Friday, August 21, 2009

Our National Health

from Jacqueline

This is a long post. You may want to read it in chapters, though on the other hand, given the points raised in Jim's post yesterday, it's not a bad idea to practice reading something longer than a text message.

Well, the pot’s really been getting stirred up lately about healthcare, hasn’t it? I was talking to a guy outside the local organic foods market the other day – he was petitioning for a universal healthcare system – and a customer had just told him where he could shove his healthcare reform ideas, because if we weren’t careful, we’d end up like Cuba. Really? Cuba has more doctors per capita than any other nation, as far as I know, and also sends more doctors into the troubled zones of the world, as well as the untroubled – Finland’s doctor shortage has been helped out by doctors from Cuba. But that’s all beside the point. I thought that I would weigh in with some observations based upon the experience of living in a country with a universal healthcare system (UK) and one without (USA). Neither are communist, although the second gives the impression of being pathologically afraid of communism and there are many people who seem sure that taking care of our sick and needy will take us all the way down the slippery slope towards the red terror and backwards into 1917, Lenin and all.

When I first came to the USA, I had no healthcare insurance. I didn’t go to the doctor for several years and tried not to have accidents or get sick. Fortunately, I was in great health, apart from this niggling little thing where my heart kept missing beats then had lots of beats all at once. Then I landed a job with benefits, and went along to the doctor. Wow, all these forms to fill out – but never mind, only the once, eh? After all, notes get passed on by the doctors ... don’t they? Anyway, it transpired that the ther-thump, ther-thump, ther-thumpety, thumpety, thumpety .... thump, was more than a little blip and needed some attention, if only to rule out imminent cardiac arrest. I was sent somewhere else – well that was quick, next day service. Then they gave me all the forms again. Why more forms? Why the same truckload of questions? Doesn’t anyone talk to anyone else around here? And it was a bit it worrying too, because when they red-tag you though like that back home, it means it’s serious. But it wasn’t so bad after all, and eventually after a raft of tests I cancelled an appointment for yet another test due to being busy at work and just assumed I’d be called back again, because that’s what I had been used to in the UK. Nothing happened, and I was surprised – I might as well have fallen off the earth. Then I started to get all these bills and wondered what the heck a copay was, and what was a deductible? I felt like a car. What was all this about? I began to get the measure of how healthcare ran in this country, and how much sheer energy and worry goes along with any visit to the doctor – and that’s when you’re covered by health insurance and all you’re doing is filling out the forms.

Britain’s healthcare service was founded on the heels of the Second World War, and as Tony Benn said in Michael Moore’s documentary, Sicko, “If you can find money to kill people, you can find money to help people.” If you want to hear what he had to say, go to this link:

But to put it in context, prior to the war there was no healthcare system in Britain. This meant that, when my Uncle Joe was about six years old and had all the symptoms of an acute appendicitis, for him there was no ambulance to the hospital and emergency surgery. Instead my grandmother carried him on her back and walked for miles, from hospital to hospital before she found one to take him in, because she didn’t have the money for a doctor to see him. By that time his appendix had burst and he had peritonitis. The war brought with it severe and terrible civillian casualties in Britain, and the country had to take care of the injured – especially as so many came from the poorest areas. They demanded – finally – the “land fit for heroes” promised during the First World War, and a man by the name of Clement Atlee made the promise of a national health service – a promise that paved his way to Downing Street. He gave the country universal healthcare, though at the time the designers of the system could never have imagined the expensive and high tech animal healthcare would become.

I’d read reports about how terrible the National Health service was becoming, mainly due to the pressure on it by asylum seekers, and people who knew that, once on British soil, if you are ill you will be treated, free and gratis; and if you are there illegally, they won’t throw you out if you’re sick. Even if you’re on vacation, they’ll take care of you. To give you an example, last year some American friends were over in the UK, and while there the woman fell and broke her arm. They reported that the treatment they received was excellent. And it didn’t cost them a penny.

But I confess, I read the doom-mongering in one British tabloid in particular, and when my mother was so ill a few weeks ago I felt forewarned, and was ready to duke it out with anyone who gave her less than excellent medical care – after all, I was used to America, where you may have to fill out all those forms, but you get cable TV in your room. Our first stop was her local doctor, and from the second we walked into his office, I felt my hackles smooth out. “Joyce,” he said, reaching for her hand. “You don’t look your usual self – you are very poorly. Let’s find out what’s going on.” He introduced himself to me by his first name, Peter. He listened to her for about 15 minutes or more, then asked if he might examine her. It wasn’t an instruction, but a respectful request of a senior citizen. Another five minutes and he said that he was admitting her to the general hospital, and why. By the time we reached the hospital, I was in get-things-done-now mode, so much so that my mother said, “Don’t you go in there bossing everyone around with your American ideas.”

In the assessment ward nurses immediately began the vital signs checks, taking blood (“Really sorry, Mrs. Winspear, but we’ll take enough so we don’t have to do it again.”), etc. Then a young – and heck, I mean young – doctor came in, huge grin, held out his hand to my mother and said, “Hi, I’m Ken. I’m going to ask you loads of questions and another doctor is going to come in soon and ask you most of the same questions. We all hear things differently, and this ensures we don’t miss anything, because we exchange notes and we can make a better diagnosis when we do it this way.” I was beginning to be impressed. After all, this is nationalized healthcare, the big bogey man. And my mother didn’t have to fill out one form, because at the touch of a computer screen, notes, x-rays, test results, etc., were available from previous visits and from her GP. I knew that, on the performance scale, this hospital was not the best, not the worst, but somewhere in the middle; but they were up there in my estimation. The other thing was that there were hand sanitizers everywhere and for everyone. Doctors, nurses, patients, visitors had to sanitize their hands before entering a ward, and on the way out. There were hand sanitizers at the end of each bed, at every nursing station, hanging on the walls. I sanitized my hands so much I will probably never get sick again!

My mother had the best of care in that hospital. Not only was she diagnosed with heart failure but the psoriasis she had suffered from for the past thirty years or so went haywire. She lost every layer of skin from most of her body, so looked like a burns victim. She’s eighty-two years of age and, contrary to the impression given by some American politicians recently, no one tried to euthanize her.

I was leaving the hosptial one day after seeing my mum. I had canceled my flight back here and was wondering how things were going to work out, and I was really worried about her, so was in another zone as I walked along the corridor. Suddenly I felt someone touch my arm, and one of my mother’s doctors was standing in front of me. “Let’s talk about your mum,” he said. We chatted for another ten minutes, with him giving me a prognosis and an estimate of when she might be able to leave. Chalk up another raft of points on the satisfaction scale. I’m not used to doctors speaking to me without an appointment.

There are people in the UK who are very disatisfied with the National Health Service, who marvel at American medicine (well, who wouldn’t, when you’ve got George Clooney as an ambassador), but many of those people don’t really understand the alternative. When I broke my arm in 2001, I was in the emergency room and separated from another patient by just a curtain. I had medical insurance, so even though I had wept in pain while trying to fill out the forms – which were insisted upon – I felt blessed. My neighbor had no insurance and had just had a bad accident in his garden. His wife was crying and he was refusing painkillers because he knew that with every shot, every test, every word from the doctor there would be a charge – and they couldn’t afford it. God knows what happened to him.

The UK also has private medical insurance companies, one of the largest being BUPA, which has a huge corporate market. In recent months BUPA has experienced an increase in cancelations, given the economic downturn and the number of people losing their jobs. Same thing’s happening here, except that in Britain, they’re covered automatically, because there’s a National Health Service. It’s not perfect, but it’s bloody good, all things considered. And a woman no longer has to carry her son screaming in pain from hospital to hospital to try to get someone to see him.

There’s more I could say, but I’ve said far too much already – making up for the weeks away. The truth is, we’ve got to get away from the idea that if we pay for universal healthcare with our taxes, someone, somewhere will be getting something for nothing. Medicare doesn’t distinguish between those who were productive workers and those who weren’t, and the Veterans’ Administration doesn’t look at the on-the-job performance of our servicemen and women; we just know we need to take care of them. And in my estimation, there is something lacking in a country that does not take care of its people – all of them – when they need it. But that’s just my opinion, and as we know, opinion is not fact, just a personal truth based on the writer’s experience and world view.


  1. As we watch the fearmongering and hear the distortions and lies, your post, Jacqueline, is a refreshing counterpoise. I wish it were on a forum that extended even Nakeds' reach. Thank you for your thoughts. I truly believe that the yelling and the anger that are greeting this healthcare "debate" is manufactured, and what we really need is to get back to the calm reality of improving an out-of-whack system.

  2. I agree with Sandy. Some people are fanning the fear fires to win the next election. For the life of me I can't understand why reasonable people can't sit down and solve a problem that threatens our moral fiber and economic future.

  3. Fascinating perspective.

    There's a great American tradition of being scared shitless of things European. (I'm including UK here...I was never sure whether the British Isles considered themselves part of Europe or perhaps some separate galaxy).

    I'm encouraging others to read your post.

  4. from Jacqueline

    Thanks, all, for your comments. Perhaps I should have added that, one of the key questions asked of my mother was, "What sort of support do you have at home when you're discharged?" Any doubt, and with one click on the computer screen, the social services department would have been notified and my mother's situation assessed, with carers being sent in to help if necessary. And interestingly enough, one of the people most annoyed about negative fanning of the flames on this side of the Atlantic, is my mother.

  5. Thanks, Paul, for refer from FB. Thanks Jacqueline for the posting.
    So much misunderstanding going on.

    People are always surprised when someone as youngish as me is on Medicare, not realizing that if you are on Social Security disabilty, which I am, you're automatically enrolled in Medicare.
    It is a blessing for those with a chronic illness whose work insurance ran out long ago. I have no complaints about Medicare, especially after a recent surgery that would have left me bankrupt otherwise.
    The people against a public option must have always had a safety net.

  6. we have a pretty good healthcare system here in germany but people still complain.

    i was always fascinated by the NHS when i lived in london. once i had a blinding toothache and went to the dental clinic in leicester square. i just walked in from the street, was called to go right through, had a new filling and was sent on my way again. that was it! no names, no addresses no nothing.

    i'm glad i had our kids in england. everithing was so refreshingly informal. they sent us reminders periodically to come into our local health center. i didn't need to bother about making appointments or anything. everything was so easy. i miss that!

    hope your mum is on the mend now, jackie.

    paul, i hope that lots of people will read your post om facebook and follow this link.

  7. sybille
    (sorry, forgot again to sign it!)

  8. from Jacqueline

    Thank you "patebooks" and Sybille. We need to hear from more people thankful for Medicare - a government program, though to hear those on Medicare go on about how they don't want socialized medicine suggests to me that there's a lot of manipulative information out there.

    And Sybille, thank you for your comments about the NHS. It's coming in for a bit of a beating right now, but people don't know how lucky they are to have it - as with many things, it's the people that abuse the system who weaken it (a bit of a cold doesn't mean you have to rush to the emergency room).

  9. James O. Born8/21/2009 4:34 PM

    Good post, Jackie.

    I agree we need reform. I don't want to see small businesses be forced to pay for. I don't believe anyone who says it won't cost something.

    I would take all the shouters at the town halls and put them in a time out for manners.


  10. from Jacqueline

    Jim, I think we need you out there showing people how to have an opinion and still mind their manners. And of course any kind of universal healthcare costs money, but as we know, we're paying through the nose for the existing system. (I pay a small fortune for what is supposed to be "excellent healthcare coverage," and for some reason, a minor biopsy in May has still cost me an extra $5000-plus.

    One example of how they reduce costs in Britain is in the bulk buying of drugs - they can negotiate the drug companies right down in price because there is terrific buying power there. That's also why prescriptions are cheaper in Canada. I didn't even know what a generic was until I came to America.

  11. Well done, Jacqueline, and thank you for doing it. It's so important for folks to hear about comparative personal experiences in both systems. We can be far too insular here in the states and need eye-opening information to combat the distortions and outright lies. I hope we're all helping by calling and e-mailing our Congress critters in the D.C. wilderness.

  12. Thank you Jacqueline for saying everything that has been on my mind. I've been afraid to speak my mind on this subject here for fear of being spat on or harassed. I've been called a Socialist and sneered at in a pitying way in the past by the ignorant wife of an acquaintance, as well as cut down in public by the wife of another friend who works for our medical insurer. We lived in fear of her for awhile in case she did something dire to our medical insurance. Ours personally costs us over $12000 per year plus co-pays. Thank god we don't have kids.

    We still think about retiring to Australia, but the wacky current govt there is trying to turn the country Chinese Communist. Sigh.


    PS: My family have received the best of care when they've each been in hospital over there this past few years. Thank god for NHS.

  13. Thank you so much for your posting and providing a different persepective.
    Reading this post I am reminded of a conversation with an American friend (in the U.S.), and we ended talking about healthcare. I found out she does not believe in universal health care, and if you want health care, you should work and get health care that way. In other words, no work = no health care. I was so shocked the question of what about people who work full time but STILL have NO health care escaped me. Among several other questions and comments.
    I didn't realize that health care was a privilege not a right. It seems to be that way in the U.S. Frightening.


  14. Thank you Jacqueline for standing up for the truth. Sometimes when I see and read the rubbish that comes out of America, I think the lunatics must have taken over the asylum.

    Sorry, what's that? They did? Over two hundred years ago? Wow.


  15. from Jacqueline

    Dee, Marianne, Lea and Robert - thanks, all for your supportive comments. I think a balanced view is what is needed here, and I too cannot believe the sheer rubbish I am reading. In the UK there's a groundswell of support for President Obama's quest for universal healthcare, where people are really fed up with the troublemakers here flinging unwarranted criticism at a system that is cherished - warts and all. The British are free to see fault with the system, but for every tale of woe from a British hospital, I could give you one from an American hospital - nothing's perfect. But they also know when they have something that's worth keeping - and sticking up for.

  16. It's refreshing to know that some people are thinking rationally--and compassionately--about this issue. I'm with you.

  17. Jacqueline, thanks so much for your post. As a primary care doc who would love to see Medicare for all, it is helpful to hear from those who have directly experienced the UK's National Health System. I write an online health column and would love to post your comments there - with appropriate credit, of course. Let me know.

  18. Your tale of the British system is so touching and personal and it makes me ache for what is missing. Americans seem to prioritize 'privacy' (thus the lack of communication between providers and ad nauseum forms), and 'choice' but fail to understand the realities--namely that just because there isn't Universal INSURANCE, emergency care can't be denied, so we end up paying for the health care ANYWAY, but at the point where it is most expensive.

    Unfortunately, the people who read and seek out information already know this. We are just outnumbered by the ignorant and easily manipulated masses.

  19. Truth is delicate concept. Particularly within a volitile "change" charged environment. I daresay, even more precarious: is the platform upon which "truth" is delivered to the masses. Because, you see, history tells us the story that "truth" is packaged; wrapped within lifetimes, eons of nameless, often murderous, agendas. Moreover, it is parceled from one to another, willing beneficiary or not, stamped with propoganda; hardly disguised yet often, barely seen nor even distinguishable among the din of whispering misguided consensus. I find this sort of reasoning quite careless, to be honest. Even the most trusted source of reason should always be questioned. Surely, you must understand, my dear favourite author-ess, that your own noble intentions cloud sound judgement and independent reason. Which is why, I respectfully disagree with "notables" swinging their swaggering influence around this way or that as they frolic in the gardens of misguided intention. I quote: "When we walk, and when we look out at a view other than one we are used to every day, we are challenging ourselves to move freely in our work and to look at our conclusions from another perspective... Maisie realized that in his final words to her,... Maurice had made an assumption, an assumption that was quite wrong."

  20. Oh, I am so sorry as it seems as if I have forgotten to mention... my post was written as a social commentary, perhaps even as a primary review of judgment. I am in hopes that your pupil, namely, spiteful "Rob" becomes fully aware of his significant contribution to humanity: ripples of division, perhaps even hatred, born under the name of "one truth."

    How careless.

    "Thank you Jacqueline for standing up for the truth. Sometimes when I see and read the rubbish that comes out of America, I think the lunatics must have taken over the asylum.

    Sorry, what's that? They did? Over two hundred years ago? Wow."