From 1949 until 1997 I lived in the United Kingdom under the National Health Service system. From 1997 until now, I have lived in the USA under the private health care system.
Below the fold is my experience of receiving health care under both systems, and my conclusion is that they are roughly the same.
At what cost?
The GDP per capita in the UK is somewhat less than in the USA (http://www.swivel.com/data_sets/show/1001530).
However, in the UK, NHS spending in 2007-2008 was projected to be 7.8% of GDP (http://www.hm-treasury.gov.uk/media/801/75/sr2004_ch8.pdf).
In the USA, Health Care spending in 2007 was 17% of GDP (http://www.nchc.org/facts/cost.shtml).
Wow, just wow! 7.8%. 17%.
Just what is the problem with a single-payer solution?
In the UK, there is no direct connection between paying for health care (via the equivalent of taxes from ones pay) and its receipt. Treatment under the NHS is free at the point of delivery, unless one chooses to pay for private treatment.
My USA health insurance is provided under my wife’s employer program (ironically, a UK company). The insurance company is Cigna, co pays (not an awful lot) are required for doctor visits, procedures and prescription medications.
It might seem surprising to many, but the thing that I found was that the experience of health care delivery was so similar to that in the UK. In both cases, if you didn’t bother your provider, they would leave you alone.
This is not necessarily a good thing. I am now 60 years of age. When I came to these shores, I was 48, and no previous history of anything very much except a touch of self-diagnosed high blood pressure and one lab report indicating that my cholesterol was a bit high. I was and am not overweight, and was and am quite active. So, at 48 there had been no particular reason to have any regular interaction with the medical or related professions.
However, as one gets past 50 years, there is increasing need to have one’s BP, cholesterol, blood sugar, etc. checked.
In the period between 1997 and 2008, the only proactive action taken by Cigna (and by Kaiser when we used them for twelve months) was to request a stool sample.
‘Welcome to Cigna/Kaiser – now send us some sh*t!’
In the first case I didn’t bother to comply, and they didn’t follow it up. Later, when we reverted to Cigna after the Kaiser year, they sent another stool sample request, which I did comply with. I never heard the results.
This speaks volumes about these so-called ‘Health Maintenance Organizations’. Exactly what is their commitment to maintaining health?
In the end I took matters into my own hands 12 months ago because a rash on my legs wouldn’t go away with drug store preparations.
Once into the system, it moved like greased weasel droppings. I was assigned a general practitioner (a very likeable and knowledgeable young man only a few years older than my son – I was one of his first patients at his new job, and I think I made him nervous), who took my blood pressure (high, prescribed treatment immediately), did the eye-watering prostate test, ordered lab tests (high cholesterol, treatment prescribed at next consultation) and ordered a sigmoidoscopy.
Oh, and by the way, suggested a drug store remedy for the rash that I had originally decided to get help for.
The cost to me, thus far was for 2 consultations at $20 each plus about $10 each for 2 generic prescriptions from Costco. The prescription co pay is $15, so it was cheaper to pay ‘out of pocket’.
The prescription charges in the UK are about the same as my co pay in the USA. Drug prices are much less in the UK.
So far, so good. Would I have got this treatment in the UK?
Certainly. The big difference is that I would have been summoned for an appointment at ages 50 and 55 for prostate and BP exams and a lab test, because the physicians get extra pay for doing preventive medicine.
Thusly, I would have been on medication earlier. Whether that might have been a life-changer in my case is doubtful, although for someone else it could have been a life saver.
The sigmoidoscopy was performed as a clinic procedure at the end of the month, about 3 weeks after the initial consultation. Not too much of a wait, not much different than in the UK. However, they discovered a possible pre-cancerous polyp up there, and decided that a colonoscopy was in order.
The first available appointment was 5 months away, in December. In the mean time, my spousal unit and family were a bit anxious that I might have undiagnosed colon cancer. Despite my reassurances, they were still a bit concerned. For 5 months.
In the UK I would be expected to wait for 1-3 months. Hmm... Not much difference? (http://www.theparliament.com/fileadmin/theParliament/pdfs/Brussels_EuroParl_Feb_Cancer_Screening_Dr
aft6.pdf page 10)
With the New Year came nose bleeds. Heavy nose bleeds. Once, twice, three times a day. I went to my doctor, and he cauterized my nose. Things got better for a bit, but relapsed. I was at the point where I couldn’t possibly attend a usual work place (fortunate, as I ‘work’ from home). I needed to lie down 2 or 3 times a day, and the bleeds happened with such lack of notice that I would be likely to bleed all over whomever I’m talking to. So, it was pretty urgent.
Back to my primary doctor I went. He had another go at cautery, and wagged his finger at me and said, ‘If you are still bleeding in a couple of weeks, let my nurse know and we’ll get you to see a specialist.’
Two weeks later, I was still bleeding (and getting very pale), so I called to make an appointment for the ENT department’. This was mid March. When was the appointment? The end of May. I was anemic, couldn’t work, and the best that can be done was more than 2 months away.
I asked (eventually, when the appointment arrived) why there’s such a long wait for what I consider to be an urgent procedure, and the surgeon said there was a staff shortage. I asked why they simply don’t hire more staff – it’s private so they can do that, can’t they – and he says that no, Sharp Healthcare can’t afford more staff.
I’d like to bet that I would have been seen sooner on such an urgent item in the UK. But in any case, let’s call it a draw.
So the two systems deliver equivalent results. I’m not going to claim that the NHS is better (although I guess I could make that claim), just that it’s not worse, for a reasonably well-insured person in the USA.
For those with no insurance or ‘junk’ (Catastrophic) health insurance in the USA, the UK NHS wins, hands down.
Now go back and look at the cost.
Just what is the problem with a single-payer solution?