NHS – Sheila Kennedy

One More Time….

The American Prospect sends out a regular newsletter, titled Kuttner on Tap, in which the author, Robert Kuttner, addresses a variety of issues.

Kuttner is a longtime journalist– currently a professor of social policy at Brandeis University.. He co-founded and co-edits The Prospect, which (according to Wikipedia) was created in 1990 as an “authoritative magazine of liberal ideas.” He is also a co-founder of the Economic Policy Institute.

Given Kuttner’s background, his preference for national health care is unsurprising, but a recent issue of the newsletter really resonated with me, not just because of stories like the one I shared last Friday, but because it mirrored my own experience with England’s National Health Service (NHS).

Kuttner was in London when he felt ill.

Yesterday, I had some odd health symptoms that suggested a visit to a doctor. This being Britain, off I went to the walk-in clinic of the nearest hospital of the National Health Service. What happened next is enough to make an American progressive weep.

I arrived at St Thomas’ Hospital, one of London’s busiest, at 10 a.m. By 10:20, I had been through a courteous triage process, filled out a basic form, and was scheduled with a GP. The doctor saw me at 11:00, took a history, examined me, performed a couple of tests right in his office, assured me that this was not serious, and shook my hand.

“Do I need to check out?” I asked.

“No, you are free to go,” he said. Less than 90 minutes after arriving, I was on my way.

Bill: zero.

As I said, this account mirrored a personal experience. A few years ago, my husband and I were on a cruise to England when he developed upper respiratory symptoms. By the time we got to Nottingham, where our oldest granddaughter was living at the time, he was really unwell, and she insisted we go to the nearby walk-in-clinic.

After a very brief wait, we were called back to the nurse practitioner. She took a history, examined him, and called an ambulance to take him to Nottingham University’s hospital. (She said she might be “over-reacting a bit–I hope so” but “better safe than sorry.”) The ambulance was there almost immediately, and I rode with him. I can’t say enough about how efficient and caring the EMTs in the ambulance were.

We were taken to A and E (Accident and Emergency). Again, we were impressed with the efficiency of the process; first, an evaluation and a number of lab tests, then further tests based upon the initial results. Throughout the (very long) day, personnel kept us informed of where we were in the process, and why they were doing what they were doing.

The fear was a pulmonary embolism; fortunately, the scans ruled that out. However, what the ship’s doctor had shrugged off as a cold or allergy turned out to be a heart problem that hadn’t been detected by his cardiologist on his visit a week before our trip. The NHS doctor explained that his symptoms were the result of fluid accumulation–probably the result of unusual activity on the trip. He was admitted for a short stay so that they could eliminate the additional fluid.

Only when he was released were we asked whether we had insurance, since we weren’t British citizens. (The ultimate bill was $1900.–for all the tests, and a two day hospital stay. And Anthem–our insurer at the time–bitched about that and delayed payment.)

As Kuttner wrote,

NHS is far better, fairer, and more cost-effective than our system. Britain is a poorer country than the U.S. but has an average life expectancy almost four years longer (80.9 years to America’s 77.3).

Because the NHS is true social medicine with salaried doctors and nurses, the money and time wasted in the U.S. on parasite middlemen, coding and billing, rapacious insurance companies, hospital profit-maximization strategies, and excess lucrative procedures, is simply not a problem or a drain in Britain. All the money goes to patient care….

In this fiscal year, the entire NHS costs 152 billion pounds, or about $180 billion. That’s close to two-thirds of all of Britain’s spending on health care. By contrast, the U.S. spends a staggering $4.4 trillion.

Relative to GDP, Britain spends about 12 percent and covers everyone. We spend just under 20 percent, and tens of millions of Americans have no coverage while tens of millions more are woefully underinsured and must pay exorbitant sums or do without.

Other Western countries have other versions of national health care. All of them deliver better results for many more people for far fewer dollars.

It turns out that it’s very costly to refuse care to “undeserving” (i.e. under-resourced) people…..

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Unhealthy, Unwealthy, Unwise

When I was doing research for a former book–my first sabbatical project, back in 2007– I came across data confirming the relationship between individual and social health. It turns out that countries with strong social safety nets have substantially fewer social ills–not simply less crime, but also less divorce, fewer unwed teenager mothers, etc.

I thought about that research when I read a fascinating article shared by a reader of this blog.The article from Harpers Magazine was written by the son of a doctor who’d practiced for most of his career in Great Britain’s National Health Service–the NHS–and it compared his observations of that system to the reality he encountered after moving to the United States.

When I moved to New York, many things seemed strange. Among them were the crutches I saw discarded on the street, leaning against the hunter-green fences of construction sites or on the steps of the public library where I had an office. It felt like finding evidence of miracles: the lame had risen up and walked. Later I learned that people were often expected to buy such items, rather than being given or lent them by a health provider. Once finished with them, they naturally enough threw them out. I connected this in my mind to the chronically ill people I saw living on the street, many with mobility issues—people who seemed to need care and weren’t getting it, like the woman nodding out on the corner in a wheelchair, or the man wearing nothing but a hospital gown, looking as if he’d been discharged from a psych ward straight into Tompkins Square Park.

As a freelancer, I bought my own insurance—my second-largest expense after rent. Despite spending hundreds of dollars a month, I still had to hand over something called a copay to be seen by a doctor. When I expressed shock at this fact, my American friends laughed bitterly. Step by step, I was initiated into this strange new health culture, so different from the one I was used to. Why did I need permission from the insurance company if my doctor thought a treatment was necessary? This was a medical decision, wasn’t it? In that first year, I went to see a physiotherapist and realized that he was shamelessly upselling me, trying to persuade me to embark on a complicated and expensive course of treatment that I didn’t need. Oddly, this disturbed me most of all. I was used to a system where there was no incentive to do such a thing, and it felt like a breach of trust. Deep inside, I was still the doctor’s kid, conditioned to see medical professionals as benevolent authorities.

I began to hear horror stories: the uninsured woman who slipped in a gym changing room, knocking herself unconscious, then woke up and tried her best to stop the ambulance from coming, as she couldn’t afford the cost; the young musician who’d tried to set his own broken arm using instructions from the internet. Everything seemed absurdly marked up ($1,830 for a pair of orthotic insoles?), and hovering over us all was the threat of medical bankruptcy. It was mind-bending to think that I was one serious illness away from losing my life savings. I contributed to GoFundMe campaigns and began to experience something new, a low-level background anxiety.

That reference to “low-level anxiety” triggered my recollection of that long-ago research, because it found that individuals’ feelings of personal safety have a marked and important effect on the health of the overall society. People who feel secure in their persons and prospects are less suspicious, more neighborly, and less likely to engage in risky or anti-social behaviors.

Recent unwarranted shootings–the elderly man who shot a teenager who rang his doorbell, the homeowner who responded with a hail of bullets to an unknown car in his driveway–point to the negative aspects of a society in which “low level anxieties” are widespread.

The Harpers article traces the history of America’s health care failure–how we got here. The paragraph that best explains just where “here” is, is the following:

The U.S. health care sector is massive. In 2020, it amounted to 19.7 percent of GDP. In the previous (pre-pandemic) year, that number was 17.6 percent. The United States spends more on health care than any other developed country, and not by a small amount: $12,318 per capita in 2021. In the rest of the developed world the average is under $6,000. What do we get for all this money? Lower life expectancy and higher infant mortality than almost all other developed nations. Despite the huge deployment of resources, the system is, by almost every metric, a dismal failure.

It isn’t just a failure that harms individuals. We Americans pay extra for the social dysfunction.

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Up Close and Personal with the NHS

We had our first (only) encounter with Britain’s National Health Service yesterday.

Bob’s cough kept getting worse, despite the cough medicines and lozenges, and our granddaughter and her partner suggested we take him to one of the NHS’ Walk-In facilities. There were two nearby (we walked from our hotel).

When we got there, we took a number from a dispenser and sat in the waiting room. The system was that the people at the desk would call a number, and you would then register, explain what was wrong, etc., and wait to be called back to be seen. Our number was called almost immediately; when we described the problem, the very nice woman behind the desk put a monitor on Bob’s finger, pronounced his oxygen levels low, and said she was putting him at the “head of the queue.” (She also said that she very much regretted that she would have to charge us for service since we weren’t British. The cost was fifty pounds.)

Bob was called back within ten minutes to see a nurse practitioner. She took a history, examined him, and called an ambulance to take him to Nottingham University’s hospital. She said she might be “over-reacting a bit–I hope so” but “better safe than sorry.” The ambulance drivers were there almost immediately, and I went with him in the ambulance while our granddaughter and her partner drove separately. I can’t say enough about how efficient and caring the EMTs in the ambulance were. They were also very proud of the vehicle itself, which they explained was new, and certainly looked well-equipped to my untrained eye.

We were taken to emergency (they call it A and E, for Accident and Emergency). Again, we were impressed with the efficiency of the process; first, an evaluation and a number of lab tests, then further tests based upon the initial results. Throughout the (very long) day, personnel kept us informed of where we were in the process, why they were doing what they were doing, etc.

The concern was that he was having a pulmonary embolism. Thankfully, the scans ruled that out; however, what we thought was a bad cold (and what the ship’s doctor had shrugged off as a cold or allergy) turned out to be a heart problem that has evidently been developing for some time and had not been detected by his cardiologist on his visit a week before our trip. The doctor explained that his symptoms were the result of fluid accumulation–probably the result of unusual activity on the trip. He was admitted for a short stay so that they can eliminate the additional fluid and he can safely fly home. (Only then were we asked whether we had insurance; a nurse took our information and nothing more was said about payment.)

To say that we had a stressful day would be an understatement. I extended our hotel booking in Nottingham and my son managed to change our flight home from tomorrow to Saturday (unfortunately, we lost those first-class seats we’d used our frequent-flyer miles to secure..). My granddaughter and her wonderful partner pretty much saved what sanity I managed to retain. So at this point at least, it looks to be an “all’s well that ends not so badly” situation.

When you live with an 80-year-old husband with heart problems, you see the inside of a lot of emergency rooms and hospitals. I don’t know whether my experience yesterday was representative, but I was very impressed with the efficiency and thoroughness with which Bob was treated. There were adequate numbers of personnel, and they were unfailingly pleasant and responsive. Our waits were for lab results. Doctors and nurses took time to ask questions and listen carefully…I really could not have asked for better or more reassuring care.

The systemic differences between my previous experiences at home and here really boiled down to two: 1) The clinic and hospital were both in old buildings and certainly didn’t have the physical amenities/decor of most American hospitals. They were clean and well-equipped, but not the sort of plush environments we generally encounter in the U.S. 2) At home, unless he was having a heart attack, treatment wouldn’t have commenced until payment had been arranged–I always check him in by providing insurance information, etc.

As academics like to say, anecdotes aren’t data. But my anecdote says lots of good things about the NHS.

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