American healthcare reform

I’ve been watching the discussions in the media and on the internet (such as this somewhat one-sided website) around President Obama’s attempts to reform the US medical system with considerable dismay. As many of you know, I’ve spent quite a lot of time in America over the years, and like any country there are aspects of it that I like, dislike, love, and hate. One of the things that falls squarely into the latter category is the disparity in quality of life between the haves and the have nots, and particularly how this affects the ability to get access to healthcare.

I’ve known people in the USA go through periods of their life where they were struggling to pay their basic living expenses, being forced to borrow money to take their sick child to see the doctor. The safety net appears to be set so low that to all intents and purposes it doesn’t exist.

And now we have right-wing American politicians and media drawing largely factless and unfavourable comparisons, based on carefully chosen examples from the UK healthcare system. Needless to say, as someone who has had their life saved by the UK healthcare system, I find this rather galling.

So let me state my view of the current American system; from what I’ve seen, if you have private healthcare, or are rich enough to self-fund, then you can have immediate access to the most expensive (usually perceived by Americans as “the best”) treatments that are available anywhere in the world. If you don’t have private healthcare or money then your chance of getting anything beyond the most basic emergency room cover is minimal.

Whereas in the UK, we all pay a proportion of our income towards central provision of healthcare, which is provided free of charge at the point of demand. If anyone in the UK is ill they can see a doctor free of additional charges. If their condition requires referral to a clinical specialist (as mine did) then that again is provided free of charge, as are any further treatments that are required.

If you want to access private medical care in the UK then you can; you can self-fund or take out private medical insurance. You still pay for the NHS, but you can “top it up” if you want. In general that means you get much faster access to non-critical medical procedures, you get to choose your care-team, and you get to stay in a private room rather than a general ward. You may or may not get to spend more time with your care-team.

Is it worth it? Depends on your perspective. In my case the radiotherapy, surgery, post-operative care, and chemotherapy, not to mention the many years of subsequent diagnostic follow-up work that are needed to ensure on going health would all have been provided to me free of charge on the NHS.

In my case I used my private medical cover to fund my radiotherapy, purely because it simplified the scheduling of the treatments. It didn’t provide the treatment any faster, or provide any different treatment. I had my surgery under the NHS because the complexity and length of surgery was such that I wanted the treatment carried out in a hospital with 24-hour access to surgical staff – not the case in a private hospital. My post-operative complications meant that had I chosen to undertake the surgery privately then the private hospital would have transferred me back to the NHS anyway – they don’t do long-term care, as it breaks their business model. I’m now doing my chemotherapy privately, purely for convenience – the treatment and timing is identical, but the scheduling of each of my IV sessions is much more flexible, and the surroundings for the 5 or 6 hours I spend undergoing the infusion are much more pleasant.

But perhaps most telling of all, back in 2000 (the last time a ranking was produced) the UK NHS was rated 18th in the world by the World Health Organisation, whereas the USA only managed to get to 37th place. The most recent 2009 data from the WHO Statistical Information System shows that healthy life expectancy is 72 in the UK, but only 70 in the USA. And life expectancy is 80 in the UK versus 78 in the USA. So you have a longer healthy life in the UK, and then our healthcare system keeps you going longer in infirmity. And that’s despite healthcare spending per capita in the USA being nearly 3 times that in the UK ($6714 vs $2784), and this not taking into account the skew of spending across the US population.

But it seems that fat cat politicians and media moguls the world over never like to let the facts get in the way of a good bit of spin…

Acceptable behaviour

One of the things that I’ve found interesting while spending time in hospital, is watching the other patients around me. I’ve seen quite a few people with varying illnesses, and their attitude to their condition and the people looking after them has been fascinating.

Perhaps the biggest contrast has been between the old and the young; in general I’ve found that the younger patients (into which general category I would include myself) have less patience, less tolerance for pain, less consideration for those around them, and distinctly less gratitude for the efforts of the people caring for them. I’d hold up Mr. A (an ex-civil servant, who at the age of 53 is already retired) as a prime example of this. He’s suffering from a long-term problem largely of his own making that is eminently curable without surgical intervention. The hospital have been working on that for him for the last week, and during that time he has complained constantly about every minor issue, setback and problem (perceived or real) that has affected him.

Whereas Mr. B is in his late 70’s, admitted with a case of prostate cancer. And that’s on top of his already diagnosed incurable liver cancer and (previously successfully cured) bowel cancer. The hospital are working to provide him with the best possible quality of life, so he can go home and spend the remaining time that he has with his family. And I’ve never heard him complain once about anything – apart from the food, and we all complain about that! He’s always ready with a smile and a joke when someone else needs cheering up, and always makes the effort to thank people for their help.

So I wondered if this was some sort of change in society. Part of the DNA of Generation X and Y. Is this a case where people under a certain age believe that they should have the right to the best of everything without consideration for anyone else?

And then I met Mr. C.

Mr C is my age. He’s in hospital because of complications arising from his situation as a paraplegic resulting from a motorbike accident from many years ago. He’s in hospital (this time) for at least 3 months to undergo treatment for a variety of problems, all of which seem to be invasive. He needs to be turned in his own bed every 3 hours, and needs help with many of his most basic needs. If anyone deserves to rail against the world, it’s him. And yet he doesn’t. He’s friendly, kind, generous and polite. Nothing seems to get him down, and through it all, he’s still interested in the world around him, and being a part of it. His spirit shines through.

If I ever wanted a role model for how to live my life in difficult circumstances, Mr B and Mr C have provided it to me these last few days.