I caught up with a few British friends at the recent STM Spring Conference in Boston and regaled some of them with my stories of moving to America: lots of good things but a number of frustrating things too. One of these is the healthcare system (actually to be more accurate it's a healthcare business). My colleague Tim pointed out that he was hacked off with hearing the same story, so to help him I thought I'd write it on the blog and in that way just point people here when they want to know my experiences of the US healthcare 'system' when compared to the UK's glorious National Health Service. If you're British and think that the NHS is rubbish, let me just say now that you don't know how lucky or privileged you are - it's one of the UK's crown jewels, a remarkable achievement and a shining beacon to all. Be thankful for it and bow down to Nye Bevan's most glorious creation every day.
Here's one story to highlight my frustration.
Having had my first epileptic fit in 17 years last September I visited my GP. Of course, no one really knew why this was and we all just shrugged our shoulders, with a view to taking a look
ONLY if it suddenly transpired that I was having monthly fits or something.
Of course, the moment I mentioned this to my new US doctor he referred me to a neurologist (bear in mind I pay $25.00 each time I go to the doctor). And he, in turn, decided that I needed to have an EEG and an MRI. I really didn't need these, although I don't want to be ungrateful. What was more interesting was the fact that I was originally 'denied' the MRI by my insurance company, and I'm convinced that's because they deny all initial claims and then sit back and rely on apathy and inertia. Of course, when I appealed all was OK (sigh). Then I had to go about setting up the appointment with a third party to do the whole thing; certainly not just waiting for my GP to arrange everything for me. The whole event was very, very tiresome.
But someone is having to pick up the tab for this. Neither test is really needed (so long as I keep taking my medicine) and I guess that's money that could stay in the 'system' for someone, somewhere who must really need the money. It's all very odd and very puzzling, but unfortunately there's a financial incentive for all this to happen...and continue to happen.
This isn't really too irritating, although it's extraordinarily puzzling and wasteful. What irks more is the whole co-payment thing. Every time one of us goes to the doctor we've got our hands in our pockets. The whole thing just seems wrong, but then maybe that's the (socialist) libertarian in me. Plus there are some treatments (e.g. the kids' orthodontic treatment) where we have to pay too. I'm going to be shelling out ~$2,000 per child for that !!
And, with that in mind, here are a few quotes from an excellent book I've just finished reading - "Free Lunch" by David Cay Johnston:
"In the US it's government policy to make health care a business and as we know business exists to make a profit. 'That is the appropriate standard for taking care of capital, but not people's health'"
"If health care as a business worked, it would be a success story to embrace. If it resulted in lower costs, more and better care, and longer lives, it would be just what the doctor ordered. The American system provides superb acute care, trauma care, and access to the highest technology. But by every other objective measure - cost per capita, health status, longevity, costs of paperwork, and economic pollution - the uniquely American approach to health care is a complete failure. We pay more, enjoy shorter lives, and are drowning in infuriating makework, filing claims and making appeals, while distorting the whole economy because one giant component is a commercial activity"
"No other modern country regards health care as an insurance business. While some nations refer to their plans as health insurance, they mean that in the political sense, just as we call our basic old-age pension system of Social Security a 'social insurance' program. No other country uses the word insurance in the business sense, which means to spread risk. The business sense of insurance includes the concept of examining claims to see if they fall within the contractual boundaries for payment,... This is how we ration health in America, through contracts that limit care and exclude coverage - and by having tens of millions of people go without insurance at all."
"In Europe, Japan, Canada, Australia and New Zealand, people benefit from a system of
health service, not health insurance. In many of these countries doctors still make house calls. The overwhelming majority of people who seek immediate care are treated that day or the next, which is also true in America. But the other countries do not spend vast sums on reviewing claims for payment and billing, a deadweight drain on the American economy that costs every man, woman and child more than a dollar a day"
"The business of health has created a massive makework program, run by health insurance companies, whose purpose is to justify denying care. That in turn has forced physicians, hospitals, laboratories, and others to employ their own armies of paper pushers to fight for payment,..."
Let me just finish this rant by saying that this is all, obviously, just the Brit in me. And the fact that I've been spoilt by the NHS. In all other ways, being in the States is fantastic and me, Steph, Joe & Hannah love it :-) We all love school, the job, shopping, visiting NYC, Saturday & Sunday breakfast at the diner, etc.
