22 February 2012

More On The NHS

Posted by Happy Homemaker UK

While 16% of Americans are medically uninsured,
should America abandon their awesome medical care
to look more like the UK's National Health Service?

Or should the focus be on getting care to those 16%
instead of changing the entire system?
Are we throwing out the baby with the bathwater?

Very controversially,
President Barack Obama pushed the approval of Universal Healthcare
to look more like the NHS

:: A side note on pronouncing 'Barack' ::
English: BEAR-ick
American: b'ROCK

Faux Fur Hot Bottle Covers sold by This Is Pretty

Like many American expats here,
we have the option of seeing private doctors through our company's insurance plan
or using the UK's 'free' healthcare system, the NHS

The NHS is one of the world's largest employers,
behind the likes of the Chinese Army

Our family has used private insurance so far
because it is a system I understand

Although I like that our private doctor provides house calls, 
his primary practice is out of his home, which kind of creeps me out

However, I can get an appointment the day I call
and I have been satisfied with the care he has provided thus far

I pay for the visit up front (£60/$100)
and our private insurance company reimburses us with a check in the mail
It is a bit of a hassle, but that's okay

Get Well Soon Chamomile Kit sold via Amazon

A few months ago
I decided I should register with the NHS in case of an emergency
or due to some mystery disease (they see so many cases of everything)
plus visits are free (prescriptions too, for kids)

So I went to register at the medical center my neighbor said I HAD to go to,
for they have the BEST doctor

So I walk in and let me just say
'Greyhound Bus Station'

...meaning cement floors, plastic bucket chairs affixed to the floor,
dim lighting, a long row of 'ticket windows' with receptionists,
and even a light up board that displays your last name once it is your turn
I. Kid. You. Not.

I grabbed my kids' hands and walked a speedy u-turn (or should I say 'roundabout'?)
before you could say 'ah-choo',
and off we went to another location that hadn't been recommended,
but at least was another option

We drove up to an old Victorian home, with bedrooms as examining rooms
and the living room served as a waiting room
It seemed much more civilized, maybe even quaint

As I registered, the receptionist asked if I wanted to give 
a urine sample today (uh, no thanks)

TShirt available via My Cow Dazy

Okay, so now that our registration has been processed
look what came in the mail last week...

the seeds of a blog post...

My first PAP Smear 'Invitation'

You are allotted a 'smear' every three years in the UK,
whereas in the US, women receive one annually

'The Facts' brochure said I could stay dressed from the waist down
if I wore a full skirt
And I would lay down 'on a couch' for the smear test
- so interesting! -

Well, I almost got a chance to test-drive the NHS system
when I called to make an appointment for a rash on one of us

It is a good thing the rash disappeared in a few days and was not contagious
for I called on a Monday and they could not see us until Saturday(!)

Now that we are moving to a semi-rural village,
my catchment area is small and I only will have one NHS GP possibility

This means I won't be able to choose my doctor's office,
so I hope it is a good one

I hesitate to post this, for I know the NHS is something many Brits are very proud of
But I push 'publish' because it is something Americans are very keen to read about as
we march in this direction...

More medical posts:


Jen@ADropintheBucket said...

Very interesting to read your take on this. I have been in Scotland for just a short few months, and it took me too long to get registered with the NHS, but I did a few weeks ago. I would also have the option for the private drs, but thought it would be a good experience to use the NHS.

My first observation was interesting because I had to call THREE offices before I found one that was accepting new patients. Seemed hard to believe, especially since one of those first two is part of the same practice as the one I ended up at.

2nd observation is that the things people say about you get 10 minutes and it's in and out (and of course there are signs in the office saying that as well)...well that is VERY, very true. I asked the Nurse Practitioner (who did my intake appt.) about options for birth control...mostly just saying I wanted a prescription for the pill, and she urged me to make another appointment, or attend a family planning clinic on a Monday night. And I realized the reason was because I was at my max of 10 minutes already.

But my appointment did start on time, and everyone in the office was extremely friendly. So, at this point I think the system seems to work fine, but guess I will have to wait and see. Although, I am hoping to not have to deal with it too much (since of course that means we would be ill!) during the rest of our time here.

Tanya said...

We have used private health care over here so far. I did register with the NHS. At least, I think I did. I never received an invitation for a smear! We love the two private doctors we have seen in a local private hospital. The care has been similar to what we would have had in the US.

Diane said...

An interesting post. Being British and brought up with the National Health, and having used it a fair amount, it has been a God send to my family. It is not perfect or ideal and the services are being eroded. As a family, we have some private insurance through my husbands work, which we also use and the difference is amazing - and annoying when you see the same doctor in a NHS hospital and his attitude stinks, then you pay privately and see the same "charming" doctor!. My view is that having the choice of both if you can afford it is better than not having access to any if you can't. x

beetree said...

All I will say at this point is that our country is marching toward some very sad days ahead in its present course. There is always hope, as in, I hope there will be a change of direction come November. Thanks for the peak into our potential future!

Belle said...

We used both the NHS (for general health care) and private doctors (for the birth of our son). Our private doctors also taught and worked on the NHS, just not in our area, and came highly recommended. I have to say that I was impressed with the general healthcare system and found the postnatal care excellent. Health workers visited our home several times for the first 6 weeks we were home. Our GP held a baby clinic twice weekly that you could just turn up at anytime to have your questioned answered, your baby weighted, shots scheduled, etc. I liked that we had the choice of public healthcare (for things like the flu and baby shots) and private care (for things like giving birth or more serious healthcare concerns or issues).

We currently live in Denmark and are expecting our second baby in June. Let's just say it's an entirely different ball of wax here. EVERYTHING is on the national system. There are no private doctors to choose from - at least not where we live. Maybe in Copenhagen.

Knitting Nix said...

In South Africa you have medical aid, which is like medical insurance in the US. You also see state of the art doctors and facilities, but it costs you, and you have to still pay the doctors and hospitals up front and then be reimbursed. It took me a while to get my head around the somewhat antiquated NHS when we moved here, but there is merit in free prescriptions and free everything for children under 16.

Anonymous said...

17% - round up - one in five Americans have absolutely NO health coverage - not even the plastic chairs and dark corridors you turn your nose up at

60% of Bankruptcies in US cite medical costs - almost none in the UK

It is not good medicine to give you a procedure more often than it is required (ref. cervical smear) The decision of how often a preventative measure should be given is a statistical decision and not a feel-good one.

And give the smears you don't need to the one in five women who are your fellow citizens who will not get even one in a lifetime.

And say what you will, Brits are healthier than Americans on almost every measure of health. The hospitals aren't as pretty but they are dealing with health and not with hotels.

Why do you say "free" healthcare in quotation marks? - it is free - no quotation marks needed.

And one final comment - you might want to visit a few of the hospitals in an American City that do not cater to the wealthy and completely insured - far scarier than anything I saw in the UK.

Come on ladies - there is lots wrong with the NRS but the Brits have more to teach Americans about health care delivery than vice versa.

And I am not even British, though I do work in health care!

Anonymous said...

NHS - NHS not NRS :)

Jocelyn Nelson said...

I have been living in Yorkshire for nearly ten years and have always used the NHS. I live in a medium sized rural village and there is one doctor's surgery (practice) that is 5 minute walk from my house. I think the NHS is wonderful. I have never had a problem seeing a doctor on the same day I call, and if there are no appts available there is an non-appt clinic twice a day where you show up and wait your turn- usually about an hour. I am pregnant with my third child and I love that my midwife is a 5 minute walk away for appts. It makes life so much more convenient than having to trek to hospital, find parking, etc for every visit.
I can remember growing up in CA and what it was like with private healthcare- 35 minute drive to hospital assuming no traffic, $20 co-pay (prob a lot more now), never once saw the same doctor twice. Not the worst thing ever but that is because I was one of the lucky ones with insurance. I'd take the NHS any day when it means that everyone can have medical care.

brie. said...

this is interesting - perhaps because i grew up in canada, i'm used to socialised health care. many people i know, myself included, use a hybrid method. i use the NHS (which is at the end of my road and i never have a problem getting an appt, even in london!) for basic things, prescriptions (which btw if your prescription comes from the NHS, you only have to pay the dispensing fee, and birth control is free), and for yearly check ups etc.

however, last winter i tore a ligament while skiing in france and decided to go with a private sports doctor for the initial consultation and diagnosis, which sped up the wait time for MRI etc but also meant that i paid nearly £600 out of pocket. however, that private physician was able to suggest the best surgeon in my hospital catchment for the particular surgery i'd need. in fact i was able to get a state of the art surgery for free, on the NHS, by the top UK surgeon for my particular injury. the post surgery follow up care in terms of physio is leaving something to be desired, but as an active individual who has a fair bit of body knowledge i'm able to source the help i need elsewhere...

but for me that's a small price to pay (literally) for a high-end very expensive surgery that would have cost about £5000-10000 for private surgery and aftercare.

yes, the NHS has it's problems, but it also, does a great job of getting sick people well again.

Happy Homemaker UK said...

Hello Anonymous - Yes, I worked for a General Hospital in a major US city as a Spanish translator working with migrant workers, homeless patients, and those receiving Medicaid from the government. I worked in many areas of the hospital - treatment rooms, xray, laboring floor. They received the same care and attention as insured patients. I am curious if you have received healthcare in the US before? If not, the differences are difficult to describe, but I do my best to put them into words.

As stated in my post, I absolutely believe the uninsured deserve the same care as those privately insured/Medicaid patients. Some of my friends are uninsured, so I am keenly aware of the struggles (and fear) they encounter. Everyone in the US agrees that something needs to be done to better serve them. And for the record, every single person in the US is treated in a medical emergency regardless of insurance status - the problem is with long-term illness and disease such as cancer with expensive treatments and medication.

I wrote 'free' because we do pay for NHS through taxes. And the 16% came from an article in USA Today: http://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm. I would love to know your source stating 'Brits are healthier than Americans on almost every measure of health' - I have not read anything stating as such and would like to learn more.

Pom Pom said...

Yikes. I don't like the sound of all that. Call me spoiled, but I like the sterile office my doctor maintains and the lovely atmosphere in the Christian hospital where many of my grandbabies were born. Thank you for your honesty, Laura.

marion said...

wow - now you have touched on a really good issue. You are a Brave woman. I know some US folk who call NHS socialist and it always annoys me... of course they have money for private care but for those who dont ???? what happens ? I totally agree with Dianes comments. I too am a Brit and very thankful for NHS for myself and my family. Ideal world would be to have both so you can choose but better that than nothing. Theres a missionary family right now in USA who just had a car accident and have no insurance and are borrowing money all over to try to pay for x rays and are already in massive debt. NHS wouldnt allow that to happen. Anybody can get free heath care at any time - even those who dont pay it monthly. Nobody would be LEFT on a stretcher in a hallway cos they cant pay. I have U.S friends who couldnt afford to have another baby - now that cant be right. Michael Moores documentary SICKO is enlightening - I dont always agree with the man but he brings up some good points about healthcare in UK and the USA

Joyce said...

Oh my. I could write a book here. I think one thing Americans don't understand is the 'wait time' in the UK. My youngest has scoliosis and we needed to see a specialist soon after moving overseas since she was in a brace and growing. I received an excellent referral and absolutely loved the doctor. BUT-when I phoned for the appt. they asked if I was coming on the NHS or with private insurance. I didn't understand the NHS at that point so asked what the difference would be: if I used my private insurance I could have an appt in 3 weeks. If I saw him on the NHS I could have an appt in 14 MONTHS. Americans see the whole thing as free healthcare and who wouldn't want that, but living with it is something else entirely. The biggest issue I think is in preventative medicine. The costs to the trusts are too high to offer true preventative care to every single person. The US is big on prevention (mammograms, paps, physicals, etc). One more thing-America is not England speaking in terms of size/geography. What kind of works in a smaller, less populated country doesn't neccessarily translate here. I know Canada is geographically large but has a smaller population than the US. My husband works on the business side of the medical field. He could tell some stories because essentially money is at the root of the health care issue no matter which side of the pond you're on.

Meg said...

Being pregnant with our first child as an expat in the UK, I've been really interested to see the differences in the medical system. And I think that's the biggest thing- they are different ways of doing things. It's all about what you are used to and what you expect. I've been VERY pleased with the NHS care I've received throughout my pregnancy and am SO HAPPY that many things my American friends are fighting for (skin-to-skin time with babies, less intervention, etc) in the American system. Every system has it's problems, but from my experience the NHS is pretty hard to beat.

Happy Homemaker UK said...

Yes, I was feeling brave when I pushed that 'publish' button, not sure what the reactions would be. However, I always learn a lot from the comments here, and as long as everyone keeps them nice, I love the chatter :) Thank you for all your comments - keep them coming!

chris said...

I think this is fascinating. I've been both insured and uninsured in the US health care system, and received great treatment in both cases. When I was uninsured, I was able to negotiate my bills, and take care of everything...even with an emergency surgery. I would choose our system any day.

Iota said...

Interesting to read. I haven't read the comments, but I expect you've got a range of opinions there. One thing I would say is that like any system, your own doctor's office will get easier as you get to know it. Usually, you just have to push if you need an earlier appointment. That's often the case with my doctor's office here too. They say "no appointments today", but if I say it's for a child, I'm worried about them, bla bla bla, then an appointment can be found.

But your point is valid. Wait times are longer. In defence of the NHS (sorry, can't help leaping to its defence), a lot of medical issues can certainly wait a few days. It's just what you're used to. In my experience (and I say this with the same humility that you published your post), there's more anxiety about health issues in America. The idea of waiting a few days is much harder if you're not used to it, even if it's a minor complaint.

Interesting to read Meg's comment about skin-to-skin time with the baby. (OK, so I read that one comment!) Why wouldn't doctors/midwives want you to have that? That's amazing to me. Which proves my point - it's all about what you're used to.

Priscilla said...

I agree with you.
I lived in England (Suffolk) for 2 years. The village I lived in had a doctor, and I registered, but was never ill so only had to go in once. The other people in our village and others around the country that I knew, who had had health issues, were not well treated. Waiting months, sometimes years for treatment. Our dear neighbor across the lane was even turned down for treatment because she was told she was too old. She died!
When I hear of people here in the US who think they want Obama's UK style socialized medicine, I just wish they could experience it for themselves before they jump on that bandwagon.
I'd chose our system any day over that.

Priscilla said...

You're right!

Sally@Enlightenment for the Sleepy said...

Hello again!
Don't worry about moving to a rural village. The Health care will be better, seriously! The bigger the Town/City- the worse the standard of service at the point of entry. You are a number. A small village practice will take good care of you. One thing I will stress is that wherever you are, if you are unhappy with the service call the Practice Manager and complain. These practices are privately owned and they bill the NHS for the work done, so like any service you can complain if you are not happy with the care you receive. My husband would be straight on the phone if he felt the service was too bad. We would get a call back from the Manager and would be treated much better at future visits. I'm not a complainer and get embarrassed, but my husband expects a good service from his Doctor. Trust me we got future appointments quickly. It's so very hard learning your way around a new Country. We paid for Health care here for three months but couldn't keep it up. Ironically we found out that a Doctors visit cost us $120 with Insurance and only $40 if we paid ourselves. So now we pay ourselves. We have so much to learn about US Medical care. It's a minefield for us! I hope you get a great Doctors Surgery. Shop around within the area you live, don't settle for second rate even if it is free. take care. Sally xxx

Priscilla said...

How can you say NHS is free? The taxes in GB are sky high. Inland, and VAT and all the other taxes a.k.a. "fees", pay for it. Many of the "uninsured" are people who chose to be uninsured, or the millions of illegal people residing in the US. They can go to any hospital in the US and be treated. If the laws concerning purchasing insurance across state lines, were changed and the laws concerning mal-practice were changed, the price of insurance would drop considerably. No need to have more government interference. What government body can you name that is run better or more effectively than one in the private sector? If you had ever talked to people in the UK, you might have a better picture of the real story.

Sally@Enlightenment for the Sleepy said...

sorry me again_ I have to respond to Anonymous there and correct them. You were right to put 'free' in inverted commas as the NHS is only free at the point of entry. You are actually paying for your health care by deductions from your wages (and even unemployment benefit if not working) every week. It's called National Insurance payments. That covers all Healthcare. It is not a free service. You are totally correct =) When the Government stop taking National Insurance payments then it would be free. xxx

Happy Homemaker UK said...

Thank you for validating, Sally :)

Happy Homemaker UK said...

Thanks for all the good info; that is comforting. No matter which new country you live in, it is all about learning the system - isn't it?

TexWisGirl said...

well, as someone who has had to buy private medical insurance since i was laid off (and my husband's employer does not offer it) i hope that the US can get something better in place. insurance is a racket...

La Vie Quotidienne said...

I have no personal experience, but I have heard from a good friend who is from England that the medical system and care is excellent. I love that you were 'invited' for your test...so civilized.

Have a happy day.

Jenny Woolf said...

I am a Brit and I have experience of private and NHS care. I would consider private health insurance (in fact, I am currently considering it) to buy what the NHS isn't good at - I am talking a private room not a ward in certain circumstances, I would only want a private room if the public ward was noisy - for instance with demented patients. I actually think most people in hospital wards cheer each other up, encourage each other and keep each other occupied which IMHO is better than worrying and fretting alone.

The other thing I'd pay for is physio - the NHS just can't get enough of it to patients who need it. It's a really bad deficiency and there is no interface between NHS and private so you can't bring buy extra physio in an NHS hospital. Bad, bad. Other "peripheral" services are also poor on the NHS, I believe mental health is one.

My mum's doctor makes home visits and we have had visits when kids are sick but mostly I don't need a home visit, our practice has a good system and a good modern centre. (bucket chairs and cement... hmmm....where IS your doctors practice?)

Course, I live in an area where the hospitals and doctors are considered to be good. If I had failing hospitals and rubbish GPs, I would think differently, I'd guess.

Other than these peripherals, I'd prefer NHS, though it's not always luxurious. My elderly mother and father had absolutely brilliant treatment on the NHS for serious conditions over many months. A teenage relative with leukemia had years of free NHS treatment and has survived to make a career in this field (yes, he is a big NHS fan). I like it that NHS will offer all kinds of expensive treatments free of charge if necessary but staff aren't interested in getting people to have extra tests and treatments over and above what they actually need.

I dislike the "welcome, hypochondriacs!" ethos that exists in some private practices - have some trendy diagnostic test which may give unreliable results of some possible disorder and makes the patient feel important and loved, and certainly results in extra business. I don't happen to think that undergoing medical procedures and taking medication is all that good for people. Some conditions are actually better left alone to clear up by themselves. OK maybe this sounds a bit too bracing for you!

I don't find treatment as such any better in private hospitals, and all the docs I know say they would want the NHS if they were really ill.

As for the debate within the US, I am not qualified to speak on this. But I value the NHS so much when I speak to friends in other countries who are terrified of losing their jobs, because of losing the health benefits. Or who are just terrified of getting ill because they can't afford insurance for various perfectly good and decent reasons. Or who have long term expensive illnesses that they fear they may not have the money to pay for, people who are facing preventable death. I mean, these are not drug addicts or losers (although even losers don't deserve to die, except to paid up member of the Nazi party). these are people who have worked hard, been hit by one misfortune and then have the disaster of no healthcare piled on top.

And I am mystified at the moral landscape of certain people who apparently believe that God backs them up in their wish to avoid sharing what they have to assist "him that hath no helper" (as Psalm 72 has it).

Hope I have not offended anyone with these remarks, they're just what I think.

~♥~ Sara @ Doodle Dandy ~♥~ said...

The NHS is not free! It's something the Government say to ensure the electorate think they are getting something for nothing but in my opinion, you get nothing for free in this life, somewhere along the line you pay for it!
We do pay extremely high taxes and to that end the NHS system should be far better than it is. We should not have to wait 3 to 5 days for an appointment with a GP and I say 'a' instead of 'your' because at our practice sometimes the only way to be seen quickly is to see a different doctor than the one you are actually registered with!
With all this in mind, although not having experienced the US system, I can't fault the NHS from a personal view, I had both my children via c-section and had to stay in hospital. The care I received was good. Incidently, the practice I go to has lovely carpet, comfy fabric chairs and bright coloured walls!

Pat said...

Interesting post... the general take in Switzerland & France is less than favorable...in fact there is a popular joke circulating that one should avoid getting sick in England. Ever. And everyone knows American health insurance is too expensive for to afford. Maybe we could design some combo of American, French (socialized medicine) and British health care.

Kris said...

Laura, great post. I've loved reading all these comments. It's great to read about everyone's experiences with the NHS. I've taken full advantage of the NHS over the four years I've lived here (even had my baby in an NHS hospital) and have a few complaints, but for the most part I've been happy with it. I had okay insurance in the states from my employer, but it didn't cover maternity. I had a few complications during my delivery, which I imagine would have cost quite a bit of money if I had delivered in America, so I'm just grateful that I left the hospital with a healthy baby and no huge medical bill to pay.

ann said...

Wow. What a can of worms. You created a wonderful discussion. It is so easy to find fault with any program, but for my I hope not to take my American health care for granted. Soon I will retire from my job, give up my good health insurance, and go on Medicare. I will also have to buy a supplement policy to cover what Medicare will not. I really am worried what it will all mean when Obamacare kicks in. I rather like things the way they are. As for the uninsured in the US. I know many who, though they could pay for insurance coverage, they choose not to. As my dad said, you only need insurance when you need it. Great discussion.

LiSa said...

I love this discussion and I love reading the responses.... As an American living in England for nearly 7 years now, I have experienced both systems, but I have no conclusive response. Sorry!
Each has it's pros and cons... I have had, so far, positive experiences with the NHS. It's not perfect but neither is the US way.

Jenny Woolf said...

Me again. I've been reading the interesting comments above - wow you have started a discussion!

I'm very sceptical that Priscilla's neighbour was told that she was too old to receive treatment. Age is no justification for refusing care and if she died because she was refused care that is the kind of thing to get in the papers (and the courts) . Might the real situation be that this poor lady was considered too old or too ill to survive the necessary treatment? Some treatments are just awful, and too gruelling for frail patients, and the patients are generally advised if that is the case. Another possibility is that the treatment she wished to have, was not in fact effective? Many people have their own theories that don't tie up with medical opinion. A third possibility is that she wanted a treatment that was not approved for NHS as being too expensive for the likely benefit, e.g. many thousands of pounds to prolong life for a few weeks. It just doesn't make sense to me the way it sounds, so it might be that Priscilla didn't really know the full story in this case.

It is popularly suspected that some doctors unofficially "ration" treatment for frail older patients, but no doctor who valued his job would tell a patient this and it is not supposed to happen.

As I say, I'm not qualified to comment on the US situation, because I truly don't understand it. But I was interested that you recall how migrants and very poor people receive exactly the same care as insured patients in the hospital where you worked. I am now trying to reconcile this with a programme I saw the other day. It followed some volunteer doctors running a kind of camp clinic in the Southern USA and people waiting all night in their cars in order to get medical advice at this camp. One a man had a bad hernia with his innards protruding from his body. He didn't want to go to the emergency room because he said they'd only tell him to have surgery which he couldn't afford. But he was finally persuaded to go, and it turned out that they would not treat him without payment, so he went home without treatment. I am not a doctor but I would have thought that this man would probably die if left untreated for long. So if he really was this ill, why couldn't he get the treatment that the migrant workers got?

Emily said...

Laura ~ before I read everyone's comments, I just want to say thanks for braving it and publishing your post. It's F-A-S-C-I-N-A-T-I-N-G to say the least, right down to the "smear" "invitation"!

Hi, I'm back after reading everyone's comments. Laura, this has been so informative! You know, your readers may not have the answers, but clearly they've identified the problems. And it just helps to be aware of the pros and cons of each system! I have a lot to mull over, and I appreciate your timely post! Being election year over here, it helps me understand some of the issues much better. Experience is most often a better teacher than theory!

Kate and Russ said...

Wow, lots of comments on this one. I don't even know where to begin. Let's just say, Americans who want NHS should live in England with three young children for one year...then decide.

marion again ... =) said...

I have a question that so far I havent had an answer to and maybe someone can help:
How much would all inclusive fully comprehensive insurance cost in USA to cover the following:
100% health care regardless of past injuries or sicknesses for each member of a family of four -for their entire lives - and you can use it as much as you need or want - NO LIMITS - including all surgeries, maternity, child benefit - post care etc etc etc.. and include, of couse, ambulance and air ambulance if needed and would also cover anyone visiting who needs treatment even though they have never paid into that insurance. How much do you pay for your health insurance for your family? ..and is it for the rest of your lives or do you need it to be reviewed ? Can anybody provide me with an estimate for this - a monthly or annual or lifetime price?

Happy Homemaker UK said...

Like Pricilla's neighbor, I'm not sure of all the circumstances, so I couldn't say.

Happy Homemaker UK said...

So many different variables that it would be impossible to give you a hard number. So many different plans with each employer. There is no question it can be difficult to get insured with a pre-existing condition, and very expensive too. Your point is well taken.

Julie @ The Family CEO said...

Thanks so much for the post. Here in the US, we hear so many different perspectives on the UK system, that it's great to hear a first-hand account.

Amy W. said...

Thank-you muchly for sharing an insightful and resourceful glimpse into such a dense subject here in the states!
I so enjoy your posts!

Leigh Powell Hines (Hines-Sight Blog) said...

This is a great post. I am going to share it on Facebook. Fascinating. Thanks Laura.

Camie said...

I received the same letter after registering at the GP. I found it odd that I was required to sign it and send it back, confirming that I "was not interested in the procedure at this time." I didn't mind the fact that I had to send it back. My main issue was HOW to send it back because, at the time, I had yet to purchase any postage stamps and really didn't know how Royal Mail worked. So, this ridiculous letter required to me research the different postage types and find a place to buy them (I was sure there was a shop closer than our post office). One step forward and two steps back - That's a good summary of my first 6 months in this country. Looking back, I probably should have just walked the 4 blocks to the GP and dropped the letter off personally.

And I must say that our 1970's mauve themed GP is much more up-to-date than your "Greyhound Bus Station" GP. I can't believe they show your name on a board when it is your turn. That would be a giant HIPAA fine in the US!

If you haven't read already...

Anonymous said...

Happy Homemaker, what part of the "Patient Protection and Affordable Care Act" (referred to as Obamacare) are you saying is like the NHS? Enlighten us, please? I mean, specifically. I think it is dangerous to insinuate but not give specifics.

Anonymous said...


Happy Homemaker UK said...

Would you mind signing your name, so I can address you personally? Thank you for the link; I look forward to reading it.

Happy Homemaker UK said...

If you google 'NHS Obama', you will find a lot of articles from 2009 when the act was constructed. As far as specifics, I have not read the 1000+ act, but it is common knowledge in the US that Obama used the NHS as a model.

Jana said...

I'm American, an RN and lived in the UK for 6+ years. My first time in an NHS hospital reminded me of a VA hospital, only worse, and it scared me to think that this could be America's future. I feel like my choices (and freedom) are limited with the NHS. I wish people would realize that NOTHING is "free". We will be paying for it and it will drag America down. Healthcare reform is needed however, but not socialized medicine please.

Anonymous said...

There is nothing in the PPACA about government run hospitals or clinics like the one you have described. Yes, we already have VA hospitals and health clinics in the US that are like you describe. Why do you think this is the future of US healthcare? Key feature of it here (so you don't have to read 1,000+ pages)http://www.healthcare.gov/law/features/index.html

mx said...

Anyhootles - to wrap it all up nicely. This post rekindled fierce patriotism in me which was refreshinly good.
I honestly think alot of the things the U.S citizens dont like are more related to culture shock than NHS being all bad. The lady who had to do research to know how to post the smear invitation back - made me laugh so much. What seems soo normal to us - is in fact a foreign country and culture to others - yet we all assume we will adapt cos of the same lingo. Thanks for posting it - the comments were very very interesting and I really hope UK and US citizens realise that they are both incredibly blessed anyway. I am right in the middle of South America where healthcare is a true challenge and you see alot of injustice and corruption. This - on reflection - makes NHS or any Obama scheme look FANTASTIC !

Sue said...

I'm in the U.S., and while I am employed full time, I cannot afford health insurance. Some doctors will see me without it, but many won't. Clinics are often full, or I don't qualify. Every time I try to consider the health care chaos we have here, and how it bankrupts people just trying to stay alive, it still blows my mind. While the NHS isn't perfect, I'd much prefer it over a system where people constantly fall through the cracks. This is not an unusual situation: http://www.reddit.com/r/AskReddit/comments/pty2s/reddit_im_watching_my_mother_die_because_she/

Happy Homemaker UK said...

Having health care at all is a blessing, and I do think figuring it out in a different culture can be daunting. Thank you for your reflections :)

Happy Homemaker UK said...

Thank you for sharing. I absolutely think this should be changed so that you have affordable health coverage.

housewifedownunder said...

When I lived in England, I had to go to NHS hospitals a few times. Mostly to take other people to appointments or visit people, but on occasion for myself as well. I'm sure not all NHS hospitals are like this, but every single one that I went to was filthy, overcrowded, and understaffed. I guess "you get what you pay for"? It was disgusting and would never be my first choice for medical care. After seeing that, I began to understand why so many of my friends opted to go to Germany for their medical care.

Living in America, I was one of those people with no health insurance. By choice. The premiums for a year of basic health insurance were well in excess of what I was paying out of pocket in a year. And those premiums would not have included prescription drug costs, which made up the bulk of my medical expenses. For a young, healthy, single person, insurance coverage is usually a rip off. I had my own health insurance once for a year and then got rid of it because it was such a colossal waste of money.

I don't know why the English are so defensive of the NHS. There are a lot of countries that do socialised healthcare to a far better standard than they do.

Meg@SomethingSwedish said...

Very interesting to hear about. When I was living in NY and working as a dental assistant and the medical bill was being discussed everyday my boss was constantly talking down about the English Health Care system (her sister lives there). Just like any other doctor quality is always going to fluctuate but its good to have options if in a pinch and there is always the option of private. People talk about the Swedish health care system here a lot and complain that it is not as free as the one in the UK so it is therefor not as good. I have yet to go to the clinics here so I have nothing to report on that matter except that I did not have insurance in the U.S and would have been in big trouble if I had needed medical care, so I appreciate it being a back up. Thanks for the post!
(Side note- I don't find in home doctor offices creepy if they are professional and not in the same area as their personal living space. I think it is quite common. However hubby and I saw a home office during a walk two days ago and he told me it was a plastic surgeons office!!?? THAT is creepy. )

Dave D said...

The NHS covers the UK not just England. I agree that most hospitals are overcrowded but that goes for the whole country and we still keep letting them in, in their hundreds of thousands.

Jenny Woolf said...

I take your point about not being able to comment on specific cases, I'm sorry. The problem is that I don't know quite what to ask about your comment Like the lady with the postage stamps, I think it must assume knowledge I don't have! But I don't know which knowledge I don't have. (if that makes sense) :)

Specifically, you wrote, "I worked for a General Hospital in a major US city as a Spanish translator working with migrant workers, homeless patients, and those receiving Medicaid from the government. I worked in many areas of the hospital - treatment rooms, xray, laboring floor. They received the same care and attention as insured patients."

This is written clearly and unambiguously, but in my mind it doesn't tie up with the experiences many uninsured people report and which I see and hear about.

So might the problem be that a "General hospital" is maybe some special type of hospital which takes all kinds of patients for some reason?

Or do migrant workers and homeless have some special and more helpful scheme just for them, that is NOT Medicaid? (you differentiate them from Medicaid patients)

I am also not clear why a person as impoverished and desperate as this TV guy seemed to be, couldn't get important medical help to save his life by applying for Medicare. I'd guess the qualifications for participating in a Medicaid system vary from state to state, so maybe some of these horror stories we hear wouldn't apply in most states.

hm, well, as I said, I just don't understand. And I don't understand what I don't understand.

You'll be busy with house moving now so probably don't have time to answer this.

Happy Homemaker UK said...

Hi Jenny, I knew such questions would arise; to cover it in a post would be quite muddling :) So much to say, and not being in the medical profession (just a previous translator), I am sure I won't explain something right. But here goes my best shot...

A 'General Hospital' is typically a big hospital in an urban area, not a nice private hospital that may be a Catholic hospital for example (I'm just generalizing). It is the hospital you would be taken to if you were shot while walking around downtown. They often serve our poorer population, and typically you would not wish to go there unless in an emergency (car accident, violent crime, etc). I don't know who owns the General Hospitals, but they certainly get a lot of funding from the government through the patients.

The government would cover the emergency care for migrant workers because generally they do not have insurance. Part of the reason employers like to employ migrant workers is so they don't have to pay for their insurance, thus saving money.

Also, migrant workers would not be on Medicaid because they are typically in the US illegally and would not want the government to know they are there. They would be more of an 'uninsured walk in' patient (my words), but not on a particular medical program. I would guess they often give a false name when they check in at triage.

Employers don't have to pay for insurance if you are employed part time (fewer than 30 hr/wk, I believe), so this creates a population that is employed but not insured. In an emergency situation, the government pays for the medical bills of the uninsured but not for prolonged critical care (such as cancer treatments) or treatments deemed not necessary. There are religious organizations and non-profit organizations that provide routine check-ups in some cities for the uninsured at a nominal fee (mostly funded by outside donations).

Those who work part-time, self-employed, or work under contract would not qualify for Medicaid for they make too much money. Yet they have no employer to help pay for the insurance costs. Personally paying for insurance without the help of an employer can be cost prohibitive, especially if you have a family - employers often pay for insurance for the whole family. This is the majority of the folks who are uninsured - many of them work but earn too much to qualify for Medicaid but not enough to pay for insurance without the help of an employer. I remember being laid off ('made redundant') when I was still single; I paid for my own insurance for a time being and it was really expensive.

Also, some insurance companies will not cover employees with pre-existing conditions, but this varies on the employer and insurance company they work with. Or if offered, the insurance costs a lot more.

Medicaid is medical treatment paid for by the government. One has to prove that they qualify based on no or low income, etc. (incl the homeless). Our pediatrician takes insured, uninsured and Medicaid patients - the doctor's office will bill the insurance company or Medicaid for services rendered. If one is uninsured, s/he would pay out of pocket after their visit.

I don't know about the care in the Deep South (southern states), but they are sadly known for having worse public services than the rest of the country (schools, doctors, etc). Statistically, it holds some of the poorest areas in the country.

I am not sure if I helped clarify anything - I write with an understanding of the system, so I don't know what you don't know :) Let me know what questions you may have. Now off to pack some more; thanks for the break :)

Now I have a question for you: There is a lot of attention given to the homeless in the US. Lots of dialog, nonprofit organizations helping, and donations given to that population. Yet in the UK, the focus tends to be on hospices over other groups. Why?