It’s been interesting to see the rabid foaming of the mouths on both sides of the Atlantic in the wake of the healthcare debate in the US. The anti-reformists in the US are all saying that it’s going to end up like the NHS if Obama gets his way. In contrast over here, there’s been a massive “We love the NHS” campaign on newspapers and social networking sites with a usual kind of sneering anti-American bias. Even the Prime Minister and Stephen Hawing have got in on the act*
So who’s right? Well, I spent quite a while combing through OECD tables on health care quality comparitive indicators in the hopes of finding a juicy graph or maybe a killer statistical table and my conclusion is that whatever the basis of the argument is, it isn’t fact. If you want to compare the US and UK on 5 year survival rates for cancer it very much depends on the cancer, but they often aren’t too far apart. What are your chances of surving a heart attack 30 days after hospitalisation – you’re better off in the UK, which I found pretty surprising (though I already knew that on many indicators the UK comes off better).
The really interesting thing though is that while often UK and US figures were close – a couple points off one way or the other, they were often not as good than other rich countries. So, that’s my first point – both sides are saying that their health care is the envy of the rest of the world – but that will only be the rest of the world without the ability to read a statistic table. Looks like there are some much better health outcomes to be found in Australia, Iceland, Norway, Switzerland, France, Germany…and so on.
I will say this about the US vs UK thing – the US pays vastly more for outcomes which are often not better than those in the UK.
Let’s leave fact aside
Since no one seems to want to argue on the basis of fact, I’m going to leave the numbers aside. This is a battle of emotion and personal anecdotes, so I’ll give you some.
I don’t love the NHS. The NHS let me down. It’s let me down on a number of occasions. I had an appalling birth experience and I was left in pain for over a year and a half after my son was born. The pain was in fact unrelated (ovarian cyst – although it probably was complicated by the caesarian), but because complications from my caesarian were dealt with so badly no one identified that I had developed the cyst and put it down to poor recovery. It took quite a fight to eventually get the surgery which means I’m not in pain every time I brush against a counter or my handbag touches my side.
The hospital maternity ward I laboured for two days in was dismal and dingy, half the staff were uncaring and barely competent – the other half (I saw several shifts while I was there!) ranged from ok to good. The approach was interventionist and unsupportive of a natural labour, no one asked or understood my situation well enough to support the natural birth I wanted (though this almost certainly would have happened in the US, too) However, the anesthitist for my C-section was fabulous.
The ward I stayed on for two days after my son’s birth was a nightmare. It was the worst experience of my life. It made the labour ward look like a resort on the Riviera. It was hot, noisy, cramped, and none too clean. A nurse swore and yelled at me for refusing to take morphine. I caught a post-operative infection, which I then struggled to get treatment for as each service thought I was the others’ responsibility. I then struggled for over a year to get the hopsital to address my concerns.
I’ve visited the local emergency room on a few occasions. They were pretty good when my husband was delusional from food poisoning. When I got glass in my eye, I had to talk an unsupervised student doctor through washing out my eye. That was after I removed the bloody bandages from the sink over which she sluiced my eye (the student doctor was afraid to touch them). Still, she got the glass out and I didn’t catch anything nasty. The time I sprained my ankle (different hospital) when I got caught in the doors of an Underground train, I got turfed out minutes before the national target time effectively without treatment and with no crutches – I couldn’t walk. That was after I witnessed a single (very good) nurse in my area being run ragged while a bunch junior doctors stood around doing nothing.
On the other hand, I’d certainly like to dispel some myths about the NHS. I can change my doctor, I can opt to go private – and even private treatment in the UK costs less than in the US, I can even buy private insurance. When I had a lump in my breast, my only complaint about that experience is that they were probably crazily over cautious even after it was fairly well established that it was a benign cyst. I saw the same practitioners every time, they were pleasant and explained things well. Oh, and I’ve never had to pay anything (except a flat rate for prescription drugs) at the point of delivery. Yes, I do pay handsomely through my taxes, but it costs me less than a typical employee contribution and co-payments in the US.
Why I don’t love the US Healthcare system
Doctors offices and hospitals in the US are a lot nicer than they are in the UK. And everyone but dental hygenists seems to have a more pleasant demeanor, but this may be more about US service culture than anything else. There’s more emphasis on making you comfortable in the US, which is something that’s quite good when you’re not feeling so hot. I’ve had fewer experiences of US health care, but the ones I’ve had were nicer. Mostly. When I was insured.
When I wasn’t insured, it wasn’t so good. I paid exhorbitant rates for shoddy care at walk-in clinics. I was chased by a debt collection agency for a bill I had in fact paid (it was the doctor’s office administrative error). When I got out of University and was no longer covered, I lived in fear that my financial future would be wiped out if I got into an accident.
I know people who were forced to accept worse pay and condititions just because they had to hang on to their insurance because a spouse had cancer. Others face pressure and worry of medical bills. My mother knows people who probably died due to lack of care after TennCare (state funded health care in my home state of Tennessee) collapsed.
Don’t put your love in institutions
Any time, whether it be in the US or the UK, you think you’ve got the best thing since sliced bread or you persist in telling yourself so until you believe it – your doomed to complacency and quality less than you deserve. There are some excellent features of both systems, but there are also some serious flaws. It just isn’t right that so many people in the US have little access to adequate health care or that people barely in the ranks of the middle class are just one medical disaster away from a bankruptcy.
The love-cult of the NHS has allowed staff to become unaccountable and uncaring – underperformance just isn’t addressed, it’s always excused by lack of resources (which may sometimes be the case, but not always). The love-cult of the US health care system has allowed insurance companies to become the “death panels” in deniers of service while raking in profits – all while not actually delivering a much better (and often worse) service in terms of actual medical outcomes.
* I find it rather ironic that people like Stephen Hawking are saying that they wouldn’t be here if not for the NHS as part of their argument. If he’d been a professor at Harvard, rather than at Cambridge – I’m quite sure he would have had absolutely excellent health care.
Here’s another expat American blogging about the healthcare debate.