Monday, 3 May 2010

#11 Boy you have no Faith in America.

In stark contrast to Mary Baker Eddy (see my previous post), I have considerable faith in medicine. It's just that you can't get it in America.

Now, America has been debating the benefits of 'socialized' (a clever coinage of the American right, which cunningly aligns not letting your citizens die of poverty with communism) medicine very vocally of late. Well, not really. Rather, the watered-down concept of 'universal healthcare', the late Ted Kennedy's life work, has come closer to reality, as the Democrats finally managed to pass Obama's very sickly healthcare bill. The debate is uncompromisingly partisan, depressing, and ill-informed, and the NHS is frequently referenced in exceptionally derogatory terms, of the 'well at least we aren't as unlucky as those Limies' school. Nice work Mr. Murdoch.

Pithy sarcasm aside, I have until now had little perspective on how the American healthcare system actually works for an average Joe. I imagine many Brits are as clueless as I, and so I thought I would recant my totally esoteric and probably not-at-all representative experiences.

I was decidedly ill within a week of coming here, and I never really get ill. I attributed my persistent cold/migraines/nausea to pollution, diet changes or a minor infection, and soldiered on. However, when I deteriorated from subpar to spectacularly queasy (after about three weeks), it was decided that something must be done.

I have a basic health insurance package, as required by the US Government under the terms of my visa. I am led to believe it is typical for people on smallish incomes with insurance. (Out of interest, it costs about $800 a year; I get the cheapest package there is, being young and male.)

So, the first minefield was making a doctor's appointment. Whilst I could theoretically go to any, my insurance company had a list of preferred partners, with rather better benefits (they pay 100% of appointment costs if you go to a partner, for example.) No matter, there is one a couple of blocks from the studio. I then had to call the surgery, call the insurance company back to make sure my policy was acceptable to the surgery, then call the surgery again to schedule an appointment. (I should point out that most of this faff was because I'm a foreigner - and it was only three quick phone calls.)

I got an appointment for the next day, having called mid-afternoon (how often does that happen on the NHS?). C'est bon.

By the next day zombies were stopping in the street to ask if I was okay, and I rocked up to the surgery in a delirious, semiconscious frenzy. I filled out 100 forms (that's two more than the 98 forms you have to fill out on the NHS, because you have to provide your insurance details twice), then waited patiently for about ten minutes, at which point I was ushered through to a nurse (about ten minutes ahead of my original appointment time - again, chalk one up for America).

The nurse took my blood pressure, asked me some basic questions, then left me to die for a while. Then the doctor and his student came in, and did typical doctory stuff.

The conclusion was that I had hayfever - um, what? After several minutes of me asking skeptical questions (apparently, you can get really ill from untreated hayfever because - and don't read on if you're squeamish, have ever kissed me, or wish to - of the vast volume of phlegm entering your stomach), he wrote me two prescriptions and bid me a cheery farewell.

At this stage I was thinking private healthcare was rather jolly. Then I got to the pharmacy. Now, my policy only pays 50% of prescription costs, which I hadn't thought much of - after all, we pay prescription fees in England. Except the pharmaceutical companies charge ludicrous prices, on the basis that, if you have a nice package, you never pay them, and they can rake it in from the insurance companies. The total bill at the first pharmacy I went to for some eyedrops and a nasal spray was to be $300, half of that payable by me.

$300. Seriously. Both of the drugs I'd been prescribed are available over-the-counter in the UK, for no more than 10 pounds. (You can get a LOT less stuff over-the-counter here. Also, you can't buy wine and spirits in supermarkets. How mental is that?)

So I walked out with some Clarityn (which you can buy OTC) and a very grim aspect.

Where things get weird was a day later, when I was so ill I was weeping and decided to at least pay the $50 for the spray. The pharmacy in Staten Island called up the insurance company while I was waiting, and sort of bartered over the price they would pay. In the end, they offered to fill the very same prescription for $20, and I hastily assented. It's really very curious.

I'm home next week, so will stock up on all manner of drugs in case of future need. Most Americans, of course, don't have that privilege. What I hadn't realised about US healthcare is that the problem runs deeper than the 40 million uninsured. Tens of millions more are underinsured. Even if you have great coverage, until the recent bill comes into effect, insurance companies frequently denied coverage to 'repeat offenders - the chronically ill; insurance evaporates when you need it most.

Most of the people I know here have no insurance. So, if they have any kind of minor ill - flu or fever - they won't go to a doctor; the whole enterprise would cost them hundreds of dollars. I would be interested in a study comparing the general health of this country - sick days, how fast epidemics spread - to other Western nations.

And the thing to remember with all of this: the American government, with five times as many people under its wing than Britain's, spends twice as much per capita on healthcare. I'm no math whiz, but economies of scale aren't supposed to work that way. 'Socialized' medicine is no panacea, nor is it at all easy to institute, but something is seriously wrong here.


  1. Good post - interesting insight.

  2. Since I'm not one of those weird non-Americans who are more interested in American politics than politics in their own country, I haven't bothered to spend hours reading about the American healthcare system.

    "the American government, with five times as many people under its wing than Britain's, spends twice as much per capita on healthcare"
    Just to confirm, do you mean the American government?

    "$300. Seriously. Both of the drugs I'd been prescribed are available over-the-counter in the UK, for no more than 10 pounds."

    Is $300 the cheapest you can get them? Can you get them on the internet? If these are generic drugs, not still under patent, then why isn't anyone competing and undercutting them? Has competition been made illegal in some way?

    It sounds like the problems with American healthcare are caused by government.

  3. A very plausible alternative is that $300 is the true cost, and that they are subsidised in the UK by the state.

  4. My mistake, Hugo. You're right - what I mean is that the per-capita spend is twice as much. Much of that is by individuals (health insurance coverage). However, the US government does 'overspend' relative to, for example, Canada's:

    You can get them cheaper, potentially, from websites etc. A lot of people aren't terribly comfortable with that (it would, for example, invalidate any insurance you might have), and some don't have the luxury.

    What you have to remember is that, whilst competition should drive prices down, it also means more people along the pipeline want to make a profit.

  5. "What you have to remember is that, whilst competition should drive prices down, it also means more people along the pipeline want to make a profit."

    Why is that a problem? It is possible to both offer better service and make a profit at the same time. In fact, the two things tend to be correlated.