because it was so minor it probably wasn’t worth their time to do the paperwork. If you had had a serious accident requiring surgery or had required a hospital admission for something like dialysis I am certain you would have been billed for it.

    2 The NHS is *not free*! It is free at the point of need. It is funded by National Insurance, which you pay if you are working.

    3 I’m astonished that you were offered a housecall in the middle of the night for something like conjunctivitis. You certainly wouldn’t have got a night time visit from the surgery I used to be registered at at home unless you had something potentially life-threatening like suspected meningitis or unless you were elderly and very frail. But then I looked at where you were in London – oh surprise surprise – only Marylebone, one of the most affluent parts of London, nay the world, and home of Harley Street. And then you were treated in Kensington, which is the same. I’m not surprised they have bloody excellent services – can you imagine what kind of tax revenue the boroughs of Westminster and K&C get? It’s like being surprised that there is quite good health care available in the Upper East Side.

    4 “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?” The answer is that nobody from Britain with half a brain cell would travel to the US without taking out travel health insurance. It is pretty cheap and the standard thing to do when travelling outside the EU. This is what EVERY visitor to the US has to do if they don’t want to risk being in an accident and getting a huge hospital bill. I’m a bit surprised that this would never have occurred to someone.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Steve Silberman says:

      For the record, I was offered the NHS house call before I told the guy where I was. I could have been anywhere.

      VN:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Jon says:

      I think the GP was correct.

      If you check the article “Am I entitled to NHS treatment when I visit England?” on the NHS webiste (http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68&subcategoryid=162) it says in the 1st para: “When you visit England, you’ll normally have to pay for all NHS treatment unless you’re exempt from charges.”

      *But* it goes on to say:

      “Emergency treatment

      Regardless of how long you’re staying or your nationality, you’re entitled to free emergency NHS treatment from:
      a primary care practice, such as a GP surgery
      an A&E department
      an NHS walk-in centre
      However, unless you’re exempt from charges, you’ll have to pay NHS charges if you’re:
      admitted to hospital as an in-patient (this includes high dependency units and other emergency treatment, such as operations), or
      registered at an outpatient clinic.”

      Conjunctivitis counts as an emergency in my book, I’ve had a mild case and it was no joke.

      The rules appear to be designed to discourage people from coming to the UK when they are already ill, which of course would put an intolerable strain on the NHS and British Taxpayers.

      But I love this story. Long live the NHS. I now live in the Netherlands and miss the UK system. I’ve visited almost 50 countries and I’m convinced it’s the one thing the UK has got right! I wish everyone would adopt it then we would not be arguing about weather or not a tourist should be treated free of charge!

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  20. Nylund says:

    My wife and I go back and forth between Canada and the US (I’m American, she’s a Canuck). Unfortunately, we’ve had more than our fair share of medical emergencies recently (both to ourselves, and our parents) and have way too much experience with medical care in both countries. We both much prefer the Canadian system. The American hospitals tend to look nicer…big atriums with nice art, with bigger, nicer, more private rooms, but everything else is a Kafkaesque version of hell compared to the simple, straightforward Canadian system. After seeing me nearly bleed to death as the US hospital subjected me to 30 minutes of paperwork when I was barely conscious rather than treat me, my wife decided that she’d never seek treatment in the US, and always travels back to Canada for any medical needs. How we treat people under our for-profit system does seem incredibly inhumane, barbaric, and third world once you’ve experienced a system where you simply go in, get treated, and leave. We both (sadly) had to watch our respective mothers battle cancer (both survived, thank God), one in each country. And personally, I wish my mother had the experience her mom had in Canada. Never was bankruptcy, insurance forms, approvals, etc. ever an issue.

    The difference was truly, “You’re sick, and we want to make you better,” vs. “You’re sickness hurts our profits and we’ll do everything we can to deny you treatment so that it doesn’t hurt our bottom line.”

    I have years of first hand with both systems, and I can’t believe that anyone would prefer the US system after experiencing how a serious illness or injury is handled in both systems. When I meet Americans who are so certain that the US is better, I can almost guarantee that they have never had serious first hand experience with both systems in which to form their opinions. Its all based on assumptions, second hand stories, political and media blowhards, and a blind faith to a preconceived political ideology.

    When its you (or your mother) that’s facing death, you really do want the system that wishes nothing more than for you to get better, not the one pissed off about how much money they’ll lose on you.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Dana says:

      I was shocked after taking a job in a civilian healthcare system because the decor in my doctors’ office was so fancy. I had never seen wallpaper like that before, nice art on the walls, wall-to-wall carpeting (yes, in a place in which you can occasionally expect someone to bleed out all over the floor) everywhere but in the lab, bathrooms, and exam rooms.

      When I’d been a military healthcare beneficiary there was nothing fancy about any of the facilities I visited or worked in (I was an admin clerk in the military for a while). Bare floor, cheap art on the walls when there was any, hard plastic chairs in the waiting rooms. No one ever complained. When you’re that sick you really don’t care about your surroundings. Even if it could be argued that it matters what color the walls are, paint is cheap.

      And they wonder why health care is so expensive here, and inevitably they blame the patients for wanting more than a once-over and a turning away because the doctor hasn’t looked deeply enough to figure out what’s wrong. Whatever.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  21. John Mack says:

    When I was a kid in New York our first-generation American family physician belonged to a self-created doctors’ cooperative. By sharing expenses, with one business management office, they could keep their fees reasonable and buy advanced equipment. They also encouraged visits to the excellent free hospital clinics where they volunteered (we were poor even though all our relatives were well off and my parents once had been well off too). They hired new doctor interns (usually minorities, to help them break in during an era of discrimination) who made house calls, even in the middle of the night. This doctors’ cooperative could get immediate appointments (within a few days) with specialists (a rich relative had to wait 3 months).

    The doctors operated this cooperative because their European values motivated them to spend a great deal of time with their families. They did not want to become “heroic” workaholic US physicians.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  22. Pingback: I’ve got your missing links right here (16 July 2011) | Not Exactly Rocket Science | moregoodstuff.info

  23. My cousins, Aunts, and Uncles can give you some horror stories about their medical care in Canada – but I suspect it might be more of a result of living in a small Province with no big city or medical research centers.

    At least 2 times members of my family had to go through paper work to go to another province with advanced medical centers for care of serious conditions.

    They all have travel insurance if they put so much as a toe over the boarder.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Joy Sabl says:

      Wheras my cousins, sister, and in laws in Canada are very pleased with the system (sis having grown up in Orange County before marrying a Canadian). Various Canadian co-workers have been disconcerted, not to say horrified, by the paperwork and inefficiency of the system here (disconcerted in the Seattle area, where things worked fairly well; more distressed elsewhere in the US). The only negative I’ve heard, more than once, involves high cost treatments for diseases high in pain but low in actual damage (like sonicators to treat kidney stones). But in cases where the treatment is cheap, in terms of equipment (like 90% of doctor visits) or else essential for future good health, like, say, chemo or heart bypass surgery–treatment is at least as fast, far more available and far cheaper under the Canadian model. This may be faint comfort to someone with a kidney stone, who might well be willing to pay any amount to make the pain stop, even at the price of forgoing access to chemo to save their life. But for anyone not in the grip of a pain that overrides rationality, the CA system has a lot going for it.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • John Mack says:

      Remote areas always have problems with inadequate medical resources , especially for complex problems. This happens in the USA as well. I know of three instances where I had to browbeat friends in the US to go to research hospitals in Boston (we are an hour away) for their weird conditions which were going untreated, the doctors saying the conditions would go away by themselves. Upon examination at the research hospital two were immediately put into surgery for for their life threatening states. The third was given medicines and prescriptions and told that the regime had to be strictly followed our he might end up crippled. All,three had the best of private health insurance from their employers.

      My own brother was told in an expensive private suburban hospital by 3-4 doctors that his heart condition was more or less hopeless and that he could be dead in 6 months. At the research hospital in New York the doctors were startled when he asked, “What are my chances?” They mumbled and then said there might be a 1% chance that things could go wrong. They performed a quadruple bypass (but there was no damage to the heart itself) and he had to be wheeled out on IIC in a few hours because he was awake and would not shut up. Everything went fine except that he refused to restrict his really fatty eating (steak smothered in cheese almost every night, with potato smothered in butter). He lived for 17 years afterwards and refused another operation (which he was assured would work well). My brother had the best of private health insurance from his wife’s employer (he ran a small business).

      The point is that no system can make medical care perfect in all locations and issues beyond the ordinary are generally better diagnosed and treated at large specialist or research hospitals.

      The research hospitals, by the way, rely on government granys for most of their research projects, which are honestly conducted. So many research projects funded by pharma corporations are found to be falsified over and over. Jonas Salk developed the polio vaccine in a government funded research project and the vaccine was made availalble to all without any royalties to Salk or any pharma company.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Dana says:

        The fat wasn’t what was causing his heart problems, though. And it probably helped him live that next 17 years.

        One of the problems with American healthcare is the shoddy science propping it up. Over a million years of eating vertebrate animal fat, with the knowledge that any hunting animal, including us, routinely targets the fatter members of a herd and suddenly this stuff is causing us heart disease? Right.

        My current health insurance lets me go straight to a specialist without a referral, and I almost had to take that route, because my doctor couldn’t feel anything wrong with my problem saliva gland other than some swelling. Having the saliva glands in your lower jaw back up is a wretched feeling, and I was at risk of developing a chronic infection and requiring it to be removed, which would have then impacted my quality of life. Fortunately she was sensible enough to go ahead and make the referral. The ENT literally found a rock in my head. Had I been on Medicaid instead, I’d have been out of luck.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
  24. Don says:

    What is the similarity between Obamacare and NHS, other than Republicans do not like either one? The author seems to imply that my future and entirely involuntary experiences under Obamacare might in some way involve cheery off-hour housecalls, and that the Obamacare movie will somehow morph into a tea-and-crumpets NHS sitcom.

    I add in my skepticism that a guy as knowledgeable as the author would 1) not understand in advance that a minor ailment visit to a UK doctor would be at most minimally expensive, and 2) would be willing to sit on hold at $1/minute — stir briskly, and take a small taste — yep, the house dressing tastes like propaganda.

    That said — would you like to reduce costs?

    Then please! Allow me, as a competent adult, to sign a BINDING waiver of liability w/ the physician of my choice so that our interactions can occur entirely unmolested by lawyers.

    As to the prospect that Obamacare will reduce costs — should I pass a law requiring everyone to buy a six-pack of beer every week, what will happen to the price and quality of the brew? And will beer consumption rise or fall?

    I predict that costs will go up, quality will go down, and pre-paid people will seize every opportunity to go to a doctor — which in turn will prompt care-providers to ensure that visits are not TOO pleasant…

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • M. says:

      You predict that the experience in the US will be diametrically opposite the experiences in the rest of the world.

      And, by the way, the malpractice costs add up to whopping 6-8% of the healthcare cost in the US. That IS too much, don’t get me wrong, but your “binding agreement” is barely going to make a dent in your hugely overpriced bill.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Don says:

        I doubt the rest of the world has anything that much resembles Obamacare — that said, the prediction is based on what has occurred in the states previously — mandatory insurance being nothing new in America.

        My observation — proponents ALWAYS argue that “costs will go down when everyone is in the pool”, and rates ALWAYS skyrocket once the system is in place. That includes mandatory auto and malpractice insurance in several instances — got a counterexample wherein the concept worked as promised?

        Lastly — I believe the 6-8% number you cite is DIRECT costs (i.e., awards and etc.) is it not?

        The reasoning behind a binding contract that includes liability pre-agreements goes deeper than that — a doctor can reduce insurance costs to near zero, and cease practicing defensive medicine, should he choose to do so. And, to use a stereotypical example from the distant past, no 8$ aspirin tablets either, should a patient choose to seek care on a limited liability basis.

        Most do not consider that in an open market, insurance companies not only compete against themselves, but also against people who do not carry insurance.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
    • Dana says:

      Have you ever had an automobile accident? If so, were you satisfied with your insurance company’s coverage and payout?

      I don’t like the mandatory coverage either and I feel that if we have to do that anyway, we might as well transition to single-payer. But what in the world does mandatory coverage have to do with quality of care? I *have* heard people praise their auto insurance companies after a bad auto accident. In states requiring coverage, which I think is all of them now.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  25. Pingback: False Choices and Health Care

  26. Sara Wolfson says:

    The real point here and the only one that matters is this: the difference between the US and its European counterparts is that they cover ALL their people with insurance and we don’t. Our poor and vulnerable citizens have either no coverage or coverage by Medicaid that is in jeopardy. That is unforgivable, and exactly why the US is behind France, UK, Denmark, Germany and others in health care quality. We care so much about our rankings and reputation in education compared to these countries but what about our reputation for caring for our vulnerable folks?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Dana says:

      Medicaid isn’t anything to brag about. Only some doctors take it and they’re generally not the best, either because they work out of training hospitals or because they don’t have good reputations so they will take patients where they can get them.

      All my local newspaper ever talks about with respect to Medicaid is how expensive it is for my adopted home state. I spent a year and a half under that coverage and I never felt so disrespected by medical providers. They behaved as if everything I ever needed from them was a huge hassle. Except for the weird dentist who spent half my appointment time with him being a mouthpiece for Listerine mouthwash. I have never had a dentist push a name brand dental artifice on me before or since, not even when they had product pamphlets out on the front counter. Not what I’d call professional. I suppose he had to pay his bills some way.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  27. Sean D says:

    This is NOT socialized medicine. Kaiser is a commercially operated HMO – that is, a private operation. You know, like the ones that the anti-universal health care people claim will solve medicare, Medicaid, all our problems. Run by MBAs, and greed. It demonstrates the REAL PROBLEM – that dehumanizing medical care, and allowing the profit motive to intrude, solves NOTHING. Kaiser in not socialized medicine. Claiming it is is purely propaganda.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Steve Silberman says:

      Sorry, Sean, you have to read more closely. You missed the point of the piece entirely.

      VN:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  28. Sunfell says:

    I recall my own experience with the NHS when I was stationed in Suffolk- just after I got out of the USAF. I was in a multi-car pileup on the A12, and got an ambulance ride to the local hospital in Ipswich. They took good care of me- thankfully my injuries were minor), and even telephoned a local friend to come pick me up.

    Like you, I was stunned that I didn’t owe them a penny, but before I left the country, I made sure to donate a generous amount to a local charity as thanks for their excellent care.

    Would that we could have such things here- it’s really sad that the first thing you get asked when you visit a US hospital or clinic is about your insurance status, not your health problem. We are so backwards, it isn’t funny.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  29. Anne Ehrlich says:

    Great blog. Thanks. Although I wouldn’t wish sickness on anyone (well maybe someone), I do wonder how it might change the world if Palin or Bachmann or their kids got sick in a place more civilized than ours. I fear that most folks only learn from their own experiences.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • A. Marina Fournier says:

      Ah, but Palin admitted sneaking over to Canada to get some sort of medical care for members of her immediate family.

      She doesn’t see the contradiction.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  30. John Mack says:

    Two Points:

    1. What role does bad food play in the disaster of health in the USA? Why is diabetes skyrocketing, becoming “normal”? I am 70, all readings good to excellent. Have Medicare, have not used it. And I am overweight. I eat healthy food, and am fortunate to have 2 places serving organic food (some traditional meat dishes included) near me at reasonable to inexpensive prices. I also have bacon 2-3 times a week with eggs, toast (butter only, than you) and home fries. On the other hand people in the UK do not eat particularly well, so maybe they are in bad shape too. Nonetheless I cannot imagine that their diet is as universally miserable as in the US.

    2. I don’t know if it’s still the case, but Americans, Canadians etc. with one grandparent born in Ireland can get Irish citizenship. Maybe still not the case, but Irish citizens can immigrate into the UK freely, go to UK unis at in-country rates, use UK NHS. This arrangement goes back to Irish independence in the early 20th century.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • marrog says:

      I eat healthy food [...] have bacon 2-3 times a week with eggs, toast (butter only, than you) and home fries.

      I’ve got to say, mate, speaking as a Scot, I have toast and eggs with baked beans once a week, and I consider myself a bit of a pig for doing so. Bacon and chips/fries are the sort of thing I would only have once a month or so as a special treat (probably less often than that, thinking back), and certainly never both at once.

      And I’m fat, and generally pretty unconcerned about my eating habits – I’m not on a diet or anything. So I’m not sure you have a terribly objective view of what constitutes ‘healthy’ eating…

      However, if you’ve reached 70 and are perfectly healthy then you’re presumably lucky enough to have the sort of constitution that can handle such abuse, so more power to ya!

      @Steve: This is the same story I hear over and over again from Americans – they have a medical emergency, they go to the hospital and are astounded when they aren’t asked to pay for it. Your experience in A&E/walk-in was actually rather a lucky one – most places/times you might be waiting a few hours to get seen. But that being said, the bottom line is the same.

      I am quite poor – in the bottom 30% financially according to a test I filled out today and I’m living in one of the more expensive British cities. As it happens I’m also very healthy – I’ve averaged about one doctor’s visit every four years since I left home.

      However, it’s a great comfort to me to know that if anything happened to me there’s no chance of me being bankrupted by it. In the meantime, I’m happy to pay my National Insurance safe in the knowledge that my gran, my friends, my sister, acquaintances, strangers, who do need that care, are receiving it – and in Scotland they don’t even pay for their prescriptions.

      Some people call this state of affairs Socialism. I call it rational and humane.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Dana says:

      Sometime when you’re bored (whoever is reading this, I realize I’m commenting months after the original), look up the nutritional content of bacon and eggs on the USDA nutrition database. We used to eat a lot more animal food in this country than we do now (though a lot of it was offal and fat–which is not as bad as it sounds, look up beef liver too while you’re at it), but we’re sicker now.

      If we’re going to talk about bad diet we need to be honest about which parts of it are bad. The current fad of guilt-tripping everyone into adopting vegan diets is only watering down what little good nutrition we get with foods of little caloric value and not much more nutritional–and too many foods rife with antinutrients as well. For example, one of the worst things you can do to your health is replace meat with soy, yet that’s something vegans recommend.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  31. Pingback: Friday Pix: Recommended Reading For The Weekend | RealDelia

  32. Pingback: Yet another take on socialized medicine « ideadigest

  33. Graham J. says:

    Great to see this.

    I was a grad student at LSE last year living just on the edge of the City and the East End, and on my way back from a party I foolishly ate a chocolate that turned out to have a peanut in it (I’m allergic, you see). I got back to the dorm feeling woozy and then immediately starting throwing up. Tried to use my epipen but ended up just bending the needle.

    At any rate, I shouted into the hall for a flatmate to help. One called the front desk and 999. NHS was there in eight minutes. I was quickly stabilized, nebulized, etc., and brought straight to the ER at Royal London Hospital in Whitechapel, where I continued to be monitored. Eventually I was awoken and moved to the recovery room.

    The next morning, I woke up to find a cucumber sandwich and orange juice, along with profuse apologies for the need to keep me there a little while longer while they filled a prescription for some sort of medication. About an hour or two later, I was discharged in full health, well-fed, and with several medications to keep me doing well. Total cost? Nothing.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  34. Jeff Wilson says:

    I knew an elderly couple who was visiting Russia in the late 1980s — still the Soviet Union era. She developed severe gastric distress. With dread, they went to the public clinic in Moscow. They were there less than 30 minutes. She was given a tablet, which proved to be effective, for her problem. Total cost: $3. He was a confirmed capitalist, but the experience opened his mind a little.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  35. Mark says:

    I am currently one of the few people on Obama Care. I am 32 years old with 2 crushed disc in my lower back. First time I’ve had a decent Insurance in 12 years. It’s been a huge hassle to get them to approve Disc Fusion surgery, almost 8 months so far just like any other insurance company. Looks like I will finally get it after the 5th doctor in a row recommended it, the doctor they sent me to. Obama Care still cost a ton of money, $250 dollars a month just for myself and $6,000 a year in deductabiles so it’s not exactly the free ride everyone thinks it is. Now when it goes in full effect there will be programs to help poorer people pay for it. Just hate when I hear people say your not paying for it, I’m paying out the rear for it, 7k last year and will be another 9K this year. I just could not be insured by anyone else, how are you supposed to live if in this country if it is impossible to get insured because of pre-existing conditions? Just end up with people costing tax payers more money cause they are stuck on disability for life!

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Andrew says:

      What do you mean by “I am currently one of the few people on Obama Care”? There is no such health insurance provider entity by that name. The health care reform bill that is commonly referred to as “Obamacare” is simply an individual mandate to obtain insurance (in most cases private insurance) or face a financial penalty. It also provides protection for the public so they can obtain and not be booted off their insurance for pre-existing conditions, in addition to subsidies to those who are unable to afford their insurance.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • JFS says:

        The “high risk pools for people with pre-existing conditions” went into effect late last year. Looks like that’s what Mark is talking about. google [pools for uninsured] or ‘high risk health pools] for more details.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
  36. Richard Noble says:

    Citizens of the U.S.A. might be interested in my experience of Britain’s socialist B minus health care system. I have a personal G.P. in a practice of five doctors. When i need to see him (and it is always him except for holidays when I would see one of his partners) I see him the same day if it is urgent and within 48 hours if routine. He does all his own home visits except at night and the weekend where the practice operate a rota system amongst themselves. I have never waited more than twenty minutes at his surgery to be seen. Eleven years ago when i was 67 I had a quadruple heart bypass. My nearest heart centre was overloaded at the time so I was offered a place at a major London teaching hospital. Where the operation was carried out with all the care and attention that was possible. I have had two minor surgical procedures since then. A hernia operation and surgery to my prostate. In both cases I saw the specialist within one week of seeing my G.P. and the operation was carried out a week later. Recently at 77 I broke my ankle in a spectacular way and needed complex orthopaedic surgery which left me with a complete meccanno set on one side and a metal rod with attendant fixings on the other. The recovery has been total and the ankle now functions exactly as before the accident.

    My wife recently died of bowel cancer and throughout many years of illness the care and treatment she received was exemplary and her stays in hospital were marked by the great attention to her comfort by the staff and the skill and attention of the physitians and surgeons. On one occaission because of the cancer in her bones her leg broke and due to the fragile state of he bones only the consultant surgeon could carry out the operation. The consultant came to her bed with one theatre assistant and chatted to her before the operation then invited us to follow her to the doors of the theatre (since we were all aware that with tumours in her lungs and in her brain anesthaesia was not a good option) and give her a wave and a kiss as she went in. He then personally pushed her bed to the theatre. She recovered from this but made it plain that she wished to die at home not in hospital. All the necessary equipment was sent to our house and two nurses tended her four times a day. A nurse attached to our practice came once or twice a day and our doctor came every day until she died.

    Finally I am over 65 so do not pay for medication, I am also deaf so have two high quality hearing aides these and the batteries are supplied free of charge.

    I find it interesting that Americans are convinced that their high cost private system is so much superior to this ‘socialist’ one.

    Richard Noble

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Ramona says:

      As an American this health care system is far lacking. I just don’t think Obamacare is the fix-it for the broken system where millions are uninsured or deemed uninsurable by this very broken system. I don’t have insurance. It would cost me between 600 and a thousand dollars a month.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  37. Robert Woolley says:

    Strictly speaking the NHS should have billed you. You’re non resident and non EU….

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • JFS says:

      I believe you are right. In the Netherlands, I had to pay up front, about $40, for a tooth reconstruction at the dentist on a Saturday morning, barely more than 12 hours after I broke the tooth at a nice dinner on Friday night. They apologized profusely for making me pay, as a foreigner. It was still less than a quarter of what I pay for a basic tooth cleaning in the states, of course, let alone the cost of a nicely sculpted tooth reconstruction here.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • marrog says:

      Not for emergency/walk-in care, no.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  38. Canadian says:

    There is a very big contrast between our two countries …. and with the USA going TRILLIONS into debt, it may be too little, too late.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  39. We were in Scotland 10 years ago when it became apparent that the sore throat I had developed on the flight over there was turning into something really nasty. Unfortunately, it was a Sunday night in Inverness when we realized that.

    I called the hotel reception desk. They phoned a doctor who was on call with them and set up and appointment about a hour later. They drove me over to the doctor’s office (around 5 minutes or so away, as I recall). I walked right in, no waiting. He examined me, confirmed that it was strep throat, gave me an antibiotic prescription and charged me something like $40 USA for the office visit. I took the prescription to the Boots a block from the hotel, got it filled for around $7.50 American, and that was that.

    I assume the reason I had to pay was because it was after hours.

    By contrast, when I got food poisoning in San Antonio a few years earlier the hotel had no doctor on call, wouldn’t call one for me, and told me I had to vacate my room the next day no matter how sick I was because they had already sold it.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  40. Snoobies says:

    This sounds like a regular clinic here in the U.S. that practically illegal immigrants can go to. Except you have to pay out of pocket but is significantly cheaper that a mega insurance corporation. Apparently someone doesn’t know how to shop around… Too bad such systems are going through austerity…

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • mMark says:

      Lol I used to Live in St.Louis, there was one such clinic, since I made a whopping 7 dollars an hour 30 hours a week I had to pay $50 a visit, $150 for x-rays anything you needed above that meant you had to go to the hospital and pay full price. Anyways, the place was horrible hours of waiting and the doctors were very bad. One time i went in the doctor said I had Bronchitis, took no x-ray I asked for one he told me “It’s Bronchitis now I have a lot of other patients thank you.” Well 2 weeks later after tearing a chest muscle coughing I go back a diff Doctor x-ray’s me was pneumonia the whole time. That’s the quality of care at those clinics. Also When I was in Kansas city there was no such clinic, you have to go to the emergency room for everything and just ignore the bills and ruin your credit.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  41. Chris M says:

    The ridiculous thing is that if people can’t afford basic preventative healthcare because they’re underinsured, they develop health problems they wouldn’t have otherwise. Which means *more* serious illness that costs more to treat, *more* drastic treatment options needed, *more* strain on the emergency system, *more* preventable illnesses like rheumatic fever (which develops from untreated throat infections) and, basically, more cost. The public good *is* the individual good. Even aside from the money, if everyone has adequate healthcare they’re less likely to spread dangerous illnesses which even someone with insurance can catch.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  42. fred lapides says:

    Question: Are veterans using V.A. Hospitals using “socilaized” medicine?

    Now we do have a fine private system–very expensive, however, and the real problem is that too many unable to afford it. Not by chance, though one comment suggests all the Canadians coming here, that increasingly Americans able to afford it are going to India etc and state that they are getting better care and at much less of a cost. Canadians coming here clearly are those able to afford care anywhere and choose what is best suited to their needs. They are able to use our doctors or use their own. Many in the U.S., alas, can not!
    I am by the way fully covered and so have no problem..on the other hand, when I look at infant mortality rates–a good indicator overall health care–and of average life expectancy, I do not see us as Number One–and in fact fairly far down the list.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  43. Pingback: What!

  44. Stephen says:

    I like how the author words her article as if she is an unbiased American visitor to England…then she goes on a tiresome and hateful liberal rant against “quacks like “Dr.” Bachmann”.

    I call B.S. on this article due to her obvious bias towards socialized medicine. Of course she’s going to write glowingly of a socialist system that she agreed with before she even turned on her laptop to write the article.

    If the NHS and other socialized medical systems are so grand, please tell me why we (the USA) have thousands from Canada and the UK fly over to the USA to have major surgeries and everything else outside of a sprained ankle? It’s because a capitalistic and competitive healthcare system provides to the most coverage to the most people and at the same time frees up free-flowing capital to invest in new technologies and procedures to save lives.

    The reason why the USA has so many problems and high costs with it’s healthcare system isn’t because it’s not run by the government, it is because the government has stuck its murky hands into our healthcare system to begin with. Regulations, preventing competition between insurance companies in other states, high legal costs for insurance companies due to no reform of the tort system.

    It is simple: Get government out of the way => increase efficiencies => you decrease costs => more people can afford health insurance => increase profits => increase jobs => you have a self-sustaining healthcare system available to even millions more people at a fraction of the cost.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Steve Silberman says:

      Stephen, honestly, you skimmed so fast and with so many preconceptions that you can’t even keep my gender straight. Your theories about free-market health care might sound fabulous when Rush Limbaugh barks them into a microphone, but I was talking about my actual experience, not theory.

      VN:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Chris M says:

      But he wasn’t biased towards socialist medicine. Until, you know, after he’d experienced it. He straight out says he was biased *against* it.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Charles Young says:

      “If the NHS and other socialized medical systems are so grand, please tell me why we (the USA) have thousands from Canada and the UK fly over to the USA to have major surgeries and everything else outside of a sprained ankle?”

      Actually we don’t. It’s a myth. There has been some really good peer reviewed research on this issue, including here in which it is found that there are extremely small numbers of canadian patients in the US hospitals surveyed and almost all of those were tourists with emergency issues.

      Medical tourism to the US is almost non-existant.

      Just thought you’d want to know.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Declan says:

      As someone who has actually gone through surgery in a socialized health service just like most of the other people from my country, I can tell you have never experienced it for yourself. I was brought straight to the hospital, seen within an hour. I had my appendix removed the next day after some tests, and was well enough to be released within 2 days of the operation. All of this did not cost me a penny except the tax I pay for this service, and the staff in the hospital are always very nice and have time for each patient.
      When my father had a triple bypass while unemployed, this system offered him a way to have his operation and time in hospital for free and subsequently saved his life, what would happen to you if you were in that situation with no insurance where you live?
      Over here it sounds as if the American system is barbaric in that they would rather let poor people suffer and die than offer them an affordable alternative.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • myne says:

      Hahahahahhahahahahaha!
      Mate, as mush as people complain about the Australian Medicare system, I’ve never had a problem with it.
      A mate, at 17yo got a free liver when his poor genetics made it necessary. Can you get that there, or do you have to become an indentured servant for the rest of your natural life?
      How much is say… a top shelf antibiotic there, like say ciprofloxacin?
      It’s $30 here thanks to our PBS.

      Tort reform would go a long way in the USA, though. Practitioners who are able to perform in good faith without the constant threat of malpractice suits would remove a whole load of inefficiencies from your system.
      Covering your ass constantly is not efficient. Ever.

      At the end of the day, it’s results that count.
      Our life expectancy is nearly 3 years longer than yours.
      If I have to pay 1.5% tax to an inefficient system that gets me an extra 3 years of life, sign me up!

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Felicia says:

        Actually Ciprofloxin is a $4 prescription at many pharmacies now. There are a few places that offer free, yes, free antibiotics. The free list is short but usually adequate.
        BTW I am a health care provider and have my own gripes about our US system and our US patients.
        None of which I feel comfortable posting on this public forum. Social media and all that you know.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
        • Dana says:

          Yes, well, I’m sure your patients have plenty to say about you, too. I worked in the health care system for long enough to figure out that a good doctor spends more time treating patients than complaining about them, even if a few of the patients are problem children. Ditto for nurses, lab technicians and so on.

          VA:F [1.9.22_1171]
          Rating: 0 (from 0 votes)
      • Dana says:

        I’ve seen some interesting arguments that the malpractice insurance companies inflate their rates and then use all that extra money to lobby Congress to enact malpractice tort reform. Meanwhile, all sorts of actual malpractice happens in this country and not everyone can afford to get something done about it. Even with the lawyers who advertise on a “you only pay if you win the case” basis, that’s time off of work that the working poor can’t afford to spare.

        Then there’s the fact that a malpractice suit really only matters if you lose the suit.

        And if doctors don’t want to lose malpractice suits it would help if they wouldn’t do things like amputate the wrong foot, prescribe a medication for the wrong purpose or break a baby’s neck on its way out of the birth canal.

        None of which is strictly illegal if you can prove it was an “accident,” so how else should patients obtain recourse? “Gee, I’m so sorry” doesn’t bring back a loved one or reattach a foot.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
    • Cap says:

      I’m afraid that you simply aren’t dealing with the facts.

      The US system costs approx 18% GDP while the UK system costs about 9% GDP. This is the main reason why the President wanted to change the current system. If the government is ‘inefficient’ why does healthcare cost twice as much in the US private system?

      No-one in the UK ever goes bankrupt because they have a life threatening illness. Can we say the same about the American system?

      Can you honestly say you feel safer having an Insurance rep deciding your future rather than a doctor?

      The problem with ‘socialised medicine’ is that people had decided against it before it was even enacted because it was Obama’s pet idea and he was a democrat. If you look at the facts, there is simply no competition.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • marrog says:

      If the NHS and other socialized medical systems are so grand, please tell me why we (the USA) have thousands from Canada and the UK fly over to the USA to have major surgeries and everything else outside of a sprained ankle?

      Are you serious? In the UK the USA is famous for how bad provision of care is – and at twice the cost, no less. The inefficiency and barbarism of it is, to the average Brit, utterly staggering. Nobody wants your healthcare system.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  45. derek says:

    My wife and I experienced something very similar to Steve Silberman. At Christmas 2009, my wife had to see a doctor in Hereford, England. My sister, an English citizen who lives in England, drove us to a clinic where my wife received free medical care with the only cost incurred being the cost of the prescription my wife had to get. My sister looked at the cost of the prescription and told me that it was exactly the same that she and her family paid. What a system of health care!! No hassles, no forms to fill out – and free, except for the prescription. Why can’t we have this in the US?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  46. Pablo says:

    Sounds like a typical visit to my urgent care clinic here in the U.S. (we need more of them here), except it’s not free. But it’s not terribly expensive either. I usually pay out-of-pocket because of my insurance deductable, which isn’t a big deal, but the monthly insurance premiums are ridiculous. Effectively I pay twice for U.S. health insurance. Once for Medicare or services for the poor and again for insurance. Medicare I can’t use yet and I’m not poor. Being an adult in “middle America” sucks for health insurance because I pay two or three times for it but either can’t or don’t use most of it yet. The upcoming insurance mandates don’t give me hope and neither does the GOP. There has to be a better way.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Joy Sabl says:

      On monday, we heard we’d been exposed to whooping cough over the weekend. Our shots were out of date. The urgent care clinic near where we’re traveling (on vacation) told us it would be $300 for a doctor’s visit, and $200 for the vaccine–each. Luckily the local pharmacy was offering the vaccine for only $50 each. I wonder, though, if whooping cough would be resurgent if we treated it as a public health issue, and vaccinated everyone who was willing, regardless of ability to pay? I figure it would mean fewer deaths, fewer long term disabilities, and fewer people away from work for weeks, coughing so hard they may vomit, pass out, break a rib, or any of the other lovely described side effects of pertussis.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • A. Marina Fournier says:

        My sister and I have been vaccinated against pertussis, as has my son, unlike many kids in the Bay Area. Because there is so little vaccination, the populations falls below the threshold necessary for herd immunity (or whatever it’s called).

        BTW, from only “regular” coughing, my sister cracks ribs, and I vomit (unless I reverse the flow of muscle movement by drinking even just water). Because I am allergic to vicodin/codeine, there is no cough medicine currently on the market that works for my cough when I have a cold or flu.

        However, it takes a full 8 oz of cheap (single malt, still) Scotch whisky to stop it long enough for me to sleep a few hours. I’m a hardcore insomniac, and alcohol never puts me to sleep. In this case, it’s just a muscle relaxant so that I have a chance of sleep by not coughing so often.

        I’m not all that fond of this method, as life is too short for cheap single malts, but I won’t waste the good stuff on coughing. I’m waiting for theobromine-based cough suppresants.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
        • Dana says:

          I’m suspicious of some of the claims about vaccines now (though I still get the more important ones) because “herd immunity” shouldn’t be an issue if individual immunity is achieved. If someone doesn’t want the shots then they accept the consequences of that. Those who *are* vaccinated, though, shouldn’t have to worry about anything. The shots protect you, right?

          That said, one of the issues with pertussis in the past couple years is they haven’t updated the vaccine in quite a while. It’s a bacterial infection and you can’t go on from year to year expecting that the germ will never change. Bacteria are gene sluts, constantly dropping bits of themselves and picking up bits from others. I’m surprised we didn’t have a whooping cough epidemic *before* now.

          VA:F [1.9.22_1171]
          Rating: 0 (from 0 votes)
  47. I’m also in the North of England, and the large-ish practice I go to will almost always have someone see you the same day for an urgent problem (with limited gate-keeping of what’s urgent), telephone consultations also available. Many of the same-day appointments are with a Nurse Practitioner or in the Nurse-Doctor clinic, but they are both able to pass on to a doctor if they think it’s necessary or don’t know what to do. Call-outs are available 24 hours here – from the GP surgery during their hours, and the on-call service the rest of the time. They are limited, however, to people who are too ill to come in. It kinda screws people who don’t drive and are supposed to go to an out-of-town out-of-hours centre, but it’s not that bad, as they always assess by phone first and advise you to see your own GP (or someone else at their practice) the next day if they don’t see a need for in-person assessment.

    I should point out that the NHS doesn’t fully cover dentistry except for those who ‘qualify for help with health costs’ (anyone who qualifies for free prescriptions gets dentistry free, and others get reductions ) – similar systems are in place for optometry and glasses (not sure if contacts are covered except where medically needed). For dentists, there’s two or three ‘levels’ of charge, and everything the dentist may do is in a level. Over a course of treatment, the highest level invoked is what’s charged (last I checked, the highest charge was a little under £80, but I may be out of date – the lowest one is around £16). This includes all appointments and procedures that a part of a single course of treatment, including if a filling falls out soon after being put in, for example. No extra charge for different filling materials, but they have to be clinically justified (I have a composite one as it’s a large part of a front tooth, back teeth will always be basic amalgam unless there’s a problem with doing that, front ones will be something I forget the name of – white but not natural-looking up close). For optometry, pretty much all regular opticians are commercial, high-street entities, mainly big chains. The NHS specifies how much they’re allowed to charge for a sight test, and pays it for those who entitled to help; if they want to charge more for eye tests, they can’t offer any NHS-funded or subsidised services and can’t cash in NHS vouchers. Then, glasses themselves are commercial, but if they are working with the NHS they can accept the NHS voucher you’re issued if you need new glasses and qualify for help. They have to have some glasses they’ll give you for just the voucher, and they also (I think) have to accept the voucher at face value against any glasses in store. Some will actually accept it at higher than face value. Just by way of explanation, there. There are complications for eyesight if you need complex or particularly strong lenses. Ophthalmology is done through hospitals, and is fully funded.

    The big problem with dentistry for most people is that there’s a shortage of NHS dentists. There has been an effort to improve that in recent years, moderately successful, and most areas have a special dental service for those who aren’t registered, but they will only fix problems when they arise, not do checkups.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  48. Canuck says:

    Aaron: OHIP no longer covers chiropractic or physiotherapy (recent change). I live under OHIP and find it a very good and cost-effective system (not as cost-effective as the NHS, since we have to compete with the US right across the border for doctors and nurses salaries, but still not bad); however, I also want to be careful not to oversell our system. It’s important to realize that OHIP also doesn’t cover dental, unless it’s emergency surgery in a hospital, or prescription drugs, unless you’re a senior citizen.

    Richard: another point to add is that while you always pay eventually (through direct-pay, insurance premiums, or taxes), healthcare is much more efficient in other countries than it is in the US, because in the US you also pay for the huge hospital and insurance bureaucracy.

    The US taxpayers already pay more per citizen on healthcare than UK or Canadian taxpayers do, but in the US, all that money manages to cover just the poor and the elderly, while in the UK and Canada, it covers everyone.

    To get coverage for the rest, Americans have to pay again to their insurance companies (about the same amount as they already paid in taxes), so basically, they pay twice for healthcare. Nice system.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  49. Michele says:

    I had an experience similar to Steve’s back in the 1970s. While staying in London I came down with a horrible sinus infection, saw a doctor and left with a prescription for an antibiotic. The only thing I paid for was the medication. Everyone I encountered in the NHS was courteous, caring and competent. I am sure that’s not universally true — nothing involving humans is universally true — but it is a memory that has stayed with me all these years.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  50. Mags says:

    I think you make an important point in your article – Americans pay for healthcare (which they may never use) through their insurance. Those who use it less end up subsidising those who do. This is in fact the *exact* same thing we in the UK do. We pay for healthcare through National Insurance (and tax). Of course, the major difference for us is that it is also free at the point of entry/need. However, on the bigger scale I really don’t get the big distinction between the funding streams. The entire “choice” rhetoric is baloney and the “I’m not paying for some sucker who doesn’t work enough” point of view is frankly idiotic. If you have insurance, you already are paying for someone else’s healthcare. That’s how it works.

    If we want top ups to the NHS (say, for that B+ American cancer care), we are perfectly at liberty to pay for very affordable private insurance on top. For the little things, such as conjunctivitis, flu, etc then private insurance is way, way over the top.

    I get a little upset about people bemoaning the prescription charge. It really is small beans in the grand scheme of things and waiving that as well puts the service under more pressure than it already is. £10 for the 50p antibiotics isn’t such a good deal, but it’s more than balanced out by the times you pay £10 for the £300 inhaler.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  51. Vivian says:

    I’ve been living in the UK now for a few years to do a PhD, and the NHS is one of the things that makes me want to stay here forever–imagine not having the stress of wondering whether a new job will come with health insurance, and how much of a screwing it will be? I used to work for a hospital in the US, in the department where we spent 40+ hours a week filling out the same ridiculous forms trying to get the doctors onto the insurance panels so that we could get paid by the insurance companies for the procedures we did. It was beyond ridiculous, and there are a LOT more unrelated people between you and your doctor now than there would be under a public program.

    Anyway, living in Wales where there are no prescription charges either, it felt like a miracle when I got ill and had been examined and had a prescription within hours. I even showed up here with a skin condition that I could never afford to treat–and that’s working for the hospital! But it’s apparently ‘cosmetic’ to have your skin peeling off your body, rather than legitimately medical, so the insurance would never pay for treatment and I spent years with a condition I couldn’t afford to fix. It took less than a week to clear up once I saw an NHS doctor, and all for free.

    Yes, every system has its problems–in more populated areas, it might be harder to see a doctor, and because NHS docs are human beings just like any other, they do sometimes make mistakes. This happens in the US all the time, which is the part the conservatives try to overlook. At least here, the mistakes don’t drive you bankrupt on top of making you ill.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  52. SCHADENFREUDER says:

    Comparing the survival stats of the UK’s (I’m British) NHS to the US’s Healthcare “System” is to compare apples with oranges.
    The comparison of survival rates are of people who have RECEIVED treatment.
    Long forgotten from the stats are the milions of Americans with NO health insurance and received no treatment at all. To paraphrase the author “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”. Its like comparing the living standards of the top 50% populus of country “A” with the living standards of the entire population of country “B”.
    Some of the LIES puked on US TV about the NHS are shocking – my mother-in-law received a kidney transplant in her mid-70′s. My mother full and succesful breast cancer treatment in her late 60′s, my father open heart surgery and valve replacement in his late 60′s – all of which they would have been denied if you believe FOX “NEWS”. Also, all of which would have bankrupted them each of them at their second most vunerable time of life in the US if they weren’t in possession of a platinum card level health insurance.
    One caviet though: medical tourism. I firmly believe in reciprocation of health care provision between nations. The NHS is not a bottomless pit of funding and foreign nationals should receive the same level of health care a British subject receives in that other persons country. i.e. A US citizen should have to pay in the UK – as a UK citizen has to pay in the US. A New Zealand citizen would receive free treatment in the UK as a UK citizen would receive free treatment in New Zealand – and so forth; levels of cover matched to the levels of treatment for our (UK) subjects receive abroad.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  53. Adrian says:

    I have to say my worst doctors appointment was in the USA. I had a painful inner ear infection. Three hours waiting in a crowded waiting room plus an unnecessary blood sample taken by a nurse who used the syringe like a javelin and left me with an enormous bruise for a week. I was prescribed ear drops for wax buildup – luckily a friend had some left over antibiotics which did the trick for the infection.

    Any system will have anecdotes of good and bad treatment though, perfection just isn’t possible. I think the earlier comment about not living in fear of getting ill was a good one. That’s a real benefit of a nationalised and ‘free at point of service’ health care system. The last thing you need when you’re ill is stress over money and the bureaucratic form filling you get in a private healthcare system.

    One inaccuracy in the article – it implies we have no freedom of choice for healthcare in the UK. It’s not true, in more populous areas you can often try different NHS doctors practices and even within a practice you can request to see a different doctor.
    On top of that there are several private health care companies, private hospital networks and associated insurance schemes. Of course you only have freedom of choice for private healthcare if you have the money to pay – just like the USA.

    One of the big problems with the healthcare debate in the USA is the way it’s framed as a binary choice, it’s not, you can have socialised health care alongside private. The only people that would lose out would be the healthcare companies making a fat profit providing a second rate service.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  54. Brendan says:

    Hope the goopy green gunk leaves you soon.

    What I found most surprising about European health-care is the system of providing care. The offer for a doctor to visit you, a system of funded and functioning clinics– this all makes perfect sense. One reason hospitals are broke and crowded is because people have no where else to go when they have non-emergency complaints.

    Given the option between rotting in the ER all night or having an ambulance pay a visit to examine me, leaving medical professionals to make the decision whether I need in-call care, I would be thrilled to wait. When living in Paris I knew that should something begin to bother me I could go to a pharmacy were RNs are required to be on staff. If they can’t help me they send you to a doctor. If the doctor can’t help you they send you to the hospital. You go to the hospital and it’s not choked with people trying to get someone to look at their eye infection which needs some drops to clear out.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  55. David says:

    My experiences in Canada are mixed. I live in Richmond BC, which is a suburb of Vancouver. I have a family doctor(not all do in this province) but when I have a problem I usually go to his clinic and seldom see him personally. They have all my files so it is like visiting him anyway.

    For prescriptions it is a matter of about one half hour to be served until I’m out the door. For anything emergent you will be treated quickly and possibly sent to a hospital if conditions warrant. I’ve had two ‘serious’ conditions. One semi emergent. A cyst that was ready to get vicious and to check my hearing.

    The cyst took about one month to get operated on after having been sent to a specialist. The hear problem took 9 months to see a specialist and another 6 months and four total visits to be tested and told I needed a hearing aid which is not covered and costs about 6 times what is charged in the US for the same equipment. With that bit of information I am suffering through hearing loss without the desire to pay for the hearing equipment required to help my condition

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • phil says:

      David,

      Costco has a Hearing Aid Center near you and they sell hearing aids at reasonable prices. Check out their website.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  56. Andrea Gill says:

    Odd, that. Our local surgery in a wealthy part of the North has week-long waiting lists and wouldn’t dream of making house visits. The NHS in a few parts of the UK may be fit to impress a tourist in need but it isn’t all it’s hyped up to be, not if you’ve actually got to live here permanently.

    And that nice free service is costing the country considerably more than it can realistically afford.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • guthrie says:

      On what basis is it costing us more than we can afford?
      In my own experience across several towns in the last 15 years, the GP system works pretty well, with the usual caveats for human stupiditiy which will always be there.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Robin Williams says:

      Andrea, I am an American who has lived in the UK for the past 28 years. I can’t believe you would complain about the NHS. It is amazing. I would love to go back and live in the US one day, but there is no way my husband (English) and I could afford private health insurance. The NHS is one of the best things about the UK. To be sure, it is not perfect, there is no system in the world which is, but to not have to worry about the cost of health care, to be seen by dedicated professionals, to know that you are not going to be ripped off by prescription charges, that is priceless. When I lived in the States, I had an accident and I ended up in hospital as a young adult without a credit card or health insurance, and they said they would not let me leave the hospital until I had paid in full!!! Now, how was I gonna do that?? That is unspeakable, and actually unlawful, behavior. As someone else in these postings said, this is a free country?

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Adrian Ratnapala says:

        In my experience the GP system is rock bottom. My last GP surgery would not make appointments over the phone (in fact they rarely answered the phone). When I actually did get anything done, the level of service was appalling.

        My cousin has had a serious stomach problem for seven months now, which once put her in the emergency room. Only this week was she even obtain a referral to see a specialist. In the meantime, she has decided to fly to Sri Lanka and back in order to get it checked out.

        This is much worse that being “not perfect”, it’s a system actively trying to avoid performing any service. The baffling thing is that the NHS isn’t like that in all postcodes. I had thought the trick to getting good service was to live outside of London. According to this article you can also just live in a *really posh* area of London.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
        • Cassie says:

          Yup, it’s definitely a postcode lottery in the UK. Some places are really good, some places are awful, and the rest are a million shades in between. If you are middle class and know how to work the system you can get better care too. Still, I’d much rather be in the UK than in the US if I were sick.

          VA:F [1.9.22_1171]
          Rating: 0 (from 0 votes)
        • Daveon says:

          Actually not even a particularly posh part of London will do. I’ve lived in Willesden and Ealing and had exemplary treatment in both. I *can* get same day appointments where we live in Seattle, but the last few times we’ve used it’s cost us $100+ co-pay and deductible – not to mention the fact that there is really no way to work out in advance what bill you’re finally going to get… which then you have to query because you can almost guarantee it’s wrong.

          VA:F [1.9.22_1171]
          Rating: 0 (from 0 votes)
  57. John Mack says:

    When I was a child in NYC, we had socialized medicine. That is, you could go to a hospital clinic, pay a voluntary fee of a dime or a nickel or a quarter, and get excellent health care. If you needed to return you would see the same doctor. Even posh doctors volunteered once a week for this socialized medicine. And all children were given free medical exams in school. What happened?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Dody Bush says:

      In Somerset PA USA, 1985 -1989 we received free doctors visits 2 times a year, free dental visits 2 times a year, free shots, and free eye doctor visits at the beginning of the school year. The first week was all doctor visits. We also received free snacks, and free milk.

      If your family could not afford proper clothing, there was a closet that children could go through and pick 1 of each item they needed. (Winter boots etc..) The school provided ALL the school supplies you ever needed. The only thing a child had to do was show up and try.

      NOW, I have children and the teacher expect me to PAY 20 usd per week per child. On top of me having to buy all their supplies, all their medical needs, all their food, and all their clothes.

      What happened to my country?

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  58. Rachel says:

    This is just one small anecdote that cannot be representative of reality. Neither is comparing an HMO that clearly offers terrible service to real insurance. Like a previous commenter mentioned, the health care is never FREE, it’s just paid through different channels.

    My husband wad hit by a car in London and had his shoulder crushed and femur broken. He was lucky to have leg surgery the night he arrived at the hospital, and luckier still to have no internal bleeding. Because of this, he was put in a study where they took blood every day, while he wad waitlisted for arm surgery. He was bumped twice and waited THREE days. They would not let him eat because he was in the surgery queue. They ended up having to hive him a blood transfusion and he almost died. The staff was cold and lazy, they would never get him anything he needed which was how the oversight happened. When he got home, his arm surgery had to be redone, they had left a piece of bone hanging loose off a tendon in his shoulder. The hospital could not get him a sling for his arm, so I FedEx’d him one. It was a total, absolute nightmare.

    Here’s the kicker. If he had known to ask to be transferred to a private hospital, insurance would have covered it and he would have most likely received a much higher standard of care. The total bill was 10k, all covered by insurance, but no American today would stand for the terrible care he received. I don’t know about you, but I’d rather deal with delayed conjunctivitis treatment than almost die waiting for a broken bone to be fixed.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Robin Williams says:

      Well, Rachel, I’m very sorry your husband had to go through that. But no healthcare system is perfect. In the US, my mother needed a hip replacement. Even with her ‘Cadillac – gold plated’ insurance plan, it took her 15 months to have it done, whereas if she had been in the UK and had it done it wouldn’t have taken nearly so long. And to use your phrase, ‘here’s the kicker’: during this time, she was being continually monitored by her physicians and even had a stent put in. Doctors appointments twice a week for 15 months. She was medically managed to an almost intrusive degree. But they still failed to spot during this whole process that she had advanced lung and cervical cancer which killed her eight weeks after her hip replacement. So you see, bad stuff happens everywhere. I still say that on balance, the NHS wins hands down.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  59. Nick Coghlan says:

    As far as travelling to the US and your bizarre employment-linked health insurance system goes, standard advice here in Australia is to *never* travel to the US without purchasing traveller’s insurance. Your health system is too broken to risk needing treatment while uninsured.

    The system here is far from perfect, but it’s a hell of an improvement over the US one:
    1. Everybody is covered by Medicare. However, most elective surgery has very long waiting lists in public hospitals. Some facilities also charge more than the Medicare rates, so it is up to the patient if they want to go to the most convenient facility (which may require additional payment to cover the difference in price) or a facility slightly further away which just charges the standard rate (and hence no out of pocket payment is needed). Some people are lucky and don’t have to make that choice (i.e. their most convenient facility charges the standard rate)
    2. If your income is above a certain amount and you *don’t* have private health insurance then your Medicare levy is bumped up accordingly.
    3. Employers don’t pay for private health insurance, individuals do. Since the option of “just rely on Medicare” is available, and because individuals can switch insurers online or with a simple phone call, private health insurers put a lot of effort into convincing their members that they’re getting value for money.
    4. Since individuals are paying their premiums directly, at least some insurers offer premium reductions if you undertake certain preventative activities.

    This “user pays, with a government-backed safety net” far better resembles a properly functioning free market than the US system where employers are paying for health care on their employees behalf. The US approach may have made sense in an era of “jobs for life” but it’s sheer insanity now.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  60. Chris says:

    Thank you for shedding some light on this issue. The only thing I would add is that it’s not just the Koch brothers and Bachman types spreading disinformation in the U.S. It’s hard to find a single politician or media pundit who does not accept as fact that socalized medicine would be a huge step down and a major compromise in the level of available care. The debate is framed that it would either be 1) like a horror scene from the hospital in Jacob’s Ladder the movie complete with demonic doctors wielding rusty instruments, or 2) not quite that bad, but close. The American public no longer seems able to think for itself. Even when we go to the doctor and it is a paperwork nightmare as you describe, we can be fooled into thinking we have it great. I pay $2K a month for private health insurance. I’ll bet a single payor nationalized plan would be a fraction of that and the care would be as good or better in time once the system adjusted. Thanks for the great article.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  61. Al says:

    That’s funny — Mark Steyn described exactly the opposite. A elderly British visitor who finally got her gout diagnosed and treated in a small New Hampshire hospital — CT scan included– after getting only palliative care in the UK:

    I had an elderly British visitor this month who’s had a recurring problem with her left hand. At one point it swelled up alarmingly and so we took her to the emergency room. They did a CT scan, X-rays, blood samples, the works. In two hours at a small, rural, undistinguished, no-frills hospital in northern New Hampshire, this lady got more tests than she’s had in the last decade in Britain — even though she goes to see her doctor once a month. He listens sympathetically, tells her old age often involves adjusting to the loss of mobility, and then advises her to take the British version of Tylenol and rest up. Anything else would use up those valuable resources. So, in two hours in New Hampshire, she got tested and diagnosed (with gout) and prescribed something to deal with it. It’s the difference between health “care” (i.e., going to the doctor’s every month to no purpose) and health treatment

    Of course, feel free to ignore since Steyn appears on Fox News, Limbaugh, etc. is a far right winger, writes for National Review, and therefore “has no credibility.”

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Al says:

      Sorry — forgot to give the link:

      http://www.nationalreview.com/articles/228070/youve-had-good-innings/mark-steyn?page=1

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • FOARP says:

        People saying “here’s the kicker”, well, here is the kicker – I’ve seen examples of terrible enough service on both sides of the Atlantic to know that:

        1) there are lazy, useless doctors in both countries.

        2) In the US there is much motivation to prescribe expensive treatments that you don’t actually need – a friend of mine was diagnosed with sleep apnea and depression when his problem was actually constipation.

        3) In the UK there spending short-falls, and hence waiting lists.

        4) In the US medical insurance often doesn’t cover everything, and is dependent on your employers etc.

        5) Americans spent more than twice as much per capita on health care than British do.

        Given the choice, I’d take the British system, warts and all. Hell, even if you get private all-inclusive health insurance in the UK, you still don’t spend as much on healthcare even counting your tax-money that goes to the NHS.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
    • David Gillon says:

      No system is a protection against a lazy doctor and the US right-wing delights in digging up the most egregious failures they can find, sometimes creating them from whole cloth, and trying to present them as typical of the NHS, much to the bemusement of Brits everywhere.

      Is the NHS perfect? No. Does the NHS deliver an acceptable level of service to the vast majority of its patients, without thought to finances or insurance. Yes. Can the US system say the same? No.

      Let’s consider my experience as a contrast to Al’s little tale. I have a severely disabling back condition, I can normally get an appointment with my own doctor in a busy inner city practice in a socio-economically deprived area within 2 days for a non-urgent matter, while my personal record for hospital treatments in a year, seeing my consultant at each one, is somewhere in the mid to high 20s. When I complained of worsening symptoms in my neck last year, the rheumatologist I was referred to sent me for x-rays, MRI and a full body bone scan with isotopic tracer without the bat of an eye. The x-rays were done on the spot and all three had been done within about 3 weeks. After further referrals I’m currently awaiting an appointment with a visiting professor from one of the London specialist hospitals for further tests. Total cost to me in all of this, zero.

      Now when you consider my situation: unemployed, with a long term and disabling medical problem that is ineligible for health insurance cover, which system will I do better under? The US which will bankrupt me if it treats me at all? Or the UK, where things might move a little slower without the profit margins to grease them, but no matter the complexity or the test or the noteworthiness of the specialist, I will be treated and the only cost to me is for prescriptions, with an absolute maximum cost there of about £120/year, no matter the cost of the drugs or the number of prescriptions needed, and where I will receive even those freely if my finances warrant it.

      I have incidentally bumped into the UK version of private medicine, when my former employer wanted a medical report on my disability. As soon as I presented myself at the reception desk of the private hospital, I was met with the demand ‘Who is paying?’, so I pointed out that my employer had made all of the arrangements, ‘I need a credit card, can you give me yours?’ ‘No’. Having reluctantly accepted that they would have to invoice my employers, I finally (after a 45 minute wait) got to see the doctor — the same consultant I see freely on the NHS, and usually without the delay. When a colleague was injured in the course of company business she was treated at the same private hospital, until her condition worsened, and the private hospital had to dial 999 to ask for an ambulance to come and take her to the NHS hospital because they couldn’t cope with any kind of medical condition they couldn’t turn a profit on.

      The US right bleats about the ‘threat’ of socialised medicine, crossing to the other side of the street so that they can keep their eyes turned from the third world standards of medicine that the rest of their compatriots have to put up with. I know which system I would choose, I know which system I will survive under, and that isn’t the US one.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Daveon says:

      I remember reading that story at the time, and thinking: ‘oh he’s got my mum as a house guest…’

      I can just imagine the conversations she was having with her Doctor.

      *When* we finally got my mother to be specific about her symptoms rather than vaguely mentioned she was a bit more tired than usual and ached a bit, the Doctor realized she needed some more tests. A few days later and she was on thyroid medication and being treated for the real condition.

      Doctor’s aren’t telepathic, and people my mother’s age (80s) are lousy at telling Doctor’s exactly what’s wrong.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  62. Toby O says:

    Having lived now on both sides of the Pacific (in Australia now), I wholeheartedly agree with the sentiment that if I were rich I would go private care and if I were poor, Medicare. The problem is that there is an even wider chasm between basic and immediate needs vs what the system calls ‘optional’ or ‘elective’. To get elective care in australia you’re often out of pocket by $100-200 and that’s *with* private health insurance.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  63. Charlie Potts says:

    You can get free medical care in the U.S. All you have to do is go to prison.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • jecca says:

      While we’re swapping anecdotes… I know someone who needed extensive dental work done. He had an abscess, but when he saw a physician, he was given pain killers. He couldn’t afford to see a dentist, and his problem continued to worsen without adequate treatment. When he was at his wit’s end, he held up a store, was sent to prison, and had his dental work done for free. He wound up spending less time in prison than he had previously spent waiting to be able to afford oral surgery and antibiotics.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  64. I can tell you, from first hand experience from living in Toronto, Canada for two full years (much longer than the business trip of this gentleman), that the Ontario Health Insurance Program is top-notch.

    I saw a chiropractor about my bad back (after throwing it out laying carpet), which cost me nothing, the prescription was less than $5, and the overall care excellent.

    I saw a second doctor for a sprained ankle, in a very posh clinic, and got outstanding care, which again cost me nothing, with zero forms to fill out. I was given a pain killer prescription, again for dirt cheap, and ankle brace and was on my way.

    My wife also lived in Toronto, Canada (it’s how we met), and saw a doctor for lice, and a dentist for a root canal. In both cases, the attention to her medical needs was top-notch, and it cost her nothing.

    In all four cases, there was no line, no waiting endlessly in an emergency room (I waited 1hr45min for stitches here in the U.S., while profusely bleeding from a deep laceration in my hand), no clipboards with endless forms to fill out, no questions about pre-existing conditions, the clinics were clean, the doctors knowledgeable, the bill free, and care excellent.

    And, for those who like to whip out the “you must pay higher taxes”, it certainly wasn’t anything noticeable. For crying out loud, I would much rather pay for the taxes to support a national health care system, than pay a $500 monthly premium, and $30 copays every time I visit the clinic. Seriously.

    Lastly, can we please stop calling it “Obamacare” and “Romneycare”? It shows nothing but ignorance on your part, and just makes you look childish.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  65. Ipp says:

    Great post and all, but what’s with the fascination of pointing out everyone’s race? The ‘dreadlocked Rasta’, Asian doctor, Muslim pharmacist… it was a bit much. All very tedious.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Steve Silberman says:

      It was very deliberate on my part, Lisa; an antidote to the vision of medical expertise that prevails on American TV, in which heroic doctors are almost always white. Thanks for reading.

      VN:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • nick s says:

        I’m not going to speak for Steve, but Americans also generally overlook how so many of their medical facilities beyond the E.R. are tacitly segregated, whether by location or policy or income.

        The new Cook County Hospital in Chicago was built to replace the old one a decade ago and provide greater capacity, even though the area’s other hospitals had plenty of empty beds. They just didn’t want African-Americans occupying them.

        London’s NHS facilities look like… London.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
  66. Vanita says:

    I’m an optometrist working in the NHS and I am a big believer in free healthcare. I know that as a tax payer, I am likely to pay far more into the NHS than I ever get out of it – many people I test don’t even pay the NHS fee for glasses, contact lenses and so on as they are on benefits. But the crucial factor is NOT LIVING IN FEAR.

    If I was unable to work or lost my job, I don’t have to be afraid of treatment costs if I fall ill. That’s a huge deal and I truly believe that every country which considers itself to be a developed nation should offer at least a basic level of healthcare to ensure it’s citizens do not live in fear.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  67. Mackenzie says:

    Mike:
    No jobs in the UK? Way I hear from Scottish friends, they’d love for some immigrants to come and help with their labour shortages. An American friend tells me a couple years back she was in Ireland and was constantly asked “would you like a job?” in all the shops, then as soon as she opened her mouth, “Oh….you’re Canadian, huh? Darn.”

    However, the UK Home Office did change their rules this year. They got rid of the Tier 1 visa. You used to be able to say “I speak English, have a degree, have plenty of savings, and have an established income over £40,000/yr. I’ll be a valuable asset to your economy”, and they’d give you a visa to go over and look for a job upon arrival. No more. Job offer or pending nuptuals are required. Well, or you have to be able to plausibly claim “I will win a Nobel Prize someday” (or have already done so).

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  68. Canuck says:

    My spouse and I had similar experiences in both the UK and Germany for minor medical problems – in the UK, they apologized that we’d actually have to pay the £5 minimum charge for a prescription because we were from out of the country (the rest of the cost of the drugs was still free). In Italy, when I had conjunctivitis, I didn’t need to see a doctor at all — I just went to the pharmacy and explained the symptoms to the pharmacist in halting Italian, and she sold me an inexpensive bottle of antibiotics without a prescription.

    Here in Ontario (Canada), your experience wouldn’t have been quite as simple. If you’d wanted a medical exam, you would have gone to a drop-in clinic, and, I suspect, have paid (just a guess) $35-75 for the exam, since you’re not covered by OHIP. None of that US-style medical bureaucracy, though – with a single-payer system, the paperwork is minimal (and a huge part of the cost of healthcare in the US is the paperwork and administrative overhead, not the healthcare itself).

    Actually, in this particular case, since you knew it was conjunctivitis, you could have just gone to a 24-hour pharmacy and bought a bottle of Polysporin drops (a topical antibiotic that’s available off the shelf in Canada) and your eye would have been better by morning. That’s a special case, though.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  69. “This is the National Health Service — it’s free.”

    Actually, it is not. (Incidentally, I am an elected governor of an NHS hospital). The examination is not be free (how could it be? if it was free how would the staff be paid?). The reason why you were not charged is that it was simply too much effort to give you a bill.

    The clinic you attended is run by the Primary Care Trust (Kensington and Chelsea PCT) and they are paid a capitation – a fixed amount per year for every registered patient in the area they cover (there will be an extra amount to cover non-registered patients – people visiting the area and the homeless). The capitation is calculated based upon lots of criteria like the deprivation of the area and the age and ethnic profile. The idea is to estimate the cost of *all* the healthcare for everyone in that area. The capitation covers primary care (GPs and the minor treatment you received, dentists, optometrists, community pharmacists), secondary care (hip replacements, cataract replacements etc, and A&E) and tertiary care (organ transplants etc). The capitation also covers the mental health costs for the area, and public health costs (campaigns against obesity, smoking, teen pregnancy etc).

    The clinic you attended will also be funded through a capitation (per registered patient plus an extra amount for transient population). Hospitals are different. Hospitals charge for their services. For NHS patients the bill is unseen by the patient and it goes directly to the PCT where the patient is registered. I mentioned above that I am a governor of an NHS hospital. The hospital is in a tourist town, so it treats a fair number of tourists in A&E (the accident and emergency department), in fact, about 4% of the hospital’s income comes from tourists. When a patient is treated they are asked for details and if it is clear that they are tourists then the accounts department will pursue the patient at a later stage for payment. Don’t worry, the average cost of treatment in A&E is £40 – the NHS is extremely cost effective and efficient. (I like to amaze my US friends by telling them that for my recent cataract replacements – for two eyes – the hospital was paid $2400. Can you get *one* eye done for that?)

    The important principle of the NHS is free at the *point of use*. It is not free. Eventually the taxpayer will have to pay. However, since it is free at the point of use the system is equitable, and you are treated regardless of your income.

    Until recently I used to visit the US five times a year. I have type 1 diabetes, so I travel with a bag full of medicines and the worry that I may need some medical care. I also have travellers medical insurance. Once, when I was a speaker at a conference (in San Francisco, as it happens) I spoke to my US colleagues about the issue of health insurance, Since my colleagues were all out of their home state, it turned out that I was the only person with any insurance cover!

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Adrian Ratnapala says:

      Since you understand the system much better than me, can you explain the postcode lottery? This post describes what seems like top class service from the Kensington and Chelsea PCT. I lived “just next door” under a GP with the Imperial College trust, which seems to exist for no purpose than to avoid providing services. They also seem to give bonus points given for absurd “Kafkaesque” methods, such as only making appointments between 8:30am and 9:00am, but then not actually answering the phone until all bookings are filled.

      Variations in service are expected everywhere, but the NHS seems to magnify them. In Australia, where GPs are private-but-subsidised, some clinics will be better than others. But you can always get an appointment, and I’ve never walked out fuming with rage against the entire medical profession. Perhaps its because, Australians are actually permitted to shop around between providers.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  70. Pingback: 10 Afternoon Reads | The Big Picture

  71. rob says:

    Seriously, happy for your experience in the UK but as a long time ex-pat from the US, I’d rather not have 25% VAT to pay (on top of income taxes) for “free” health care. You could buy into a Cadillac plan for the extra you’d have to pay in taxes, mate. Sure the US needs reform but here in Vienna, Austria they have to cut €1 billion from the annual city health care budget this year and everybody has supplemental insurance to get them better care anyway. Also, if you’re not Austrian looking (like my Chinese wife) you get treated worse by all the staff.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • There’s plenty of other things that Western European countries spend more public money on than the US, other than health care. Benefits for the sick and disabled, those out of work (usually conditions on evidence of activity seeking work, and more for long-term claimants), I think old-age pensions are higher generally, there’s significant support for early years education, childcare, many have top-up schemes for people in work but earning not-very-much; outside the welfare side, there’s also greater art subsidies, education (especially Higher), in at least some cases public service broadcasting (funded by a dedicated tax in the UK, that can be avoided by not having a television – even though you can benefit from the radio stations funded by the same stream). Military spending is lower in many cases, of course, and what negatives that would lead to for the populace at large is debatable.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • First, VAT in the UK is not 25%, it is 20% and a year ago it was less – 17.5%.

      Second, VAT does not pay for the NHS.

      Every EU country has to charge VAT – the EU is paid through VAT although member countries do keep some of the tax. Nominally, the NHS is paid for by a tax on earnings called National Insurance. This is 5-13% of employees’ pay.

      You are talking about Austria. That is an insurance based health system AND you also have to pay 25% VAT.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • John Mack says:

      The NHS service in Britain and health care in Canada are based on a concept of the common good. Some individuals pay more, some pay less in taxes but the point is not individual self-interest. There is a good beyond the individual, as long as the individual’s rights are not harmed. Taxes really used for the common good are not a harm to anyone, but a moral and economic good.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Robin Williams says:

      Rob, VAT in the UK is not 25%, is is 20%, which is still high, but only rose to that level last January as part of the budget reduction efforts. But I’d rather pay that as a ‘pay as you go’ system than worry that I was going to lose my house because I can’t pay my medical bills. I also have private health insurance for me and my husband, costs £157 a month for a brilliant plan, no complaints.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • Ellie says:

      Well, I wouldn’t be able to buy into a “Cadillac” plan because of good old pre-existing conditions. If the Republicans have their way, that provision of reform (people not being denied for pre-existing conditions) will vanish.

      And, yes, what about the common good? Low income people (who maybe even work full time but can’t find a high-paying job) will never be able to buy into a “Cadillac” plan.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Robin Williams says:

        Yes, Ellie and John, I totally agree: what about the common good? Why is it that the demonizers of socialized medicine feel it is acceptable to turn their backs on not only the more vulnerable members of our society (ie, the elderly and disabled) but people who through no fault of their own find themselves without insurance and live in the grip of fear that maybe they or their kids will get sick and they can’t pay for it? You will always have malingerers in any system, that is the way of the world. But are we to punish a huge section of our society just because we think, like kids on a playground, that it’s just not fair that someone gets something that the people at the top of the gravy train feel they don’t deserve?

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
    • Garm says:

      Late to the party, but…Rob people in the USA pay more in taxes for government health care than Europeans.

      The Brits pay among the lowest amounts. The US runs medicare, medicaid, VA, IH, etc, each covering a specific group, on its own with a lot of redundancies. And the total cost of that is higher than the UHC systems of Euroepan countries which covers everyone. (Barring oil-rich Norway). You’ve already paid more for health care than a European, before you even think about paying your private insurance.

      http://blogs.wsj.com/economics/2011/04/09/number-of-the-week-u-s-spends-141-more-on-health-care/

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  72. Ruth Heasman says:

    Great article! The NHS is quite literally one of the best things about living in the UK. Americans would be crazy not to want such stress free access to health care. And if you can afford the insurance, or can pay out of pocket, the private option is there too. The vast majority of the time, there is no need to go private, however. I just can’t understand how the US can continually demonise such a great system?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  73. I never understand the American Right’s rabid bile about socialised medicine producing horrific bureaucracy. Everything I hear about what it’s like to see a doctor even when you have insurance in the US, and there must be people doing things with those forms… that must be costing money. Only part of the NHS that I really dislike is Accident and Emergency departments (same as US Emergency Rooms, for reference), where you do sit for hours on uncomfortable chairs unless they think you may be imminently dying. Then again, no-one should ever need to go to A&E for ‘normal’ health problems, and use of A&E as a Primary Care substitute is frowned upon.

    Then again, people who are holidaying here or whatever don’t get full NHS provision – I think it’s only A&E (and necessary follow-up) and urgent primary care that’s covered for foreigners. People with long-term leave to remain (like a work permit) are fully covered by the NHS.

    Oh, and for people who are really rich, the level of care available isn’t much behind the US. You can still get lavish private rooms and almost-instant responses from specialists, if you pay, and you can get somewhat-improved care with private insurance. The more you pay, the quicker you can get tests and so on. The biggest complaint in that area is the fact that there’s limits to how much you can integrate private and NHS elements of care.

    Christopher: You either need to have a job lined up, for which various qualifying checks have been made and a work permit secured, or you can come in as a ‘top-tier’ immigrant bringing in large amounts of money to invest or use to start a business. Or you can marry a brit.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • James says:

      It’s not a great big surprise that the machinery around US healthcare produces a bureaucracy which slows down the provision of care and makes life tough for patients and physicians. The healthcare industry fights against its patients to make sure they don’t get treatment to which they’re not entitled, and against physicians to keep the cost of the supply side down.

      In the UK, the NHS concentrates on the provision of healthcare. It can still be impersonal, since many things are optimised for throughput and there are some odd performance targets (like waiting queue length) which sometimes incentivise odd behaviour. If you’re optimising for throughput patients can sometimes seem like assembly line products rather than customers.

      But it sounds like the picture in the US isn’t that comfy either, and they folks in the US have become used to adversarial relationships with those who are supposed to be providing care.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • John Mack says:

      The increasingly libertarian right in the US believes in a Neo-Liberal economics, that is, laissez-faire, a guarantee of “liberty” as property rights and privacy but not social justice or anything resembling a common good or egalitarian benefits). In essence , neo-Liberal/laissez-faire allows for no government interference in business. The right would rather be ruled by the country club set (on the local level) and corporations (on the national level). Well actually, they are the country club and the corporate elite so they would be doing the ruling.

      In effect the right wants a return to the absolute rights of big property of the 1700s-1800s, the laissez-faire rule that brought the wrong response to the Irish potato crop failure (resulting in famine) and the vicious prison gulags of Australia, among other insults to human dignity.

      To be fair, the right offers a moral basis for laissez-faire/neo-liberalism. The right wants economic rewards to go only to those who have earned those rewards – that is, the owners of big property (who are considered the productive class because their investments supposedly create goods, services and jobs) and to the strivers who run small businesses or provide professional services or who strive to advance themselves within corporate America. They do not want any “rewards” (including basic necessities) to go the those who are poor because they do not work or to those who voluntarily contract to put themselves in penury and bondage in the form of minimum wage jobs or who cannot get relatives or friends to support them or who get salaries but waste them on imprudent and hedonistic spending (which is ok for those with a lot of money). The right would be quite happy to see a property requirement for the vote.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
    • guthrie says:

      The funny thing is that the proportion of NHS funding devoted to paperwork and bureacracy increased after the conservatives introduced the “internal market”. I wonder why…

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
  74. Glen says:

    Yes, medical care should not be a luxury. The NHS is a superb institution.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  75. A. Marina Fournier says:

    Er, his ears were clean. Gahh.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  76. A. Marina Fournier says:

    I have some friends who were somewhere near the wilds of Dartmoor when one of them needed some minor medical attention. They went to the nearest NHS doctor, he got the treatment he needed. He also asked how much it would be, and was told not a New Penny. They did not contact their insurance first, thinking to pay it out of pocket.

    When I was taken off Wellbutrin cold turkey, still needing *something*, but had been dismissed as “merely overly chatty” by a local pdoc (grrrr….), I was in the FL panhandle. Our insurance at the time would not cover mental health needs out of area. I was miserable, and unfortunately made those around me unhappy as well.

    However, earlier, in Boston that trip, I discovered that my 6 mo. old son had green goo coming out an ear. I found in the yellow pages that an advice nurse could be called (a public service!), and did so, about 2 am. She reassured me that he was okay, and that he probably had not burst an eardrum, but that I should visit a doctor in the morning. Now, I had gone to our pediatrician the day before to get him checked for ear troubles, as it was going to be his first plane flight. His ears was clean, they said.

    I called my cousin, who works in a pediatric office, for assistance. They didn’t take my insurance, nor could he be seen that day. She recommended I seek a “doc in a box” aka urgent care, so I sought one of those in yes, the yellow pages. He was seen quickly, the cost wasn’t too bad, and he had a prescription to take. I haven’t mentioned that my husband had suddenly come down with strep throat, and this was a business trip for him. He had to be bludgeoned into staying in bed and trying to recover. I was fine.

    Midway through the sabbatical in FL, my husband was in great pain, and it was a kidneystone. He got good care at a local small hospital, at our expense, and eventually the stone emerged, and that was that. It was not the best vacation for him–he got the flu when we got home. I found that the house/pet sitter had not dealt with fleas at all because they didn’t bite *her*. My 20 yr old cat was covered in them, and so low in red blood cells that she wouldn’t live long. She had to be put to sleep.

    We’ve had better years for health issues, really we have.

    I’m glad your experience with the NHS was so positive.

    Yes, Christopher, you must have a job before immigrating to the UK or to the US, if you’re not on a marriage visa. Sorry about that.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  77. Slideguy says:

    Countries with decent social services are reluctant to take in Americans unless they have a job there, or a fat bank account. They rightly fear us dumping our sick and elderly on them.

    How do I know? Before I got onto Medicare, I was tied to a deadend job in order to have health insurance due to being a cancer survivor. So I looked into emigrating to Canada, England, Sweden, Norway and Denmark. And despite being a minor culture hero in all of them, none would take me at my age and income level.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  78. Luisa says:

    I was visiting London years ago when I suffered a minor eye injury: a tiny chip of concrete blew into my eye as I walked past a construction site. At the nearest ER a pair of inept, giggling, very young nurses tried to flush the mystery irritant away. They seemed like high school students volunteering for community service credit, to be honest [and perhaps they were]. I thought, “So this is the NHS.”

    But the eye hospital where I wound up later that evening was another story. A doctor saw me almost immediately, deftly used an array of high-tech tools to locate and remove the tiny chip from the inside of my eyelid, gave me some pain meds, patched my eye [which was good as new when the patch came off three days later] and sent me on my way. No charge. None. I still remember my amazement.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
  79. Mike Finlay says:

    The needing a job question is moot – there are no jobs in the UK.

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • James says:

      According to May figures reported at the BBC, job openings in the UK are up 22% on the previous year.

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • Romney says:

        The same BBC that has itself been making major redundancies this year? If this is an improvement, last year must have been appalling!

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)
  80. How hard is it to emigrate? In all seriousness. Do I need a job first? Is New Scientist hiring?

    VA:F [1.9.22_1171]
    Rating: 0 (from 0 votes)
    • Ben Stuart says:

      idiots. Idiots, all of you

      VA:F [1.9.22_1171]
      Rating: 0 (from 0 votes)
      • John Mack says:

        Here we see an example of the Rush Limbaugh School of Civic Debate. Spew out an insult, no thought, no arguments, no specifics. Mindless.

        VA:F [1.9.22_1171]
        Rating: 0 (from 0 votes)

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>