Thursday, December 11, 2008

Health Care: a lot for the few or a little for the many?

As I get older, and realize that I will probably not live forever despite my strict adherence to a wine and cheese diet, I appreciate more the importance of good health care. 

When I lived in Kentucky I worked a decent job that provided some health care. This covered, wonderfully enough, my dental needs but not my need for old-lady prescription glasses and contact lenses. I never had a hospital experience there so I can't really comment on that, but I know I would have had to pay a certain amount for each visit.

Since coming to the UK I am consistently amazed at the 'free at point of care' concept. Now I have no insurance but, because we are on a low-income, I get free dental care (which is also offered to every woman for the first year after she gives birth). I just enjoyed having my wisdom teeth out for free - joy.
For the general population, if you can find an NHS dentist over here (good luck, they are out there) then you get a portion of your basic dental care covered.

Everyone gets free eye tests and a discount on glasses.

I especially appreciated the health system when I got pregnant. Not only did I receive free care and advice, I had a midwife who visited my house and talked me through everything. There were lots of options from which I could choose, in terms of the type of hospital stay and birthing plan (including access to a birthing pool). Of course, some of this was determined by my location. In the end, a hospital birth made the most sense because I did not want to be in screaming agony (epidurals are not generally offered at birthing centers) - but to each their own.

The follow-up care is also pretty comprehensive. You get a health visitor who, well, visits. Trust me, this is very valuable when you have just had a baby, haven't showered in weeks, are still bleeding/scarred, and when you've not been through it all before.

All in all I have a pretty positive view of the NHS. Granted, I read about MRSA and I've waited for hours in waiting rooms, but I prefer this broken-down system to the broken-down system in the US no question.

The trick is, however, to find a balance between the 'advanced and innovative' health care in the US (advanced and innovative being code words for expensive) and the 'free and egalitarian' health care of the UK (free and egalitarian being a code words for inefficient). 

One of the differences between the two systems (outside of the structural, bureaucratic differences) is the focus in the US on the individual paying for their own health care needs. That is, if you have private insurance, or even employer-based insurance, you are paying now for some circumstances that might occur in the future to yourself. Even then, of course, there is no guarantee that you will be covered for everything. 

The same might generally be said of the UK except that, because the NHS is a national behemoth, the cost of healthcare comes out of your paycheck in taxes and is poured into the NHS system. Your money might be paying for some little child's cancer treatment (as long as it's not new or experimental) or some junkie's methadone dose

I know this isn't actually how it works - certainly not on the US side where your money paid to a private insurer covers them just in case one of their other clients gets dreadfully ill and they actually decide to pay out - but there is a fundamental difference in ethos that I think is important. It is the reason why people like Michael Moore look over the pond and think "If only...", ignoring the many problems with the NHS.

The NHS is not a solution for the US. But neither is allowing health insurers to dictate policy

One of the main benefits of paying into a system that is free at the point of care is that it encourages people to visit the doctor. You see that chunk of money come out of your paycheck and you feel entitled to have a doctor or nurse look at your mole or listen to your phlegmy throat. This means that illnesses are often dealt with at an earlier stage, saving costs in the long run. 

The prenatal care women receive is also important for their mental health and the health of their child. My older brother, a pediatrician in New York, was impressed at the prenatal care I received and despaired that more comprehensive care was not offered to people in the US. 

A recent Reuters article called the American system of health care 'costly and inefficient'. This epithet is also often applied to the NHS, despite its attempts to keep costs low by only paying for the cheapest drugs for any particular illness. 

I hope there is a middle ground somewhere, between what seems like a lack of accountability of the health insurance companies, which puts consumers on uncertain footing, and the political accountability of the NHS, which means they can't be seen to be 'wasting' money on costly treatments.

In both cases many of the people paying into the system don't seem to be getting what they want or need. However, at least in the UK you can get decent treatment (equal treatment) even if you are not paying into the system at the time of medical need.