This was my reply to Strawberry’s post about the NHS.
I enjoyed your article, but it’s only one side of the story. I have a very different opinion.
I’m an American living in the UK for about 3 years, and I prefer the AMERICAN system over the NHS. The NHS is truly a mixed bag, and lot of it depends on WHERE YOU LIVE. Instead of getting tied down to your employer for healthcare, in the UK you’re tied down to your address. It’s a bit like public education and good schools — if you want good healthcare you have to move to a place where the hospitals and doctors are good.
I live in West London. I have NO CHOICE of my GP. All the other GPs in my area are fully booked. If I don’t like my overworked doctor, the best I can do is choose on of the other two equally overworked doctors in that office. I have no other choices, unless I move.
My doctor makes all the decisions and I don’t have much choice about it — and usually neither does he. Here’s a textbook situation:
When I had a foot injury, I knew that I needed to go to a physiotherapist, and I could have worked through it quickly. The doctor agreed, but the NHS doesn’t allow him to make that referral. Instead he could only refer me to a podiatrist specialist. It took two weeks to get that appointment. The podiatrist also agreed that I probably needed to see a physiotherapist, but the NHS wouldn’t allow him to make that referral until I got an MRI scan. It was another two weeks before I could that appointment, and then another week to get a return visit to the podiatrist, and finally he was able to write a referral to a physiotherapist. Guess what? There aren’t many of them in my local area, and so of course they are extremely overbooked and I would have had to wait about another 3 weeks or more to get an appointment. Imagine limping around on a bad foot for about 2 months before getting the treatment that you really need. In the US, faced with a similar problem, my PPO insurance plan allowed me to go *directly* to a physiotherapist, as long as it was within their network, up to 10 times per year, for about a $25 co-pay. I would have gladly paid that to get the immediate care I needed!! And it wasn’t a gold-plated insurance plan, it was a very basic one compared to some of the ones I had when I worked in the US. American healthcare for the win!
What about employer insurance in the UK? Almost worthless, in my opinion. Since the NHS covers nearly everything, a company has no incentive to offer a comparable plan. It’s only good emergency cover, and only for very limited kinds of emergencies. For my wife’s pregnancy, the only things they cover are the most extreme emergency problems that would probably result in a miscarriage anyway. Furthermore, private insurance often won’t kick in until AFTER you’ve gone through the NHS! For my foot injury, my company’s insurance company *did* cover the cost for a physiotherapist, but only *after* the podiatrist specialist would approve it. Because I was able to use it I went to see a private physiotherapist only having to wait 1 week (for the insurance papers to go through), but that still meant that in total I had to wait over a month before the insurance kicked in.
The NHS does *not* believe in preventative care. As he said, you only go when you’re sick — usually from something that was completely avoidable!! There’s no such thing as an annual checkup here. In America, I would go every year on my birthday for a checkup, blood & urine workup, and as I get older, prostate and other such exams. And it was always covered by all of the insurance plans I had, because they have an incentive for keeping you healthy, and nipping bigger problems in the bud. In the UK, I had to beg & plead my NHS-appointed GP to even give me a simple blood & urine panel to check for cholesterol, etc. So sure, if you get prostate cancer the NHS will take great care of you. But if you want to avoid getting prostate cancer in the first place, American healthcare wins again.
A few other issues I’ve had with the NHS:
- my pregnant wife practically missed her first trimester pre-natal scans and screenings because (as usual) the local maternity wards were full. First the GP would *not* refer us to the hospital of our choice because it was a little farther away and the NHS wouldn’t let him do it. The problem is, all of the local hospitals were rated in independent studies as being near the bottom of the list for worst maternity wards in all of the UK (not just in London, but the entire UK). Then our case went into a black hole and unless we called and pushed the GP, my wife probably would have had the baby before we got re-assigned. We ended up having to pay for our first trimester scans from a private company. (Again, the company’s insurance plan doesn’t cover it because it’s not an emergency.’)
However, after all our pushing, we finally got reassigned to one of the better maternity wards in London, and now things are going very well. It’s further away and takes longer for us to get there, but the facilities and the care are so much better. It all has to do with location.
There are some good things about the NHS. Pregnant women get free medicine – the NHS co-pay is waved. My wife also has a chronic illness which requires regular scans and medications. She had to wait a bit to get referred to a specialist, but once that happened she is getting good care and the prescriptions are quite cheap because she only needs to pay the low NHS co-pay. I would also say that if I had a car accident, heart attack, or other emergency, the NHS would probably give me excellent care. (Then again, I felt the same way about the US, too.)
And dentists… don’t even bother. The NHS dentist offices in my area look like medieval torture chambers. I went once — flickering lighting, dirty, ancient equipment. They wanted to take an X-Ray and I told them to skip it — I’d probably get sterilized from the shifty-looking X-ray machine.
In my experience, as a pretty healthy mid-30’s male, is that I prefer the American health care system and I would not want it to turn into the NHS.
My biggest fear about the proposed changes is that the insurance companies will cut down their coverage and only offer limited, emergency care because they will have no incentive to compete in the basic-care market. I liked the preventative care that I got in the US and the ability to go directly to the specialists without having to be pre-screened by my GP. I liked having a choice of GP that’s not limited to where I live. Ditto for maternity care. I may have paid a bit more for the care, but I felt that I got my money’s worth.
Posted by LondonMitch 
Posted by LondonMitch 
Posted by LondonMitch 
