Tuesday, May 1, 2012

Healthcare Sucks In Britain (or does it?)

So...I've had another one of those Twitter conversations with a ‘well-informed’ Conservative, who believes Free-Enterprise and private businesses are the solution to all of the nation's woes (Hi Liz). It actually started as a snipe from another Twit. We had been discussing the use of statistics to 'fudge' employment data and, suddenly, this second Twit jumps in with something, almost Palin-esque, along the lines of "How's that British socializy-mediciny-thingy working out for ya?"

Based on this, I am guessing that the British National Health Service (NHS) has received some bad Right Wing press over here, because it is struggling to meet the needs of an aging population and, under conditions of global financial stress, a double-dip recession and high unemployment, the British (Conservative) government is concerned about future costs. The NHS is undergoing some considerable reform (again) so that it is sustainable into the future. I have no doubt that such reportage in the USA has been less than accurate (wow, d’ya think?) and, in the light of current distrust over Obamacare, the NHS will have been used - falsely - as an example of how things always decline rapidly into disaster once 'Big Government' gets involved (if by “rapid” we mean 75-odd years and counting). I am confident that this sort of reportage is occurring, because I watched good old Bill Whitless give another one of his laughable “Firewall” presentations recently and he specifically mentioned how socialized medicine had “failed” everywhere it had been tried. What a doofus!

So, I mentioned that my father, in Britain, has just had knee-replacement surgery, and that he is doing well. The returned incredulity was almost palpable…”Privately, or through government???” 

Yes, folks, it was that awful National Health Service.

Actually, in the last few years my dad has also had both hips replaced and the experience has been perfectly fine-and-dandy thank you very much. No complaints from the bionic man. But I wanted to share two other experiences and then ask a simple question: under which system would you, dear reader, prefer to live?

Experience One:

Four years ago, I was living and working in Spain (here). I began feeling ‘peculiar’ and, after 3 weeks, actually felt permanently drunk. I was dizzy, had double-vision and had developed a nystagmus (an involuntary ‘dancing’ of the eye) on my left side. It became difficult to function – crossing the road was a nightmare. Working - all but impossible.

Well, you might know that Spain has a perfectly adequate socialized medicine system (yes it does, rated 7th best in the world by WHO in 2007, but now also struggling because of economic stress), but my Spanish was poor and the doctors with whom I consulted did not speak English very well, so this added to my stress.

So, I called my parents in Britain on a Monday morning and asked them to make an appointment at their doctor. I caught a flight from Madrid Barajas Aeropuerto on Thursday, landed at the East Midlands Airport 50 miles from my folks’ house and went to see their doctor on Friday morning in a small practice in the Leicester village of Syston. The doctor was obviously concerned by my symptoms and was particularly impressed by the nystagmus. He brought another doctor - a second opinion - into the consultation room, who waved his fingers in front of my face and asked me to “follow” them. “How bizarre!” he said. “Great!” I thought.

The two doctors decided that the best course of action was “tests”, and the optimum test would be a brain scan.

Luckily for me, the British National Health Service had, just a few months before, at a cost of several million pounds Sterling, invested in several mobile MRI brain scanners. These are state-of-the-art machines mounted on the back of a 40-foot tractor-trailer. They come with a driver and an MRI technician. The idea is to make such technology more accessible to people who live in rural areas or to old folk who can’t travel very well and to cut waiting times for these important services. Even more luckily for me, there was one of these shiny-new machines parked outside this particular medical practice in the sleepy village of Syston. It had been scheduled to be there for two days before moving on to another community. My timing could not have been better. My initial doctor’s appointment was at 9:00 am and I had had the brain scan by 11:00 am that same morning. I stayed with my parents for a week until the results came back (Easter weekend put an additional delay on this) and these results showed no evidence of anything untoward in my brain (I was happy they’d even found one!)

I don’t mind telling you that I cried tears of relief and joy when I discovered, thanks to the NHS and their rapid response to my condition, that I did NOT have a tumor on the brain stem – a possible cause of my symptoms and a condition with a poor prognosis. The doctor referred me - and my results - to a neurologist and HE surmised that, in the absence of any oncological phenomena, there had been some damage to my ‘balance center’ probably caused by a virus. It would likely improve over time as the brain rewired itself and I could expect to make a full recovery. And, thankfully, I have.

Total direct cost to me? Zero. Value of having this reassurance? Utterly priceless.

Experience Two:

In 2005, when I was working towards my PhD at the Medical University of South Carolina, I had a friend, another graduate student, who was helping out in a neuroscience class where several new diagnostic tools were being demonstrated. Unfortunately, as the volunteer, my friend tested positive for several of these diagnostics and the faculty members expressed some concern. She was advised to seek further medical advice, which she did. The diagnostics were pointing to the possibility of a tumor on the brain and she was advised to get a brain scan. This is where our stories change.

She was told by her insurance company (yes, she was insured), that because this ‘condition’ had been diagnosed prior to her request for a brain scan, they would not cover the costs and that she would, if she wanted to pursue that option, need to foot the $10,000 bill herself.

Months later, thanks to her friends and family, she eventually raised the money and had the scan. The results, like mine, were negative, so all was well. Except she was $10,000 poorer and an insurance company, who continued to take her premiums, was several thousand dollars richer. Had the results been positive, would the delay have been too long? It is an academic consideration now I guess, but you can bet this was of ample concern to her during the interim.

Back to the Twitter conversation.

A question raised by one of the conservatives (in response to a statement by someone else about “free healthcare in Denmark” was – “What exactly do you mean by “free healthcare””? A leading question designed, I suppose, to make one think that socialized medicine is not free because the taxpayers pay for it. And this, of course is quite true. And yet, in the USA – where Free Enterprise and the Free Market are supposedly all the rage, tax payers foot the nation's healthcare bill to the tune of 18% of GDP, or $2.5 trillion dollars every year. So, if you have healthcare insurance, you are paying twice! You pay for your own healthcare (unless the Insurance company blows you off for a condition that is not covered or is deemed pre-existing – like pregnancy, but that’s another story) and you pay for the healthcare of a bunch of other folk too. If you think of the fluidity of finance, you might also consider that the not-insignificant profits of healthcare insurance companies arise because of the inefficiencies of the system and the tax payers are, in fact, giving money to these companies. It’s a stretch, I’ll admit, but Denmark's system costs half of the American system (per capita) and they have more doctors (per capita), and at least in Britain, they only pay once and then no questions are asked. You’re sick, you see a doctor, you get treatment – no pre-existing conditions, no co-pays, and nobody goes bankrupt because of healthcare costs (a leading cause of bankruptcies in the USA).

And, when the system gets stretched by economic stressors, as is happening in Britain, and Spain (and in the USA), what do these countries with socialized medicine do? REPEAL!!!!  Well, no, they reform. How civilized.

And if, as an American, you'd like to better understand "free healthcare", might I suggest you take a vacation to Britain (or Spain). Go see some castles and some beautiful countryside. See some history. Then, while you're at it, fall sick or get hit by a car. You'll be treated and you won't pay a penny. See! Free healthcare!

Leeds Castle in Kent. A beautiful place to get hit by a car.
Finally, I’d like to mention my grandmother, who turns 100 years-old this year and who, like Ann Romney, has never worked a tax-relevant day in her life. She has not paid a dime for the 75 years of NHS care she has received (it began in the 1940s). It has certainly been “free” to her and I can pretty much guarantee that, with some of her medical issues over the years, she’d not be so happy (or even alive) if a private health insurance company was negotiating her care.

UPDATE: Nanna passed away in November 2012, just a few weeks after her 100th birthday. So she is a nice example of the extended longevity of people living under socialized medicine (average female life expectancy in Britain is a year longer than in the USA).

Doris Grimes: 1912 - 2012
So….here it is - under which system would you, dear reader, prefer to live?

Whatever your answer, please don't tell me how British healthcare sucks, because if that's what you think, then you clearly haven't got a clue what you're talking about.