Despite my bad back, I did a fingertip search for the pill I dropped on the floor. I eventually found and swallowed it – having first blown off the dust. After all, medicine is money here.
One friend looked forward excitedly to reaching 65 when he could go on Medicare, the nearest thing the US has to the British National Health Service. When he received his prized Medicare card he went on a healthcare spending spree, sorting out lots of minor, and some not so minor, problems that he had put up with for years. Before, he had risked doing without eye-wateringly expensive private insurance which only partly covers bills.
The National Health Service is creaking, but its cradle-to-grave care gives Brits the peace of mind my friend is only just starting to enjoy. Many Americans are in a constant state of low anxiety about their health.
All health systems are imperfect, and ageing populations clamouring for increasingly pricey advanced treatments add to those imperfections. In Britain, scarce resources are rationed partly by waiting times. Here it’s price. Dear Brits, please read this and fight tooth and nail to preserve the NHS.
Chats with my GP can be as much to do with affording medicine and procedures as with deciding the best treatment. I usually leave the surgery juggling free samples, for which I am absurdly grateful. They help offset the near-£100 bill for a ten-minute visit. The last time I went I was chuffed because she gave me a money-off coupon for an asthma inhaler so it cost £12 instead of £40.
I once watched a pharmacist do the paperwork for a tiny tube of eye ointment I’d been prescribed. I knew it was costly, but when I read £600 I assumed I’d mistakenly been given several tubes. “I only need one,” I said. “It is only one,” said the pharmacist. With her help, I shopped around and found a pharmacy selling it for half that price – still £300. At the time I was paying nearly £500 a month in insurance premiums.
In Britain, the TV drama Call the Midwife induces nostalgia for when the NHS was shiny and new. Here the show makes some Americans dream of how a public system could transform lives.
Being a sickly working class kid, I wouldn’t have stood much chance of bettering myself, and maybe of even getting through childhood, if I’d been brought up in the US. Virol, the thick, brown, sweet and sticky malt extract dispensed free by the National Health clinic helped to rot my milk teeth, but it kept me in the game, along with free orange juice, medicine and doctors’ visits. People who can’t afford insurance here rely on patchy schemes run by their state and the federal government. Often they can’t find a doctor and receive inferior care.
One of the big divides in America, along with Democrats versus Republicans and the liberal coasts versus the conservative heartland, is between those who have good insurance with their job or their partner’s job, and those who don’t.
The phrase “friends with benefits” means more than casual chums having sex. A woman once described her daughter’s financé as a wonderful man and, she added, he had great insurance. People stay in bad relationships and jobs they loathe for the sake of good cover. The latter is not just bad for individuals, but for the economy. Productivity, creativity, and entrepreneurship suffers.
Health crises are often also financial crises from which there may be no recovery. Healthcare absorbs so much of people’s earnings that they’ve less to buy homes, save and invest.
America is alone among the world’s rich countries in not having some form of government healthcare for all. One reason is that employers began offering insurance as a perk to attract staff during the Second World War government-ordered wage freeze. This slowed momentum for a national scheme.
And America hasn’t had the wake-up call from a modern war requiring mass citizen mobilisation. Other countries started universal care partly after realising that healthy citizens made a better fighting force, and partly to reward people for their service. President Richard Nixon might have managed to bring in a scheme during the Vietnam war when lots of men were drafted, but he was toppled by the Watergate scandal.
Lastly, Americans tend to believe people should make their own luck, and that those without good insurance could get it, if only they worked harder.
Hearing my British accent, a woman at my hairdressers once launched into a tirade against “socialised medicine”. She didn’t trust a government to be in charge of healthcare. I said better that than “commercialised medicine” with insurers and pharmaceutical companies in charge – and overcharging. The British health service, I added, is nationalised, not socialised, and Brits feel, sort of, that they own it.
I’m not going to try explaining America’s Byzantine system. Soon after arriving here, I gave up asking American friends for advice. People have different policies. They don’t even understand how their own works.
Suffice to say any private insurance-based system is inherently expensive – patients are paying insurers’ profits, which insurers guard by avoiding payouts. Moreover, when things are insurance jobs, prices are inflated.
Pharmaceutical companies charge Americans far more than people in the rest of the world because the government lets them. They’ve argued that their American customers have to subsidise patients in countries where governments cap their prices.
Employer-sponsored insurance, so prevalent here, can’t help people who lose jobs, can’t work, or go self-employed.
President Obama’s health reforms, though means-tested and far from ideal, at least enabled many people with existing health issues get cover, and capped out-of-pocket spending. God knows what will happen now with the new government.
But there’s a glimmer of hope. Obamacare has given many Americans a taste of decent healthcare. They may not give it up without a struggle, and there are signs that they will battle for more.
As a child growing up in a Yorkshire village, journalist Lynne Bateson rarely went to the city of Leeds just a few miles away, but she dreamed of living in the US. She made it. Here she recounts her adventures, taking a down-to-earth look at life Stateside.