Healthcare

One of the things which most British people know is different about living in the USA is that you have to pay for healthcare. In the UK, everyone who needs it gets free heathcare through the National Health Service (NHS).

Well, it's not quite that simple. For a start, people in Britain do pay for healthcare. Anyone who works, either on an employed or self-employed basis, has to (or is supposed to) pay National Insurance contributions, which go to fund the NHS. The Government, of course, funds the bulk of the NHS, although that money in turn comes from taxation. And many people have to pay one-off charges for certain aspects of NHS treatment, such as prescriptions, although such payments don't generally represent the full cost of the medication. And there are private medical practitioners too, for patients who choose to pay, and who may or may not have private medical insurance. In general, though, it's true that anyone who lives in the UK has the right to walk into a doctor's surgery, clinic or hospital and get free treatment for any genuine medical need. The first point of contact for most people is their GP (general practitioner), and most GP's surgeries are recognisably similar, offering roughly the same kinds of services.

Here, medicine seems to be a completely free and open market. Medical practices take many different forms: doctors can set up their businesses in whatever way they want. It's no different from someone who runs a vacuum cleaner shop or a guttering business. Doctors charge a fee which represents the full, realistic cost of their time, services and expertise, including a profit margin. Most people, of course, can't afford to pay this, so they take out private health insurance with any one of a number of insurance companies. This is very expensive; and then there are additional fees on top. Most of the cost of a visit to a doctor's surgery will be picked up by our insurance; but we have to pay what in the UK would be called a 'premium', and here is rather more cosily called a 'co-payment' (oh, we're paying together! What fun!) of $25. My doctor friends in the UK would probably say that's no bad thing, as it helps to discourage time-wasters, and perhaps they have a point.

My wife (who, for the purposes of this blog, I will refer to as Kathy) recently arranged a first visit to a doctor. Having failed to get a good recommendation through word of mouth, she picked a practice, billed as a 'family doctor', pretty much at random from the list of doctors covered by our insurance, and rang them for an appointment. The next available appointment was about 2 weeks away, which seemed rather a long time, but she took it anyway.

When she arrived, she walked into a room which had young children, toys and noise everywhere, and was decorated with kids' pictures. Don't get me wrong, Kathy's got nothing against children, but she wants a visit to her doctor to feel different from a visit to a primary school. She waited for about half an hour before being called in to see the nurse, and a further 45 minutes before finally getting to see the doctor. Apparently, these kinds of timeframes are normal, because female 'family doctors' routinely get called away to the local hospital to deliver babies (there are no midwives here).

The doctor finally came in. She was wearing lots of pink lipstick and a short skirt. She read out Kathy's name in a sing-song voice, looked at her, and smiled. Kathy was rather hoping for something more along the lines of: 'Good morning, I'm Doctor X.' Kathy told the doctor about some medication she needed. The doctor wrote out a prescription and then got up to leave. Kathy said, 'Excuse me, are you going?' The doctor said 'Yes.' Kathy said, 'but I've got two further issues to discuss with you!' Reluctantly, the doctor turned round and came back to her desk. The appointment lasted about 5 minutes in total, and the whole visit took about an hour and a half.

Kathy went to reception to pay, and said, 'Excuse me, but do you have any doctors who don't have children as patients?' She described the woman behind the desk as 'looking at me as if I was some sort of ogre.'

I decided to cancel my own appointment. I will need to get one medicine on prescription, but it can wait. The other one I take seems to exist in a myriad different forms on the shelves of CVS and Walgreens, so I suppose I'll just buy it over the counter. I've worked out that's why there are so many adverts for medicines on American television - anyone in their right mind will avoid visiting the doctor if they possibly can.

Kathy's looked into some different doctors. A work colleague recommended a doctor who doesn't take any patients under the age of 18. On enquiry, the next available appointment is in November, and in any case this particular doctor moved to California in July. So much for the free market.