One Year Home: Calculating my Health

For thirty years I paid for my healthcare through my taxes. I was happy to do it. That meant when I went to my GP at our local surgery because I had the flu or when I went to the hospital for major surgery, no one asked me for money. No one asked me for my insurance information. No one denied my care because I didn’t have money or insurance. I was just taken care of. In the UK that is called the National Health Service and it’s been going strong since 1948. (Some years have been stronger than others. The Tory Party dislikes, or even hates, the NHS on ideological grounds. As a result, the NHS tends to be weaker when the Tories rule the land, but that is not to imply that Labour governments are perfect.)

The three basic principles of the NHS are that:

• It meets the needs of everyone;
• It be free at the point of delivery; and
• It be based on clinical need, not ability to pay.

Because the NHS is paid for by the taxes of the people in the country, it is indeed a “socialist” program and institution. Because of that simple fact, because it is paid for by the people for the people, such an approach to national healthcare is offensive to the majority of Americans (44% of Americans supported Obamacare, with 56% against. By party affiliation, 75% of Democrats, 27% of Independents, and 14% of Republicans favored the law overall). It is also important to note that Obamacare is far from the kind of socialized medicine of the UK or Canada. Obamacare demands that every citizen have health insurance from a private company, or if they cannot afford insurance from a for profit company, they sign up for government assisted care. After living for thirty years with the NHS it is difficult to comprehend American attitudes towards healthcare. Here it really is business first and care second. I watched a Republican presidential debate at which the candidates were asked what should be done with a veteran who could not afford healthcare. One candidate said he should die in the street and the audience applauded. When in Italy I had lunch with an American woman (it’s a long story) who told me with complete confidence that the people of England hated the NHS because it was socialism and provided terrible care. When I informed her that I lived in England for years, had had excellent care from the NHS, and that the popularity of the NHS often polled in the 80’s, she told me I was wrong. How do you respond to that? The actual truth was dismissed because it ran contrary to her ideology. Ideology trumps the facts. Ideology is more important than the actual care of human beings. (I have written about the American irrational attitudes towards social programs in the past: I’m a Member of an American Socialist Collective.)

I’ve been back in the US for a year. Because of my age and the fact that my wife works, my primary insurance is Medicare and my secondary a private health insurance company. That means that most of my medical care is financially covered, though not all. Yes, my healthcare is no longer free at the point of delivery, but I can afford to be cared for. I’m fortunate to be middle class. And yet, every time I walk into the doctor’s office or pick up a prescription I know it is costing me. I suspect the notion of walking into the hospital for triple by-pass heart surgery not resulting in large bills, is incomprehensible to most Americans. It’s not their fault. I must seem incredibly naïve to my American friends.  Of course, you have to pay something! There are no free lunches!

For the record. The NHS wasn’t free either. I paid for it through my taxes. However, the way the healthcare system is financed is crucial. In the American system you could never say: Everyone’s needs are met; no money is demanded at the point of receiving care; care is based on clinical need not a person’s ability to pay.

From icosystem.comWhat all this means in practice for me now that I’m back in the U.S. is more interesting than dramatic (the lack of drama is solely because I can afford health insurance). What all this means is that every time I see my doctors I calculate, at least vaguely, the cost. For example, I have had to see my doctor three times in a two weeks period. The resulting bills have started coming in. Now each time I see my doctor I think to myself, “This is going to cost.” I know, it’s crazy because I can afford it, but I can’t help myself. On my last two visits it was necessary to check my heart – I’m fine, but it needed to be done to eliminate heart issues. When she was done my doctor sat with me and said she would refer my to a heart specialist for further tests if I wanted. It was an interesting moment. I sat there and thought, “If I were in London I would probably do it, but now it will cost. So, hmmm…”

I suspect that my friends and acquaintances here would find my hesitation and questioning interesting, if not silly. But after thirty years being cared for by the NHS it is difficult not to notice that here you’ve got to pay each and every time for each and every procedure.  

Now some home truths. First, I’m getting great care here and, as I have said, it is not a  financial hardship. Second, I’m very aware that I received good to excellent care through the NHS partly because of where I lived. Third, Obamacare is making healthcare more affordable and available for Americans than it ever was. Fourth, the Tory Government in the UK is in the process of selling off the NHS bit by bit (some of the companies taking over healthcare have begun to suggest that the principle free at the point of delivery be revisited). The reason the NHS is being privatized: Ideology and economics, of course. Tories share the American dislike of socialist programs and in privatizations a small percentage of people get rich, or richer.  

I like my new doctor. She’s great. I’m more than pleased that my wife works and provides me with health insurance. I’m glad the U.S. congress, in a more enlightened mood, created Medicare. I’m fairly secure in the knowledge that I won’t go broke because of my health needs. And yet, I can’t shake the impression that I’m now living in a less civilized society. Thirty years, remember.

Copyright © 2016 Dale Rominger