Suddenly San Franciscan

Further to my previous post on the ‘debate’; The last couple of weeks I’ve finally had direct contact with this “finest healthcare system in the world, what do you mean it’s broken and needs fixing, you unAmerican, you?” healthcare system.  And speaking obviously as an outsider, I’d just like to say;

“This system is broken and needs fixing”.

Part one - a sudden spectacle crisis means The Mrs needs to get new glasses.  Not a huge worry as I’m pretty sure we have some form of coverage for this based on my work insurance.  And indeed we do.  Turns out it’s 10% off the eye test and 10% off the glasses.  Which, assuming the local optician isn’t a total rip-off merchant, makes the test $90+ (around £60) and the glasses, well, we’ll have to see.  I only found this out after contacting three different organisations to work out exactly who deals with the vision part of the coverage, by the way.

Cost of an eye test in the UK, where you just walk into any high street optician and no one has to call anyone to work out who’s paying - between £17 and £30 depending on where you go; lots of groups get them free, and everyone in Scotland does too.

Part two - As I’ve blogged before, I have asthma.  Except for the fortunately rare occasions when I have a major attack, my asthma is pretty mild, and generally managed by inhalers that for a lot of the time I never need to use.  It’s mild enough in fact that the supply of inhalers I picked up back in the UK in February has lasted me perfectly well ever since.  However, I’m now running low, and about to be travelling (again), so rather than risk running out while I’m away, I needed to sort out a US prescription.

Setting aside that some of this system is going to be complex to me simply because I haven’t grown up with its nuances, the effort involved in again, finding out what’s covered, by whom, how I need to deal with it, what information I need to give to the various providers, seemed excessive.  Having eventually established that a particular doctor I had had recommended accepted the insurance cover I have, and that the insurance company accept him as a real doctor, I went along and paid the $150 registration fee, had a fifteen minute consultation, and on leaving, paid $15 which is the ‘co-pay’ on our work policy.  I actually don’t know how much the rest of the bill was that the insurance company are picking up.  But handing over a payment card at the end of a GP appointment?  Oh my god did that feel wrong.  Actually ‘made-my-stomach-churn-slightly’ wrong.

And then to a pharmacist.  Which I had to specify, because the doctor sends my prescription to them, rather than giving it to me (for Americans, in the UK we’re given the prescription and can take it to any pharmacy).  This is actually, broadly, a good idea - the doc lists three refills of the prescription that I can request direct from the pharmacy without having to go back for a new prescription.  This one little bit of the process is wonderfully logical, and I approve.

Happily, having sorted this out I went along to the designated pharmacy and asked for my prescription, which was already made up and waiting for me.  “$299 and change, please”, said the Pharmacist.  Who then actually took a step back, so violent was my double take.

Turns out you have to tell your pharmacist who your insurance provider is, too.  I didn’t know that and didn’t have the details with me, so had to go back to the office, retrieve them and then return.  Once they were in the system and validated, via the $25 co-pay for each the $300 was reduced to $50.

So if I was the kind of serious asthmatic who needs this prescription monthly or even more, even with insurance I’m looking at an annual bill of at least $600 - without it, I’d be staring at $3600 a year just to control my chronic condition.  And people are usually without insurance because they can’t afford it in the first place. So where you get that kind of money from is anyone’s guess.

Again, to compare.  When I get a prescription in the UK, the prescription gives me a couple of each of my inhalers at a time, and each type of item (not each item) costs £7.20, so I can get twice as many inhalers for £14.40 ($24) as I can get for $50.  That’s without any kind of insurance. And potentially I can get more - when I was being moved over here for three months initially last year, I told my GP I was going to be working abroad for three months and he wrote me a prescription for double the quantities so I wouldn’t run short.  The cost was still just two lots of the individual prescription cost.

And again, by the way, lots of people across the UK qualify for free prescriptions.  For example, a friend of mine is diabetic, and as a consequence, any prescription she ever needs, not just those relating to her diabetes, is free.

The US system is complex (I’d argue needlessly so), expensive (Oh yes, I also pay quite a bit of money a month towards our cover, as does my employer), inequitous, inflexible, and by every account I hear, run entirely for the insurers’, rather than the patients’, benefit, and to their arcane rules.

The NHS is far from perfect.  It’s also expensive to the state, and even then it’s underfunded.  But it’s “free at the point of need”.  For EVERYONE, not just people who can afford it, and not just for people who live in the right neighbourhoods, or work for the right employers.  And it’s staffed by dedicated professionals who I assume love the fact that they don’t have to ask some faceless insurance company if it’s okay to do so before they save someone’s life.

Every single time I hear some know-nothing ranting about the nightmare of British healthcare compared to the perfection of the US system, my temptation is to shout at the screen.  But in the interests of my own well being and keeping my blood pressure down, I’ve adopted a policy of writing posts like this, that might inform a few people, and smiling knowingly to myself that one day I’ll grow old under the aegis of a healthcare system that won’t care if I’m worth one quid or a million.

August 27th, 2009 | Tags: news, real life | Category: Uncategorized | Subscribe to comments | Leave a comment | Trackback URL