Americanizing the NHS

I was on a boat in the middle of the Gulf of Finland when I found out my uncle had passed away. We all knew it was coming, but the speed with which it arrived sent my head and heart spinning, because once again I would miss the funeral of a family member. That part of the story is more about being an immigrant; another story for another time. The part of being an immigrant that is relevant here, is that as a permanent UK resident who grew up in the US, I have experience of both the American healthcare system, and the NHS. I know what is coming if the NHS is dismantled and sold off bit by bit, like spare parts for someone else’s machine of empire.

My uncle, one of my dad’s younger brothers, was always an enigma. He moved from job to job, favouring those focused on the outdoors, like a park ranger. He moved around the American West, from California to Nevada to Washington and back again. Duke, we called him, though I cannot remember where the nickname came from. In the summer of 2016, after my mom’s recovery from a serious illness (more on that later) the Nelson side of my family had a big reunion in Nevada. We couldn’t make it because the flights were so expensive. It is one of the big regrets of my life.

Apparently, Duke was sick even then, thinned and stretched and not eating much. The last photo I have of him with his four brothers he is a slip of a man. His smile takes up most of his body. He wouldn’t go to the doctor, however, a refusal grounded both by years of socialised male stoicism and lack of health insurance. A year later he finally went to the doctor and was diagnosed with cancer. My dad flew to California to be with him. My mom was here in Belfast with me; she planned to fly there after returning home. She didn’t make it, however, as he passed while she was still in Ireland helping to look after my kids while I was away. Hence the phone call from my dad, on a ferry between two countries, learning my uncle had died of cancer that would have been treatable if he’d had access to healthcare.

This story is so common back home as to be nearly mundane. It is taken as normal by so many, natural, even, that some people just won’t have access to certain things if they don’t have the money. We explain it away with great skill – health insurance comes through being employed, they should just get a job! – forgetting that not all employers offer good insurance, insurance doesn’t cover everything anyway; forgetting, never even contemplating, that healthcare should be a human right. We are skilled at mental gymnastics when it comes to healthcare.

A few months before my uncle died, my parents were visiting us here for Christmas. After a few weeks of a hacking cough we finally convinced my dad to go to the GP (at a cost of £50 since he was a visitor; my dad thought this was a bargain compared to what it would cost for a non-insured person in the US to see a doctor). The doctor found a leaky valve in my dad’s heart and he ended up in the Cardiac Unit at the Mater Hospital for three days. Thankfully my parents had travel insurance, though even without that the cost was only £3,000.

Yes, I said only. Only £3,000 because the same stay would’ve costs tens of thousands, perhaps approaching $100,000, in the US. It would have been disastrous. Little surprise, then, that a few months after they returned home, I was researching how much it would cost for my dad to return here for privately-paid life-saving heart surgery, instead of taking his chances with what Medicare may or may not cover back home. Life-saving heart surgery reduced to a budgetary question. Again, a ‘normal’ conversation, a ‘normal’ concern, a ‘normal’ calculation for Americans (who aren’t rich, anyway).

I wish I had the words to convey this level of desperation, of quiet fear that constantly hangs over life in the United States of America. I have so many more examples that this essay would be thousands of words long, and you would probably stop reading. I need you to read this because I need you to hear what is coming if the powers that be succeed in selling off the NHS. Briefly, then: when I was quite young, my aunt got bone cancer. They just finished off the hundreds of thousands of dollars of medical debt incurred during her treatment about two years ago. When I graduated from college my parents had to take out $500 a month very basic insurance for me in case I got into a car accident or something serious (and that’s about all it would cover. My mom is currently in what’s known as the ‘donut hole’ of Medicare coverage, which is complicated, but effectively means she is responsible for 80% of her medication costs until the New Year, which means $450 a month for her inhalers – each, she has two – so she’s simply not getting them. It’s too much.

And the one that wounds me most: My mom contracted bacterial meningitis on New Year’s Day 2016. We didn’t know what it was at first. We thought it was just the flu. I wish I had been paying more attention. I would’ve insisted the ambulance was called long before it finally was. My dad didn’t want to take her to an urgent care centre, didn’t want to call an ambulance, because it is a several thousand-dollar minimum payment for an ambulance call-out. They usually aren’t covered by insurance. We did eventually call one, and I wonder every day how differently things might have turned out for her if we had had the confidence to call it earlier. To know that it was there for us, that it wasn’t a bargain we had to strike or a calculation we had to make, but a vital resource there to help us. She is ok, by the way, but with life-changing repercussions from the illness.

What we have with the NHS is an odd opposite problem. Any treatment we need is free, except we can’t get to it. I see echoes of this in the seven-hour wait I had with my toddler in A&E last weekend, the three year wait he faces for his paediatric cardiology review, that it takes nearly a month to get a GP appointment, and so many other problems. My parents can get any treatment available, quickly, if they can pay for it. Neither system is working right now. The NHS needs funding to work properly, and the American system is set-up to prolong the lives of only those rich enough to pay.

But a particular problem here is that people don’t have the cultural mindset of healthcare costing money, which means they don’t have it in their monthly budgets to set aside money for health insurance or other healthcare expenses. Almost everyone I know back home has a separate healthcare savings account that they pay into each month like a regular savings account. If the US system is brought in here, not only will people suffer and probably die, but they will likely be pushed into poverty as well as they struggle to figure out how to pay for insurance and care alongside all their other monthly bills. They’ll present themselves at A&E for treatment only to get an astronomical bill in the post a few weeks or months later. At some hospitals in the US, you are turned away unless the treatment you need is emergency, is life-saving. No possibility for prevention, just for mitigation.

Just like my uncle.

Photo by sasint is licensed under CC BY-NC-SA