American Healthcare

International comparisons

From a member of Labour International currently living in California

As a Brit in the US, in common with most other Brits here, the US health “care” system (actually, profit-making industry – health is an occasional by-product which is nice, but not essential) is one of the most shocking, awful, unequal and frankly disgraceful aspects of life in the US.

There is the obvious aspect which most Brits are aware of – people that simply cannot afford to get medical assistance.  About 50 million people.

But, there are so many other sociological aspects of this system with subtle impacts which you only really understand by living here.  I could (and maybe I should !) write a book.

  • The insurance companies are king.  Their power is immense.  So immense that they control prices of everything in the market.  Fine, you say.  That is private health care and surely that only affects those with insurance?   Well, no.  It affects EVERYONE.  Because, simple remedies that you would find  Over The Counter in the UK are made prescription only here – Zovirax cold-sore gel, pain killers stronger than 750mg paracetamol (for example Solpadeine codeine/paracetamol is only available on prescription).  So, that forces you to to to a doctor far more than would happen anywhere else.  That is money in the bank for the insurance companies, most of which also run large primary care operations.

  • Over The Counter medicines are FAR more expensive here.  What you can buy is always MUCH more expensive, because the insurance companies lobby hard to keep them controlled.  Aspirin (bought some yesterday at Heathrow 39p for a pack of 12) – $6.80 at my local supermarket.  I suffer from regular hayfever – I can’t buy the same eye-drops as in the UK because the active ingredient is regulated and therefore only on prescription (a Doctors Office visit here costs me  between $50 and $80).  Here, the next best thing is over $25 for a tiny bottle.   There is a LOT of smuggling of drugs from on-line pharmacies or from Canada and Mexico.

*What is even worse about this is that those with health-insurance can usually put the cost of both prescription and OTC medicines onto some kind of tax-exempt savings card.  So, the bulk of the pain of both lack-of-insurance and medicine prices driven up by the insurance companies hits the poor and disenfranchised twice over.

  • The stories you hear on the news are supposed to be “heartwarming” – charitable efforts with doctors and dentists giving their time free to treat the uninsured.   The last time this happened round here was over a holiday weekend in Oakland (one of the most deprived cities in California).  The TV news showed people snaking around a very large football stadium in which a number of doctors and dentists treated people – it was reminiscent of a refugee camp.  Rather than thanking the medics for giving their time freely, the news should have reported how it is that the richest country on earth can stoop so low. One woman interviewed said that for 5 years she’d lived in pain from needing three fillings, but couldn’t afford to have them done until then.   It is utterly sickening.

*Or the other news stories of bankruptcies due to visits to the ER.  Take the case of Brian Stow, the 49-ers supporter that was badly assaulted and left for dead at the LA Dodgers stadium.  He had basic insurance. But this was no-where near enough to pay for the emergency care and rehabilitation he required.  His family had to (and keep having to) arrange charity appeals to pay for him and support his family.  And what makes this worse ?  He was a paramedic working for the public Fire Dept (ambulances are run by the FD in Californias cities).

But surely if you’ve got medical insurance, then you’re fine ?   Err, no.  The impact of the private health system is far more insidious.   It rots the core of society in ways which you would not believe.

1) You and your family’s health is tied to your job.  As pre-existing conditions cannot be transferred from health-plan to health-plan, then the WORST position to be in is to be using the health system and lose your job.  Because, no matter if you walk into a job the very next day with health insurance, tough – those are now pre-existing conditions and You’re Not Covered.  There are some protections (the COBRA Continuing Health Care) that allow employees and their families to stay on an employers plan for up to 18 months after being fired, but that is usually at full market rate – i.e. not with the subsidy that your previous employer would have given.  So, you’ve lost your job and your health care payments have just gone up massively.

2) So, losing your job is bad.  That has a massive knock-on on workplace attitudes.  Confrontation is bad.  Disagreeing with your boss is bad.  Because work in most states is “at will” – the will of your manager.  Say you don’t agree with her on something ? Best to shut up if you’re on any form of medication (and chances are you are, because, as I said before, the insurance companies lobby hard to keep drugs behind the prescription wall).

3) People stay in their jobs when, frankly, they should have been pensioned off sick years ago.  Not only for THEIR benefit, but for their company’s benefit as well.  I’ve seen this SO many times.  They cannot afford to retire, because their expensive treatments won’t be covered until they hit Medicare at 65, and even then, you can bet that it will be no-where near as nice an experience as the private insurance has weened them onto.   Dentists, doctors, clinics advertise here based as much on the type of coffee they serve as the medical outcome.

4) You want your son to go on a Scout Camp, your daughter to play tennis ?  You need an ANNUAL medical for that.  Yes, a full medical.   And you HAVE to have insurance.  Every time my son goes away on Scout camp, I have to fill-out a medical waiver form with the insurance details including dental.  No insurance – doesn’t go.  Some sports require even more rigorous exams with increased frequency.  At any age.  The medical is paid for by my insurance plan, but that is a $250/child expense.  Every year.   No exceptions.  Last week, someone was interviewed on NPR asking what she thought of the Affordable Care Act (Obamacare).  “Great,” she said.  My daughter has wanted go to tennis camp for the last three years, but I’ve had to say no as we don’t have medical insurance and can’t afford it.”   Isn’t that truly repulsive ?

5) Even with the ACA, we’re not out of the woods.   A number of companies that have decided to self-insure (pay their own medical costs rather than use an insurance company) have done so in the hope that they can dictate their political or religious views to their staff.   The fight is not over – there has been huge opposition to the provision of birth control by the Catholic charities which took several years to resolve.

6) Then there is just the sheer inefficiency of the system.  My wife is a TEFL teacher.  She was asked to teach at a local school.  State regulations require that she had a TB test.  To do that, she had to register with a doctor.   That was a $50 joining fee.   Covered by insurance, but the plan I have only kicks-in after we’ve spent $4500 per year.   I have to budget and save for that…..    So, in early January, she registered, and had the test ($42).   It came back negative, and we paid the bill from our savings account electronically.    In March, we had a final demand to pay the bill.  The doctor we used is part of a national chain, and the health savings account had paid the wrong account so it hadn’t reconciled.  A call to the collection company in Ohio.   Three months later, a summons to pay $42 plus $250 late costs.  Another phone call – this time a conference call with the doctor’s admin and the savings people.   Great.  All sorted.   Until last week.  “Your non-payment has been passed to a debt collection agency and this action will be reflected on your credit score.”   We’ve PAID !   So I phoned then debt collection agency.  “Oh yes, this happens ALL the time – about 50% of medical bills go astray.  Don’t worry about it.”   The irony is, my wife wasn’t even ILL !  Can you imagine if you were seriously ill having to deal with banks, credit reference agencies, debt collectors ?

If anyone EVER thinks of dismantling the NHS, then they should come and live in the US for two years, ideally needing to go to the doctor once, send their kids to camp twice, and break a tooth (I did within 3 months of moving – a crown cost me over $5000 compared to the £150 I paid at our UK dentist two years earlier).