Even if you’re insured, healthcare in the United States is broken

Yes, there are problems with the NHS. But in the US, I was billed $125 for handing a form to a doctor. 

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This weekend, Nigel Farage told Fox News that the “Save the NHS” demonstration was motivated by a desire to end the NHS. He warned viewers that: “If you were to introduce universal healthcare, paid for centrally under taxes, you would never ever be able to remove it.”

He has a point. The median age of Fox News viewers is 65 – the age Americans can claim Medicare – and they’d be furious if their universal healthcare, paid for centrally under taxes, was taken away.

Also this weekend, I – a British person living in America – took my son to hospital because he gave himself a small cut below his eye. (Spoilers: he’s fine, it’s already healing.)

My situation was, I’d say, probably the least serious a situation can be and still count as medical. I wanted peace of mind, mainly – a young child hit his head, enough to draw blood, close to the eye. Was anything fractured? Was the eye in any danger? It didn’t look serious, but what do I know? It’s the sort of thing a school nurse could deal with in a couple of minutes. So, how did the American healthcare system cope?

My family has health insurance: pretty good health insurance. I’m one of the “haves”. In the SyFy Channel version of this, I’m the one flying my hovercar towards the gleaming HealthPlex Spire while the masses below huddle and cough. The killer app for American healthcare is meant to be that the people who are covered have access to amazing 21st century medicine. The way the brochures and commercials tell it, whatever your ailment, you’ll be whisked to the sickbay of the USS Enterprise, and then Dr House and his team will put you in a scanner and find out exactly what’s wrong, use lasers, robots and wonder drugs that only just came onto the market, and then you go home.

Nah.

First, the local “Express Care” (walk-in centre) turned us away because my son was too young: it would be “illegal” for them to look at him. So: to the ER of a big hospital. Go through a metal detector, show insurance card, get ID tag, sit down in a waiting room that looks like a British hospital waiting room.

My son was weighed, his blood pressure taken, I was asked about scheduling a consultation with a plastic surgeon (this cut was  an eighth of an inch; three days later it’s pretty much healed). Two people came out to confirm insurance details, another asked for $100. No one put a bandage on the cut, or paid it any attention.

Four hours later, we were ushered into a side room. Half an hour after that, a nurse took his temperature, and said the doctor would be 20 minutes. A further 45 minutes after that, the only doctor on duty (on a Friday night!) stuck a bandage on the cut, gave him a dose of ibuprofen and said he was fine. I signed another piece of paper, the assistant clarified it was now after midnight, so I should date it the previous day.

I’ve no idea what my experience would have been in NHS. I like to think a nurse would just pop out, stick a bandage on and send us home if it didn’t look like there were complications. I imagine, though, that somewhere a kid with a cut on his face ended up in A&E for ages while the one doctor on duty saw everyone in order of acuity.

The big difference is that then it would be over for the NHS patient. For me, it’s just started.

Soon, the bill will come. I already paid $100: that should be it, the insurance should cover anything else. But what else was there? I have no idea. I once dropped a form off at a doctor’s office to say I’d already had a vaccination. I was billed $125, because I handed it to a doctor: $100 for the “consult”, and $25 for “sundries” because the doctor was wearing latex gloves. Everyone I know in America has an anecdote like that – except in some cases, it’s $25,000. And in my experience, every single bill has a similar… creative flourish somewhere. Arguing the toss takes months. So, this won’t be done for months.

Everyone at the hospital was pleasant to deal with, but I’ve always got the impression all the activity – contact with 11 staff, I think – was there to justify the bill, the equivalent of the “security theatre” at airports. A UK doctor never took my blood pressure before treating a small cut: are they guilty of systematic malpractice? My suspicion is that the US hospital bills for each procedure, so checking blood pressure earns them, say, $20.

The best analogy I have is car ownership. The NHS is like being under warranty – you get a rattle, you get it sorted and you’re not out of pocket. The American system is like a car insurance claim. There will be an excess. No one can say for certain what’s covered: they can tell you a different policy would have covered it. The garage will change your wiper blades while you’re not looking and add that to the bill. The insurance will kinda cover it, but not quite, and there’s always that vague air you’ve been swindled.

Debate about the US system tends to divide people neatly into “insured” and “uninsured”. This is clearly the main problem with the system: it is, to my pasty, limey eyes appalling that there are people in the United States with no health insurance. However, I think concentrating on the number of “insured” obscures something important: that even if you are insured, American healthcare is broken.   

So, for any Fox News viewers reading: there’s a reason that people go out onto the streets to preserve universal healthcare. It’s because it’s better. 

Lance Parkin is an author whose books include The Impossible Has Happened: The Life and Work of Gene Roddenberry and Magic Words: The Extraordinary Life of Alan Moore.

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