Wednesday, April 19, 2006

The Best Bureaucracy You Can Find, Part III

Thursday, before the four-day holiday weekend began, I went to my first appointment at the National Health Service's neighborhood clinic (earlier installments in this saga are here and here). I was to go in for a screening appointment with a nurse practitioners, but the receptionists in the office had suggested I call day-of and see if a doctor also could squeeze me in so I could get a new prescription issued. They found a place for me in a doctor's schedule. So first I saw the NP, who did the standard height, weight, blood pressure, medical history, family history, and vice checks. When that was done, I had about an hour to kill until the doctor's appointment (I could have walked back home, but that would have been pointless--so I read Cornwall Today magazine instead). The doctor called me before my scheduled appointment time. The first thing she did was call up my medical record on a computer screen--yes, the much-derided British medical system has the Holy Grail of the U.S. health care system, the electronic medical record. I handed her my U.S. history on that antiquated form of recording information, pen and paper. She quickly wrote up a prescription for me and sent me on my way, instructing me to drop off my U.S. medical record at the front desk so they could scan it in to my electronic record here. At the front desk, I waited awkwardly for them to tell me what I owed.

Nada. No money changed hands.

Today, I took my scrip up to the chemist, who gave me my prescription (in efficient blister pack form, not loose pills in a bottle) in 10 minutes. Total bill? Six pounds, 65 pence.

The NHS has been somewhat embattled lately, but as someone with a more intimate knowledge of the U.S. health care system, I can tell you right now I'm picking the Brits over the Yanks any day. The big NHS deficit the members of Parliament complain of amounts to US$24.12 per person in England and Wales. That's a pittance compared to the deficits run by the U.S. public coverage programs.

The most comparable program in the states is Medicare. While Medicare's hospital insurance program is self-funded through payroll taxes, its supplementary medical insurance program, Part B, is funded by general income tax revenue and beneficiary premiums. When originally envisioned, Part B was to be half funded by the taxpayer and half funded by beneficiary contributions. In reality, however, the beneficiary share has shrunk to just 25 percent, so the Medicare deficit could be said to be 25 percent of Part B spending, which was $138.3 billion in 2004. One quarter of that is $34.6 billion.

Distributed over the whole of the U.S. population of 295.7 million people, that deficit is US$117 per person--four times the per-person deficit for the England/Wales health care system. Given that Medicare Part B covers only its beneficiaries, however, the comparative per-person deficit is really much higher: spread over Medicare Part B's enrollment of 39.7 million, the deficit is US$872.

The English don't know how good they have it. It may have some serious problems of its own, but it covers everybody and so far has delivered for me when I need it.

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9 Comments:

Anonymous pseudonymous in nc said...

The English don't know how good they have it.

Oh, they do. My experience of the US system makes me a better judge, but the complaints about the NHS aren't of the 'scrap it, it's useless' variety: they're made with a long-seated affection for the system, flaws and all. It's been a political plaything for too long -- Thatcher's 'reforms', in particular, were the kneejerkery of someone who simply didn't like the idea of being treated with the little people.

Even the Tories aren't looking to the US system as a model for NHS reform these days. They may want something closer to a market system, but they're not stupid. Many Brits travel to Florida on holiday and are told to get $3m in health insurance minimum. Many end up having to pay ridiculous sums for basic emergency treatment -- cuts, bandages, etc -- before claiming it back. That's the sort of thing that sticks in the mind.

Don't forget that you can buy a pre-payment certificate if you're going to be getting more than a single prescription per month. And you can backdate it and claim back the cost of anything you've paid for per-item if you get an NHS receipt.

A quick NHS anecdote: I needed a vaccination record for my USCIS medical exam, and couldn't find the bit of paper I needed with batch numbers and other technical data. So I called up my old surgery, and asked if they could fax it across. It wasn't something they'd normally do, they said, but in my case, they'd make an exception. The fax arrived within ten minutes.

7:50 PM  
Blogger Middle Kid said...

Smitty, after the revolution, you can be in charge of setting up the health care system.

9:18 PM  
Anonymous Tony said...

This will be useful ammunition for the running battle I am having with a friend recently departed for DC, thanks!

Sure you've seen it, but Gladwell and Gopnik's debate was quite interesting.

http://gladwell.typepad.com/gladwellcom/2006/02/gladwell_v_gopn_1.html

1:10 AM  
Blogger Smitty Werbenmanjensen said...

I haven't seen the Gladwell thing. I'll be sure to pick it up.

7:39 AM  
Blogger Smitty Werbenmanjensen said...

And of course the Medicare "deficit" I speak of is before we start spending money on the drug benefit, which is going to make $138 billion a year seem like chump change.

7:45 AM  
Anonymous The Old Man From Scene 24 said...

My faith in Free Market dogma has been shattered thanks to this subversive information. I'm contacting the DHS.

2:41 PM  
Blogger Gary Karr said...

Said well by a healthy person. Then you have disputes like this one:

http://news.aol.com/health/story/_a/british-health-system-eyed-in-cancer/n20060412213109990006?cid=474

I don't parade myself as an expert, but were I to get seriously ill -- cancer, AIDS, etc -- I still think I'd rather be here than there.

The big question about the U.S. system is how inefficient it is.

2:20 PM  
Blogger Smitty Werbenmanjensen said...

First of all, I'm hoping that Gary gets an opportunity to read this. I know he's passionate about the free market, and I also know he's a bit too modest about whether or not he's an expert.

Secondly, I'm not a healthy person. As I indicated in earlier posts in this series, I have a chronic condition, one that is manageable, in my case, with medication. I pray every day it doesn't get worse, because it can be quite disabling if it does. The fact that I can get in and out of a doctor and pharmacy spending only six pounds 65 pence matches or exceeds the coverage that most Americans get.

Thirdly, Gary's right: If I contracted AIDS or cancer, I probably would want to be in the States. On the other hand, if I were poor and had AIDS or cancer, I probably would want to be in the UK. A certain journal of repute not long ago published an article indicating that about half is much is spent on the health care of uninsured people with cancer as is spent on insured people, which strikes me as a virtual death sentence. Given that the 45 million or so represent a not-insignificant share of the U.S. population (15 percent or so) and that, broadly, cancer rates are about 486.6 cases per 100,000, that's roughly 219,000 people a year we endanger with lousy coverage. At least in the UK, even though they may wait in line, they get full coverage once they're in.

Finally, yes, NHS has some problems that go far deeper than their not-as-bad-as-the-U.S. deficit. But, as a public program, there is public reporting. In the U.S., you never know how bad your hospital is until it kills you.

10:16 PM  
Anonymous Anonymous said...

best regards, nice info
» »

6:15 AM  

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