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Monday, 17 August 2009

Rationing Health Care

As you know, I'm an American living in the UK and I've had a few health issues and have dealt with the NHS some. But I want to talk about how my mom got sick a few years ago.

She had been having a few problems and went to her GP for help, but the GP didn't correctly figure out what the problem was. A week or so later, when she was suddenly partly paralyzed, my dad took her to the hospital, where first they thought she had a stroke and later they diagnosed her with a brain tumor. There was a national holiday, which delayed things for a bit, and then she had emergency brain surgery.

After the surgery, she needed to talk to some specialists about followup care and so had to wait to get on their calendars, despite needing care fairly immediately. They were on summer holidays. It took so long to see them that time was running out to actually start treatment.

Everything I've described so far could have happened in any first world country. The next part of it is uniquely American.

If you have a brain tumor, there is a very typical path through treating it. First surgery, then radiation + chemotherapy. Almost everyone does those things. But when it came time to start radiation, my mom's insurance said no. That would not have happened under the NHS. The NHS would have covered it and she would have been able to start radiation within a reasonable time frame. Instead, my dad had to have a lawyer write a letter to the insurance company. While at the same time trying to cope with his wife having terrible cancer. So he approached Stanford Hospital to see if he could just pay cash. They said no. That also would not have happened in the UK. If my mom had been in the UK, she might have lived longer than the few weeks it took her to die, after she finally started radiation too late.

When I hear of people talking about how having national health in the states would cause delays in treatment or rationing of care, I wonder what planet they're on. I've read that insurance companies spend 30% of their budget looking for ways to say no. In the UK, the NHS just follows standard treatment models. The doctor prescribes a treatment and the patient gets it. There is not an accountant involved in this process.

I have waited to see specialists in England. Sometimes months. But my issues are not life threatening. And I can see a GP usually the next day. In the US, I've been told I had to wait several weeks for a normal checkup. When I tried to get a gyno exam, the waiting list for that was six months. For a normal checkup. The NHS is faster and more efficient.

And, in the UK, if I decided for some reason that I wanted to see a private doctor or I wanted a prescription that they weren't too keen to pay for (like the topical form of testosterone, for example) or I just thought it would be faster to go private, I could do that. Unlike my dad and Stanford Hospital, which only knew how to deal with insurance companies.

The US has the most expensive health care in the world. Per person, we pay more than anybody else in the world for our health system, which ranks at the very bottom of the first world. We pay twice as much as the NHS costs and we're not getting better treatment, we're getting worse.

So if the proposal for health reform in the States was to put in an American NHS, I say go for it. They've done fine by me and most everyone I know here. People in the UK don't need to declare bankruptcy to pay medical bills. They're astounded that we do. It's responsible for half of all bankruptcies in the US. Here, like none. When people are hit by a car or something, they're worried about getting better and getting back to work to pay their regular bills, not how they're going to pay their medical bills. And we're already paying twice as much as Brits for our system.

But just about everybody I know in the states has had some sort of issue with medical bills or insurance or something. Paying well over a hundred dollars just for a normal doctor visit or having to wait forever or being declined. Can we all take a moment and share those stories. Because the "rationing" fears I'm hearing from the states seem to be describing the present, not some dystopian future.

The NHS exists to keep people healthy. Private companies exist to turn a short term profit. Which do you think sounds more trustworthy?


steph said...

Thanks for sharing your story.

Jillian said...

Then there are people like me who can't get private medical insurance in the U.S. I have to either rely on getting a job with medical benefits, finding some other form of group coverage, or going through the state to get special insurance for "high risk" people, all because I was previously tested for sleep apnea and previously received treatment for depression. I'm currently fortunate enough to be covered under COBRA insurance from my old job. I pay a rather reasonable amount of about $350 per month for the premiums, but COBRA only lasts so long. In six months I will have to find another source of insurance or risk being uninsured.

Also, the uninsured are penalized even when they do finally obtain insurance due to the "pre-existing condition" clauses that all insurance contracts seem to have. Once you finally get coverage, you have to wait six months before your insurance will pay for treatment for conditions you had seen a doctor about before becoming insured. For some uninsured, that means they don't seek diagnosis of a problem or they postpone medical visits, which often leads to conditions being treated when they are much more advanced. How does that benefit anyone, least of all the insurance companies who are then paying for more expensive and extensive treatments?

I hope that we find a system that works much more efficiently, soon. Any new system will have kinks to be worked out, but ultimately what we have doesn't work.

Charles Céleste Hutchins said...

Thanks for sharing Jillian. I've heard that almost half of uninsured people in the US are not eligible to buy private insurance.

And, the stuff I see the NHS about is actually specifically excluded by most private insurers, so in the states, I would pay out of pocket, insurance or not.

Obama's private option is way less than perfect, but certainly better than the current mess.