Boosters of the US health care system often claim that the British system, in which the government’s National Health System actually employs doctors and owns and runs an extensive system of hospitals that provide most of the care though there is a private system overlaid on top of it, is inferior to what we have here. They are aided in the claim by the fact that successive Conservative governments in the UK are underfunding the system causing some problems.
But contrary to those claims, Britons who come to the US to work and are thus able to directly compare what they get here with what they left behind are shocked at what they have to go through here, baffled by the Byzantine rules that they have to learn about and the many hoops they have to jump through.
The linked article starts out with David Dray, a Briton in New York, who got sick one year and got treated well in a fancy doctor’s office. Then next year when he got sick again, he went to the same doctor’s office but the reception he got was quite different.
A year later, the reception he received was quite literally chilly. Gray, suffering from a chest infection, cold, exhausted and weak, headed out in a snowstorm and stumbled along to the same doctor’s office.
When he handed over his insurance card, the receptionist’s dazzling smile faded. His employer had changed healthcare providers without Gray’s knowing it. “Sliding the new card back across the desk, she said ‘this is not insurance we accept.’ She turned away. Sixty seconds later I was back out in the snow, bent over double coughing,” Gray says.
Us veterans of the US system have become so accustomed to this absurd system that we might be surprised that he did not check before going to the doctor. We have become conditioned to accept the idea that before we go for any treatment we have to check if the treatment is covered and the doctor and facility is ‘in or out of network’. We have got used to the fact that at every annual period of ‘open enrollment’ we have to check if the doctors we have been seeing are still on the plan and compare the complicated cost formula of each plan, weighing the relative merits of deductible amounts, co-pays, and the like. It is maddening
And even then we have to brace ourselves to deal with a number of bills and invoices and ‘errors’ (that are never in our favor) that are almost impossible to correct. We have been beaten down and propagandized to think that this is normal when in reality we are the only developed nation whose population has to go through this and, amazingly, puts up with it.
The article goes on describe other reactions to the “byzantine, chaotic and confusing” system we have here with its ‘deductibles’, and ‘co-pays’, and ‘out-of-pocket’ jargon.
In the United Kingdom, people don’t have to spend too much time thinking about how to get healthcare or how to pay for it – or even worse, how to do the paperwork like they were making an insurance claim on their car or their house.
The UK’s under-pressure National Health Service is far from perfect – the standard and speed of service can depend on where you live and people often wait for many months for certain hospital treatments and procedures.
But anyone can visit a doctor or spend time in hospital without having to think about the cost.
As a child, I lived in the UK and had major surgeries and extensive hospital stays. My parents never had to deal with any bills or paperwork. All they had to do was take me to the doctors’ offices and follow their recommendations. That is the way it should be. People should not have to learn how to negotiate a bureaucratic and expensive nightmare just because they are sick. It is madness.
What we have in the US is a system is a system whose primary purpose is to generate profits for health insurance companies, so-called non-profit hospitals, drug companies, and manufacturers of medical devices. Concern about people’s health is way down the list of priorities. What amazes me is that people are putting up with it and I have to suspect that it is because they don’t know any better, coupled with the arrogant attitude that the US must, by definition, have the best system.
One thing of note is that despite the claims of some politicians on the right that the US Health Care System is the best in the world, virtually nobody in the UK would want to switch to an insurance based system. Even the Conservatives couldn’t get away with actually coming out and saying they wanted to dismantle the NHS
Forthe reverse situation, a US doctor getting emergency care for her son while in the UK, see here.
A friend of mine, a US citizen in the UK on a work visa (“further leave to remain” was the official name of it), fell and broke something in or near her foot, and was seen pretty much immediately by an NHS facility. I’m pretty sure she got good care, though I can’t speak for how much she got billed later. Meanwhile back in the US, a visit to a doctor’s office STARTS at $100, and they don’t even tell you how much it will actually cost until it’s too late. Oh, and they require full payment at time of service, regardless of your financial circumstances.
And we bitch and moan about NHS wait-times? Please. Go to a US hospital, and once the immediate threat to your life is dealt with, you’ll find yourself sitting (or lying) about for HOURS waiting for anything like a follow-up. One person I know was told she’d be getting discharged at about 1-2pm; and didn’t actually get her papers, or the IV drip removed from her arm, till 5pm. Then there’s the time she lay stuck in back and neck braces, while the staff LOST the X-rays they’d taken to verify whether anything was actually broken. (It wasn’t, which means she was forced to suffer unnecessarily because of that inexcusable mistake, for many more hours than a decent response would have required.)
When Mutt Romney looked us in the eyes and said private insurance companies are EAGER to insure anyone who applies for it, so no one needs government help and what’s everyone complaining about, and neither Obama nor anyone else called him out on it, it made me absolutely sick. We, as a people, have been so crippled by corporate disinformation that we’re simply incapable of really understanding how our “healthcare” “system” really “works.” The corporate interests who run it spend billions just for PR campaigns whose sole objective is to confuse, obfuscate and deter honest informed discussion.
America’s corporate healthcare “system” is so fucked up that even the Economist — yes, the same magazine that said slavery was acceptable because it created wealth efficiently so historians shouldn’t be so critical of it — has been forced to admit it has a problem. (They still routinely ridicule every policy proposed to fix it, but hey, baby steps, right?)
Oh, and don’t even get me started on the Catholic hospitals — someone else I know said she had been prescribed birth-control pills, not to prevent pregnancy, but to stop life-threatening bleeding, and the pharmacy in the same hospital refused to fill the prescription because RELIGIOUS FREEDOM!!!, which I guess they have and their actual paying customers don’t.
I know that any tourist who visits the UK and gets sick is seen immediately at any hospital they visit, with no questions and no charge. Which led me to wonder — what happens to foreign tourists who come to the US and get sick? Are they covered by their system at home for our ridiculous overcharging? Are they encouraged to get some kind of special tourist insurance? Or are they on the hook to come up with all the cash themselves?
If the latter, I’d think that would seriously depress our tourist industry. I’d think twice about visiting a country if I knew that an illness or broken bone could cost me thousands of unplanned-for dollars.
brucegee1962, as a Brit who’s visited the US a few times I get travel insurance as the horror stories that routinely come from people visiting the US, getting injured and ending up with bills stretching into the 10s and 100s of thousands are numerous and terrify me. One of the most recent was this story (http://jezebel.com/british-couple-delivers-premature-baby-in-nyc-short-2-1677074387). I am constantly baffled by the US system, not just in its complexity but why anyone would willingly put up with it.
anat #2,
Thanks for that link. That the doctor was so casual about payment is as it should be. When you take the whole billing thing out of the equation, then doctors and nurses get back to doing what they want to do, treat people who need it.
brucegee1962 #5,
I know that I would be very worried when my mother used to come for a visit because I was never shire what her travel insurance covered and what might happen if she got sick. Fortunately, nothing happened.
I think that foreign tourists may think that the system here is like what they have at home and get a shock if they actually get sick and have to be treated.
Here’s one recent horror story about a Canadian woman who got a bill for almost one million dollars even though she had purchased travel insurance.
Yup! I lived my first 30-ish years in the UK and a bit longer (so far) in the US.
My mother still lives there and everything medical is free: no co-payments or anything.
For the last 7 years of my father’s life he had to have dialysis three times a week. He was picked up from the door, taken to the hospital treated and brought back. Again all for nothing. There were even organised holidays (I think to Belgium, maybe other places) with hospital treatment and accommodation for him and my Mum. This too was free, though my parents (being reasonably well-off) could and did pay.
Guess which one I’m about to retire to.
Ooops! Guess which country I’m about to retire to.
A mostly off-topic question for Mano: How’s the Doc Martin viewing coming? (See, British healthcare system. And you never see anyone paying him!)
Don’t forget about the health care providers profiting. Back in the day, Medicare claims had a “severity” code of 1 to 5, 5 being the most severe. Medicare paid more for higher severity cases. Many doctors would put fives on routine office visits. Medicare caught on and started rejecting those claims. A colleague, who was involved in an electronic claims processing system, also caught on, and started rejecting the claims before transmission to Medicare… to save everyone time of course. 🙂
Trebuchet,
I binge watched all the shows over the holiday break and had a great time! Each time I am impressed by how money plays absolutely no overt role in the show. People get sick, they see the doctor (or he goes to them), he treats them or calls an ambulance to send them a hospital, and that’s it.
@3: billions of dollars are spent on PR, and probably billions more are spent hiring people whose only job is to find (or invent) a reason to deny people the very service they’re paying for.
That’s what appeals to the Tories about it. Their philosophy seems to be that every social activity ought to make a profit for someone.
It’s not just the “health insurance companies, so-called non-profit hospitals, drug companies, and manufacturers of medical devices” who profit from our dysfunctional medical system. There is this whole other system of alternative medicine which benefits here in the USA. A large percentage of my friends and family have largely abandoned western medicine. Instead they each rely on their own unique combination of diet, exercise, vitamins, supplements, herbal medicine, chiropractors, homeopathy, acupuncture, yoga, meditation, crystals, biofeedback, massages, tincture of time and other alternative medicines. To them, anything is better than the miseries brought on by seeking medical care at a clinic, doctor’s office or hospital. Much of their “care” is not paid for by insurance. It doesn’t need to be. It only needs to be cheaper and easier than seeing the doctor.
My Canadian doctor married an American a few years ago and could have have easily moved her practice to the US, but she had absolutely no desire to do so.
She only has to pay the salary of one staff person — the receptionist; she never has to spend any time on the phone arguing with an insurance agent about whether a test or procedure should be covered for you — it’s either covered for everyone or it’s not covered at all; and she is out of the office every day by 4:30 pm, except for Fridays, when she takes the entire afternoon off.
Why would she want to give all that up?
The U.S. healthcare system is the best in the world, if you can afford it. In the article, the person they use as an example, Mr. Gray, seems not to understand that plastic surgeons don’t treat chest colds. He’s not exactly a great person to be commenting on the nature of the healthcare system is he doesn’t even understand that simple fact. That said, much of the criticism in the article is spot on. The system is hard to navigate and doctors do over-treat. Those issues are different aspects the healthcare system itself though and that is part of the problem when we talk about healthcare in the U.S., we don’t break it down. There are three main parts to U.S. healthcare.
1. Payment -- This is the insurance system and it is hugely screwed up.
2. Medicine -- This is the actual care and it is among the best in the world. U.S. doctors are among the best-trained and have access to some of the best equipment. It is state-of-the-art in most places.
3. Legal -- This is a mess and the reason doctors are forced to over-treat colds. Angry patients sue and ignorant juries award them settlements. There are legitimate reasons to sue, but those aren’t the reasons doctors practice defensive medicine.
Our goal should be to fix 1 and 3 without screwing up 2. Unfortunately, every plan put forth by every candidate and every party in government manages to screw up 2 without really fixing either 1 or 3.
The article notes that they were fine with treating him while he was insured with a company that covered that office (“Though the office was devoted to plastic surgery … they treated Gray.”), and that all such care was withdrawn as soon as the insurance was with the ‘wrong’ company. This broad point was not, I think, tarnished by it being a plastic surgeon’s office.
I remember several years ago seeing a letter to the Editor in the local paper where he talked about the Canadian and American health care systems from the perspective of somebody who had grown up in the U.S. but had now lived in Canada for many years. His comment was, “The U.S. does not believe it is perfect, but believe it is closer to it than anyone else. Therefore any problem they haven’t been able to solve must be insoluble, and they will gladly shoot the messenger who tries to prove otherwise.”
I also have an artist friend up in Ottawa who was attending a convention in the U.S. to sell some of his work, and had his first-ever case of diabetic shock while down in the U.S. He spent months fund-raising afterward to pay off the bills he acquired there.
In Australia we have a conservative national government that is currently trying to undermine (and ultimately to destroy) the current Medicare system -- which is not unlike the UK’s NHS system. Unfortunately for the government it is clear that voters are very unhappy with the mooted changes, and Mr Abbott and his government have backflipped several times over proposed changes that would make the Aussie system more like the US one. From what I read, and from my son’s experiences in 2014 travelling the world, the US system is one of the worst in the developed world for ordinary people.
Three experiences:
-- I used to work in a hospital and the general consensus seemed to be that every doctor spent at least an hour each day, sometime much more, on the phone begging, persuading, and/or negotiating with a representative of an insurance company to get permission to give treatment. I’ve never talked to doctor that didn’t think this was an enormous waste of their time. many were outraged that the person they had to negotiate with was usually a person with little or no medical training. Their core competency was following a series of yes/no/ and simple multiple choice questions offered up by the computer.
Going along with this is the way the insurance companies set the law up to excuse insurance companies from any liability. If a treatment was declined or delayed because of negotiations with the insurance companies, and this caused the person to die or be injured, you cannot sue the insurance company. Not even if the rejection was wrong. They have set up a system where insurance companies have no incentive to make admission of coverage or extracting payments easy.
-- I used to work around a man who had dual US/British citizenship. He maintained coverage through the NHS. He would take vacation days and fly to England to get all his medical issues addressed. He blew out a knee and had it rebuilt in England. According to him the round-trip ticket was a small fraction of what it would have cost him in the US.
One night he had abdominal pain so bad it forced him to the ER. Having never seen a ER in the US he was appealed at the treatment. Hours waiting, reams of paperwork, exhausted doctors desperate to classify people as quickly as possible. The next morning I saw him and he was haggard, drawn , and mumbling under his breath about how next time he won’t go to the ER. He will instead go to the airport, fly into England and, in the end, he still would get better medical faster and far more inexpensively.
-- I grew up in a military family and we had, in effect, national healthcare here in the US. Even as young boy I was told that if I was ever seriously injured I was to get to the local military clinic. It didn’t matter the branch. As a dependent all I had to do was present my military ID card, and tell them my father’s name and rank. From that point on it was all taken care of. It is hard to explain how much of a comfort it was for a kid to know that doing something stupid and breaking a leg wasn’t going to sink the family budget. I went to a clinic once at an early age after kneeling on some glass. I walked a block to the clinic. They had to dig out the glass, clean everything up, and I ended up with eight stitches. That was before military dependents were shunted off to civilian doctors.