I was recently asked by someone to sum up how I feel about the NHS care I receive here in England. I remember living in the States and, except for that radical period I went through where I read up on foreign cultures and politics as a way of back-stopping arguments I had in my Anthropology 101 class (which was really a collection of beatnick hippy anthro students like myself and a load of Texan Ride 'Em Rough conservatives who took the course as a liberal arts elective and then spent their time banging on about Bibles, shotguns, and Old Glory), I really didn't think a moment about how other countries handle their social structures. The Dobe Kung were as relevant to me then as the Finnish political system.

What the hell was I thinking getting a degree in anthropology, anyway?

So how do I find the NHS care I receive here?

In a word: Excellent.

I know this will wind people up, but frankly I don't give a shit. I tire of reading diatribes of people that like to bash the UK health system because it's-oh my GOD-socialist. "Socialism" is uttered in the States like a bad word, it's on par with assuming that McCarthyism is relevant and the government is out to take your paycheck which they will use to color the world a new Dulux color of pink. It annoys me when I read articles from writers who have never been in a socialist health care system and they decide they have to fight the evil and support truth, justice, and the American Way (I don't read bloggers who bash health care because those aren't the types of blogs I read.)

Having socialist health care isn't a way of debasing truth, justice, and the American Way. If you are happy with your health care here it doesn't mean you have a tattoo of Karl Marx on your ass, it simply means you're happy with your health care here. I'm not a communist, but as someone who's been in socialist societies for 8 years now, I can see there are elements of them that work.

My past saw me born and raised as an Air Force brat. I was truly immersed in the most patriotic of cultures, in a culture which you didn't question and you were completely and utterly supported from a health, schooling, and housing perspective. I have to say that our health care wasn't the best, not because military doctors aren't good because a lot of them were, but because we moved every 2-4 years and the doctors moved every 2-4 years and it was therefore impossible to build up a doctor-patient relationship in that respect. I think because I never knew what it was like to go to the same pediatrician I saw when I was an infant to when I turned 18 that I am ok with how things operate here, too.

Doctors in America can be fucking fantastic. They really can. You have an amazing amount of choice and expertise at your fingertips, as long as you have access to a reasonably metropolitan area (you're not likely to find a world-renown oncologist in a town of about 600 people.) I honestly had some incredible doctors while I was there.

I also had to pay for them.

When I was in college I had to resort to that status quo of being at patient of the university health care system. Whenever you had anything wrong with you, you were presented with two options: STD and pregnancy testing or Prozac. Clearly the only things wrong with you were the clap or depression. Once I broke two of my toes and still had to convince the doctors that no, I swear for the fourth and final time that I've never had an abortion, now can we please address my broken toes?

I went to the clinic because I had to.

I couldn't afford anything else.

I remember once they prescribed me some antibiotics for a cheerful bout of bronchitis I had. When I went to the pharmacy to pick them up I found that the pills weren't covered by the clinic. I had to walk away without the pills, because I simply didn't have $130 to pay for the damn things. What average college student does?

When I first started working I had what I called Health Care Lite. I was allowed to see a doctor but only if I called the insurance company, spoke to a barking dog-like administrator and convinced her that yes, the bleeding out of my ears really wasn't a good thing, at which point I would get a clearance code to see a doctor from an approved list (and they were always too busy to see people) and I could only have certain prescriptions should they decide medication could stop the hemorrhaging from my aural canals.

I remember my ex-sister-in-law going to give birth at Parkland Hospital because, as she explained, it was a county hospital so they couldn't come after her when it was time to pay the bill. She couldn't afford health insurance and a healthy baby's birth came to a cool $1000, money they didn't have.

We lived in the land of hope and plenty, but not for healthcare for the poor.

I did at one point have really good health insurance. Towards the end of when I lived in the States I was making a fair amount of money (and working myself to an early nervous breakdown.) I worked for a very large company that potentially did care about its employees, and so I had a $10 copay (I had to see my general physician who would refer to me a specialist if I needed it, and it could be any specialist) and a max £1000 a year on meds, at which point they were free after that. My care was excellent. Among the treatments I had was my skin cancer doctor, who was professional, kind, and absolutely excellent.

For the privilege of being able to use this service I paid $400 a month from my paycheck (and again, this was 1999. Costs have surely gone up since then).

And that was just for me, I remember a colleague talking about how much it cost to pay for 4 members of a family, and the costs were frightening. I wondered how he could afford it. Looking at my situation now, of myself, my partner, two stepkids, and a set of twins on the way, I know I could never pay for healthcare there like I did when I was a single woman. When that company laid a lot of us off, I took off to Sweden while a lot of the families searched for jobs and looked at COBRA, which was prohibitively expensive.

Sweden was my first view of socialism. In Sweden, everyone who wants a job can have one and everyone who needs a place to stay can have one. It doesn't mean there isn't unemployment (as I know only too well) and it doesn't mean there aren't homeless, because there are. But there is a lot less of both unemployment and homelessness than many other places. Medical treatment in Sweden is free (unless it's something elective like plastic surgery) and prescriptions are very cheap, with a limit on how much you have to pay per year (it used to be 1300 SEK).

If you are sick in Sweden you go to the hospital. Very few people have a family physician, they're an unusual entity. The hospitals aren't beautiful-enormous concrete structures that are about as soulless as it gets. Most of the doctors aren't Swedish but come from Eastern Europe or Asia and sometimes following either their English or their Swedish is a struggle. I'll be honest-I found that the care is ok there, you will get seen if you are ill, but don't go looking for a cuddle if something is wrong with you. They're not into that. They don't love you and if you don't get better, that's too damn bad (Angus has said similar about his and his kids' experiences in Sweden). They're also not big on medication-if you're ill suck it up, medication is an enabler. If you're truly ill, take a paracetamol (Tylenol). If you're verge of death then-and only then-will you be seeing the business end of a prescription. In general, unless you're chronicaly ill, medication is not that common (I know this. I had a sigmoidoscopy administered without anesthetic. Really makes for an eye-opening experience, I tell you.)

Swedish health care will make the ill better but it won't be a pretty process. They are also seriously intolerant of heavy drinking. I remember once going to the hospital to get stitches in one of my fingers and seeing beds of bleeding passed-out drunks in the hallways. I asked about them and was told that they would be attended to when they sobered up, but not before. This was their punishment. I sure was glad I only had a sliced finger, not a sliced finger while I had been out on a bender.

Compassionate mercy, maybe, is something not included under that particular brand of health care.

When I moved to England I got an NHS number around the time I got a national insurance number (like a social security number). Here you sign up at your local GP's office and you see them when you have a problem. If they can't help you they send you on to a specialist, a process which (in our area) takes a few weeks. The hospitals themselves tend to be soulless, concrete buildings. You tend to have to wait a while before it's your turn.

But I've had great care here.

Doctor visits are free (except for fertility treatments, which do cost, as do, I imagine, plastic surgery and things like that). Prescriptions have a maximum cost of about £6. And while it's true that in some areas of the country they have really, really long waiting lists to see doctors (Angus' dad needed a hip transplant and was looking at a 6 month wait, so he paid for the surgery out-of-pocket to jump the queue), in our area if you're referred to a specialist I've found you'll be seeing one in about a month or two. If you're willing to pay for the service or have private insurance, you can move ahead in the queue. I do have private insurance through work, which costs me about £50 a month, and it covers both Angus and myself. I have used it approximately once, to see a hand specialist about the trigger finger I had. I jumped the queue by 30 days by doing so.

It's true we pay a fucking load of taxes, way more than I did in the States. In Sweden I think I paid around 40% in taxes. It's less than that here but it's still a hell of a lot of tax. But I personally think that the health care I get in return is worth it. If you're sick you see a doctor. Maybe it makes me a bit pink, but I don't think it should matter if you have money or not, everyone should have the right to health care. We can't all be judges, lawyers and stockbrokers, blue collar workers get ill, too. Just because I support social egalitariansim doesn't mean I'm out to rape the Constitution.

People say a lot of bad things about socialism. Socialism isn't the source of all evil that it's said to be, if you're in a socialist country it doesn't mean that Big Brother is looming over your shoulder. I understand that when the railways were under government control they were generally in better shape than the privatized nightmare they are today. Socialized health care is, I think, equated with shoddy doctors and crappy service. But in the three years I've lived here I've had nothing but good care. My doctors are kind and knowledgable. I get seen when I'm ill. I may have a wait for a specialist, but if I need one then I will be seeing one at some point.

Yes it's true that in our geographic area we have better health care than in other areas, and it's true that in some areas there aren't enough doctors and not enough clinics, but I think in some part that's due to doctors being lured off by bigger grander pay in other countries. It's also true that the NHS is apparently running out of money and looking at how to handle health care. There are debates it should be privatized (which I am against) and debates on how to pay for things. Angus' brother thinks that people should have to prove their financial earnings before they can have access to service, but I think his view on that is full of shit. Elitism makes me weep.

People who haven't lived here can trash the health care all they want, but unless they've lived here they simply don't know how it works, and supporting a socialist health care system doesn't make you Red. I get to see a doctor if I need one and it doesn't cost me anything. I get a prescription if I need one, and if it's a fancy antibiotic all I will pay is £6.

No one can tell me that the doctors here don't care and don't try, because I've yet to find one that has let me down. And when I had to go to the hospital bleeding all over the place and miscarrying last August, the doctors were kind and held my hands. They spoke in gentle voices and offered support. They had answers. They spent as long as they needed to talking to me and discussing options with me.

And that, in my opinion, is good health care.

-H.

Posted by: Everydaystranger at 10:09 AM | Comments (18) | Add Comment
Post contains 2323 words, total size 13 kb.

1 Very interesting post. Thank you for your insights. But it seems to me that the crux lies in this line: It's also true that the NHS is apparently running out of money and looking at how to handle health care. If that is the case, why would our country (the US) consider adopting a model that is not economically sustainable? I think that is a main concern of many Americans. As is the 'jumping the queue' thing, which makes money the determining factor in quality (speed) of health care, just in a different way than we have now. But thank you for the time you took to write this. And for writing every day. I enjoy it. Good luck with the babies!

Posted by: Amy at June 04, 2007 11:13 AM (I9LMv)

2 Amy-Yeah, you got me there. I have no views on how funding the NHS should take place, other than looking at how they handle admin and promotions (which is apparently inefficient on both sides.) I've heard the U.S. is bandying about the idea of taking an NHS-like system, but I doubt that will ever happen. For the jumping the queue part, well-private insurance is pretty rare, so it doesn't happen often. Just like most people can't afford an out-of-pocket hip replacement, so that's rare too. But I do take your point.

Posted by: Helen at June 04, 2007 11:25 AM (2nilo)

3 I am sure you will hear this more than once today: the medical system is socialist in Canada too, and there are other options here that allow you to pay for some things or "jump the queue" (complaining nonstop is one of them). Our (Conservative) gov't has been investigating moving away from the purely socialist system to more private health care, ostensibly because of the costs involved. In an overall picture, the costs involved are bullshit. We also do pay high taxes, and without going into a full description of how money is handled at the federal and provincial levels in this country, the money isn't the problem. The money is there, it's just being re-routed. That being said, everyone can see a physician when they need to, and anyone can go to the hospital any time for treatment. There are wait times. You don't pay out of pocket to see your family physician, but you might not be able to get one if you live in The Sticks because doctors don't want to go there. You don't pay for non-elective (plastic surgery and a few other things) visits. Sometimes drugs are expensive, but not if you have extended health care or if you're over 65. It's not perfect. No system is perfect. Tommy Douglas (Keifer Sutherland's grandfather) is the "Father of Socialized Medicine" in this country, and he'd be ashamed of what it's degenerated to and what the current block of feds is doing with the system. One thing though, you will never be denied care. Most of the time the doctors are excellent, but again, no one is perfect. Sorry about all this writing, but health care makes me rant.

Posted by: Hilary at June 04, 2007 11:35 AM (3yCot)

4 It seems to me that the profit margin has to be removed. The problems arise when the stockholders are held in higher esteem than the patients

Posted by: ~Easy at June 04, 2007 12:04 PM (X+de8)

5 10 years ago I was dead set against social healthcare, but now I'm not sure there's any way around it. Until this month, I was paying $1,200 A MONTH for medical coverage (not visits, just premiums) for a family of 4 (I have a history of skin cancer). I recently got a new policy and am now only paying $950/month, and we have a $25 payment anytime we go to the doctor. I'm paying more for medical premiums than for my house payment (on a 4 year old 2200 sq ft house on the outskirts of a sizable city); and that includes property taxes and homeowner's insurance. I don't like the idea of nationalized healthcare just on principle, but I think the gov't may need to assist people based on their income. It seems like there needs to be some cost for regular visits or people will go to doctors for piddly reasons.

Posted by: Solomon at June 04, 2007 01:09 PM (x+GoF)

6 Having the comparison case is really, really interesting. My own experience with the US health care/insurance system is ... interesting. I was on grad student insurance when I had a 25w3d preemie. Our insurance was capped at $100k per "incident" - and anything related to her prematurity was considered the same incident. Her room & board for 89 days in the NICU & special care nursery was $289k - that doesn't include any doctors or radiology or anything else. Thankfully the combo of her "disability" (based on her birthweight) and our grad student poverty meant that we qualified for MedicAid, which we had absolutely no complaints with. (Well, except that they make it bloody impossible to STOP receiving MedicAid and SSI...)

Posted by: Sarah at June 04, 2007 01:31 PM (VMuXG)

7 I can't even get started on health care-it is still too early in the morning. All I know is something here in the States has to be done. I don't know if national health care is the answer or not, but I do know that in$urance bigwigs control things over here, and that ain't right. This is a really interesting post, and I am glad you are happy with your healthcare. It does really make a world of difference.

Posted by: Teresa at June 04, 2007 02:27 PM (D8TLu)

8 The US healthcare system is about ready to implode upon itself. But then again, healthcare in every country rides a slipery slope, don't you think? It takes money to get the best care and best technology available. It has to be funded somehow, right? It's my opinion that every human being has a right to healthcare regardless of their ability to pay (all those Public health and sociology classes taught me well)...and I'm sure that the doctors I work with would shutter to hear me say that. But then again, in the US healthcare system the charges for care and technology is abused; it's a bold statement but as a person who works in an ICU/CCU, I've wittnessed it first hand. This is what contributes to the high costs of healthcare here, and couple that with the high cost of malpractice they have no choice I guess then to pass it on to the consumer. I work for a hospital and for a single person my monthly premiums are stupidly high, that doesn't include my co-payment before I see the doctor or the co-insureance bill I recieve after care has been administered. Don't even get me started on Rx costs. They got us all by the short hairs here.

Posted by: Heidi at June 04, 2007 04:20 PM (IlSaL)

9 The US healthcare system is about ready to implode upon itself. But then again, healthcare in every country rides a slipery slope, don't you think? It takes money to get the best care and best technology available. It has to be funded somehow, right? It's my opinion that every human being has a right to healthcare regardless of their ability to pay (all those Public health and sociology classes taught me well)...and I'm sure that the doctors I work with would shutter to hear me say that. But then again, in the US healthcare system the charges for care and technology is abused; it's a bold statement but as a person who works in an ICU/CCU, I've wittnessed it first hand. This is what contributes to the high costs of healthcare here, and couple that with the high cost of malpractice they have no choice I guess then to pass it on to the consumer. I work for a hospital and for a single person my monthly premiums are stupidly high, that doesn't include my co-payment before I see the doctor or the co-insureance bill I recieve after care has been administered. Don't even get me started on Rx costs. They got us all by the short hairs here.

Posted by: Heidi at June 04, 2007 04:21 PM (IlSaL)

10 I had a sigmoidoscopy administered without anesthetic. As did I. I wasn't given any other option. To be fair, I didn't have anyone to drive me home and I would have chosen the non-anesthetic option regardless. However, it was a decidedly unpleasant experience, one which left me feeling disgusting and dirty. Also, because they pumped so much air in to make the viewing easier, I kept farting the rest of the day. Lots and lots of little hissing fanny burps that didn't stop until sometime in the middle of the night. Good times, good times.

Posted by: physics geek at June 04, 2007 05:25 PM (MT22W)

11 Great post and great comments. As physician in the US system I can honestly say I think our system is the best in the world. As a consumer and a reasonable human I can honestly say the US system needs to undergo some fundamental changes. My health insurance costs little over $2,000/month for a mediocre policy. And lucky to get an policy. Is socialization a la the NHS the solution? Not sure as different societies place different values on various attributes. An example is coronary artery bypass surgery. Success rates are similar in both US and UK- on the surface. On data analysis one learns death rate in UK does not reflect the waiting list for procedures that would be done ungently if not emergently. Result is "sicker" patients done in US never make it to surgery. Another example is hip replacement surgery vs treatment for metastatic lung cancer. UK system will treat the lung cancer and place hip on extended waiting list. For same dollars to treat one lung cancer patient with no real meausuable benefit on life length could treat many many hip pateitns with replacment returig them to productive pain free ilves. Bottom line to me seems to be allocation of resources. And who gets the dollars. Chances for meanigful reform are I fear slim thanx to the insurance lobby. BTW my eldest grand daughter was born in a Irish NHS facilty in Dublin. The care daughter and grand daughter recieved was first class. And I monitored very critically.

Posted by: Foggy at June 04, 2007 07:08 PM (WlHuv)

12 It's interesting to see it from your perspective. The government is increasingly keen to pay the private sector to provide healthcare because the NHS doesn't have the capacity. I struggle to see how they will gain capacity if they carry on that way so surely the private sector will get ever more involved. That happens to be good for me as I work for a leading private healthcare provider (not in any kind of clinical role). Is it good for our society though? I don't think it needs to be a bad thing as long as a line is drawn somewhere. One of the greatest things about living in this society is that no sick child need remain untreated just because his parents don't have the money. I believe every first world country should provide free care for children.

Posted by: mrDan at June 04, 2007 08:39 PM (+yD63)

13 i wish more people from the states understood NHS. i have worked in both public and private health facilities in the US and see the need for a healthcare plan to fit the needs of all people. it is very sad to see the health of people at young ages who require emergency surgery because of the lack of access to regular treatment. great post. i enjoy your blog!! and good luck with the babies!

Posted by: kate at June 04, 2007 09:20 PM (p3j4e)

14 I think experience with the NHS varies from person to person and with what is wrong with you. I belong to a couple international sites that deal with a couple different health issues. I've seen some pretty awful treatment from NHS, but these are for issues that I would think that healthcare nearly anywhere would make it difficult. PCOS, Fibromyalgia, and weight loss surgery (yes it is a health issue, my duodenal switch saved my life) are the issues I see people have nightmares with. Otherwise, if you are doing pretty standard stuff, I think the NHS does a fantastic job. I just hope that they are able to continue to do so, because money can be an issue. Ontario's OHIP is becoming a gigantic mess and I'd hate to see the NHS go that way.

Posted by: Dani at June 04, 2007 11:15 PM (CD1jr)

15 Just a note there Foggy - Ireland doesn't have NHS. We have a public health system run by the HSE (Health Service Executive). No offence but please don't mistake Ireland and England as the same country.

Posted by: Elisa at June 05, 2007 10:17 AM (AlPvn)

16 For Elisa. Sorry got the name wrong. Should have said the Irish Health System rather than NHS. My daugher was well pleased.

Posted by: Foggy at June 05, 2007 07:07 PM (WlHuv)

17 I meant to tell you how much I appreciated this post the other day, but I got distracted. I think the differences between the Swedish and English systems are interesting. I would guess (and that's all this is, a guess) that when Americans opposed to universal health care freak out about "socialized medicine," it's the seemingly impersonal Swedish system they're envisioning in their nightmares more than the UK one you've described in this post and others. That is, I know I jumped outta my chair at least 3 feet when you posted about that anesthesia-free sigmoidoscopy. GAH! But it sounds like you are very well taken care of by the OB/GYN practitioners (and Dr. Hand Herpes, can't forget him) where you are now. Nothing alarming about that at all.

Posted by: ilyka at June 06, 2007 07:50 AM (EApP5)

18 That's the one Foggy. My sister went through the public health system when giving birth to both of her kids. She could have gone private, but then would have had only one consultant with a LOT of patients. Going public meant she had a team of midwives, plus a consultant who had a set number of other patients. The only thing she didn't like was the noise of the cleaners in the hospital at night.

Posted by: Elisa at June 06, 2007 09:25 AM (6/XCd)

Hide Comments | Add Comment