GELFAND’S WORLD-This is what happened to a friend of mine under a socialized medical system. It may be a worst case scenario because it happened in England under what they call the National Health Service, or NHS for short. It's a system that has been routinely criticized for being underfunded. The story I'm about to tell may be a bit much for those with weak stomachs, but here goes. My friend was in London, climbing into one of those big taxicabs they have there. He didn't quite understand something about the geography of the back seat, and instead of climbing all the way back, he seated himself down on … nothing. A trip through the air and onto the floor, and he was seriously smitten. Not with love, but with pain.
He eventually got back to the hotel, and by now it was really a killer. One of those stunners of a backache. As I was listening to this story, it reminded me of a few choice hits I took on the rugby field, or the times I banged my knee against an asphalt playground. It hurt. A lot.
But there he was in a foreign city where they speak the undecipherable and eat the inedible, and what was he to do? And remember, his health insurance was American, and might very well be rejected out of hand. But the pain was truly severe, and he managed to squawk out to his wife that they should get a cab and go to whatever the English equivalent of an emergency room was.
Curiously, with the assistance of the hotel desk clerk and an accommodating cabbie, he was delivered to an English care facility. He checked in and took a seat. He describes the wait as follows. From time to time, people would come in who were obviously quite sick or seriously injured, and they were taken immediately. This seemed not unreasonable. He says that his wait was a little over an hour. This was another curiosity, because the American right wing is always talking about how long you have to wait under any nationalized care system.
But perhaps the American right wing is talking about being on a list for elective surgery, where your life and health are not at stake, and you are not in acute pain. Dealing with the sick and injured is apparently better over there than over here in terms of wait time.
So within a period of time that would be chalked up as considerably less than the wait in a comparable American big city emergency room, he was taken to see a doctor.
The rest of this story is notable, like the dog that didn't bark, for what did not happen. Perhaps a little of this story will begin to parse out the differences between our system and what happened in that English facility.
My friend was examined, and was told approximately the following: You have a really bad muscle strain. You don't have a damaged spinal disk, because it would have shown up in the examination. Also, you're an American, and in America they would probably X-ray your back and maybe even do an MRI. Trust me, he was told, you don't need that. I'm going to prescribe some pain killer and an anti-inflammatory, which you should get filled, and which you should take.
He was then shown out. His wife offered her credit card, but was refused. That was the first major shock outside of the injury itself. His treatment came without a bill under the National Health.
If he could have shaken his head, he would have, but he still needed the meds. A cab took him to a pharmacy that had late hours. He got the meds, and once again his wife offered the credit card. No charge.
So this is the true horror and shock of the socialized medical system that takes our notion of single payer and turns it up a notch. From the time of his injury, to his treatment under the English health care system, to getting his prescription filled at the pharmacy, to riding back to the hotel, his out of pocket expense was the 3 cab rides.
As he and his wife were getting into the last cab to get back to the hotel, my friend couldn't contain himself. He expressed his amazement and pleasure that he had seen a doctor and gotten the medicine he needed, and nobody had put a form in front of him demanding to know who his employer was, or his drivers license number, or the number of his bank account. By then, with the pain killer starting to kick in, he may have been a bit voluble, but he couldn't help complimenting the cabbie for the system which had worked so well for him.
Apparently this wasn't a first, because there was a laugh, and the following comment: "We love it," the cabbie said.
Now I would be the first to admit that this is not a properly administered, careful statistical analysis of comparative healthcare outcomes. It doesn't look at comparative cardiac mortality or time to treatment of the gall bladder, but it does reflect how one person in pain was treated by a system that makes medical care available to everyone.
I would also be the first to admit that somebody is paying for this treatment, and it is the British taxpayer. Of course it is also true that British taxpayers are assessed a much lower proportion of their national income compared to Americans. As a country, we pay more than twice the amount the British pay in terms of the number of dollars spent per person and a comparable difference in terms of overall GDP. What we get for that money is a system which rations care according to whether or not you have money, whether or not you have a job, and whether or not you live somewhere that has a doctor shortage.
The Brits apparently have to wait to get a hip replacement. Considering that most Americans who get hip replacements try to put it off as long as they can, I don't see this as the major obstacle that the American right wing likes to flog.
On the other hand, having health insurance and access to good doctors is a major plus in the U.S. if you have an early cancer. Our system seems to be pretty good at dealing with those. On the other hand, if you have limited income and don't see where the two thousand dollars is going to come from (or maybe the twenty thousand dollars), then you will probably put off that doctor visit. The English person, faced with a suspicious lump, may wait a little longer than the well connected American patient, but gets seen by a doctor without having to worry about being forced into bankruptcy.
In recent months, there has been something of a flurry about cancer mortality when compared across the American and European systems. The right wing wants us to think that our system is substantially better than the European and the British systems, based on a rather spurious statistic. The counterargument has been ably made by David Gorski MD, who shows that the systems are fairly comparable in mortality rates.
In other words, you can live a pretty good life in Britain, France, Germany, Japan, or any of dozens of other countries and you can get excellent health care without having to worry about ending up in poverty because an X-ray came out wrong.
Looking at a lot of statistics about annual expenditures by lots of different countries, it becomes painfully obvious that the American people have been played for suckers. All those other countries mentioned in the paragraph above have managed to provide health care at less than half the annual cost that we pay over here in the U.S.
I think it's fair to point out that people fear getting cancer and they want to get adequate care should they be that unlucky. But people also fear and loathe the financial consequences of getting some medical condition. That's what the Affordable Care Act is supposed to be attacking. Compared to what is already in place in Europe and in Britain, even our revamped system is comparatively inadequate. We still have substantial copays and deductibles. But it's a start, and for a lot of Americans, the financial fear that comes from going to the hospital will be substantially reduced.
If the U.S. could evolve its system to reduce our total costs to anywhere near what the rest of the modern world pays, we would enjoy a substantial increase in the money we would have to spend on other things, including rebuilding our export economy.
(Bob Gelfand writes on culture and politics for City Watch. He can be reached at [email protected])
-cw
