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A letter came in the post last Friday and after I read it, all I could do for a few minutes was stare at it in shock.  I sat down and put my hand on the couch to steady myself, and then read it again.  It wasn’t so much the news that it brought — though that was bad enough — but the way it made me feel: vulnerable… so, so very vulnerable and out of control.  The letter was from the girls’ insurance company and it informed me that, due to “increasing [insurance company] financial losses”, the premiums for their cover will be increased from October by 350%.

The girls are covered by the state’s CHIP programme — the only long-term cover I could find that they qualified for when we lost our health insurance because M was suddenly laid off three months after we arrived in the US.  Because the girls are US citizens, they did not qualify for the insurance policies that are usually offered to incoming immigrants.  And because we had just moved from abroad, they did not qualify for most normal insurance policies which, I discovered to my utter bewilderment, all seemed to have “residency requirements” that disqualified anyone who had not lived in the US for the last 6 to 24 months.  My daughters had both been recently diagnosed with potentially life-threatening food allergies (my elder daughter to eggs, my younger daughter to no less than eight foods, which later rose to 12) which had had a huge impact on our daily lives, and I was desperate to get them onto a good, long-term policy that would give us some peace of mind.  We were still reeling from a string of devastating events that had begun almost as soon as we arrived and had consumed nearly all our mental, physical, and financial resources (besides M losing his job and our insurance, I suddenly developed incredible pain that debilitated me for months before we got on top of it, the medical bills started rolling in and  ate up half our moving fund, we found we had to pay the IRS a huge sum which wiped out the other half of our moving fund, the house we were renting was put the market, we were going through  all the stress, isolation, and disorientation that an international move almost always brings, and it felt like we were doing everything wrong).  Looking for insurance under these circumstances was turning into a nightmare and when I found out the girls qualified for CHIP, the relief  was so strong I burst into tears.

The coverage was excellent; the price surprisingly affordable.  The programme is funded by the state, but administered through a choice of several large insurance companies.  I picked the one that we’d been on with M’s previous job, out of sense of familiarity more than anything, and got the girls signed up as fast as possible.  Each month a bill arrived with bold letters telling me that one missed payment would result in permanent cancellation of the policy — I began sending the premiums in two months in advance just to make sure I never paid that price.  In a world that felt like it was falling apart, knowing the girls had such excellent coverage gave me a sense of stability that I clung to like a rock in a stormy sea.

So as I read that letter — and reread it, and then read it again — all that stability seemed to drain away and the horrid, terrifying, desperation of a year ago rushed in to fill its place.  Could they do this?!?  Could they just casually send me a one-page letter which matter-of-factly stated they were increasing the premiums not once, not twice, not three times, but a full three-and-a-half times what they were now?  No warning, no alternatives, no choice…  This is our only option, this is our salvation!..  Could they do this?!? I rang M up at work and he listened patiently while I told him the news, then began to cry, and then composed myself and told him I’d be alright and thanked him for listening.  My tears were more out of fear and uncertainty; we will  be able to make the new payments (just, and with sacrifices), but it’s what they represented — the lack of control — that put me over the edge.

When I told my mother, she was shocked, then horrified, and then began to rant.  Was this what Obama had in mind for the middle and lower classes?!? Or was it the Governor’s doing?!?  It didn’t seem ethical!  I pointed out that it wasn’t Obama’s doing — his reforms haven’t even taken shape yet, let alone been enacted — and it wasn’t the Governor’s either.  It wasn’t to do with the CHIP programme itself at all.  It was the insurance company’s doing: they take the money the state gives them and then set their price within an approved range — but times are harder now than were before, there are these “increasing financial losses”, and so they’ve raised their price.  And, no, I told her, it didn’t seem ethical… but I don’t know that I think ethics plays any part in this.

I have to admit to feeling rather annoyed with her, to harbouring some deep-set and mostly unjustified feelings of blame.  I had been concerned about healthcare before I moved back to the US… concerned… afraid… frightened…  But my mother and my father and my sister had all assured me that I was making a mountain out of a molehill.  It’s fine, they told me.  It’s a system!  It’s not the system you’re used to, but it’s a system.  As long as you work hard, you’ll be fine.  My husband, I thought to myself, does work very, very hard.  And I do too, in my own way.

My had mother added that she didn’t know anyone who had a healthcare problem.  What about my sister?, I asked, pointing out that she’d gone for years without health insurance, avoiding going to a doctor even when she needed one.  “Oh… yes… ” my mother’s voice trailed off, and then came back again with strength, “But she never had a problem!”  I felt misgivings at that, paused, and then… brushed them aside.  It would be fine.  It would be fine.  …And so if there is blame to laid, perhaps some goes to my mother for closing her eyes to the problem, but some goes to me too for choosing to believe.

There is series of ads for one of the largest insurance companies in the region which they run on television all the time.  It shows someone walking a dog, or jogging, or riding a bike.  At some point the camera closes in on the person, and they look directly into it, before raising a hand and pressing it with palm forward and fingers spread, so that it appears to be just on the other side of the glass of the television screen.  And as the person fades out of focus, the handprint remains, glowing blue and pulsing gently, and a warm and reassuring voiceover says, “Giving you a greater hand in your health.

As I sat there staring at this letter, with its incredible, horrible news, I had to wonder: is that hand meant to be pulling us up… or pushing us away?

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As the healthcare debate picks up pace, I find myself being asked with increasing regularity what I think of Britain’s healthcare system.  Six months ago, I’d have jumped into the answer with gusto, but these days…  I don’t know, I am just so fatigued by all the fear-mongering and hysteria, the ignorance and the downright idiocy of the current debate that I can hardly summon the energy to add my voice to the cacophony.

But the other night when a friend of my mother’s emailed me and asked that now-familiar question — what was my experience and what did I think of British health care? — and I was surprised to discover that, once the initial weariness had worn off, I found myself turning her question over and over in my mind, composing my answer.  When I sat down last night and started my reply, the words fell out me, my fingers tapping rapidly at the keyboard and my mind so engrossed in the assignment that I was stunned when I finally looked at the clock: it was 2.30 in the morning.  I had been so consumed because what I had to say had been bursting to come out, an outraged truth that was tired of being bottled-up and was begging to be told.

When I lived in the UK, I railed against the NHS (the National Health Service).  I cursed every delay, every perceived inconvenience, every way it differed from the care I had received in the US.  But I moved to the UK only a few months after graduating from university and, until then, I had been covered on my parents’ very generous insurance so I had experienced American healthcare only as a dependent.  I was judging my British experience from a lofty and privileged position of someone who’d always had gold-plated insurance.  And I was naive, because I’d never had to pay for it, never had to worry it wouldn’t be there, never really had to deal with the paperwork.  I never really understood what I was comparing the NHS to at all.

I also realise with hindsight that a lot of what I held against the NHS had nothing to do with the system itself and actually were issues that could happen in any system.  I blamed the whole system when the loo in my local doctor’s office or hospital wasn’t clean enough.  I blamed the whole system when the only space I could find at the hospital carpark was miles away in the very furthest corner.  I blamed the whole system when the doctors’ receptionist was grumpy or I didn’t much like my doctor’s manner (or his diagnosis).  But the truth was that I believed in the healthcare system I had grown up in and I didn’t like the idea of socialised medicine — I didn’t like socialised anything — so I saw problems with it where-ever I chose to look.  And I held onto that belief right up until I arrived back in the United States, and discovered that grumpy receptionists and dirty hospital bathrooms and annoying carparks can happen in any system — because they have nothing to do with the system itself.  They’re management issues, human nature issues, and they happen everywhere.  And a lot of the fear that Americans have about change in their healthcare actually center around these kind of issues that have nothing to do with the system itself, be it socialised or for-profit.

So my return to the US and my sudden immersion in the American healthcare system was a rude awakening for me and it made me look at both systems a little more realistically.  There are great things about healthcare in the US — great things — and I truly do believe that the quality of the care here is second to none.  But there are great things to be said about Britain’s system as well and the trouble is that, at present, far too few people are saying those great things and far too many here in the US are beginning to believe utterly ridiculous things about the NHS.  Let me play a small part in putting that right by outlining my experience of the British healthcare system.

  • First, I’ll start by pointing out that the NHS is truly one of the most socialist — almost Soviet — healthcare models that a country could possible choose.  Unlike the health systems in France, Germany, and most of the rest of the developed world, it is totally government-run, almost totally centrally-controlled, and supported entirely through taxation.  It is mammoth — the single largest employer in Europe, which is incredible when you realise it serves a small country with only 60million people.  And with that kind of size come huge problems — consultation times are too short and it takes too long to get test results, amongst other things.  It is not a perfect system by any stretch of the imagination.  But it’s important to realise that when I talk about my experience, I am talking about the kind of system that truly is the very far extreme of what the nay-sayers are claiming will be the end result of public health provision in the US.  The British system is the very stuff of their nightmares and yet, the truth is, it’s nothing like what they imagine.
  • My healthcare in the UK was never dictated by a bureaucrat.  Decisions were made by me and my doctor alone, and whatever we decided was the right course of action was the course that was taken.  The scope of care available to me was far, far wider than what is covered even by the ‘very good’ insurance policies I’ve had here in the US.  There were no limits on the number of times I could see my doctor, or the number of tests/procedures/consultations/etc that I could have in a year (or month or lifetime…)  Whatever was deemed medically necessary by my doctor was covered — period.  In fact, I’ve experienced a lot more limitations on my care since I’ve moved back to the US — the most memorable of which was when I had to beg the insurance company to cover a single visit to a nutritionist when E2 was diagnosed with 12 food allergies and was severely underweight.  That simply never would have happened in the UK — if she needed it (and she did), she’d have got it (as her sister did after being diagnosed with a single allergy). To illustrate the point further, when I gave birth to E1, I stayed in hospital for five days because she had problems with breastfeeding — and that was entirely my decision.  I was free to leave hospital whenever I wanted, be that after one day or after a week, and I had the full support of the midwives to stay until they were sure we were breastfeeding properly and ready to leave — no administrator/bureaucrat/insurance company made that decision for me!
  • There are delays — there are delays — but to be honest I have experienced delays just as bad here in the US.  In the UK, I might have to wait weeks or months to see a specialist if my case was not urgent, and that was frustrating.  Here in the US, when I was in excruciating pain last year (so bad that I lost control of my bodily functions when the pain hit), I was referred to a breast surgeon by the ER doctor (7 hour wait in ER) — but the trouble is that we had to call five medical centers before we could find a surgeon who could see me any sooner six weeks, and even then it was only because they had a surprise cancellation.  And the last time I needed to take E2 to the allergist here in the US, the earliest they could fit me in was two months later.  There are delays in both systems.  And by contrast, you can get very speedy service in the US… and you can get it in the UK too.  When I needed to see my GP in the UK, I rarely had to wait until even the next day.  When I thought I’d found a lump in my breast, I saw the doctor the next day and was sent to a specialist within the week.
  • I had my choice of doctors.  My small rural town had two GP offices (a GP is a General Practitioner, a family doctor) with about 5 GPs in each office — I could choose either office and any GP in that office I chose.  I could choose to go to the GPs office in a neighbouring town if I prefered (though some offices limit the regional area they’ll cover).  I could change GPs at anytime for any reason, no questions asked.  When I had my babies, I had my choice of any of the hospitals in the region, or a homebirth (the midwives in my area loved doing homebirths!).  When my GP referred me to a specialist, he’d send me to whomever he thought best, but if I wanted someone or somewhere else, I could request that, no problem.  And I always had the option of a second opinion, either through another NHS doctor or a private doctor.
  • I never once received a bill in the UK.  There are no copays, there are no deductibles, there is no such thing as max-out-of-pocket.  I have an NHS card which I showed at my GP’s office when I registered, and from that point on, I never had to fill out any forms or show any ID ever again. In fact, I think I lost my NHS card years ago — I have no idea where it is. It doesn’t matter — I don’t need because I am covered for everything once I am registered with my GP.  When I stepped on a piece of glass and sliced up my foot, I went up to the local hospital, was seen immediately (rural hospital on a Tuesday afternoon), they took note of my name and address, patched me up, and I went home — simple as that.  No bills, no paperwork, no hassle.  Yes, Brits pay to cover it in their taxes, but the cost spread across the entire country and so it isn’t nearly the burden that insurance is for Americans.  In fact, Brits spend only 8.4% of GDP on healthcare, compared to the 16% of GDP spent by Americans and what they get back is a system beats the US on so many basic measures of healthcare results.  This is good quality care.
  • Brits believe that healthcare is a human right and are happy to have a system that covers everyone, all the time.  They are HORRIFIED when they hear stories of Americans who have to hold fundraisers to pay for desperately-needed operations.  It blows their minds that anyone goes bankrupt or loses their home because of medical bills.  The idea that someone would lose their coverage because of a pre-existing condition or because they are so sick they can’t work is totally alien to them.  These things simply do not happen in Britain.
  • Even with a comprehensive healthcare system that is available to all and completely free (at the point of delivery) the UK still has a healthy private system running alongside the state system.  There are numerous large private insurance companies providing private health insurance to those who’d like to have it (or whose companies want to offer it).  There are private hospitals up and down the country.  Most specialists practice both within the NHS and also privately (they split their weeks).  You can pretty much get your healthcare however you’d like — on the NHS, through private insurance, or paid out of your own pocket.  I hear people in the US saying that with in the British system, you can’t see anyone but your government-assigned doctor, but that is totally untrue.  And you can chop and change your care as it fits your life — I’ve had my care for an medical issue start on the NHS, and then switched my care to my private insurance if it suited my needs better.  I’ve had other medical issues that I stayed with the NHS for the whole way.  And when my husband had an elective medical procedure done that was covered by neither the NHS nor insurance, we simply paid for it out of pocket.  It’s a flexible system and the private sector has not been quashed by the fact that there is a comprehensive, free public system running alongside it.
  • Because healthcare is not tied to employment, companies are free to focus on their core business and people are free to make career decisions (and life decisions) based on what is best for them instead of what preserves their healthcare.  Brits never worry about keeping their healthcover — they never worry about pre-existing conditions; they never worry about continuity of care if they change jobs; they never get trapped into a bad-fit job because they have to keep their healthcover. They are much freer to be entreprenuers than Americans, because their only worry is whether their business will succeed, not how they’re going to provide healthcover for their families when they’re self-employed.  Companies, particularly small companies, are free to focus on their core-business because they not burdened by the administration of healthcare for their employees — they never have to pay someone in HR to manage health benefits; they don’t have to juggle insurance companies and negotiate lower premiums; they don’t lose employees because their healthplan isn’t as good as some other company; they don’t see their bottom line rocked by a sudden rise in premiums.  Decoupling healthcare from employment is hugely freeing to both individuals and employers, and can actually a very good thing for the economy at large.
  • When things go wrong, the government answers to the people in a way that insurance companies never do.  For example, there was a cancer drug called Herceptin which was not covered on the NHS because of the cost.  A group (led by Ann Marie Rogers) began a campaign to change this, suing their local health trust, and gained huge public support.  They ultimately won their case and got their local trust to offer the drug — but because of the political pressure this campaign had created, the government extended the drug to the entire country.  Imagine trying to convince an American insurance company to cover some expensive drug that they don’t want to cover, and then having that decision convince every other insurance company to do the same.  And again, when I moved to the UK fifteen years ago, wait times in the NHS were much worse than they are now — but the public got fed up with it, made their voices heard in the General Election, and the new administration made cleaning up the NHS one of their highest priorities.
  • There is an emphasis on preventative care and the simplest way this happens is that people actually go to see their doctor when they are sick.  Because there’s no cap on visits and no copay and everyone is covered, hardly anyone hesitates to go to the doctor when they need to, which gives them a chance to catch little issues before they become big issues and spot contagious diseases before they spread to the rest of the population.  And here’s another way the focus is on prevention: when I had my babies, the midwives came to my house to check on us every day for the first 10 days after the baby was born, and then the Health Visitor (a community nurse) came to the house once a week for six weeks, and then I could go to her clinic (held once a week in town) for as long as I wanted after that with any concerns I might have (as well as being able to see a doctor — my choice).  It’s all done to ensure the mother and baby are healthy and well, to support breastfeeding, and to catch problems as early as possible.  I was utterly shocked when I found out that most new mums in the US are simply sent home with their babies, with no follow up in the first six weeks, and left to muddle through as best they can!
  • None of this actually tells you anything.  Isolated anecdotal stories (like these) don’t actually give anyone the information they need to decide the merits of one system over another.  All it does is tell you whether my particular doctor was good or bad, whether the nurse I encountered was having a good day or a bad day, whether the receptionist liked her job or hated it.  There are good stories and bad in both systems, and it just depends on who you talk to.  It’s much like public schools. You could ask parents across the US to tell you what they think of their kid’s school and you’d get a whole spectrum of answers: some schools are good, some are bad, some districts are rich, some are poor, some teachers are passionate, some have lost the will to live. But none of these things tells you whether the overall concept of publicly-funded schools is a good or bad one. If you drew your conclusions based on a bunch of stories from a handful of people about their personal experiences, you’d only be getting part of the story. And it’s no different with the concept of public healthcare.

I can sum up my experience of the British and American healthcare systems in one simple sentence:  given a choice between the two systems, I’d choose the NHS in a heartbeat.  And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth.

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Addendum:  This is an incredibly important issue with a lot of misinformation flying about.  If you have experience of both the US and UK healthcare systems, I invite you to please leave a comment here and let us all know what you think of both systems.  This debate needs more voices of experience and a lot less uninformed fear.

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