Rally in support of the Affordable Care Act Image: LaDawna Howard
ObamaCare is now the law of the land, and I am happy to report that the United States has not yet collapsed into a dystopian nightmare. The elderly and infirm are not dispatched by “death panels”, nobody’s healthcare is being rationed (unless you count being rationed by the invisible hand of the marketplace, but that’s a different angle), and healthcare in America actually seems to be headed in the right direction.
At long last it feels as though my country is starting to claw its way out of the swamp of private insurance and managed care. Even though we’ve only just begun, I have hope for the first time that my children will live in a country where they won’t question the fact they have healthcare, and where everyone’s healthcare will be taken simply as a matter of course. We’re not there yet, not by a long shot, but I do feel that we’ve at last taken the first steps toward that happy reality.
So it is with no small amount of shock and dismay that I follow the news from across the pond about the continuing process of dismantling the NHS. I still don’t understand why you would take apart and sell that which we, in the USA, are trying so hard to build. I’m stunned that the British public has even allowed this discussion to go on so long. Is there anyone who doesn’t legitimately see what’s coming? Disguised by words like “efficiency” and “competition”, you’re opening a Pandora’s Box. You’re not likely to be pleased with what you’ll find inside.
The world I’m used to is one where the common citizen (actually, we use the word “consumer”) has a confusing and frustrating relationship to healthcare. It’s never clear and it’s never simple, and it’s certainly never cheap. From securing healthcare in the first place to the quagmires of billing, private healthcare in the US is a terrible mess. Personally, I see it as an imposing thicket of brambles, grown on money and blood, a thorny wall between the patients and doctors who need each other.
Some quick examples from the ground: you don’t automatically have insurance as an American. Insurance is something you must get. If you’re of a certain socioeconomic class, the jobs you’re looking for provide benefits - health, dental, vision, and some kind of stock market-based retirement plan. Not that these benefits are perfect. There are invariably gaps in coverage and you end up paying for those gaps from your own pocket. Consider this: medical bills underlie 60 percent of US bankruptcies. More than 75 percent of those bankruptcies did have health insurance.
"Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy"
Still, it’s leagues better to be involved in a large company’s healthcare plan. The alternative - and the reality for millions of Americans - is that their jobs simply offer no coverage at all. Either they work park time, which disqualifies them, their jobs are too low status - think cashiers and baristas, for instance - or they are self-employed, meaning anyone from contractors to farmers to performing artists.
In practical terms, what this means is that you’d better not get sick. Everyone knows that the worst thing possible is to fall seriously ill without insurance. That’s when the insurance companies deny your private application for insurance and then, when you’re reeling from the denial, agree to cover you at drastically higher rates due to your preexisting condition.
Obama’s health reforms will ban insurance companies from this kind of discrimination, but only beginning in 2014. The temporary fund designed to help these patients until then is closing to new applicants because it is running out of money. This means that there continue to be people with serious illnesses who cannot afford to get treatment. This of course will end up being more expensive in the long run, and doesn’t even begin to address the human cost or the moral issues of allowing this neglect to continue. This is the reality in America. This is what you’re looking at in the future if you allow the NHS to be taken apart and sold to the highest bidder.
Recently, my friends and relatives in the UK have been sharing some grisly details about what’s happening with their healthcare. I was taken by their news of the Mid-Staffs scandal, where cost-cutting measures and target chasing directly contributed to the deaths of many patients. I have to admit that, as an American, I was struck mostly by my friends’ reactions to this news rather than the sad news itself. The problem, I think, is that this kind of thing is so common in the US system that we are all inured to it. To be quite honest, I find the shocked English reaction almost cute. Such horrors are, most unfortunately, a daily reality in America. They don’t even make the news. By some estimates, the US loses about 75,000 people a year to inadequate treatment, another 22,000 die due to lack of insurance, and hardly anyone notices. It’s not shocking; it’s so much part of reality that we don’t even question it.
So this is what you’ve got to look forward to without a strong NHS: a broken system that sort of functions for the fortunate and the wealthy, while the rest of the population remains under-served or not served at all. Even for the lucky ones who do have insurance the system will be obtuse, expensive, and designed to confuse (just like privatised rail fares). Massive, inconceivable profits will pour into the coffers of people you don’t know, and if you’re ill and don’t have a job, you might just get a condescending letter deigning to cover you for much higher premiums. As for me, I’m still dreaming of having National Health in the USA, and I’m waiting eagerly for ObamaCare to kick in all the way. For us in America: bring on the future! For you in the UK: think carefully about what you’re doing. My country has been there, and it’s no good.