Wednesday, July 29, 2009

Life Under Socialised Medicine

I live in Britain, under the NHS. Now, I want to say this up front in case anyone gets the wrong impression: the NHS is not perfect and no-one should ever claim it is. Having got that established...

I suffer from extremely severe depression and anxiety disorders. As a result of that, I self-harm frequently (please, no lectures). I also have a completely unrelated condition where my stomach produces too much acid and slightly high blood pressure.

Every morning, I take two antidepressents and an acidity regulator. My prescription for these drugs is for two months supply of each and costs me £7 (roughly $15) to get filled. If I was unemployed (which I will be shortly), young or elderly, I would be exempt from that charge. But surely those are pre-existing conditions? Yeah, they are. Makes no difference. Under nationalised healthcare, the only time the words "pre-existing condition" come up is when your doctor is checking that any drugs he prescribes won't conflict with another condition you have. That prescription fee is all my out-of-pocket expenses (oh, and the occasional bottle of asprin or antacids). My doctors visits, medical tests, psychiatric tests and care, the weekly visit from the psychiatric nurse, all of that is covered by the NHS. If I need a hospital stay or an operation, that's covered too. If/when I lose my job, it makes no difference to my healthcare. The only difference from my perspective is that I need to tick another couple of boxes on the back of the prescription. No-one loses their healthcare when they lose their job here, even the (*shock, horror*) unemployed are covered.

As for the government deciding your healthcare? Well, there's two things here. Under the NHS, doesn't happen. My doctor and psychiatrist decide what care I need, they note it down on a computerised system and the NHS reimburses them, the actual exchange of money nevers involves you. The career civil servants who run the NHS don't decide your care, they just direct the resources where they're needed, quickly, quietly and with a minimum of fuss. Admin costs average 6.8% of the budget, including pensions and benefits. Secondly, how is that different from insurance suits deciding your healthcare? Given the choice, I'd rather go with the career civil servants. The insurance industry has a profit motive, they are actively looking to screw you out of your healthcare because the more people they can cut off from care, the more money they make. The civil servants don't care either way, they get paid exactly the same regardless of whether the NHS runs a surplus or a defecit. I could ring my doctor this morning and get an appointment this afternoon. Ah, but perhaps I'm special because I have "SUICIDE RISK" on my file? 'Fraid not. Most people will get an appointment on the same day or, at worst, the following day.

Now, I keep having the sam argument with conservatives who believe the NHS is a failure since it usually runs at a loss. IT'S SUPPOSED TO! Look, healthcare is not a product like a Big Mac, healthcare is a service. The Post Office doesn't make a profit either and it doesn't matter if they do. Their primary purpose is to move the mail about for the mutual benefit of all. The fire service puts out fires for the mutual benefit of all. And that's how the NHS works. They're not a profit driven business, they just treat illnesses for the mutual benefit of all. It is in an insurance industries best interests to deny you care. It is not in the governments best interests to do so because the quicker you get better, the quicker you get back to work and start paying taxes again.

The right keep screaming about waiting lists under the NHS. Yes, there are waiting lists for non-emergency operations. The actual time varies depending on the specific operation needed but they might well be there. Do you really not have waiting lists in the US? You can just walk into a doctor's office any morning, slap the cash on the counter and have the op there and then? Or do you, more likely, have to arrange a mutually convienient time for a consultation, arrange payment and arrange a mutually convienient time for the op? See, you already have waiting times, you just don't call them that. And how long do you have to wait if you don't have the cash to slap on the counter? Waiting lists might be annoying and sometimes painful but you will get the operation eventually and it won't cost you a penny (your employer is legally required to pay you while you recuperate). If you need a non-emergency operation in the US and you don't have the cash, how long do you have to wait? Don't get me wrong, I'm not defending waiting times. They're a major flaw in the system and one we're trying to correct but what I am saying is that waiting a short time for care and getting it is better than never getting the care at all. I have been offered an operation to correct the problem with my stomach but I always turn it down. Not because of the waiting times but because stomach operations are fairly major surgery and I'm happy to keep taking the pills.

How about costs? I pay around 22% income tax and about another 8-9% National Insurance (our version of Social Security, there is no such thing as a payroll tax here). That's about average. How much do you pay in taxes? Now, add the cost of your health insurance (assuming you have it) to that figure and work it out again. The NHS running costs work out at just over $2000 per citizen, per year. How much can you get a year's health insurance for? The US spends, on average, $2.3 trillion a year on the combination of Medicare, Medicaid and private insurance. Assuming the same $2000 per citizen, per year cost, the entire US population could be covered for around $600 billion a year, not counting start-up costs. Yes, some people here choose to take out private insurance anyway, that's their right and they do it for many different reasons. Some want the option of skipping the wait times, some want a more luxurious hospital or brandname drugs (the NHS tends toward functionally spartan and generic drugs to keep costs down), some may have more esoteric reasons but the option is there. Some employers offer it as a perk for their high-value employees. I smoke about a pack a day. Marlboros here cost about $12 a pack, 80% of which is tax. I don't mind paying that because the vast majority of that goes into the NHS. The government takes in about £10 billion annually from tobacco taxes and spends about £6.8 billion treating smoking-related illnesses. Again, I have no problem with paying that. I have a habit which is damaging to my health so I pay extra to cover the extra care which may be required.

A very brief word about abortion: The NHS will pay for abortions which your doctor considers medically necessary for physical or mental reasons. Abortions which are not medically necessary are not covered, they must be paid for privately, albeit at NHS rates. Whether you agree with that stance is up to you but that's the position.

A lot of people think the British hate our healthcare system because we bitch about it so much. This is a basic cultural misunderstanding. We bitch about everything, we're a dour people. Complaining is our national hobby, second only to football. This is the same country that had two books called Crap Towns where people were competing to get their town entered. The city where I live, Stoke-On-Trent in the Midlands, was once voted the most depressing place in the nation to live and we're proud of that. Whinging is the British passtime so our complaints about the NHS shouldn't be taken at face value. Rather, look at the fate of the rare politician who proposes abolishing the NHS: They catch hell at their surgeries (a monthly meeting for their constituents), get shouted down and usually booted out of office at the first opportunity.

And how about the charge that government will then tell you how to live your life? Yeah, it's bullshit. Utter bullshit. As mentioned above, I smoke about a pack a day. I don't drink much but I enjoy the odd pint of real ale. The government makes 80% of the price of my smokes in taxes and they skim a couple of pence off the price I pay on a pint but no-one's stopping me indulging those habits (although I can't smoke in pubs anymore). The health impact of fast food is generally dealt with indirectly (by taxing the corporate profits) but we still have plenty of branches of McDonalds, Burger King, etc. Sex is a health issue here, not a moral issue so any doctor will give you a dozen rubbers, free for the asking. The idea is that promiscuity is not a health danger in itself but unprotected promiscuity is. Therefore, provide a means of reducing the risk. It works, sort-of (the high teen pregnancy rate is more to do with them not using contraception in the first place).

Every other nation in the industrialised world manages some form of universal healthcare. It takes many different forms, with varying methods of delivery and paying for it. Since you're coming to this relatively late, there's nothing to stop the US setting up a committee to examine the existing systems and then mix-and-matching the best parts, absorbing Medicare and Medicaid along the way, until you come up with something special and uniquely American. The USA is the richest nation in the world. California alone is the fifth biggest economy on earth and yet, you are the only industrialised nation which doesn't guarentee at least basic healthcare for all of it's citizens. Guys, Italy manages this without it turning into a socialistic nightmare. Are you seriously telling me that US politicians are markedly worse than those of Italy? In most of the civilised world, only a very few unfortunates (mainly homeless people or drug abusers) die for lack of care. That's a tragedy, no questions there but how many people in the US die because they can't afford care? Triage by wallet.

The pressure for healthcare reform has never been higher. In poll after poll, about two-thirds of the USA wants healthcare reform but Congress may bargain away the public option (and let's not forget that the public option was the compromise position in the first place). Write, call, fax or email your CongressCritter. Take the Andy Dufresnes method (watch The Shawshank Redemption): Bug the living piss out of them until they'll do the right thing just to get rid of you. You guys need reform in the worst way and the wind is in your favour. So let's get it done.

Then we'll start on the legal bribery known as "campaign contributions". You grok?

1 comment:

  1. You make too much sense. There's no way Amurka would adopt what you have. Sigh.


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