Monday, November 4, 2013

Health Care in the U.K.

A good friend in England provided a balanced and well thought out response to my recent post (10/22/13) on American health care. Below he describes the system in Great Britain as a mixture of public and private options.

" I’ve been meaning to comment on your blog item on healthcare – not necessarily to contradict, but perhaps offer a different (U.K.) perspective. I was chewing this over with a retired health worker on holiday recently, then I read your blog.

  You’ll remember the rather crazy opening ceremony to the Olympics with the paean of praise to the National Health Service. Well, that was silly and over the top, and the NHS isn’t always wonderful by any means – we’ve had a series of scandals relating to appallingly poor care of the elderly recently. But that’s certainly balanced by some wonderful care over the years shown to my family and friends.

 Last year my youngest son suddenly had two detached retinas – he came very close to losing his sight. The very speedy care he received at our local eye hospital was wonderful – he’s now had a series of operations, and treatment will continue until they are satisfied that everything is as good as possible.

  Some years ago my grandson was born prematurely – it had been a difficult pregnancy. He needed to remain in the maternity unit for a week – a small apartment was provided so both of his parents could be with him for those first few days – at no cost.
  A few years ago my wife found a lump in one of those places that women fear most. Within a week she was at the hospital having a biopsy, and all, thankfully, turned out benign. The following week it was removed.

A good friend foolishly ignored symptoms he shouldn’t have done. One day he collapsed and was rushed into hospital with advanced bowel cancer. There followed two months in hospital, and two major operations. It may not be the end of it yet – but the treatment couldn’t have been better.

  What’s good is that, even for the poorest, visiting a GP or getting children vaccinated is free, and all necessary treatment is covered. My GP is good – not as good, though, as my last one, now retired, who told me once that my liver function was far too good for a man of my age and I clearly wasn’t drinking enough alcohol! (He was an Irishman with a great sense of humour.)

  It’s often assumed that there is an either/or situation in medicine – either state funded, or private medical insurance. This isn’t so in the UK. As it happened, my son was covered by private medical insurance provided by his employer. When he weighed it up, it made more sense not to claim – there was a (relatively small) excess to pay if he did so, and the free care was excellent anyway. A while back I took a different route – I needed eye surgery to correct a squint (strabismus) that has always bugged me, and for which I’d been operated on by the NHS previously. It had got worse again. It wasn’t urgent, and, yes, there would have been a waiting list, so I simply paid for it at the local private hospital so I could have it done when it suited me.

  You may quite reasonably say that taking out private medical insurance in the UK means you are paying twice. Well, yes, you are – the National Insurance Contribution (which I’m not now paying as I’m over 65!) and the insurance premium. But comparing costs, the total of both these is quite a bit less than Medical Insurance costs in the US. So you can opt out of the NHS and it’s still cheaper. Even if it wasn’t, I think paying a little extra to help out others who cannot afford treatment is an ethical thing to do.

    I’m aware that compulsory enrolment in a healthcare scheme goes against the grain in the U.S. – the advantage of it, though, is its simplicity and efficiency. The Brits like it – which demonstrates, I suppose, one of those cultural differences between the U.S. and Europe.

   Folk from the U.S. we have spoken to of our age (mainly my wife's chums on Facebook!) have told us how difficult it is to get insurance once you are over 60,  and how there are limits on what can be claimed per treatment – a problem for those with chronic conditions. The treatment itself, though, is first rate - my (insured) mother had a stroke when in Florida and the treatment was superb - it saved her life.  Of course, not all is wonderful with the system here. In particular, problems are looming because of the aging population - those free blood pressure pills are keeping us all alive long after we should have been conveniently buried! I guess this problem exists everywhere. When my wife's mother had a stroke (at a similar age to my mother) our feeling was that, although the treatment was O.K., we felt the attitude was 'she's too old to make it worthwhile', the opposite of my mother in the U.S. who was told she was too young to give up.

I do agree with your remarks on life expectancy. That’s mainly to do with lifestyle. Traditionally, the Mediterranean diet is the one to go for, though even there there are problems – the traditional diet, high in olive oil, was fine when most people did hard manual work. Now people sit at computers but still eat the same diet, which is why heart problems have increased hugely around the Mediterranean!

   From what I’ve read of the Obamacare proposals I tend to agree with you that it all looks expensive and inefficient. All I’d say is – there are better ways of doing it."

The mixture of public and private options in the U.K. that he describes above would appear to be the norm throughout Europe. Sadly, I do not believe it will be possible in the U.S. under the Affordable Care Act (Obamacare). Each day in the U.S. it becomes increasingly clear that individuals will lose their individual and even group insurance plans and be forced into the one-size fits all government sponsored plan. President Obama's assertion, "If you like your insurance plan, you can keep it," has turned out to be one of the biggest  deceptions in the annals of the U.S. Presidency. It will go down in history along with "Read my new taxes;" and "I did not have sex with that woman."

I turns out that President Obama really meant was that "you could keep your policy if he liked it." He insists on calling these policies substandard even when most of them were doing a really good job. He doesn't define what he means by substandard, but it would seem that they lacked low cost benefits like health club memberships and contraceptives. For hospital bills and high cost procedures it would seem that they were doing a more than standard job.


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