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Bill of health

  • Jon Kelly
  • 7 Oct 08, 06:27 AM GMT

NASHVILLE, TN: Beware when life imitates art. In 2007, Molly Secours was a successful film-maker who had just completed a documentary about Americans impoverished for want of health insurance.

Then doctors told her she had uterine cancer: now she too faced financial ruin.

"The financial stress was almost as bad as the diagnosis and the treatment," Molly, 45, grimaced.

Molly Secours "All the time I was thinking: how am I going to pay for this?"

Having spoken to so many patients left destitute by illness, Molly had made sure she was insured. But her policy - the best she could afford - had only covered 80% of her treatment costs. She was still faced with a bill of more than $40,000.

Unable to work as she underwent chemotherapy, Molly watched her credit card debts spiral upwards. She assumed she would lose her home, her car - all her material possessions.

But her friends came to the rescue. They organised a fundraising concert in her adopted home city of Nashville which, together with an internet appeal, raised some $30,000 - enough to keep the creditors at bay.

When I met her, Molly was back at work having just received an all-clear from her latest check-up. But she was on her way to a rally in support of healthcare reform: she desperately wanted Barack Obama to win the election and introduce a universal safety net.

Back in New Mexico, I encountered a story very similar to Molly's. After I blogged, I was struck by the polarization among readers' comments: back home in Britain, people often find it difficult to understand why Americans run their health service as they do. The fact that 47 million of them have no coverage seemed shocking to a country reared on the NHS.

Nashville seemed an ideal location to explore why Americans might feel otherwise. The city might be best known for its country music, but it can also claim to be the healthcare industry capital of the US.

Paul WrightPaul Wright offered a perspective on why so many support the system here. The 60-year-old could point to the fact that the United States spends far more per capita on health than any other country in the developed world.

Paul didn't want to see the system radically changed. The company he worked for, a commercial tyre firm, contributed to his insurance as part of his overall employment package. And here in America, he said, people had a duty to look out for themselves.

"I agree with John McCain on this one," he said.

"Here in the US, you can get treatment almost immediately if you need it. I've heard stories about people in Canada having to wait.

"At the end of the day, I think there does have to be personal responsibility."

It was a tough, uncompromising view of the world - but one in keeping with the American virtue of self-reliance.

Liberals and conservatives could argue about whether Molly or Paul's outlook best expressed the national ethos. But I wanted to hear the story from the sharp end of the health care system.

reginaReginald Coopwood Reginald Coopwood met me outside the Nashville's Metropolitian General Hospital, where he served as chief executive.

His was a difficult job, he told me. Here in Davidson County, he added, some 56,000 people - 10% of the population - had no health insurance. He expected the figure to rise as turmoil on the financial markets started trickling down.

"We're going to have more with people losing their jobs," he said.

"It's going to make the issue real for a lot of people."

He could be right. But whether either US presidential candidate will be able to overcome cultural hostility to universal healthcare isn't something I'd want to predict.

Comments

  • Comment number 1.

    As a native California who lives in England for the past ten years, I would rather go to healthcare in California than NHS here. NHS is not free, everyone pays in from paychecks. If everyone did that in U.S. then you wouldnt hear stories. Most did not want to be bothered to sign up for health insurance from their work or by themselves. NHS services is terrible, dirty and hard. One has to really know how the system works to get the services needed. I would rather go to St. Judes in Orange County in California where it is so clean and so professional in services.

  • Comment number 2.

    In theory, universal healthcare for Americans is a concept I would whole-heartedly embrace. My resistance to seeing the plan implemented in the US stems from cynicism and a complete lack of trust that our government could do it with any level of efficiency.

    Again, I'm not adverse to the idea. However, the government is very, very good at creating huge bureaucratic departments; government is very, very bad at making huge bureaucracies work efficiently and cost productive, an example being public education. Medicare also comes to mind as my retired parents are currently banging their heads against the wall with the inefficient running of that system.

    Too many people are, indeed, suffering for lack of healthcare. And the current situation in which many have healthcare but it only pays a percentage of cost is catastrophic to those with serious illness. My nephew is in his 2nd year of 5 years worth of treatments for childhood leukemia. We have a large extended family and like Molly's friends, our family gives financially to my nephew, as well as fundraisers being organized to help off-set the costs. We all do it willingly, because we love him, but honestly there SHOULD be a better system in place so that this doesn't have to happen. That a person should lose their home, income, etc simply due to an illness is criminal.

    Certainly we as Americans will need a lot of information on universal healthcare if the idea is to go forward. Extremely frustrating to me is the contradictory opinions from other countries. Canadians praise their health system, then sometimes cross the southern border for treatment of serious illness. Why? Americans cross the border for cheap drugs, but generally not for medical treatment. Does uni-healthcare dilute the quality? I don't know. Brits criticize Americans for lack of uni-healthcare, raising up the NHS as a standard we should follow (and perhaps we should), but visit a website on non-US topics and the Brits blog amongst themselves in a competition to see who can say NHS is the worst. Again, why? As I said, we would need a great deal of info before going forward. (I don't criticize Canada or UK for healthcare system, only using this to point out my uncertainty--or fear of the unknown, to put a fine point on it). The current health system is unacceptable in covering all Americans, true, but I fear the government has an uphill battle to sell a new idea and explain (other than it will cover everyone) how the quality of healthcare will remain high for everyone.

    If---and that is a big IF---our government could provide a plan that indeed covers all Americans in a health system that puts patients first, provides treatment for illness without diluting the quality, and can do it without inefficiency (slowing down doctor visits, treatment and accessibility) without sacrificing quality and creating a huge bureacratic nightmare for Congress to plunder and pillage and screw up, I would support it.

    Presently, I don't have that kind of trust that (a) Congress could pass a plan without pandering to themselves and keep special interests out of their pockets, and (b) the government system itself would run efficiently in the long by keeping taxmoney costs manageable in the long term while at the same time keep quality of healthcare high.
    And on a note that depresses me further, Obama has a healthcare plan, but now that we're financially strapped (to put it mildly) I doubt the money will be in the coffers to see the plan to fruition.

  • Comment number 3.

    I live in the US and am presently without medical insurance. My insurance, for me and my children, was discontinued when my husband died. We were given 30 days to find new coverage, but without his income and with the high cost of coverage, I was not able to afford it. We are one accident or illness away from losing everything. It is beyond disturbing. I believe that most Americans are uninformed with regards to universal coverage. The cost of NOT having universal health care is greater than most Americans realize, with loss of workforce, other governmental costs, and a strain on emergency rooms all taking their toll on the US pocketbook. As for not wanting to be "bothered" to sign up for healthcare, I would ask nativecalifornia to understand that most independent medical insurance policies are between $300 and $400 a month. If he can figure out a way for someone making $1400 a month and raising 3 children alone to pay that much, I am open to suggestions.

  • Comment number 4.

    The helath care situation in the US could be vastly improved without the need to resort to a socialized NHS solution.

    1. Expand Medicare so that all Americans are eligible. Those under retirement age would be charged a premium; the premium (and the payroll taxes which are meant to "pre-pay" the premiums for retirees) should be calculated by actuaries so that what an average person pays over a lifetime will cover an average person's lifetime cost.

    2. Medicare Supplemental policies ("Medigap") would also be available to all Americans, without any exclusions for pre-existing conditions. The premiums for these would be uniform across all age ranges (though they might vary by state to reflect local costs).

    3. Instead of employers providing health insurance to their employees, the value of this benefit would be converted into vouchers which could be used to cover some or all of the costs of Medicare and Medigap premiums for themselves and family members.

    4. Establish some sort of means-tested program to provide vouchers for those who are unemployed or minimally employed. This is the specific step that will eliminate the phenomenon of people without health insurance.

    5. To encourage insurers to offer the Medigap policies to everyone at a single rate, establish some sort of government-sponsored re-insurance or stop-loss cover; this will eliminate the problem of adverse selection.

    This approach would keep government out of the business of actually delivering health care services, and would provide people with maximum free choice with regard to selection of health care provider. It should be viewed as an inherently fair solution. It leaves room for existing health insurers to continue to operate by offering Medigap policies. It does not require those few who presently have generous health insurance cover from their employers to give up anything. Job changing or job losses need no longer be the dangerous prospects that they are at present. It probably would require some additional expenditure. On the other hand, by putting the entire population on a single-payer Medicare plan, there are undoubtedly considerable economies that could be achieved, and these could offset part of the additional costs.

  • Comment number 5.

    PBS had a very good program that looked at the systems used in Germany, Japan, and Hong Kong (IIRC). All had their good and bad points, but all covered the entire population without bankrupting the government or taxpayers. It is possible, it just isn't popular with the insurance and pharmecutical industries since it would curb their profits.

  • Comment number 6.

    kateoneal #3

    No longer is nominal insurance available a 3 or 4 hundred with children,.. try 1200 or better.

    I as well have a healthcare situation, and I'm insured with Blue Cross-Blue Shield through my wife policy from her employer. The monthly expense for the insurance (for me on her policy) is better than six hundred dollars a month. It would be higher but I have a three thousand major medical deductable, paying only 70% of any cost above three thousand dollars.

    A simple hernia, day surgery, estimated at three thousnd seventy dollars from one provider so far, would all be out of pocket even with insurance. So I still have the hernia and will for a while as I'm currently unemployed.

    I have always thought the system here was good, because as a union carpenter in Nevada/California while my children were raised I enjoyed the best in all care. One hundred percent with no deductable on major or emergency medical, minor co-pay on other doctor office and dental visits.

    Now, I see the position from the other side. Here in Texas, being a 'right to work' state the union is non existant, pay scales are thirty percent lower, benifits for labor are non-existant, and the influx of Mexican labor in the trades have lowered the employers desire to 'hire white', as we expect/request more.

    I have no idea how to get help as I have to 'pay upfront' for services. I could put it on a credit card, but being unemployed that I can not do as our budget is that tight currently. As stated above StefanStackHouse in number 4, a system as such maybe our best bet.

  • Comment number 7.

    Say what you will about public health systems, but the fact remains that the US health care system is failing. I have a cousin who spent most of his career as an advertising executive with CBS radio. Four years ago he left his job to join a start up ad agency in partnership with several of his associates. It was an exciting opportunity for my cousin to help build a business that had great prospects for success. Unfortunately, to save on costs the new company was unable to offer health benefits, and the cost of obtaining private health insurance for my cousin (he was in his late 50s) was prohibitive.

    A year after leaving his secure job with benefits he had a stroke. He drove himself to the hospital, but because he didn't have any health insurance the hospital staff refused to admit him. Instead they put him in a cab and sent him to Los Angeles County General where they take 'charity' cases. For this service the private hospital later billed my cousin $7,000. Once at the county hospital my cousin was placed on a gurney and rolled out into an attached parking garage, where he was left for 13 hours. During that time he received no medical attention, and was pretty much left to die. When he proved to be tougher than the doctors figured (he's a former Marine who saw combat in Vietnam) they brought him back into the hospital the next morning, and finally received an operation to stop the bleeding in his brain that had brought on the stroke.

    The manner in which my cousin was treated by what we are told is the 'best' health care system in the world fully illustrates the lies told to the American public. Our system is substandard in every way and is failing the American people. When you have to make a choice between getting medical treatment or being able to keep your home the system has in fact already failed. The gentleman who criticized the British NHS while comparing it to his fond memories of medical facilities in Southern California may want to factor in one thing: The way things are in the US today he would most likely not be allowed to set foot in that nice clean facility, unless he could pay the price of admission.

    As a postscript, my cousin did recover from his stroke, although he had to undergo more than two years of intensive physical therapy. Despite being a military veteran he was required to pay out over $400,000 for his treatment from his own pocket (thanks to Bush's cuts in benefits for veterans), most of which he obtained by selling his interest in the startup he was working for. He went back to work for another company at a much lower level, but with health benefits. And he learned a valuable lesson: Better to have a mediocre job with no real future, but with health benefits, than to take a chance on starting a company of your own and risk having it all taken away from you should you fall ill. That is the reality of the 'American Dream' in the US today.

  • Comment number 8.

    The idea that people "can't be bothered" to sign up for insurance is absurd. I am sure that there are instances however, where people are overwhelmed and do not understand what is involved in the plan information that they are reading. I would love to be able to step out on my own business wise but that will never happen in the current environment. I was diagnosed with an aggressive breast cancer at age 38 with no family history. I had surgeries, chemo, radiation and medication and am doing well but there is not an insurance company around that would offer me coverage at any type of reasonable price. I am taking medication every day for at least five years (femara) that without insurance is $381 per month. And I am one of the lucky ones. We need a single payer plan and we need it soon because I am not alone.

  • Comment number 9.

    Looking out for yourself is a fine American sentiment which makes sense on a more or less level playing field. However, if the game has been rigged so that a relatively small percentage of the population controls most of the wealth, while most people are struggling to make ends meet, then the people do not have the means to look after themselves.

  • Comment number 10.

    It definitely is a mess, and no one, patient, hospital, physician, employer, political leader--is happy about it.

    So, given the range of highly imperfect choices, I still hope we will steer away from handing over the health care provision in this nation to the government that also brought us Social Security (bankrupt), Fannie and Freddie, the SEC, Department of Homeland Security, the list goes on....These folks don't deserve our trust!

    And this is not about one party or the other at this point, rather about deciding what path we can choose that will provide the best options for the most people with least economic disruption for everyone. I don't think, given the fluidity of our population, and size of the country, that we will ever be able to cover everyone. But we should try to get as close to it as we can, and practice old-fashioned charitable generosity for the rest.

    I still think that the marketplace, if allowed to work (with morally upright people in leadership), can deliver the goods. We've seen real progress already, with WalMart offering a substantial menu of prescriptions for rock-bottom prices, and the competition attempting to keep up. We've seen clinics open up in pharmacies, so that head colds can be treated before they become ear infections or bronchitis or worse.

    And I am in total sympathy with these stories. We are a lucky family, with good health insurance that we are able to purchase. But I'm meeting with my agent today to decide if we will be able to maintain our current level of coverage at reasonable price.

  • Comment number 11.

    re. 2:tiptoplisamich

    I hear the argument about government inefficiency a lot in the health care debate, and the facts really don't support that contention. The US already has a form of public health insurance called Medicare. Over a 30 year period, Medicare has actually done a slightly better job of containing costs than private health insurance plans:

    http://content.healthaffairs.org/cgi/content/full/22/2/230

    So if, as StefanStackhouse suggests, we simply expanded Medicare to cover all citizens, most people would at least be no worse off than if they had private insurance now. And the country as a whole might be better off, since the un-insured and under-insured would be in the plan and would be receiving preventive care, which would help keep costs down.

    Remember, we're not talking about public health care, just public insurance.

    There is also a general fear of government bureaucracy in the health care system. Has no one ever gotten into a dispute with an insurance company over coverage, or with a health care provider over a bill? Does anyone really think that private insurers or physicians' practices are inherently easier to deal with than a public insurance system would be?

    Once, after surgery, the office of the anesthesiologist who participated in my surgery billed the wrong insurance company for my care. It was, of course, refused. Even after I contacted them and pointed out their error, the doctor's office sent a bill collection agency after me rather than wait for the proper insurer to process the claim. It was a year after the surgery before all of the bills and claims were settled. I'm sure everyone knows of a story like that. Does anyone really think the government would be worse?

    Also, remember that private insurance plans are businesses that rely on the credit markets just like any other business. Our health insurance currently depends on those companies staying healthy. If the financial meltdown continues, we could see private health insurance plans going under the way AIG did. And where would our health care go then? Wouldn't a national plan be safer?

  • Comment number 12.

    As a worker in a very small business (under 10 people), I thank God and the hardworking business owners for my health insurance. I know very well the value of it, as I speak daily with the immigrant janitor, who is often struck by extreme tooth pain as he cannot afford to go to the dentist. I do believe everyone should have health insurance. However, I do not want to lose the competitiveness of the system, because if I do not like a doctor, I can "shop around" for another. But most of all, I want to avoid having to pay for the millions of obese Americans (and those who participate in sexually risky behavior, for that matter) who refuse to take personal responsibility for thier health. Surely there is a way for all to be covered without me having to pay for other peoples' stupidity.

  • Comment number 13.

    Welcome to Nashville Jon. Looks like you brought the good ole British rain with you today. You seem to have left out few things here. Tennessee has a program for people to acquire health care at a low cost, it also has TennCare(which is terrible) for children. Anyone can go to a hospital at any time here and receive treatment, regardless of it the do or do not have insurance. There are many of the "transplants" as listed above. People here look out for each other. Self reliance does not mean that other people will not assist you in times of need. That is a benefit of living in a place with a strong faith and values base like Nashville. If you look around you will see a city growing, and not dying, built on conservative values and faith(of any kind). We also have the largest population of Ethnic Kurds in America. So faith does not mean just Christianity. Nashville would be a great shock for many of your European readers, and a dramatic disappointment for those who decry the fall of the free market. (P.S. Everyone around you owns a gun. Do you feel unsafe today?) Enjoy your stay.

  • Comment number 14.

    re. 10: OldSouth

  • Comment number 15.

    Let's try again.

    re. 11: Old South:

    "I still hope we will steer away from handing over the health care provision in this nation to the government that also brought us Social Security (bankrupt), Fannie and Freddie, the SEC, Department of Homeland Security, the list goes on....These folks don't deserve our trust!"

    Except for Social Security, most of those government problems can be laid at the door of the Bush administration: its ineptitude and its policy of lax enforcement and oversight. And if the Bush administration had prevailed in its plan to privatize Social Security, a lot of retirees would be in a pretty pickle right now. Social Security isn't bankrupt, by the way. Lehmann Brothers is bankrupt. Social Security has a cash flow problem a couple of decades down the road that we can still deal with if we adopt sensible measures.

  • Comment number 16.

    I found a link to the PBS Frontline episode. It is veiwable online.

    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

    Fascinating stuff and food for thought.

  • Comment number 17.

    Regarding #3 comment: Have you tried to access Medicaid for your children? At your income level with three children, they should at least be able to qualify for free or low cost medical insurance.

    No one in this country should feel put off about applying for any sort of aid, especially a widow with three children.

    Good luck and best wishes.

  • Comment number 18.

    I don't think the NHS is quite as bad as our Californian friend makes out. It has its faults, and waiting lists, but at the end of the day you can generally get what is needed from (normally) caring staff. Or such has been my experience anyway. As a private sector businessperson, I'd definitely like to see it run more efficiently - i.e. if doctors would start their clinics on time, they might stand a chance of taking the rest of their patients on time! However, I digress...
    Self-sufficiency is all very well as an ideal, but public healthcare plans aren't necessarily just about making it easier for those among us who don't work, indulge in risky lifestyles and then sponge off the system that the rest of us pay for (which is something of a fear among these bloggers, and among most normal working people). The fact is, very few of us can cope when faced with huge bills because of a very grave illness / injury. As with Ms Secours, indeed. So I personally think it is good to know that there is something to fall back on, and while the NHS could use some improvements, and I might choose private treatment if I could afford it, I certainly wouldn't abolish it.
    Also, I know what health insurance policies cost, and how many people have been paying through the nose for years, only to find that when they do need healthcare, they're not covered for the specific treatment they require! Again, even Ms Secours' policy only covered 80%.
    So, as a great-aunt once advised me, you'd be far better just starting up a separate savings account on your own and paying into it every month, and then if the day comes when you are ill or injured, use it for what is needed.
    Although that was perhap better advice back then when banks weren't collapsing all around us...!
    Ciao.

  • Comment number 19.

    re. 12. dixcat2:

    "Surely there is a way for all to be covered without me having to pay for other peoples' stupidity."

    How do you feel about covering smokers, or people who eat a lot of red meat and not enough vegetables? Or people who drink too much? Or people who drive too fast or skydive? Or women who have too many babies too frequently? Or children whose parents refuse to have them immunized to childhood diseases? There's a long list of possible risky behaviors. We can't exclude them all.

    If you have private health insurance, you're already paying for the care of people who refuse to take responsibility for their health. That's how insurance premiums are set. The insurance company figures out what it is likely to have to pay out in health care costs and sets the rates to cover that amount plus a profit. If it's a group plan, your rates are in part determined by the health care costs of the people you work with.

    HMO and PPO health insurance plans usually offer workshops and other incentives to get people to stop smoking and lose weight. There's no reason why a government-sponsored health insurance plan couldn't do the same.

  • Comment number 20.

    timohio#11:

    I just got off the phone with insurance company vs. doctor's office, the former denying payment for routine service because the latter didn't provide correct information on the claim. Of course the latter claims it's the insurance company's fault. I'm just the lemming stuck in the middle---ARRGGHH!
    So, I sat down and read your comment and thought to myself, regarding medicare being no worse than what exists now, you have an excellent point regarding efficiency.
    What I need to do now is find information on how quality of care would be affected (private insurance programs vs. government program).
    Thanks for your perspective.

  • Comment number 21.

    "It was a tough, uncompromising view of the world - but one in keeping with the American virtue of self-reliance."

    John, forgive me but you act as if responsibility for one's self and one's actions is a unique "American" virtue. It most certainly is not! Universal health care is not a way to quash self-responsibility, it is to give all people the "right" to health! As every other nation on earth has - ashaimidly - done already! Some "trale blazors" we are, huh?

    If you don't believe me on the self responsibility being a universal value/virtue, just read or watch Cameron's speech to the Tory confrence last week! Its chock full of refferences and schpeals on "responsibility!"

    In fact that is practically Cameron's slogon!

  • Comment number 22.

    As regards whether you wish to predict if either Obama or McCain can help the American people overcome their reservations and hostilities toward universal health care, McCain doesn't want it, so that's really just a challenge for Obama.

  • Comment number 23.

    re. 20. tiptoplisamich:

    Ouch! It's no fun to be in the middle of a dispute like that. And you've been paying in good faith for your insurance all along! Good luck.

    What happens after a while with private doctors and private health insurance is that doctors learn how to game the system; how to write up treatment orders or lab orders so the insurance companies will honor them. My doctor does that with annual PSA tests. My father died of prostate cancer, so I'm in a higher risk group. But she uses a different reason on the lab form so they will pay for the tests. Good physicians do things like that to look out for their patients.

    As far as quality of care goes, if it's the same health care delivery system that we now have and only a different way of paying for it, there should be no difference for the patient. We have a good health care delivery system in the US; our problem is with access to that system, caused by uneven insurance coverage.

    What I suspect will happen is that a modest form of universal health insurance will be enacted. Employers will little by little opt out of private coverage, forcing more people into the public system. That will create pressure for the government insurance to be better and more comprehensive, thus gradually moving even more employees into the public program. We'll end up nationalizing health insurance in slow motion. It may take a generation.

  • Comment number 24.

    "And here in America, he said, people had a duty to look out for themselves."

    Re: Post #13. "People here look out for each other. Self reliance does not mean that other people will not assist you in times of need. That is a benefit of living in a place with a strong faith and values base like Nashville."

    Good ol Christian fundamentalism and classic good ol southern US straight talk. Huh? Next time the good ol south gets hit with a hurricane or floods why don't you kindly send the money back to Uncle Sam. While you are at it, let's rip apart the TVA and other federal infrastructure projects that were created and helped lift Tennessee out of dire poverty.

    The real issue is that millions of people like me in more liberal areas of the country, completely and fundamentally disagree with this philosophy of relying on handouts when you hit a really bad patch. It's why this country will end up breaking apart.

    We probably don't belong in the same country. I, and many others like me up north, sometimes wonder how different a country we would be if we weren't stuck to the south and it's crazy religious and anti-government beliefs.

    The philosophy or culture of "scoth-irish" (many white southerners) hatred and dis-trust of government does not jive with the majority of folks in blue states. Jon, you've been spending way too much time in the south. How bout the viewpoints of millions of people up north?

  • Comment number 25.

    As a physician, I agree we have many problems with our healthcare system. I hate seeing patients present to the emergency department for illnesses that could have been prevented with proper treatment.

    However, I do feel that some patients are responsible for their own ailments. For the businessman who opens a small business but decides to forego insurance despite his $50,000 per year salary, then I believe he should be responsible for the bill that he incurs for his elective deferral of purchasing insurance.

    For the person who is living off $14,000 per year and cannot afford insurance, he or she should receive government support to help purchase insurance.

    Personally I believe that our health system is best served by non-profit insurance companies and non-profit hospitals. The idea of someone making a profit off someone's illness baffles my mind. Insurance companies are motivated to keep profits high for their investors, so that leads to ever increasing premiums and decreasing reimbursements.

    People may think that Medicare is an ideal model, but I can assure you it's not. Many physicians no longer take new Medicare patients and some are turning away existing ones because the reimbursement rates are so low. Yes, physicians may be reimbursed decent amounts when the public looks at their reimbursements, but when office staff, building leases, and other costs are added in, the physician's salary is actually less now than what it was during the 1980's. Many physicians cannot afford the salary cuts due to quarter million dollar loans that financed their medical school training.

    Finally, I would like to comment on the issue of a stroke patient being dumped to another hospital. I find it very hard to believe that a patient was left unattended in a parking lot, more so than finding it unbelievable that a hemorrhagic stroke patient was dumped to another facility. This is a direct violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), which levies hefty fines against hospitals and physicians for this sort of action.

    My colleagues and I deal with many uninsured patients in our emergency departments we staff. I have yet to see a patient not treated for inability to pay. I never look at their insurance status, and only ask about it when I go to discharge a patient with a prescription for an expensive medicine to see if there are alternatives to try if they do not have insurance that provides prescription benefits. I've never seen a hospitalist or surgeon refuse to admit a patient because of inability to pay.

    Nonetheless, we still need drastic changes in our healthcare system. As mentioned earlier, I believe non-profit insurance companies and non-profit hospitals are the best way to deliver healthcare in our country. Eliminating profit motives provides better care.

  • Comment number 26.

    I suspect the Americans who have a Cultural Resistance to Universal Healthcare care are the ones who have never had a serious illness -yet. In America most people are only a major illness away from financial ruin.That just isn't the case here.

    For all it's faults the UK's National Health Service is our greatest achievement and opinion polls regularly rate it as our most popular institution.Americans might do well to ask why this is so.As they would say themselves - "go figure".

  • Comment number 27.

    Does anyone know how many Brits have private health insurance? I bet it's staggering. I can't criticize your health system because it's better than nothing, but I don't think the American people would want it the way it is. Although your system is (free?), I don't think it is as good as here.

  • Comment number 28.

    #21 NoRashDecisions

    You're right, CAMERON'S slogan.

    P.S. Put your ego away, it's unattractive.

  • Comment number 29.

    "As a private sector businessperson, I'd definitely like to see it run more efficiently - i.e. if doctors would start their clinics on time, they might stand a chance of taking the rest of their patients on time!"

    Which sums up the problem with letting private businessmen run the NHS. My dad is a senior cancer surgeon. If he starts his clinics late is usually because his operating list has overun. Oddly you cannot calculate how long it takes to remove a brain tumour to the minute. Equally the usual cause of delays in the clinics themselves are patients arriving late. Do you suggest a patient is refused treatment because they couldn't find a parking space or got lost in the hospital?

  • Comment number 30.

    #27. Most Brits don't have health insurance because there's no point. Our private healthcare providers don't provide emergency services (ER) and subcontract major surgery , cancer treatment or cardiac back to the NHS. All your private health insurance gets you is a private room and better food while you recover. Private hospitals are no cleaner than NHS because both use the same cleaning contractors and both clean to a budget. BUPA is good for sports injuries but thats about it. Even for minor ops if it goes wrong in theatre they call an ambulance and send you to an NHS hospital to save your life.

  • Comment number 31.

    #28 Peter-Sym

    You must save you're comments because I have read this before.
    No recycling please. If you have nothing new to say then go to another site.

  • Comment number 32.

    #31. Comment 28 isn't mine. If I've said the other two before then its in response to the same garbage about private healthcare being so great being posted repeatedly too.

    In any case who made you a moderator with the right to ask me to post elsewhere? I pay for this site through my licence fee. As an american you don't.

  • Comment number 33.

    re. 25: southerndoc

    I understand that there are different levels of income for different specialties among physicians, but according to salary surveys, the lowest-paid US physician makes twice what I make, and it goes way up from there:

    http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

    I wonder if most physicians realize how highly paid they are compared to the rest of the population.

    I do understand about medical school tuition loans. I worked my way through graduate school to avoid those kind of loans. Which was wise because I'm making a non-profit salary. I wonder if physicians would be willing to forgo their high salaries in exchange for government support in medical school. Some do; there are physicians who go into the military after residency to pay the government back for their tuition. But would most be willing to make that kind of a tradeoff?

    And your response to 7. secdjr's story about his cousin is surprising. Since it is his cousin, he must have the basic story correct, even if there is some exaggeration. There was a recent case of a woman dying in a waiting room in a New York hospital and not attended to for over an hour after she died:

    http://www.cnn.com/2008/US/07/01/waiting.room.death/

    And there was this case of a patient dying in a North Carolina hospital after being left unattended for nearly a day:

    http://blogs.usatoday.com/ondeadline/2008/08/mental-patient.html

    You and your colleagues may not do things like that, and it may not happen in your hospital, but it happens.

  • Comment number 34.

    When I lived in the UK I had supplemental private insurance with BUPA paid for by my company. I never had to wait for treatment. In the US I have found that my wait times for treatment have increased compared to the wait times I experienced in the UK.

    A common misconception amongst Americans is that nationalised health cover is all or nothing. Hybrid solutions are rarely discussed. Many opinions here concerning nationalised healthcare are based on the worst cases and loudest voices of protest regarding nationalised healthcare in other countries and is rarely a balanced view.


  • Comment number 35.

    I've experienced NHS care, first as a child in the late 1960's, and again as an adult on holiday in 2004 (I had an unexpected bout of asthma). I have absolutely no complaints about the NHS, or at least none I wouldn't have with health care anywhere in the world.

    I'm a US citizen, a veteran of the US Army, and use the Veterans Affairs health care system here. It's as close to the NHS as you can get, and I happen to think it's a good deal better than the "private" health care system I used prior to military service. I know that non-urgent surgeries and procedures have a long wait list both in the UK and in the VA health system, but I don't see anything particularly wrong with that. As painful as an arthritic knee or hip might be, it's not a life or death condition. I had to wait close to a year for outpatient surgery for a chronic condition. Considering I'd been battling (and living with) that condition for 20 years, an extra year wasn't all that long to wait.

    I've had excellent emergency care from both the NHS and the VA system: the evaluation and treatments were appropriate, thorough, and the results were far better than the usual outcomes at non-government facilities.

    The other advantage I've noticed in government health care facilities is the emphasis on preventative care. Both the NHS and the VA actively monitor patients and try to stop or manage health problems before they become the sort of problems that require expensive, extensive medical interventions and hospitalisations.

    If my experiences are in any way representative, then I don't know why anyone would object to nationalised health care. It's simply better overall. It suits my needs perfectly.

  • Comment number 36.

    Peter Sym #29- my father is a doctor, as are two of my cousins and one of my best friends, my mother is a nurse, and my sister is a speech therapist, so you'll understand that I also have experience from both sides of the picture here. I am not some all-knowing patronising businessperson who thinks they can fix the world's problems singlehandedly. Even these friends and family members will admit to the faults of the NHS which employs them.

    I would never say anything so crass about the length of time it takes someone to remove a brain tumour, but I do know that when I recently went to an eye clinic, I was taken 1 3/4 hours late. And at my next appointment, I was first in the day and I was taken 20 minutes late, after the doctor walked in at 9.20. I would never get away with that kind of inefficiency in my job, so that's what I meant by my earlier comment - there is undoubtedly room for improvement, there are undoubtedly things that could be fixed with a different attitude, and those things could make all the difference to some patients.

    However, as I said earlier, I would never abolish the NHS, and am even quite happy, for now anyway, to rely on it. I think it's infinitely preferable to the US system, of which I also have some experience. And I also believe that the vast majority of health professionals are caring and hard-working, doing their best within the constraints that they have.

    #27 many normal people in the UK don't have health insurance unless it's a work-related bonus. Certainly very few of my friends and relatives have it, and I don't myself. For the reasons I mentioned before - you have to pay a fortune per month to get any decent sort of cover, and then, when you need it, chances are you'll find you're not covered for the particular problem that you have.

    The hybrid solution that #34 mentions is probably the ideal, but while health insurance costs are so high, I'd say that the majority of us normal working people will stick with the NHS, knowing that, for all its faults, at least we're not completely abandoned in our hour of need.

  • Comment number 37.

    #36, As the daughter of a small-town family doc in the US, I have seen some of the other side of doctors running late. My father is a very thorough doctor, and 15 or 20 minute slots are not enough for him to cover all of the ground he needs to to get a real picture of what is going on in the patient's life. It is not unusual for him to run an hour behind, because he is so thorough. And patients keep coming back (even though I say small-town, he has only had a practice there for 10 years in the local clinic -- not very long for the town in question; so it is not even as if it is that people do not want to offend him).

    #23, My father trys to do the same sort of things to avoid giving people meds that insurance doesn't cover. This often means prescribing generics rather than brand names... sometimes that doesn't make any difference, sometimes it does not work quite as well. Sometimes it is a matter of giving people some samples given to the clinic by the drug companies.

    #33, I think that most of them do know that they earn a lot. And boy are you right about differences in pay. The family docs are at the bottom of the pay and respect scale -- despite the fact that they should be the preventative care people.

  • Comment number 38.

    #36. Did you ask why the doctor was late? Most docs start at 8am... perhaps some kid was brought in with a nail sticking out of their eye or a junior doctor paged him/her to ask what to do with a patient who'd taken a turn for the worst. Equally rather than blame the doctors try and blame the hospital admin... my dad was delayed for 2 hours after the private car parking company clamped his car when he parked in a patients spot (no space in the staff car park). As he has to work between several different hospitals this had a massive knock on effect on his schedule for the next couple of days.

    The only way you can allow doctors to run to time is to have huge free periods in their schedules to allow for catch up time and that would be the greatest inefficiecny of all. Waiting 20 minutes is hardly a massive price to pay for free medical treatment.

  • Comment number 39.

    As a doctor living and working in Bulgaria, I cannot believe that a routine treatment could be so expensive. We are the poorest country in EU but we have universal health care based on single Health Insurance Fund (NHIF). May be our hospitals does not meet high US standards but even small municipality hospitals can provide good medical care. Treatment for this particular disease - uterine cancer (diagnosis, operation and chemotherapy) world be around 1550 BGN ( 1083 $), paid by NHIF, her personnel bill – 44 BGN (31$). She also could take up to 6 month sick days, paid by National Social Security Institute (80 % of her salary for all sick days), followed by pension if necessary. Btw, administrative costs of Bulgarian NHIF, are about 3% of the expenditures (in US HMO – 30%). There are no queues in hospitals and medical centers . Example – if you get a referral from your GP, You can visit cardiologist, ENT, neurologist, ophthalmologist the same or next day. There is a problems of course, the average salary in Bulgaria is 450 BGN (315$) per month (unofficially is higher). Doctor’s salary is between 800 and 2000 BGN (560 – 1400 $) per month.

  • Comment number 40.

    Sorry for my bad English, I wrote “her personnel bill” in #39, actually I ment something like copayment or out-of-pocket expenses. It is a fee for hospital treatment, 4.4 BGN (3.1 $) per day, but only for the first 10 days . You don’t have to pay if treatment is longer than 10 days.

  • Comment number 41.

    teh4125 wrote:

    "I and many others like me up north sometimes wonder how different a country we would be if we weren't stuck to the south and it's crazy religious and anti-government beliefs."

    teh4125 - you are ignorant of the South and it's people. Just because someone is a Christian does not mean that he or she is a fundamentalist or stupid.

    Please state your opinions without insulting others, and please be tolerant of people who are different from you.

  • Comment number 42.

    I live in Northern Virginia, very close to Washington, D.C.

    I was a Navy wife when I first got married and I was horrified at kind of treatment we got in the military. My sister was also a Navy wife, and recived a botched c-section that the Navy medical refused to fix, calling it cosmetic surgery. It was so horrible that she didn't heal on one side for a whole year and when they got out of the military, she had another doctor go in and try to fix it. She can no longer have any more children as a result.

    For this reason I am very weary of the government taking over medical. At the same time, something absolutly has to be done.

    The biggest question I want answered is why people have to find a job with medical insurance instead of being able to aford it on our own. Why does good coverage have to be attached to a job to be afordable. Everyone in the US should be able to purchase afordable medical insurance regardless of their job.

    And why do insurance companies get a discount that we regular folks don't get? Why are my retired parents paying $1500 a month for medical and I am paying $400 because mine is attached to a company?

    And why, when you go to the hospital are you charged $5 for an aspirn, when you could have bought a whole box for that amount?

    How come a hospital birth here in the US has the highest mother and infant mortality rate in the industrialized world and we are paying $1800 for it, when better care from the midwife I used her in DC costs $4000 out of pocket for the whole 9 months of care?

    WHY ARE WE BEING CHARGED SO MUCH!? AND WHO IS THE GREEDY SOB THAT'S GETTING IT ALL?

    I am not sure what the answer to our medical crisis is, but going to government healthcare might be just another kind of bad. Maybe someware inbetween is the best of possible solutions.

  • Comment number 43.

    A perfect health system does not exist. As a Canadian living in U.S., I know there are flaws in the Canadian system. But with so many Americans not having any health insurance at all (even basic preventative care, which is more important), is something that should embarrass one of the most powerful countries on this planet. Yes, we can send people to the moon. No, we cannot provide health care for everyone.

  • Comment number 44.

    Heh, heh. These "Americans."

    They can provide trillions of dollars to invade, destroy, loot, murder, maim, poison other countries, spend another another 750 billions to bail out and reward it's corrupted corporate crooks and yet, they cannot afford health care for millions of children, women, the aged and the sick.

    Ironically, they have political corrected another term for murdering women, children and other innocent victims. It's called "collateral" damages.

    Yet, it not enough, they want the Palin-McCain twosome in power.

    It can now be said without reservation that America's children have become "collateral" damages for the Palin-McCain ticket!



  • Comment number 45.

    Many people may complain about the NHS but the service I have received has been good.
    What I would like to point out to detractor of the British health care is that the average Briton is taller than the average American and the Briton lives an average of 5 years more than the Americans.
    This was not always the case. When I was at School in the 70s it was accepted the Americans were taller than us British.
    The British NHS has improved in recent years, though that is not say it perfect. No system is.
    However one thing we do not worry about is paying of health insurance. There are alternative ways to provide Health care but the idea that in the 21st century it can be acceptable for a rich country not to provide high quality health care to all is an anathema.
    There for do your selfs and your image a favour - challenge the vested interests and insist on universal health care

  • Comment number 46.

    to: #45

    And you could also add that the USA ranks first in infant diseases and deaths among the world's industrialized nations and even among some third world countries.

    It make one want to believe the reason why so many young women in the USA would rather abort their child than having them being born in a nation which place health last on it's children!

  • Comment number 47.

    It's Funny that some people say you will be accepted and taken in immediately when arriving to a hospital with conditions (In USA) and that they find it hard to believe that someone would be left in a parking lot.

    have you not heard the recent stories where two people have died- one in L.A the other in NY, while in a waiting Room at a hospital?

    One of these women was there for 24 hours before she died.
    The other was dying- bleeding to death, and people inside the hospital were calling 911 because they were terrified.

    Then there are those sent away to other hospitals because they don't take non-insured persons.

    Our system is broken! If you have money, and never have to worry about anything ever going wrong, then yes, you are fine. But if you are like me, and make poverty level wages, even with a BA, then you worry.

  • Comment number 48.

    People spend their time and money exactly the way that they want to. Having said that what single person or family with children would forfeit their health intentionally? No, no one is going to make that choice. The health system here in the US is simply harrowing to middle and working class people.

    I have a similar experience to an earlier poster. I had a cousin who was a veteran of Vietnam who was killed in 1990 as a result (partly)of hospital negligence. My cousin suffered from severe seizures and he was taken to a hospital in NYC. He had a head injury as a result of the siezure but sat on a strecher in a emergency room waiting area without being seen for over 48 hrs. He was disoriented, angry and decided to walk home with a hospital gown on and with out shoes. He was attacked by a gang and beaten to death.

    I agree that you don't get something for nothing so we as Americans must decide to either pay on the front end or the back end. No matter what health care cost for everyone, I would perosnally trade some of my disposable income for peace of mind about my health and the health of my family and neighbors. I'm talking about higher taxes here.

    I've been more engaged in this election than in any political event in my life time. One thing I can't stand is the deceit and double speak from each side. McCain seems to be targeting the low information voter when he talks about the evils of goverment run health care. The people in the crowd booing are likely working class "joe six packs" and waffle house waitresses who would be bankrupt if they had a serious illness, get fired if they miss a few days from work because of sickness, or pay huge deductibles for regular doctor's visits. The people who need it most basically. These are good people who get pushed to the side year after year based on political lies. ( Note: just because he says my friends does'nt mean you are actually his friend)As long as people stay brainwashed and complacent with status quo they will never be able to stand up for basic rights like health care. I'm paraphrasing but C.S Lewis in the last book of the Narnia series "The Last Battle"wrote that deceit was a lie with some truth mixed in it to make the lie stronger.

    Obama seems to be on the right track but as long as the healthcare system is run by the pharmacuetical companies for big PROFITS we can't be secure. I don't think people's health is for sale. Universal single payor health care is the only way. Like I said people spend their money the way they like on what is important to them. We were tricked into the trillion dollar Iraq war, lied to most of the way. We could have had healthcare for every American. But we flushed that money right down the Potomac. The whole time the Right talked about taking personal responsiblity,cutting programs for the poor, right to work, ownership, smaller goverment..look the results of their hypocrisy...at the stock market in the last month. The big boys are getting bailed out, no personal responsiblity there, nothing but handouts (massages and facials with tax payor money!!!). Why should'nt the goverment step up and help families at a time when we will need it the most.

    After all if your healthcare comes from your job and there is massive unemployment, or loss of benefits at your job beacuse the company can no longer afford it, not only the poor but everyone in between will be affected.

  • Comment number 49.

    I should note that I don't think government is supposed to fix all of our problems. Maybe if people got to choose their doctor or stay with a trusted family doctor, like Congressman John Conyers of Michigans's health plan people would feel comfortable with the transition....

    just thinking

 

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