Defending the NHS

The collective principle asserts that… no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.

You cannot failed to have noticed that there is a bit of a debate about healthcare going on in the US at the moment. One of the key Obama election promises was to reform healthcare, to address the issue that of all the major countries in the world, the US spends the largest proportion of it’s GDP on healthcare but has a healthcare system that ranks 37th in the world, with a lower life expectancy than many countries that spend significantly less. Studies have regularly shown what a mess US healthcare is in, indeed the recent Michael Moore movie Sicko was entirely focused on the topic.

Sicko highlights the problems with the US Healthcare system. Whilst certain groups such as the elderly, military and others are covered by public health schemes, the vast majority of US citizens rely on private health insurance, or in the case of an estimated forty million people, no insurance at all. What this leads to is situations where people with inadequate or no insurance do not receive treatment, so the movie included examples of patients who were left choosing which finger to reattach after an accident purely because they couldn’t afford the cost of everything, and people who ended up going bankrupt struggling to pay bills.

So how come it has become such a big story in the UK?

Over the earlier part of the debate, our news programmes have been keeping an eye on things, but mostly with a healthy dose of incredulity that there seems to be such disagreement over what seems to us to be a common sense reform to ensure that everybody has the ability to access affordable healthcare. To be honest it hasn’t figured that much because nobody in the US is advocating introducing a system such as our NHS where the state owns and runs the healthcare services, something that is now pretty well unique in the world. Instead they appear to be moving towards a single-payer health care scheme similar to those that operate in Canada, and ironically similar to the US Medicare system that already covers senior citizens in the US.

However, this hasn’t stopped the opponents of the plan, rolling out “examples” of the failings of “socialized” medicine, using our NHS as a major source. They duped two British campaigners, who support the principles of the NHS, but are campaigning against parts of the system into participating in adverts against the healthcare reforms. They have also rolled out a series of claims about the NHS, a number of which are just plain lies – the Guardian addressed many of the better known accusations. Another trump card was that they also managed to get a British politician, Conservative MEP Daniel Hannan to come onto the TV to criticise the NHS:

In fact he’s been on tour doing it:

There were even people claiming that scientist Stephen Hawking wouldn’t stand a chance under the British health care system – funny, as a British born scientist who has lived in the UK all his life he seems to have done all right up to now…

All of this incensed comedy writer Graham Linehan so much that he called on Twitter for people to post their stories of their experiences with the NHS under the hash-tag #welovetheNHS, a topic that is still trending days later.

Graham explained what happened to Channel 4 News:

Watching the stories go by on #welovetheNHS reinforced how many people were grateful to the service. Whilst complaining about the NHS is almost as much of a national pastime as moaning about the weather, the vast majority of the general public in the UK are full square behind the original idea set out by Nye Bevan, that no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means, even if we could all see ways it could be improved. Faced with this, we’ve had politicians of all persuasions queuing up on British TV to defend the NHS, indeed Hannan caused his party leader to break his holiday and distance the party from the statements in the US as detailed in this BBC News article. Incidentally, the BBC also has an interesting page comparing statistics on four basic healthcare models in use around the world and their costs and effects.

There have also been some extensive personal contributions to the debate, some of the most interesting have been from Americans with experiences of both systems. For example, an American now living in the UK responded to a circulated e-mail from a family friend describing her experience as an emergency admission whilst on holiday, and here an American who had married a Brit but recently moved back to the US compares the systems, and concludes that she’d choose the NHS in a heartbeat.

From my position, I have never experienced US healthcare. All I can do is explain some of my experiences of our system in light of some of the untruths that have been presented in the US describing the UK system. It is also worth mentioning that these are my experiences, and others experiences may be different depending on their doctor, a particular illness, hospital or whatever.

First off, some of the Americans interviewed on TV have expressed concern that they would not have choice under a single-payer health care scheme.

That is not my experience. Thanks to the generosity of my employer alongside my NHS I have a subsidised private medical insurance scheme. The way they get used in the UK is primarily to gain quick access to minor treatment, but a number of NHS hospitals have private wings which the private medical insurance can access. Many surgeons work in both public and private systems, indeed for many minor operations you’ll find the private patients being included in the same list as the NHS patients. There is also nothing to stop you paying for your own treatment, as several people I know have done for minor procedures.

I’ve also got a choice of my GP. Where we live falls in the area of several GP practice areas – in the NHS GP’s can define limits on the areas their practice covers, generally to allow them to easily visit patients in an emergency if required. When we moved here we chose to stay with the local practice for where we lived previously as this was still within area. The surgery is a little over two miles away, and there is another just over half a mile away, and several more within three or four miles of home. In more rural areas GP coverage may be more sparse, but with multiple doctors in most practices there is still some element of choice.

When Beth was pregnant, we also had a choice over hospitals – there were three within ten miles and having looked at statistics and feedback on the units, and also considering where they were located in relation to our workplaces we opted for the unit at Frimley Park rather than the hospital that most mothers from our GP practice went to at the Royal Berkshire.

That actually brings us on to another topic, the costs of treatment. As you may be aware, Beth had complications in her pregnancy which resulted in significantly extra appointments at the hospital, and several additional scans. All of this was delivered for the same cost to ourselves, absolutely nothing. Indeed as a pregnant woman all of Beth’s regular prescription costs were covered, as they still are now, and as are any prescription costs for Lucy. I have to pay for my prescriptions, but that is a £7 administrative cost. Whilst it is true that I may be able to buy some drugs cheaper, I know others who are getting drugs that cost thousands of pounds, all either for the £7 administrative charge, or nothing if they are in an exempt category. Exempt categories include pregnant women, children and those with a number long term illnesses that need regular medication. All in all something like 85% of prescriptions are dispensed for free. Also free were the several “nervous new parent” visits we paid to the doctor with Lucy after she was born with what turned out to be minor ailments, and the regular visits from the midwife and health visitor teams. As there is no concern about paying for consultations, we are much more likely to visit the doctor just-in-case, which in turn increases the possibility that maybe serious conditions are caught early.

Moving onto another subject, the idea that senior citizens are denied treatment through their age, cost or whatever, or that they are left on waiting lists despite having serious conditions. Again, in my experience not true. A couple of years ago Mum was diagnosed with breast cancer. On diagnosis she was quickly seen and treated, and indeed when she had a scare more recently, this again was addressed quickly. She received new experimental treatments for her cancer, and at the end of it, no bill, it was all covered. Unlike stories heard from the US, she wasn’t left with the choice of getting treatment or going bankrupt. We have also had a lady at Church, much older than my Mum who was also diagnosed with breast cancer. Again, there was no question of her being too old. Now I have known older people who have been advised for medical reasons not to undergo a treatment, but the decision is medical.

Like any health system, the money available is not unlimited. In the US decisions on what treatment will be paid for are made by insurance companies, in the UK we have the National Institute for Health and Clinical Excellence or NICE. This was established to try and stop what was called the postcode lottery, where different areas would offer different treatments. This is possibly where the US accusations of “death panels” has come from, as the organisation uses statistical methods to work out whether a particular treatment is financially viable. The difference with NICE is that these decisions are made by a public body, and whilst there have been well publicised cases where they have denied a particular treatment, people have also successfully argued to have them change policy. In terms of how this affects me, in simple terms unless I get something really serious, or rare, it doesn’t. Whilst there are certain pre-existing conditions that the company medical insurance will not cover me for – and this list grows whenever I change jobs, the NHS will treat me for almost anything, at no cost, whether or not I’ve had it before. Indeed I had one medical problem that spanned more than one employer that was partially treated on company medical insurance, but also under the NHS – I could quite happily change jobs without worrying that I wouldn’t be able to get treatment.

The system is not perfect, probably the most frustrating part is NHS dentistry. The story of a patient who took to repairing his crown with superglue has been mentioned as an argument against a government run healthcare system – the irony being that dentistry is the one significant part of the NHS with a large private involvement, and that is where the problem came from. If you actually read the story rather than listening to the rhetoric, you’ll find that the reason he fixed it himself was because even supposedly NHS dentists were trying to get him to pay to have the crown fixed privately. More recently, after the NHS introduced a new contract for dentists a significant number of them decided to opt out of the NHS and only offer private services – at which point they charge per treatment, rather than the new NHS contract which was an attempt to move away from that model. It is worth noting that Beth who during our time with the practice had needed several bits of dental work was invited to transfer to become a private patient – me who was only needing the six monthly check-ups was ignored. That left us without a dentist for a while as we looked around for another NHS practice, but we’ve now managed to sign up with another local NHS dentist. Dentistry treatment is not free, but is subsidised for NHS patients. Even if you aren’t registered with an NHS practice, you can still access emergency NHS dentistry cover through a network of emergency dentists.

Other times we have experienced the NHS have been via accident and emergency units. Again we’ve sometimes had a wait, but that is mainly because they prioritise admissions – if someone is rushed in in a critical condition they will be seen ahead of more minor cuts and scratches. Again you can pick and choose where you go, so for example now we have a new unit close by with a minor injury we’d go to a local minor injury unit rather than the city centre accident and emergency unit that is slightly closer, we also have a 24/7 medical telephone help-line that we have used on a number of occasions – they have been able to advise home treatment in some cases, and can also advise whether a doctor, or even an ambulance should be called. The ambulances and paramedics of course are also all part of the system too.

So would I want to make wholesale changes the NHS? Absolutely not. It may have it’s problems, but those are problems that need to be solved without chucking the baby out with the bath-water. Like any sixty year old institution it needs to change and evolve, but not at the expense of the level of care offered to the population of the UK. As to the US, like many on this side of the Atlantic, I can’t fathom why so many people have a problem with it. Check out this video:

Here is an American who is apparently vehemently opposed to “socialized” medicine (without realising that her parents are about to be part of such a scheme), despite the fact that the current private system is hitting her family business with healthcare costs for employees, and she herself admits that she is having to find money to pay for upcoming medical treatment for her child. Over here, she’d only be concerned about the medical treatment, not for how it will hit the family financially – all of the medical treatment she is having to find money for would be covered by the NHS over here.

The collective principle asserts that… no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.

Which one would you choose?

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