British vs. American Healthcare

A friend of mine asked me to compare and contrast British versus American health care, as part of some ongoing discussions she's been having with some frightened Americans who are worried about health care reform. Given my various comments on this topic in the past, I thought that here on my blog was as good a place as any to give my point of view.

I lived in England until the age of 26. During this time I never saw a bill for health care. At point of service everything is free. If you are 18-65, not a student and employed, you do have to pay $8 for prescriptions (regardless of their actual cost), unless you are poor. Other than that, everything else is free.

No one ever told me who to have as a doctor. In fact the town I grew up in various doctor practices got together and built a very large doctor building containing about 60 or so doctors, perhaps more. The particular practice I attended had maybe eight doctors. I could go and see any of them, or stick to my own GP. Wait time for my doctor was probably about 6-48 hours depending on demand. If it was urgent I could always see one of the other doctors the same day. A typical wait time from check in to sitting in front of a doctor was about 10-60 minutes. I do not recall ever waiting longer than an hour.

On the few occasions I went to the ER (known as Casualty), I (or the person I was taking there) was seen in less than 30 minutes typically. Again, by an actual doctor, not a PA or nurse. If any forms were required they were strictly medical questionnaires, and not related to billing.

Of the people I know who became seriously ill, they were admitted to hospital in a timely fashion, and were treated well. There are still hospitals where room sharing takes place, something I don't agree with. But there are private health care options in the UK that are run as non-profit organizations, and if you are a private patient, there is no room sharing, and you don't have to wait. The last company I worked for in the UK from 1997-2000 provided private medical coverage to all their staff for free, although I never had occasion to use it.

Now despite being British, I am not on any level trying to show bias or exaggerate the quality of British health care. I've been told it varies by region, and that poorer areas may not do as well as my personal experience. However, it has to be said that the priority there is health care and not profit. No one asks to see your insurance card. No one ends up bankrupt because they got sick.

I moved to America in 2000, and have watched as the quality of health care has gone down, and the cost gone up.

When I first arrived, my job provided pretty decent insurance, at a reasonable price. The wait times to see my GP were longer than the UK, but the care was good.

Sadly though, what I have experienced over the years is massive increase in premiums, deductibles, out of pocket expenses, co-pays, and other BS that really makes you stop and think about seeking medical treatment. Doctors are now quick to push generics and the medicine insurance companies prefer, rather than the very best for the condition.

My wife once twisted her ankle on the stairs and she was between jobs ironically enough. We couldn't afford COBRA because it was ridiculously expensive. I took her to the ER and we asked what a typical ankle x-ray and check up would cost and we were told $450. The final bill for this one visit was $1,450, and the hospital started chasing us for the money, despite charging over three times their 'quote.'

This is one of the things about American health care that astounds me. Unlike any other business in the country, they can literally lie or refuse to give you a quote, and then just bill you later in whatever amount they feel like. If you don't pay, they will hound you with collectors and eventually destroy your credit rating in a manner that costs you a fortune in other areas of your life.

We ultimately sued the hospital chain in question in small claims and won, the judge ruling that they had misrepresented their fees up front, and must in fact stick to their original quote. But they didn't go down without a fight, they sent a lawyer who grilled my wife and I on the witness stand, and even tried to offer us a limited time settlement before the judge came in (trying in vain to intimidate us).

Billing issues in America are so out of control there are consultants who charge to discover medical billing errors.

My wife recently had an MRI and they sent us a bill for $7,500. We reminded them we have insurance, and the insurance company reminded them of their 'special arrangement.' The bill was lowered to $2,500. Our deductible was $1,500, so we ended up owing about $1,600 for a simple diagnostic test.

The company I work for just got new insurance with Blue Cross Blue Shield of Tennessee. This costs about 25% more than the old insurance and the deductible is now $2,000 for me, and $2,000 for my wife, with plenty of other expenses we'll owe even after these deductibles are met.

In an interesting twist, we had to wait for the new insurance to kick in, because our old insurance company deliberately withheld vital information for as long as they could so that we couldn't shop around. They had wanted to increase our premiums (for the entire company) by 35%.

So I have to say, my experience with the American system has not been great. If you are rich, you can probably enjoy some of the best health care in the world. If you are not on the board of directors, dream on. Your coverage will be rationed based on your bank balance. They will take every last penny and force you into bankruptcy if you are unlucky and get very sick.

One of the important things that no one ever talks about when they compare American health care to say England or Canada is the per capita cost involved. In other words, they fail to compare like with like.

America spends approximately $4,271 per person on health care; more than any other country in the world (see link). The UK by comparison spends $1,675. Canada spends $1,939.

So if the British system is lacking in any specific areas it is due to a lack of spending, not because the 'socialized' system is inherently flawed.

So how does Britain stack up with the US in health care?

When it comes to infant mortality the US dropped in 2009 from 42nd in the world to 46th. Britain is 32nd. And no, these figures are not from some left wing Obama-loving think tank. These are statistics produced by the CIA.

Infant mortality by the age of five (according to the UN) has the US at 33rd, eleven countries behind the UK.

In overall life expectancy the US ranks at 38th in the world, Britain is 22nd.

Available hospital beds per 1,000 people is 4.1 in the UK, and 3.6 in the US, ranking at 27th in the world.

When it comes to physicians, the US does better than the UK with 2.3 / 1,000 versus 2.2 / 1,000. Hardly a major difference, here, with both countries not even in the top 50 in the world.

Cancer deaths in the US are at 321.9 per 100K, and the UK rate is 253.5 per 100K.

America leads the world in obesity, with 30.6% of the population obese. The UK is catching up weighing in at 23%

When it comes to preventable health care related deaths, the US and UK do poorly. The US was 15th in the world for this, the UK did worse at 17th of the 18 countries studied.

The bottom line is that the US spends more on health care than any other country in the world, yet oddly in almost any area that you care to look, scores worse than other countries who spend far less money, yet achieve better results.

In my opinion, the need is not for a tax hike, because the amount of money needed is already being paid. However, there needs to be a radical re-think of where all the money is going. It strikes me that too much of our investment is siphoned off by rich for profit corporations, rather than going to care for people.

Depending on which statistic you read, there are upwards of 40,000,000 Americans who do not have proper access to health care. This, considering we are the richest nation in the world, is a disgrace.

When the leading cause of personal bankruptcy in the US is health care related, there's a problem.

I personally believe that the US would do well to model some of the most successful health care countries like Japan, France and Germany when it comes to health care. I think Obama's health care plan is about as watered down as it could possibly be, but the reality is the need for reform is extreme. If this step towards a more inclusive system is the best we can do right now, it's better than nothing. I am honestly dismayed when I see such opposition to a much needed reform, because I see little about the current system that is not in dire need of reform.

For what we spend on health care, there is no excuse for the US not to be in the top ten for just about everything health related. Thousands of people (including babies and kids) are dying every year in the US for lack of proper health care, and yet people still protest reform.