Thoughts on health care, part I

By Nicola Pearson

(posted 2.7.11)

I’m from England originally, one of those countries that has what many in the U.S. call “socialized medicine.” In England, we never call it socialized medicine; we call it the National Health Service, or NHS. And, since the idea of having anything like the NHS in this country seems to terrify certain Americans, I thought I’d take a moment to describe its better features.

Let me start by admitting that it’s not perfect. Although having lived in England, France, and, for the last 27 years, the U.S., I have to say I’m not familiar with any system that is perfect. The waiting rooms in doctors’ offices in England are usually full, everyone gets triaged in an emergency room, and some people have to wait for a hospital bed if their condition is not immediately life-threatening.

But the one thing you don’t ever have to do in England is worry about how you’re going to pay the bill—or worse, worry about whether you can afford to go to the doctor in the first place. The NHS covers all doctor visits, all hospital stays, every procedure, test, follow-up, in-patient, and out-patient, and you can even get your eyes tested and a pair of spectacles under the NHS. The spectacles aren’t the prettiest pair, but I suspect if you can’t see very well and you don’t have any money, NHS specs are a great solution.

Dental coverage also is provided for anyone under 18. All this for the low price of … wait for it, wait for it … 3 percent of one’s annual income. Three percent. How can that be terrifying?

U.S. approach a head-scratcher
In this country, my current health insurance premium is about 10 percent of our income. We have a deductible that’s greater than our annual premium and, once that’s met, the health insurance company will pay just 50 percent of any medical bill. We pay the rest. I scratch my head, looking at the bill, wondering why bother? I wonder why my health insurance company can’t see that we’ve never made a claim since joining them? Why don’t we get a “good health” discount? Why don’t they notice that we’re self-employed and, consequently, never have time to get sick?

The fact is, they do notice; they just don’t prefer people like us, people who require Individual and Family policies. They want us to join a group. But, hang on a minute, isn’t a group a collective of people? Kind of like a social set? Wouldn’t that mean that the health insurance companies are proponents of—dare I say it—“socialized medicine”?

Of course they are. Why? Because there’s more in it for them.

Can you trust the system?
Which brings me to my final question: Why does it cost so much to get so little in the U.S. when it only costs the English 3 percent to get everything? Well, no one in England is trying to make money off people’s health. The NHS, by its very name, is in the “service” of people’s health, whereas the word “insurance” suggests big business. Right? Trusting that a health insurance company is in business for your health is like trusting that casinos want to see you walk out their doors with a big wad of cash in your pocket.

It’s not and they don’t. Health insurance companies are in business to make money, and, given the rising costs of health care and the growing number of uninsured in the U.S., that means there is only one direction for premiums to go: up. Health care costs are rising in England too, but that doesn’t scare anyone. Because, the fact of the matter is, not having to see the bill when you go to the doctor and not having to worry about losing your home because of illness is really quite liberating.

A dozen years ago, my son broke his arm while we were in England visiting relatives. He went through the emergency room (speedily, because he was 8), had X-rays, spent the night in the hospital, and was given a general anesthetic so that a surgeon could manipulate his bones back into place (closed reduction). The total bill was $1,200 and our insurance company in the U.S. resisted paying it. When I asked why, they told me that they wanted to know how much of that was the ER fee, because, according to my policy, that was my responsibility. So I called the hospital in England and inquired. “Oh, no,” said the gentleman politely on the other end of the line. “We don’t charge for the emergency room.”

What a concept.

Nicola Pearson is an award-winning playwright from Sauk City. This is the first in a three-part commentary.

Read part II

Read part III

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