The NHS: Best Thing Since Sliced Bread
When health care was a hot topic during the 2008 presidential campaign, I made some remark on Facebook about getting fabulous government-paid-for health care here in the UK, and how I wished everybody in the US could have the same. But a friend in New England popped up to say “Go ahead and ask for socialized medicine, if you want Americans to have the same crappy health care you get over there.”
Why would she think I would go to the trouble of posting a recommendation for a system that’s not any good? Okay, we can agree to disagree about where healthcare should come from—no problem there—but why would she think that I would say the UK’s National Health Service is great if it isn’t? Her belief that government health care must be bad seems to be so strong that it’s easier for her to believe I would say “vote for socialized medicine, even though it’s awful” than for her to believe that I get great health care from Britain’s National Health Services (NHS).
It was and is great to be at some remove from the US election process. I don’t have to see the attack ads, and I can read the candidates’ comments rather than hear them, which makes the comments I disagree with less grating. But it can be difficult when my British neighbors ask me to explain why the candidates say this or that, or why people vote this way or that way, if all I can say is that I don’t get it, either.
(One of the candidates last time talked about how we aren’t willing to pay for $150 to care for a diabetic’s feet but we’ll pay $30,000 when that uninsured diabetic has to have a foot amputated at the county general hospital. I mentioned that to a friend who got quiet and then eventually told me “That very thing happened to my mother in New York”. All the doctors except the anaesthesiologist waived their fees, because her mother couldn’t pay—laudable, but not really very fair to the doctors.)
Health care is probably going to be just as big an issue this time around, once the Republicans settle on a candidate and start gunning for Obama, so I’ll have more of those conversations. Most of the British people I talk to can’t understand why Americans don’t want a government-funded health care system. We have roads, don’t we? And nobody complains about socialized road maintenance, do they? Isn’t peoples’ health more important than the roads?
A mother with two toddlers said to me “Surely there’s health care for children, though, isn’t there?” She must have been cut from the same cloth as my New England friend who just didn’t get it. I explained that there was a proposal to extend a Medicare-type program to children, but President Bush vetoed it. She kept saying “But the little children…” in a way that would have been comical if she hadn’t been so obviously shaken by the idea that there are children in the developed world who don’t get health care because their families can’t afford it, and that the society they live in, given the choice, allows that situation to continue.
(A friend in California was pregnant a few years ago when her company changed health care systems. She had a choice of two plans, but her long-time GP was on one and her obstetrician was on the other. She couldn’t keep seeing them both.)
We may not be living in a total paradise here, but I definitely get care as good as I’ve ever had in my life, and without doubt I have awesomely, unbelievably better access to doctors and hospitals and scans and all kinds of medical services than I ever had when I lived in either Kentucky or California.
Yesterday was my birthday. Now, it’s not very festive to run errands on your birthday, but off I went to get things done, and my first tasks were to schedule an eye test—which is free, because I have a family history of glaucoma—and to pick up my refilled prescriptions—also free.
(I’ve read that over 40% of US bankruptcies are caused by medical debt. Almost no one in the UK goes bankrupt because of medical bills.)
Prescriptions are free here to everyone under 16 or over 60, anyone who’s pregnant or recently had a baby, who’s undergoing cancer treatment, who is permanently disabled with certain disabilities, or who has certain medical conditions. I get free prescriptions because I take thyroid hormones, but it could be diabetes, or epilepsy, or any of several particular conditions. If you have to have thyroid supplements to live, they’re willing to give them to you, and for other prescriptions, well, the NHS thinks it’s cheaper and more fair to pay for all of your prescriptions, because who can say which of your other ailments aren’t ultimately a result of your thyroid problem.
(A cousin of mine, in his 40s and employed full time with benefits, has just had to go on insulin, and the cost of prescriptions means he can no longer afford to live on his own, so he’s moved back in with his parents.)
I have never once since moving to the UK asked to see a GP and not gotten in the same day, though of course I don’t ask for an immediate appointment unless it’s urgent. I won’t necessarily see my own GP, but I’ll see another partner in the practice, and that’s fine with me. I haven’t run into a dud yet.
(At the California HMO I had last, before I moved here, I usually had to wait three weeks to see the doctor. For recurring painful problems, she told me to write to her by fax because her staff wouldn’t screen out faxes from patients like they do phone calls from patients, and she could then phone the pharmacy with a prescription for what I needed. Otherwise I would have to go to Urgent Care.)
Here in the UK there are restrictions on what doctor you can see, but they might not be ones you’d expect. Mainly, there is a defined “catchment area” for my doctor’s surgery (US: doctor’s office); they won’t take you on as a patient if you don’t live within that area. Why? They make house calls. NHS GPs generally do. I’ve never seen a US doctor who made house calls; it’s something from the mythic past, tales handed down from grandparents.
(The first HMO I belonged to in California didn’t allow me to switch doctors until the yearly open enrollment period in October, but when October rolled around, I wasn’t allowed to switch doctors because none of the others in the practice were taking new patients. I had to stay, for another whole year, with a doctor I didn’t like.)
Life is just…completely different when you don’t worry about pre-existing conditions, or losing your health care along with your job. If you get laid off in the UK, you’re still covered. You can change jobs at will and—here’s one for “job creators”—you can start your own business without wondering how you’re going to pay the doctor if something happens.
(An American uncle retired to Colorado to be near his grandchildren, but it turned out his retirement health care plan from his employer only paid for care in the state where he’d been employed. Oops.)
But you’ve probably heard we have horrendous waiting times for operations here. Well, we used to. That’s outdated information, but you don’t get headlines screaming “No unreasonable delays for health care in Britain Anymore”.
And admittedly, there is such a thing as the so-called postcode lottery, which means that depending on where you live, the NHS might provide better care or worse care than the average. I’ve never been unsatisfied with the care, so I don’t have anything to offer except that most large services do have local variations, though you hope that everything meets at least minimum standards.
When minimum standards aren’t upheld, it’s national news and the headlines are huge. A few years ago someone who wasn’t happy with the hospital care for her elderly mother ran up to the prime minister while cameras were rolling and asked him what he was going to do about it. If the care isn’t good, you can write to your member of parliament, who can get involved in your case. The newspapers like nothing better than to ask why the government isn’t doing more to help some sick and vulnerable person.
And you may have heard that some large percentage of British people are unsatisfied with the NHS. There are lots of British people; some probably are dissatisfied at any given time. But one study a couple of years ago asked people whether the NHS was doing a good job, and people said no, a terrible job, the hospitals aren’t sanitary, the waiting times are long. But when the same people were asked what they thought of the care they got personally, they said it was great! Their local doctor? Just fine. Local hospital? Doing a first class job. Maybe it’s a case of people believing the worst, or at least fearing the worst.
(Another California friend told her husband he’d have to give up his consulting business and get a job with benefits, because medical insurance was costing them as much as some people make in a year and covered just the parents and one child—the other kid had asthma, and she couldn’t find insurance that would take him—and keeping up with the claim paperwork had turned into a half time job for her.)
I have heard religious people in the Bible belt say that the government has no responsibility to help the sick, and that Jesus’s parable of the Good Samaritan teaches us that we should perform personal acts of charity; it has nothing to do with the government.
Well, I can’t personally go out and help everybody who needs care, so I’m very happy that the government will do that for me.
Yes, we pay high taxes here, but those taxes buy me a lot of obviously good things, including knowing that I and all my neighbors will have medical care free at the point of delivery. I don’t worry about other government services being “socialized”—paving the roads, training firefighters, policing the streets—so why should “socialized medicine” be seen as such a threat? I’m here to tell you, socialized medicine is great where I live.
The first time after we moved here that I walked out of an NHS doctor’s surgery, I kept looking over my shoulder. Were they going to come chasing after me? I couldn’t just leave; I went back in and asked at the desk. Was there really no co-payment? Nope, nothing to pay. Don’t I at least have to sign something, or fill in a form? No, no forms, you can just go on with your day.