Healthcare: the patient's perspective

The healthcare debate in the United States is reaching its climax, with President Obama hoping to get a ground-breaking law approved by the end of the year.

Barack Obama wants to expand coverage to millions of people without health insurance but many in the US are opposed to the plan, and the debate is proving divisive.

This week Newshour is comparing the experiences of patients in the US and those in European countries.

Asthma

One of the most common childhood diseases is asthma, and five-year-old Megan from Virginia in the US is a sufferer.

Her father works for the state and his job provides health insurance for the family.

Megan's mother Susan Richards told the BBC's Claire Bolderson why the insurance doesn't cover all the costs.

Tanya Bortashevic lives in Vilnius in Lithuania and her nine-year-old son Alexander also suffers from asthma.

The healthcare system in Lithuania is similar to the national health service in Britain - free at the point of use and paid for through taxation.

Tanya Bortashevic is a Russian speaker and she told the BBC's James Coomarasamy about her son's care.

Heart disease

Healthcare is provided by the state in Italy, paid for through a mandatory contribution taken out of people's wages.

But there is also private care - some of it refunded by the state, some of it completely disconnected from the government.

Giorgio Sabbatini is a 68 year old retired electronic engineer who lives in Rome.

He has had a variety of experiences since having a heart valve replaced at a hospital in Paris nearly 30 years ago.

Winfred Bowen, known as Buzz, is a 70 year old from Indiana.

He is entitled to Medicare, the government-funded insurance scheme for senior citizens which covers basics but not everything he needs, so he buys additional insurance out of his own pocket.

Of course, there are many different insurance schemes, and many different combinations of coverage that people use in the US, but Buzz's remarkable story of survival provides an insight into what the very best of medical care can achieve.

His story starts in 1992, when he was slim, fit and had had no previous signs of illness.

Pregnancy

Alena Ciecko is a lawyer in Seattle who is pregnant with her first child.

Like most Americans who have insurance, Alena's is organised through her employer who pays the bulk of the premium.

Many American companies sign up to a Health Maintenance Organisation or HMO which has strict guidelines on which doctors and treatments can be used.

Alena spoke to the BBC's Claire Bolderson.

On the other side of the Atlantic, in Germany, there is a universal healthcare system based on mandatory health insurance.

For most, that means using the state insurance scheme though there are private ones as well, and it's paid for through a payroll tax split in most cases between employer and employee.

Pia Valerio de la Cruz is from Berlin, and is covered by this scheme.

She shared her experiences with the BBC's James Coomarasamy.

Breast cancer

The British National Health Service is founded on the principle that health care should be free to all at the point of use, and paid for through taxation.

However some in the UK opt for private insurance or buy private services for one-off health problems because of waiting times and restrictions on some kinds of care on the NHS.

Cathy Luton, from southern England, told James Coomarasamy her story.

Thirty-four year old Angela Walker in Chicago told Claire Bolderson how she discovered she had breast cancer.

Throughout the healthcare debate there have been mostly unfavourable references to European systems - and in Europe it's certainly the case that governments are grappling with providing ever more technologically advanced and expensive care.

Claire Bolderson brought together a panel of experts to discuss whether Europe and the US can learn something from each other.

Ruth Thorlby, is a fellow in health policy at the independent research organisation, the King's Fund in London.

Kenneth Thorpe in Atlanta, is Woodruff Professor and Chair of the Department of Health Policy and Management at Emory University's School of Public Health; he began by explaining the basic differences between the US and the mostly state run European systems.

First broadcast 15 December 2009