Some years ago, following a flight to America, I noticed a large red spot on my leg. Blood clot, I thought, I may be about to die! Ok, post-flight blood clots happened to be getting press at the time, and I'm as susceptible as the next guy. So, needing reassurance and forgetting I was no longer in the land of the NHS, I demanded that my sister drive me to the nearest emergency room. Big mistake.
First, we had to scrape together one hundred dollars before anybody would talk to me. "This would never happen in the UK," I grumbled. "Yeah, but you'd wait about four days to see anybody, wouldn't you?" the white-coated cashier replied. "Um... no." Sarcasm on my side; shrugs behind the hospital desk. "Quiet," my sister whispered, kicking my good leg.
Several hours, scans and blood tests later, I was told by a very nice doctor that no clot was in evidence. Of course, I was relieved and as grateful to this doctor as I would be anywhere. She was wonderful. I was going to live after all. Hungry and seemingly healthy enough to indulge in fast food, I bought a celebratory portion of fries on my way home. Little did I know that behind the scenes of my A&E visit, the veritable cash register of American healthcare was leaping to life.
Several months later, the bills (take note, bills in the plural) began to arrive. My treatment was not only costly, mounting to over $1000, but horrendously fragmented. I was charged separately for the intake, blood tests, scan, and the eventual consult. The nursing service appeared to have its own agency and itemized invoice. Each demand had to be presented to my travel insurer. Most of the costs were eventually covered, but it was a bureaucratic nightmare.
This all happened before Obamacare and before our own Health and Social Care Act (2012). While Obamacare takes the US in the right direction, American healthcare will never be put right unless/until a single payer scheme is adopted. Meanwhile, dear Brits, meet your future.
The 2012 Act was long and complex. The mainstream media gave woefully inadequate coverage of the detail of the legislation and the growing numbers of voices raised against it. Licence fee payers were let down by the failure of our public broadcaster to meet its own stated objective of "providing in-depth explanation of the most significant issues facing the UK."
So, forget the BBC. Our public broadcaster won't help you. You might start by looking at Section 75 of the Act, which put into place compulsory competition for NHS contracts. Since then, the private sector has massively increased its presence in the NHS. And in what Jacky Davis has termed the "privatisation of privatisation," many of these companies are now outsourcing entire services to other private companies.
Apologists for the Act deny privatisation by claiming that our health service remains free (so far) at the point of need. That is to collude in the stealthy processes taking place behind our iconic NHS logo, where there is now a gathering of other logos, the signature of those private companies (Virgin, Serco and others) actively bidding for the most profitable services. Our NHS is, in a manner that is largely invisible to us, being carved up and delivered to providers that are, by definition, market-driven.
Here we have the same elements glimpsed in my humble visit to an American A&E: healthcare held hostage to the profit incentive in a complex proliferation of private sector contracts. This fragmentation will increasingly leave patients stranded between services, at pains to find out how they are coordinated and how to hold them to account. It is little wonder that I meet many Americans at meetings and protests against the Health and Social Care Act. We know what it means.
Alongside these relatively invisible processes, the government treats what remains of our NHS and its staff along the lines identified by Noam Chomsky in another context: "If you want to privatize something and destroy it, a standard method is first to defund it, so it doesn't work anymore, people get upset and accept privatization."
Every perceived weakness of the NHS is held up by the government and reported by the media without analysis of how that weakness came about. Of course, the NHS must come under scrutiny like any other service, but not without signalling the chronic underfunding and understaffing that followed in the wake of the Act. An increasingly demoralized staff is struggling to maintain the standards we take for granted. We need to defend them and hope that they too, will join public efforts to reinstate the NHS.
In this context, two campaigns deserve our immediate attention: the junior doctors' strike and the Tory threat to scrap the NHS bursary for new student nurses, midwives, and allied health professions. Not only will poor treatment of junior doctors and trainees cause hardship, but it will exacerbate recruitment problems. We need to come out in support of fair pay and conditions for junior doctors and all NHS staff and trainees.
Time is running short for the health service. So take it from an expat who has spent half her life over there, and the other half over here. Don't accept the Americanisation of your NHS, your greatest achievement. Don't eat the fries.