Recently I’ve read a few things on the internet about Americans accessing/trying to access health services and everything I’ve read has made reference to cost and, more precisely, the writers’ concerns about the costs of their health care. Accessing a healthcare provider, investigations, diagnosis, referral elsewhere, treatment options – no matter what the writers were writing about, every single piece mentioned how much being ill was costing the writer. Even those writers who had insurance, good insurance, found that being ill was costing them a lot of money.
Let me list what I can remember of me having used NHS services
- being born – free
- health visitor follow up as a baby/toddler – free
- childhood vaccinations/immunisations – free
- GP visits for various childhood ailments – free
- medications required for various childhood ailments – free until the age of 16 or the end of full time education for over 16s
- removal of a naevus from my wrist and investigation to ensure it wasn’t malignant
- two lots of cauterisation for my nose which used to bleed a lot – free
- removal of lots of verrucae from my feet by GP using dry ice stuff (ouch that hurt) – free
- head X ray, EEG when I was having lots of dizzy spells and blackouts – free (turned out to be low blood pressure/postural hypotension)
- allergy testing and desensitisation treatment – free
- lots of investigations when I was nearly 5 when I had a really weird immune thing going on – free (turned out I’d had a cold, produced antibodies to fight it, produced too many and then had a bad reaction to the antibodies). My clearest memory of this is being absolutely furious at having to pee into a cardboard potty to give a urine sample because at nearly 5 I was a big girl and didn’t need a potty
- childhood dental examinations, fillings, corrective braces – free (my front tooth is still a bit wonky but that’s a long story)
- childhood eye tests – free
- various GP visits as an adult – free
- audiology testing for hearing problems – free
- respiratory testing for asthma diagnosis – free
- scans and care during/following a miscarriage – free
- contraceptive consultation and fitting of an IUD – free
- contraceptive consultation, removal of the IUD and replacement with IUS – free
- several courses of physiotherapy for musculo-skeletal problems – free
- several podiatry interventions for foot problems including several sets of corrective insoles – free
- several trips to eye hospital for investigations into annual eye problems (diagnosed as allergic conjunctivitis when the pollen count goes up)
- lots of X rays, one MRI, 2 A&E visits, three orthopaedic clinic visits, one orthopaedic physio session, provision of one stick and a set of dressing equipment for my broken pelvis – free
- phone consultation with GP following unpleasant side effects from the painkillers for my broken pelvis – free
- yearly asthma review with the practice nurse – free (usually done by phone at my request)
- yearly medication review with a GP – free (usually done by phone at my request)
- so far 3 visits to the Minor Injuries unit with at least one more to come, dressings for my burned legs and probably several visits to the GP practice nurse for more dressings (as soon as minor injuries have sorted them to a point the practice nurse can take over) – free
Blimey, for a reasonably healthy person, I seem to have had a lot of bother. I need to stop falling off things and never again fall asleep in the sun without sunscreen. Also, my immune system needs to calm the fuck down.
But, my point is this. At no point during my 42+ years on this planet have I ever had to think “I’d better not go to the doctor. I can’t afford it” or “how am I going to pay this hospital bill?” I’ve never had to think “I can’t go to hospital for these blistered weeping burns because I don’t get paid till next week” or “I would like to walk with a stick while my fracture is healing but I can’t afford to pay for it.”
I’ve already paid. I’ve been taxed on earnings since I was 16 years old and had a Saturday job in a Saxone concession in the local Burtons for £1.25 per hour. Tax and national insurance has been deducted from every wage I’ve ever been paid,, and that money is my payment towards the cost of my health care.
Some of the arguments I have heard from Americans against what they call “socialised medicine” (or “socialized medicine, given their insistence on Zs where there should be Ss) are
- I shouldn’t have to pay for other people’s ill-health when I take care of myself and don’t use the services
- socialised medicine is poor quality health care
- I don’t want to pay more taxes
- countries with free health services have death panels to decide what treatments people can have and they just leave people to die
To which I say
- you have insurance don’t you? Buildings insurance? Contents insurance? Car insurance? Every time you make an insurance payment, you’re paying out for other people’s claims and hoping you won’t need to make a claim yourself. But if you do need to make a claim, the premiums you and everybody else have already paid (and which you and everybody else will continue to pay in the future) have covered the cost of whatever it is you’re claiming for. If you wanted to, you could stop your insurance payments (apart from those you are required to have by law) and put the money into a high-interest savings account and hope that when you have to replace your house/all of your possessions/your lungs via a transplant that you have enough in your account to pay for it.
- no, no it isn’t. By any account, by any way of measuring, “socialised” health care is not worse than the American health care system. Check out this page about maternal mortality rates around the world. Countries with better rates than the USA include Puerto Rico, South Korea, the UK, Canada, Denmark, Sweden, Estonia, Finland, Greece… Or look at this page about life expectancy rates around the world. At birth, people born in 50 countries around the world have better life expectancies than Americans and many of those 50 have some sort of “socialised” health care. Other studies are available and none of them will show that the USA has the best health care in the world with the best outcomes for citizens, or that “socialised” health care systems offer a worse outcome for users. In fact, according to Wiki, the World Health Organization, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world. A more recent report, the Commonwealth Fund Mirror, Mirror on the Wall survey of seven first world healthcare systems, ranked the United Kingdom as second overall, taking first place in subcategories including effective care and efficiency.
- very few people want to pay more taxes. Some people, such as JK Rowling, have made public statements regarding taxes being important. Fair enough, it’s a lot easier to pay taxes when you still have umptymillion quid in the bank, but the principle remains. Taxes are an unpleasant necessity of life. And, going back to the point about insurance, if taxes were reduced and you stuck the money saved into a high-interest savings account, are you sure it would be enough to pay for whatever might go wrong in the future? Life-threatening illness? Illness causing lifelong disability? Chronic illness requiring lifelong treatment? Illness which prevents you working and therefore earning so you can’t save? Why not just do it the efficient way, by paying taxes and therefore being sure you’re covered?
- All health systems have eligibility criteria. In the UK, expert panels led by clinicians review the evidence and decide whether or not treatments are effective and cost-effective. The sad fact is that some treatments are not effective enough to justify the NHS paying for them.. The very sad fact is that sometimes people die because the NHS can’t afford to treat them or an effective treatment doesn’t exist. When you’re paying for the treatment of every single person in the country, sometimes you have to decide whether to save 1000 lives with the £10,000 treatment or one life with the £10,000,000 treatment. That’s not an easy decision for anyone to make and it’s even more difficult if you’re the one who needs the unaffordable treatment. But that happens in insurance-based systems too! Insurance companies decide what treatments they will pay for. Insurance companies decide what conditions they will cover. Insurance companies decide which treatments they will cover for which conditions, and how long they will cover for. And you have to make your own contributions too. So, yes, it is true to say that someone has to decide which treatments will be available, and yes, some treatments are not made available on the NHS, and yes, that means some people die. But don’t pretend that’s unique to “socialised medicine” – it happens in every health care system.
Every single British citizen is entitled to use the National Health Service, from birth until death. Nobody has to worry about insurance. Nobody has to worry about finding a free clinic. Nobody has to worry about paying for their child’s treatment or buying food for the family. Whether it’s a 5 day course of antibiotics for a throat infection, in-utero surgery for a foetal problem or a heart and lung transplant, services are free at the point of use. Whether you’re a new born baby, a homeless person, or a millionaire, you won’t be turned away.
I think the NHS is the greatest creation of any UK government ever, and I am profoundly grateful for it.