Death By Copay And Relief Abroad

I've been living in London for just about a year now, leaving a good job at a non-profit to come and get my master's in the UK. Like many Americans going abroad I was warned about the dangers of the NHS. And truthfully, I became a little nervous about these 'free' doctors. Would they be any good? Would I have to wait a month to see one? I've always been fortunate to have health insurance, but being an athletic though clumsy youth gave me many opportunities to see the inside of the emergency room, and I can clearly remember my mother turning to me and saying, "Do you want to guess how much your little trip to the ER cost us?"

They say that the biggest killer of Americans in England is getting hit by a car because we look the wrong way for oncoming traffic. Well, I didn't make that mistake, but I still got hit by a car five days after landing in the UK. Luckily the driver had only just started to accelerate from a stop, but I took a short and painful flight off the hood. I was left pretty banged up and hobbling. I went to my doctor's office located just three blocks from my house, and was told that if I wanted it, an ambulance would come and take me to the emergency room. I decided to wait 20 minutes for the daily clinic. Apparently some GP's here set aside two hours a day to see patients with urgent issues who did not have an appointment. Twenty-five minutes later out came the doctor, in I went, and ten minutes later I had a nice wrap for my ankle, some bandages on my scrapes, and a prescription for high strength Advil. Upon leaving I asked what my co-pay would be for the visit, and the receptionist looked at me befuddled before nicely explaining that it really was free medicine. 'Very cool,' I thought. Maybe the NHS wasn't the death-trap I had imagined?

While that might be a nice story about the NHS, the meat of my story is just beginning. I have been doing ethnographic research with officers of the Metropolitan Police Service as part of my dissertation, and spent much of the month of July in the back of a squad car racing around to calls. I saw many incidents where patients were rushed to the hospital, and many more where they were provided care on scene. All of it at no cost, and top-notch. It began to open my eyes to the problems with our paradigm of health care as a commodity.

My most striking moment came on the last night of my project. We received an emergency call about a boy hit by a car and with sirens wailing we were there in less than 30 seconds. There is something about a child screaming out hysterically in agony that is just sickening, and knowing you can't do anything to help just makes it worse. The boy had a clearly broken ankle, and other significant injuries that we would later learn included broken clavicle, broken wrist, cracked skull, and internal bleeding in his belly and brain. His mother and sister were kneeling over him, trying to keep him from thrashing about, but the boy howled in what must have been excruciating pain. Not 15 seconds later, a station wagon from the London Ambulance Service, with a medic and loaded full of gear, pulled up and immediately began to work on the boy. Moments later a full ambulance pulled up with two more medics. After seeing that it was a child with a head injury the call went out for a HEMS teams. These are the guys that normally come by helicopter, but they also have six teams in high powered BMW's patrolling around London. In less than three minutes from the call going out I could see their lights approaching our scene, and out came another medic, a full fledged ER doc, and an two med students. This boy was loaded on the ambulance and after a few minutes was on his way to a specialist head trauma emergency room just a few miles away. Traveling with him were the doctor, two medics, and a med student/resident. As the first officers on scene, we had to stay with the victim until the full extent of his injuries was determined.

For three hours we sat alongside the boy's mother in the waiting room.

We tried to talk with her about things like the weather and other BS you say to a mom whose son is behind the door that only opens for fancy medical equipment and hospital personnel covered in blood. Luckily, it soon became apparent that the boy would probably be okay in the long run. He'd have a crappy rest of the summer in some casts, and probably a week in the hospital followed by some physical therapy. In time he'd be back to being a kid again, though more mindful about running into the street. We watched them wheel her son past us on the way to a CT scan, in an induced coma, and with a ventilator tube in his mouth. She held one hand over her mouth, softly touched his face with her other, and quietly said to him, "You're gonna be okay, baby."

What struck me about the whole situation was that the boy's mom was able to focus on her son and his well-being. She never got approached to sign insurance forms, never worried about how much the hospital bill was going to be, never any of those things that get piled on top of an already horrendous situation in our country. A boy got hurt, a boy got care, and the whole process revolved around making sure he was going to be okay. The question of cost didn't come into the calculus for his care that night.

A very simple realization came to me that night: quality of health care shouldn't be defined by money, it's just the wrong paradigm. I don't know what the right solution is for our country. I don't know how Blue Dogs will vote, or what Big Pharma is going to push for. I do know that every person deserves excellent health care that is motivated only by the well-being of the individual. If we can't bring ourselves to do that, maybe it's time we amend the Hippocratic Oath to better represent pay-for-service medicine. Cheers.

Comments

[placeyourvote]

this is all you need to understand.............

http://www.youtube.com/watch?v=a3HyK5rB9jY

[ljkcan]

I am Canadian and have been watching "these town hall bad for your health meetings" with utter disgust.
Yesterday a woman spoke in PA and nobody was going to decide who her money was spent on. I presume the thought of some unemployed person or a child or gasp an immigrant getting health care on her tab would just be too much to bear.

From my side of the border I find it utterly disgusting because I would have been put before a death panel years ago when I was diagnosed with chronic illness at the grand old age of 30. Last year I spent 7 long months in the hospital nobody came down and said how dare you stay here on my dime. We don't think that way we pay our taxes and that is it. My insurance got rich on the upgraded room besides that I did not have to pay a cent.

I wonder how many of those irate people at meetings yesterday or outside holding childish signs noted how many people were being treated for free in California they are the silenced voice the uninsured.

[efmo]

What about Switzerland - I've heard they actually have a privately run health care system that actually works - there's real competition? I wish we had media coverage of how these other systems actually work vs. fearmongering.

[Norak]

As a visitor to Switzerland over the years, i've twice been to see private doctors (no wait, served a cup of tea before seeing the doctor) and once had to go to the emergency room because of back pain after surgery in the U.S. The doctor on call met us within 10 minutes at the ER, gave me a shot and two prescriptions and spent 20 minutes explaining compassionately, in good English to me and my family, why I was hurting and how long I could reasonably expect to hurt -- something my stateside doctor had glossed over a he spoke to a very groggy me after surgery. BTW that chat with my American doctor was the full extent of post-op care I got, and the procedure, not covered by my PPO, cost me $12,000. So I would give the Swiss medical system an A+.

[colette]

The Swiss system, as I understand it, is private but heavily government-regulated and the profit margins are, by law, much much smaller than American insurance companies have. In other words, you can be in the medical business in Switzerland, but you have to put the patients first and you can't make a killing on human suffering....

[doug108]

Is England socialist or communist?

[ohmetoo]

Just lovely, how it should be in a civilized society.

[tierone]

Sadly many of the so-called "protesters" can't see the forest for the black guy leading the country.

[S1m0n]

I'm a Canadian, also a veteran of the not-for-profit sector. I didn't resign for a masters, but my agency recently folded after a funding shortfall. Three nights ago, i found myself making a trip to the ER. After two shots of morphine and the same in dilaudid & a CT scan of my privates, I was told I'd just passed a gall stone I didn't know I had, and released at 4:30 a.m. I felt half proud and half stupid that I'd described the pain as a 7, when if I'd said '10' the way everyone else (apparrently) does, the morphine would have arrived an hour or so sooner. And welcome it was, I might add. The out of pocket cost to me for this? $0.00.

The thing is, I'm Canadian. I could afford to decide to go, or not go to the ER only on medical grounds. Being unemployed and American, I'd likely have spent hours trying to tough it out, and trying to decide if the pain was bad enough yet to make me destroy my credit rating, or not.

[smilesbetter]

Aww, well as a born and bred Brit, I have to say it was really nice reading this. :)

[Archontruth]

The problem is that decades ago, some morally deficient people realized that they could make money off of human suffering like that boy's. Today they're still making a lot of money off of the suffering of Americans, so much that they will spend 2 million dollars a day in bribes to members of Congress and stir up mobs of profoundly stupid people to fight the dawn of the day when they won't be able to feed off of this country like the parasites they are.

[islandchris]

The paucity of comments on this story is very telling. While this post goes to the heart of what we should be talking about, the media can't seem to get enough of stories about people screaming at each other over issues that utterly invented. As Daniel Bear points out, the key understanding is that the distraught mother on that night can focus her energy and emotion on her injured son with no worries about anything else.

In the US - if you have gold plated health coverage you can afford that same emotional luxury. The rest of us are always worrying about the cost, and making sometimes poor decisions for that reason. I want to hear more of these stories, and less from the woman screaming that she doesn't want to pay for someone elses health care.

[doug108]

I'm in total agreement.

The fact that the the discussion has switched from health care reform to the uncivil behavior of some people at these town halls means that health care reform propoents are losing the argument. The debate has been successfully derailed.

The rightwing really does have a genius for this sort of thing.

[elips]

I too had a similar experience with the NHS - my wife and I were very concerned about the quality of care when we moved to London. However, we received excellent care from our primary care physician and our local doctor's office and I even had an outpatient surgery without any problems. When asked how much the bill would be, I received the same incredulous looks from the NHS staff.

Knowing that you were covered and would receive good quality care brought peace of mind that was shattered upon our return to the United States. We were without insurance for over 2 months because my school and her job did not provide coverage. We worried about experiencing a medical emergency during this period and when we had to visit the doctor for care, we had to pay out of pocket. My wife needed a prescription for an infection and without insurance it was $90! In the UK, any prescription was just $11, period.

Opponents of health care reform complain about rationing with a public option, however the system in the US encourages personal rationing - I fear going to the doctor or hospital because of the never ending bills from the doctor, testing facilities, and billing companies.

The NHS has its issues, no doubt, and there are many good things about the US system that must be sustained and encouraged, but I sure miss the peace of mind that the UK system provided.

[XME]

Problem is that the Right doesn't have any solutions, and as long as that's the case, they have to business criticizing those who at least make the effort to come up with solutions, imperfect as they might be.

[elips]

This is exactly the problem. They just want to defeat this bill, just like they did with Clinton in the 1990s. Its not about finding workable solutions, its about politics which is unfortunate for the 50 million Americans without health insurance and the millions more with inadequate insurance and care.

[Bronxdude]

The Reagan deregulated, for-profit medical culture has methodically raped America, while complicit, lying and self-serving republicans—silenced by payoffs, kickbacks and special interest—acquiesce. Only true competition will lower the cost of care. Since obstructionistic republicans support the systematic plundering of the middleclass by ruthless insurance corporations, this is why we need the government between the public and parasitic health insurers. Everything doesn’t have to make a profit. Republicans want you to remain sick and uninsured because there is profit in illness. When compared to the second quarter of 2008, profit for UnitedHealthcare increased by a whopping 155 percent, yet premiums continue to climb 4 times faster than wages. Real competition will end the monopolistic and greed-driven stranglehold enjoyed by morally corrupt insurers. Restricting choice and access drives up cost, increasing profit for health insurers, while working-class Americans continue to die. As it stands right now, without real marketplace competition, unregulated insurers like UnitedHealthcare not only dictate the cost of healthcare, but they also get to chose where, when and how coverage and care is doled out. Sleazy republicans in bed with insurance executives are relying on biased, distorted and flawed research concocted by the Lewin Group—a wholly owned subsidiary of UnitedHealthcare—to create lies to sabotage healthcare reform. Contrary to republican fear mongering, according to the World Health Organization, when it comes to providing affordable healthcare among industrialized nations, France ranks first, Canada thirtieth and America thirty-seventh. Public option now!

[whyisthis41]

Reagan made life hell for people dying with AIDS. Yet, he is idolized by the repugs. I have two adult children and a son in law SUFFERING because of inadequate insurance which refuses treatments for 22 years of Multiple Sclerosis damage, Juvenile on set Diabetes 35 years worth of damage, and a Bi Polar diagnosis after years of terrifying unexplained behavorial issues. All of them are in their 40's. The Carrion Eaters , insurance , politicians, ignorant mobs are circling over their heads. What the HeLL is wrong with this country!!!

[justjojo]

I lived in Germany for 12 and a half years and in Denmark for 6 months and have been trying to convince people at home in America that my health care in both of those places far outranked the crappy care I get here in the US. The AMA and whoever else has done a great job propagandizing against so-called "socialized" medicine unfortunately. We, who know how good it is, need to be loud about it and talk about it to our representatives and senators.

[Interested Party]

Same in Canada.

[doug108]

I was in Montreal a few years back and developed a problem with my eye. I went to the ER and was told I had to pay $300 to get seen. I would have had to put the charge on my credit card, then send a claim to my insurance company when I got home. My problem wasn't such a big deal, so I decided against it, because I had no idea if my insurance company was going to give me a hard time or not.

There was no line. No waiting. No jackbooted socialist thugs patrolling the hospital or city. I could have been seen in just a few minutes.