What will life be like if the NHS dies?

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A word to the well-off from Susan James, a KONP member who has lived in the US and warns of how, in an insurance based healthcare system, even those who think they are covered financially find this is not the case when treatment is needed. This is a stark warning to those who have some financial resources of their own to draw upon and might imagine mistakenly that a change towards insurance based funding for NHS care would be to their advantage.

Some people who can afford private health insurance might be thinking ‘we can always go privately, if we really need it’.  But most of us have no inkling of what will hit us, if the only adequate health care in the UK is for the privately insured.

As a British person living in the USA for 10 years, I saw the heavy financial consequences for all but the very wealthy, arising from a lack of an NHS.  If we in the UK lose the NHS to private businesses, the same promises to happen here.  To quote an American friend, health companies’ priority is profit, not health.

What does that mean in practice?

To start with, American private insurance premiums are many times more than those of UK policies.  Policy excesses can also be extremely high and, more often than not, customers make ‘co-pays’ when they consult health practitioners.  One reason why US health insurance is so expensive is that policies offering reasonable health care usually cover more services than British policies do, there being comparatively little public health backup. And prices charged by US health practitioners are very high indeed. 

Here are some examples of real-life payments made by insured people in the USA – either my own or of Americans I know:

1. Following a minor fracture to an ankle during a walk:

  • $1000 for A&E;
  • $1067 for 5 minutes of an orthopaedist’s time, following that fractured ankle;
  • An appeal to the insurers resulted in the orthopaedist’s bill being upheld.  In the end, however, there was a negotiated settlement of $350.

2. After choosing an ‘out of network’ hospital by mistake:

  • $1000 for a mammogram.

3. $100+ for a GP visit to obtain a painkiller prescription

  •  The doctor had refused to prescribe over the telephone, but the consultation comprised a conversation only, without physical examination or test.

4. Following a fall at a supermarket:

  • $7,500 for A&E treatment of a broken wrist and torn rotator cuff;
  • $1,300 for the 2-mile ambulance journey from supermarket to hospital.
  • The policy excess was $8,500.

Because these injuries happened in a State other than the one in which this person lived, the insurance did not cover an MRI or physiotherapy which would have cost:

  • MRI: almost $3,000. 
  • Physiotherapy: $100 –  $190 per I-hour session.

As she has dual citizenship in the USA and a European country, she later had the MRI in her European country instead – cost: 150 euros.

  • Physiotherapy in her European country: free.
  • However, she preferred to choose her own physiotherapist; the equivalent of $16 per 90-min session.
  • She is now living for an indeterminate time in Europe because she fears she could incur further medical bills in the USA.

On the more practical side, there was the dying man I knew, sent home from hospital when the insurance company refused to make further hospital payments – because machines had been switched off and technically the hospital was ‘no longer treating him’. Instead, the insurers paid for his wife, in her eighties, to receive assistance in looking after him during his final hours.

Then there was the widow who stored her possessions for 2 years in a well-wisher’s basement after being made homeless. The insurance had been insufficient to pay for her late husband’s final treatments and she had sold their house to pay for them.

A woman who came to me for business advice had had potentially cancerous skin growths. She had never been to the doctor before The Affordable Care Act (“Obamacare”) because she could not afford insurance.  After the Act came into force, she went to her GP and found the growths were benign.  But her happiness was shortlived when her employer cut her hours so that he would no longer be obliged under the Act to make contributions to her insurance. 

Hospitals in the USA are not permitted to refuse emergency health care to the very poor or uninsured.  A very poor, uninsured acquaintance of mine was obliged by police to report to a hospital after a psychotic episode in a public place.  In 24 hours she was sent home, telling me: ‘See, there’s nothing wrong with me; they’ve sent me home.’  A psychologist explained to me that the hospital would have done the minimum required and discharged her as soon as they were allowed, because they knew they would not receive payment.  Even I could see that she needed further help.

A friend’s son, temporarily homeless and uninsured, broke his leg and had an operation. The hospital was obliged to treat him as an emergency case, but insisted he be discharged after 36 hours. They offered to fly him to his mother’s home in another state, but would not pay for his partner to accompany him.  Instead they paid for bus tickets for the couple.  At the end of their 1,400 mile journey, which lasted 30 hours and involved 5 bus changes, his mother met him and took him immediately to the nearest hospital.  He was told that, had he waited much longer, he would have lost his leg.

GPs in the USA are permitted to decline taking on new patients, and not all practices accept policies from every insurance company.  A friend of mine, needing a doctor, has spent weeks looking for a new GP after hers retired.  One practice could accept her but had no appointment available for 10 weeks.  Another practice’s wait time was 10 months.

When our doctor retired, we were transferred to the list of a ‘nurse practitioner’ without our consent, or even our knowledge.  When we subsequently transferred to a doctor at a different practice, it took 18 months for the original practice to send us the medical records.

In the USA, finding health insurance which covers more than the State in which customers live is bewildering.  We may foresee regional complications regarding UK private policies also, once the NHS is defunct.  And the inequalities between different health districts which we currently see could worsen.

I cannot say that I know much about politics but I do suggest that, next time we choose for whom to vote, we keep these things at the forefront of our minds. 

It seems likely that losing the NHS will create a vacuum for a system akin to the American one.  The implications for the less wealthy are clear.  But what is not perhaps so obvious is that the comfortably off will not escape either.  Pockets will be hit – and badly at that. 

Susan James, KONP member

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