In Sickness and In Wealth

On the first morning of my new job in California, the head of HR came into my gleaming office with a shopping list.

What sort of dental cover did I require? How many of my children needed insurance? My job status brought top-of-the-range medical cover, but did I want any extras? Prescription glasses? Chiropractors? I could even set aside a proportion of my salary towards additional “uninsurable” costs, like therapy, or the cost of babysitting. They’d send me a credit card and I could buy whatever I wanted, tax-free.

This was an eye-opener. I’d expected the system to work a bit like private medical insurance in the UK, where you pay an annual premium and they give you a list of what’s not covered and which hospitals you can’t stay in. In Britain, if you’re lucky and your employer pays the bill, you’re taxed on value of the benefit. By contrast, in America it’s a highly sophisticated, complex and expensive industry. In the US the number of insurance administrators and advisors comes close to the number of doctors.

With half a dozen insurance cards stowed safely in my wallet in case I was run over by a bus, I felt secure in the arms of the best system in the world: for those in the system. A feeling not enjoyed by those 47 million Americans who rely on the public hospitals, Medicare (for the elderly) and Medicaid (for the poor). Obama’s dilemma is how to enfranchise the 47 million without lowering the excellent healthcare standards of the comfortably insured.

The republican scaremongers are using our antiquated NHS system to beat Obama’s reforms. I shouldn’t have thought for one moment that his administration was considering using the NHS as a model for US healthcare. There’s much that’s good about the different systems but they are just that: completely different.

When Joanna first came to the UK, she had a blocked sinus that was causing her incredible pain. “How do I find an Ear Nose and Throat specialist?” she asked, picking up the Yellow Pages. “You don’t,” I said, and rang the local GP in Hampstead. “Come on down,” said the chirpy receptionist, and twenty minutes later Jo walked out of the surgery with a prescription and a huge smile on her face. “They said it was free – what amazing service”, she said and has been hooked on the NHS ever since. She excitedly rang her girlfriends in LA to tell them that the day after our baby was born the wonderful GP in our village trekked out to the house unannounced to introduce herself, followed by a number of healthcare visitors.

But when it came to the pregnancy and birth, Jo opted for the private route. You see, in the US you expect a completely different level of service. The thought of antenatal appointments with a succession of complete strangers and delivery by an unknown midwife without the skills and training of a surgeon filled Jo with horror. Sure, it kind of works over here, and most people are happy enough because they know no better. In America you choose your own consultant who sees you right through your pregnancy, and then personally delivers your child.

In my experience, the country with the best and most equitable system is France. Like America, it operates on a private but insured system. Patients choose their own physicians who in turn have autonomy over their own medical decisions. It’s all paid for by a combination of public and private insurance, however basic insurance is compulsory and universal. There’s no wasteful system of GP referrals, no waiting lists and minimal bureaucracy. It costs far less than the American system, but a lot more than ours. My hunch is that Obama will plump for the French model; shame we can’t afford to do the same.