Within two days of emigrating from Britain to the USA in September of 2013, I was sick. Nothing much to write home about, just a sinus infection, but it was enough to give me a glimpse into the mess that is the American healthcare system as I sat in a small office at the back of a Walgreen's (think Boots with more sweets and cigarettes) and handed over my credit card to someone I presumed was a doctor of some description.
The cost of being checked over (briefly) was $80, or about £50 at home. It seemed like a lot, but then I'd only been in the country for a couple of days and didn't have any medical insurance yet. She informed me of my sinus infection (after ensuring my credit card swiped) and told me I would have a few different choices when it came to the medicine that would make me better. Simple antibiotics would cost me another $80. I could get some 'generic' antibiotics, and they'd be cheaper, but they might not work as well.
So in other words, in order to make sure I got rid of my sinus infection properly, I would be shelling out a total of about $175 including tax, around £110. For a sinus infection. This was my first dose of US healthcare, and it has got worse and more expensive ever since, to the point where I'm considering moving back to the UK and filing this entire emigration thing under 'seemed like a good idea at the time'.
To a Brit, it is a truly frightening and confusing and bank account-draining system. To an American, like my wife, it is equally so. I knew before moving over that insurance was necessary in order to get medical care in the USA, but I was in no way prepared for how they actually attempt to put this into practice. The whole thing is absolutely catastrophic. Unsustainable. Immoral. Borderline illegal. And the worst thing is that the country has come so far down this road of medical care as a money making exercise, that the current president's controversial 'Obamacare' will do little to change things unfortunately. His thinking is sound, and millions more will have health insurance despite the attempts of staunch Republicans, but sadly that just means they get to indulge in this costly mess of a merry-go-round like the rest of us.
The British are used to being treated without handing over payment beforehand. Yes, we're used to waiting lists and jam-packed A&E departments, but trust me those are present here too. Complaining about the NHS is almost a national British pastime; for as long as I can remember every single political party has campaigned on the back of fixing it. But as soon as you move to a country without universal healthcare, then the words of the Joni Mitchell song are all too relevant; you don't know what you've got 'til it's gone.
As a father to a two-year-old girl in a foreign country, I have been left astonished at what I've seen here in New Jersey, a state a few miles to the West of New York City. To give an example, when she fell ill one afternoon with a fever of well over a hundred, we needed to get her seen by someone as swiftly as possible. She was barely communicating and not in a good way at all. Any mother or father will be able to put themselves in this situation, but now imagine you're in America. Your initial thought, sadly, tragically, is 'where are we insured and who by'.
This approach was echoed when we got our daughter to the nearest emergency medical centre in our arms, and the staff immediately asked us to complete two long forms for the insurance company, and for a swipe of our credit card (you'll notice this is a recurring theme) before they even inquired what was wrong with our little girl or showed any signs of compassion whatsoever. It makes you angry to witness. Money is absolutely the priority in any medical scenario here. The average cost of an ambulance ride in LA for instance is $1,200 (£800).
Now here's where insurance comes into play. To take my wife's medical insurance (it's always organised through your employer) as an example, we are covered for 80% of the cost of medical treatment. We are then expected to pay for the remaining 20%. This isn't too bad if you're talking about a trip to your GP (around £15) although repeat visits start to add up.
Where it starts to hit you hard is if you require any kind of emergency treatment, or a hospital stay. My daughter's virus required eight hours in accident and emergency (which was full I might add, and had a wait time of around three hours) - and the cost of this was almost $2,000. We had to find 200 of it, as there are slight discounts if your child is sick rather than you (money off! Hooray!). A few weeks later she needed a follow up appointment, at which the doctor suggested something called a 'cardiac echo', which is basically a fancy X-ray for the heart. At the time I thought, 'Well fine, whatever she needs to ensure she's ok'. The doctor didn't mention any cost (why would a doctor mention money?) and she had the 20 minute-long procedure.
Four weeks later we received a bill for 900 dollars (£600). The cardiac echo had apparently cost $3,500 in total, and the insurance company had paid their bit, and now it was our turn. At no point had anyone told us the procedure would be prohibitively expensive, and as a Brit the concept of receiving such a demand after treatment is utterly unheard of. Not only do you have the worry of a child being sick, you also have to worry about being able to afford to have a sick child. It is absolutely inhuman. And we have insurance. Goodness knows what the less-fortunate, uninsured populace do in the US when faced with an emergency.
"Ah but the quality of care is better here than in the UK" is usually the argument when barrier after barrier is put in place as Obama tries to change this joke of a system. "And you don't have money come out of your monthly pay packet to fund healthcare." Well, no you don't. But thanks to the US having the most complicated system of taxation in the world, you do have all kinds of different amounts taken, none of which make sense to anyone other than a qualified accountant. And actually once you've taken into account the monthly premium you have to pay out of your wages to an insurer (around 600 dollars a month) and added it to the cost of paying for every single procedure you need, plus the cost of medication, plus the fact you must find at least $1,500 toward treatment each year before the insurer's 80% coverage kicks in, and you'll be begging for the good old days of NHS hospital food.
That's not to mention the fact that your employer actually has to match or better your contribution to the insurer in order to make up the costs. That's aside from the 1,000 dollars you have to pay a year for any treatment before the insurance companies become liable. They are harvesting money.
It is total insanity. It's dangerous. My first thought yesterday when my back started playing up was 'I can't afford to have it looked at.' And as I said earlier, we are part of the supposed lucky ones who do have insurance. It is heartbreaking and vicious and antiquated and an absolute mess. And Americans accept it because it has always been like this.
Everything here is based on capitalism; money making is the priority no matter what field you are in, and the right to be looked after and live a healthy life is in no way as feted as that of being able to buy a gun in order to end someone else's.
Because hospitals are private companies, they charge a ridiculous amount for services, which leads insurance companies to increase premiums in order to cover these services, and of course the expense is passed on to sick people. The very idea of making money from sick people is distasteful at best, but accepted as mainstream here. TV adverts are packed full of softly-spoken men and women recommending you to ask your doctor about various medicines (they actually lobby doctors themselves by buying them dinner to get them to prescribe patients their products - seriously) and the artificially high cost of everything ensures that a lot of people get very rich.
In the US, even dentists are at it. When I had a tooth extracted the dentist couldn't tell me exactly how much it would cost, they had to estimate it. They contacted my insurance company who gave them an estimate. It didn't seem too terrible. So I paid it (around £60 after the coverage paid two-thirds of the total) and thought that would be the end of it. A whole year later I received a phone call from a debt collector saying that I owed 200 dollars because the dentist decided the procedure should have cost more, and the insurance company refused to pay it. This kind of thing happens all the time here, there's always someone asking you for money, especially when you don't have very much of it.
This country is wonderfully optimistic, and still has many attractions that make it a good place to live. A great sense of community, pride in what they stand for and the idea that anyone can make something of themselves are all laudable qualities. But it is dangerously undermined by its refusal to move on from adhering to archaic constitutions that were signed when slavery was still in place and a steadfast refusal to drastically change a healthcare system that costs the lives of so many of its citizens each year, surely the antithesis of what healthcare is supposed to be for.
The NHS truly is to be cherished, because if you fall sick in Britain then there is an army of people who will work to get you better without considering the cost. And you won't have a bill at the end of it, and money won't be an issue in your mind as you're being taken to hospital. I lived in Britain for 34 years, I know it's no Utopia. I know that accident and emergency departments are being treated like GP's surgeries by those who either don't understand or can't be bothered to use the system. But I yearn for the practicality of it, the ease of use and the fact that it's just there, out of sight and out of mind unless you need it.