Hybrid Healthcare Could Be The Way

In today’s GenForward free online genealogy blog I will be talking a little bit about a subject that has been pretty much front and centre since our arrival in America, but that to us a Brits all seems a bit of an odd argument. This article has been prompted with a discussion I was having with my son about entitlement in general. I just noticed that a lot of the points we talked about on the healthcare front never really seemed to come out in the media arguments surrounding Obamacare or it’s repeal, nobody ever really gave the full picture of how it actually works in practice. It’s also something that most of Europe seems to manage perfectly well:

Healthcare. It sometimes feels like America is the only country in the civilised world without a decent healthcare system. Just to be very clear here, I’m talking about the system for delivery, rather than the actual healthcare provided by the doctors, nurses and other healthcare professionals. There’s absolutely nothing wrong with the care that is available over here, just the method by which it’s obtained that seems to the outsider a bit, well, out of step with the rest of the old guard of big powers in the world.

I would also like to point out, for the purposes of full disclosure, my political leanings. Although I am not overly political, I was brought up under the full bore influence of the Margret Thatcher years in the UK, and really took on board the basic tenets of looking after yourself, not looking for a hand out.

I am not going to go into my political beliefs any further as GenForward will always remain a non-political organisation. I simply thought it fair to mention my own leanings so that any observations that I make in this piece can be understood by the reader in that context.

It’s also important to understand that I was born and spent most of my adult life in Britain. This means that I’m used to a very different system for delivering healthcare. Now let me be the first to say that it’s still not perfect. A lot of the problems with the system come from the fact that it’s been around for nearly 70 years. If you look at the way things work and apply some new thinking, I’m sure that there are lessons to learn for the USA and the current push to repeal Obamacare.

In the UK, not long after the Second World War, it was decided by the then Labour government (political left) that had come into power, that there needed to be a material change in the way healthcare was delivered. Up until that point, healthcare had been available primarily on a pay as you need basis. There were also hospitals that gave free treatment to the poor and needy, but nothing formal. The final outcome of the desire for change resulted in the National Healthcare Service being born.

The concept behind the National Healthcare Service was a simple one, but ultimately very ambitious in its scope. Regardless of any other arguments or political leanings, I don’t believe that anyone can have a reasonable moral objection to the mission of the NHS. Put simply, from cradle to grave, healthcare was to be made available to every man, woman and child in the country, free of charge at the time of need. In short, no matter how sick you were or how much treatment you needed, you always get treated and will never be presented with a bill for that treatment.

A great idea in principle, however everyone knows that there’s nothing for nothing in this world. To foot the bill we had our National Insurance contributions. This was, and still is, a tax that represents a percentage of a person’s earnings (base is around 12% at the moment I believe but subject to various discounts). The more you earn, the more you pay. If you earn little enough, you don’t pay anything at all but still have access to the services.

So, in essence it’s a means based insurance policy, however as it’s not run for profit and as the government is the sole customer, they have total control over rates paid, charges etc. Everything works to a fixed charge rate list. The hospitals can’t charge over these rates, and there’s not a lot of option as to where to go for other sources of income so they learn to work to the rates given. It’s very much like an insurance policy you might buy for yourself, get through work, or buy from an exchange.

The main differences are that it covers all the hospitals (there are private hospitals that only take private paying patients but those are few and far between and I’ll come to that point in a minute), 99% of the doctors, there are no limits and no deductibles. You go in, you get treated, you come out. Nobody will ever try to present you with any kind of bill for your treatment.

In addition to the National insurance cost that taxpayers pay, there is also what we call a prescription fee. This is very much like the prescription fees that you would have on most healthcare plans over in the US, however it’s a fixed rate of about 10 bucks per prescription regardless of what medication it is you need. If you get lots of prescriptions, you can also now opt for a flat rate version of the prescription charge where you can get as many different prescriptions as you need for 35 bucks every 3 months (they didn’t have this when I was in the UK, I’ve just read about it myself).

This way you have a maximum ceiling on medication charges. Having been hit for prescriptions over here for my son that are over 100 bucks a time, I notice the difference on this front as well.

I have been fortunate enough in my lifetime that I have rarely needed the services of the NHS, but when I have, it worked as intended. It wasn’t all frills and fancies, the food was junk, but I got fixed and it didn’t cost me a penny. No forms to fill out. No pre-authorisations. Just go in, wait to be seen, get fixed, out.

It even works if you’re not from the UK. If you’re ever in the UK on holiday and are unfortunate enough to have a medical issue, just go to a hospital. You will be treated, given medication, and released when you’re fit and able. At no point will anyone try to present you with a bill or worry about any insurance you may or may not have.

Now, a bit of a reality check. The system isn’t perfect. It has a few side effects. One of the main effects is that there’s not the crazy overabundance of hospital capacity that exists in the USA. Over here there is so much money to be made that care providers are fighting for patients. Also, there’s a difference in treatment approach, which has both positive and negative effects.

I will use my one and only experience of having a medical problem since I came to the USA, as an illustrative example of the difference in treatment I’d expect to see here and in the UK. It was mid July about 2 years ago. I was out with my wife and son helping him with his baseball practice. IT was a typically burning hot Texas day and we were doing a fair bit of running about. Anyway, I started to feel a bit light headed so I went and sat in the car with the AC going for 10 minutes or so to cool myself down.

Now feeling ok, I went back to the baseball. A few minutes had passed and I was just about to pitch the ball. Next thing I knew I was coming round and picking dirt and grass out of my teeth. According to my wife I just went over like a telegraph pole and hit the floor face first. Being the hero that I am, I tried to get up and just shake it off far too quickly, and I ended up going down again before I finally managed to get to my feet.

Anyway, much drama later we arrived at the local accident rooms. By this time I was feeling a little more like myself, but regardless we were seen straight away and put onto a bed in a kind of assessment room. I was wired up to all kinds of stuff, given a head x-ray, and about an hour and a half later was told that it was likely just down to de-hydration, although with blacking out like that there was always the outside chance that it could have been heart related instead. They also told me I’d broken my nose but I told them I did that years before.

They pumped a couple of pints of stuff into me via a drip and I felt 100% better. At this point they said that they wanted to keep me in just as a precaution to observe overnight. My son was playing in his season championship game that evening so I checked myself out regardless as I wasn’t about to miss his game, and I really felt that they were just being over cautious. I was told to book an appointment with my doctor ASAP to get checked out, which is exactly what I did.

Now, this first part of the experience would likely have been a bit different under the NHS. First off, it’s likely that the hospital would have been further away than the emergency rooms are. Secondly, we may have had to wait for a fair time to get plugged into the I.V.. There would still have been a head x-ray and the diagnosis would likely have been the same, but there would also likely have been less talk of staying in overnight for observation. I would then have been pointed at my doctor just as I was here.

When I got to the doctor, same prognosis. Most likely just de-hydration but he’d book me some heart tests to be sure. He did say that I’d definitely re-broken my nose too. This is where I think the real difference in the way things was handled hit.

I was subjected to every test known to mankind, ranging from MRI’s to heart stress tests to sonograms. All of these tests not only confirmed that I had no heart issue, but that the old ticker was in fact strong as an ox. This was all pleasantly surprising (considering the lifestyle I have led). What was not so pleasant was the several thousand dollars in deductibles that this knowledge cost me. However, at least I had a clean bill of health and could be safe in the knowledge that the original dehydration diagnosis was the correct one.

In the UK, it’s likely that I’d have had maybe one test run, probably a few weeks later. Once I got the all clear the diagnosis of de-hydration would be confirmed and off I’d trot again, no charge. I was blown away by the difference over here. Not content with finding nothing wrong with me, the specialist then decided I should have another bunch of even more expensive tests done on an ongoing basis in a continuing attempt to find something wrong! Now they had me in the system being milked for money, they wanted to keep me!

Now don’t misunderstand me, if I have a medical issue and nobody can tell me what it is, I’d want to keep running tests till someone can say what the problem is. But if I have a perfectly reasonable diagnosis, I don’t expect tens of thousands of dollars of tests to be run on me in an ongoing and never ending attempt to find a different diagnosis.

In the UK, the attitude is let’s find the problem in as simple and cost effective way as possible and do what’s needed to fix it. Over here the driver seems to be to keep testing as long as there’s a limit left on the insurance and to make sure you can’t get sued for not testing everything. If you want to know where your healthcare dollar goes and why the premiums are so crazy over here, this is a huge chunk of it in a nutshell.

Now, let’s look at some of the downsides of national insurance NHS treatment vs the private insurance model employed here in the USA. I have been looking so far mainly at emergency care. There is however more than that involved in keeping a nation well. Routine medicine certainly causes the private model to get a bunch of points back against the NHS model.

As I stated before, the NHS model does not allow for subsidising spare capacity. The end result of this is reduced choice and extended wait times. These are facts of life with the NHS. You will not have a free choice of whoever you want to carry out your treatment, you will be assigned someone by your Family Doctor.

You will also have much less say in the timing of your treatment, as it will be more about when you can be fitted in as opposed to there being empty spaces for you to choose from whenever you want. I would however also argue that if you are being very specific about whom you want to do your treatment here in the USA; you can still hit a wait to be seen simply because the most in demand doctors are always busy already.

That being said, in most usual cases you can get treated pretty much where you want by who you want (so long as it’s within the boundaries of your insurance plan!) here in the USA. As I understand it, that simple fact was behind a great deal of opposition to any talk of a nationalised health system over here in the USA.

Well, there’s one more trick up the sleeve of the UK healthcare marketplace that kind of takes care of that issue. There’s also private insurance over in the UK. Yes you heard it right, even with the NHS in place a good number of people still opt, either through their companies or privately, to pay a private insurer for medical insurance policies for their families. I know this well as I spent many years as as salesman selling exactly these policies. So if you still wanted to opt for the same kind of choice and system as you have now here in the USA, you can do it!

The two things worked hand in glove. The NHS does well with the emergency care, long term care and chronic care, the private insurances took care of the less urgent stuff where people liked choice and the comfort of a private room rather than a ward etc.. The surprising thing is that 90% of the time, you’ll see the same doctors working on both NHS and private patients.

The big difference to the way things are here comes in the cost. Over here a good healthcare plan for a family is likely to cost over a thousand bucks a month, sometimes close to double that. In the UK, a REALLY good plan for the family should be easily obtained for about 150-175 bucks a month. No, that is not a typo, there are no missing zeros. I’m talking a no limits plan, including things like physiotherapy, hospital charges, private room charges, and NO deductibles. If you want a deductible then you can probably drop 10% off your plan price by taking a 200 dollar deductible.

Because the NHS takes care good care of all the long term sick, the emergency treatment and all the people with pre-existing conditions, the risk profile for a private insurer is much different than over here than in the UK. It’s perfectly acceptable for the insurer to exclude things like chronic conditions and pre-existing conditions because the NHS will always cover people so nobody is left without coverage.

Now, you can do the math on your own situation, and let’s assume you don’t get any of the special cost reductions.  Work out 12% of your gross salary plus 150 bucks a month for an average family (an individual in their 30’s or 40’s is probably 40-50 bucks just to give you another guideline) covering kids up to age 21. 

Whatever number you come up with, that buys you free healthcare when you need it. Nothing to pay, no deductible and 35 bucks a month for whatever meds you need. If you don’t like the option presented by the NHS and you want to use your private plan, go ahead, still no cost at time of use but now you get your own room. How does this stack against your cost and benefits now? How much more likely are you to get a medical problem looked at and dealt with under this system than the current one?

Now think not only of yourself, but every man, woman and child in the country. Over 65’s, it’s free prescriptions and no 12% as they earn no wages. If they want the private part too then it’s a couple of hundred bucks. If not it’s free. Kids it’s free. If you get a chronic illness, cover cannot be taken away from you. The national plan will always be there, free. Isn’t this a better way?

Now I won’t pretend that everything is perfect in the NHS. In recent years it’s become riddled with inefficiency and there are far too many bean counters and hospital managers, and not enough nursing staff. But even saying that, I challenge you to find even one person who has the NHS available to them now that would swap for the US system. It simply won’t happen. People know it’s always there as a safety net and those who want more buy the cheap private plans.

Now, all that being said, I still choose to live here in the USA and raise my family here, and I’ll continue to choose that way till I’m not given the choice. There’s more to life over here than the health system, and the plusses FAR outweigh the negatives. It just strikes me as odd that in a country that does so much so well, such a pig’s ear is being made out of providing basic healthcare for all of your citizens.

I do understand the desire not to have the government, ANY government in fact, buggering about with providing your healthcare. I’m a fan of less government, not more. However there are some things that are simply better handled in an all inclusive manner, and maybe if they were busy sorting out healthcare they’d have less time to try and micro manage other areas of life.

Surely when anyone lists out the most important things in life, good health has to be way up there on that list. It amazes me that there hasn’t been civil unrest to get this basic wrong put right. America as a country has a history for standing up for people’s rights and doing the right thing as a nation. Surely healthcare for all, from cradle to grave, free at the time of greatest need, should be added to your list of inalienable rights?

Just a thought……..

Tom@genforward.org

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