TRAIT 5: Free Healthcare VS Expensive Insurance

As I warned in my last post, this subject is something that I feel quite strongly one sided about, but I feel that it is one of the most interesting subjects to look at when considering the differences of opinion between Britain and America. To tackle this, I am going to take the current situation in each country as the preference of the citizens of that country, because it wouldn’t be that way if it wasn’t what the citizens had voted in at some point over history. The UK has the NHS, or National Health Service, which allows its citizens and visitors to access free health care, and the US has a policy where its citizens and visitors must pay for a personal health insurance plan. So, I begin with an apology for the bias of the following writing – the NHS is something that I believe in even more now that I live in America so I fear that this preference may be rather obvious as we work through the subject.

I Love My NHS

I grew up knowing that if I ever had to go to the doctor, nurse, get an ambulance or go to the hospital, it would be available with no charge. It was never something that I thought or worried about, and I definitely never considered my bank balance when faced with an illness. It didn’t matter if I was working, if I was paying taxes, if I was young, if I was old, if I had a pre-existing condition, if I had a family – the only thing that mattered was getting me well again. Sure, there is always a shortage of beds so they have been known to rush people through, it is also clear that there is never enough staff in any area of the medical organisation, but from what I hear, the hospitals in the US have this same problem and they have to pay a fortune to be able to go to those! Adding to that, NHS workers get paid a pittance and things sometimes get overlooked – and of course there is the popular complaint that the best doctors would never work for the NHS. For me, especially now that I see how it all works in the US, these things are insignificant compared to what we do get. If you don’t like these things, you can pay for health insurance like every single person in the US is legally obliged to do for their whole lives. The point is, you have a choice. If you don’t have any money, you can still get care and treatment.

Taxes and Payment… Blah, Blah, Blah!

In the UK, we do pay for the NHS non-directly through our taxes. A general tax is taken from your pay check, the amount of which depends on what ‘tax bracket’ you are in (which is calculated by your income). That money goes towards a large list of things, the NHS is just one of them. What I have found, living in both countries, (and I can’t say that we were expecting it or happy about it) is that we do not pay any more tax in the UK than we do in the US, even though our tax in the UK includes health care. In fact, I would go so far as to say that if there is any difference between the two, the tax in the US would come out as more expensive. Then, in the UK, if you have paid too much tax in the financial year due to moving around or the wrong automatic tax bracket being set for you, the government will send you a check for what you have overpaid without you having to lift a finger.

In the US, you pay tax to the government (which is called federal tax), a tax to the state, a property ownership tax, then depending on where you live you may also be forced to pay an income tax and an inheritance tax. I honestly have no idea where the money goes because everything that I would expect to be paid for by tax, seems to have a separate price tag on it, either for you to pay for, or companies and corporations. Things just don’t seem to add up. For example, when we lived in Boston we paid a certain amount of tax which was much higher than we were expecting when we moved to the US. When we learned that we would be moving to Delaware, we were looking forward to a lower tax payment because you would expect it with looking at the differences in the states and general living areas. Living in a city should incur more tax than living in the middle of nowhere next to fried chicken enthusiasts with chewing tobacco hanging out of their mouth (I apologise for that stereotypical statement…they are not all like that here!). We were also looking forward to having no sales tax, which is a draw for people to come to live in Delaware because you benefit from tax free shopping (and from my research, it seems to be the only draw, but please let me know if there is anything else that makes folks up and move to jolly old DE!) However, when we got here, we found out that we would be paying an extra $40 a month on tax here, which is far more than we would ever save on the sales tax. So why is that?

In the US, on top of the tax, it is illegal in most states to not have health insurance. Usually you will get health insurance with your company, but it is still an insurance payment that you make every month, which is a gigantic amount of money per person – and is paid as a completely separate payment to your tax, to a private healthcare insurance company. I have heard that the amount that people have to pay for an independent insurance plan (not through their company) is even more. Considering that I only know how much we pay to the company healthcare plan to reference it to - which I think is already an extortionate amount - I have no idea how these people can afford it to begin with, even before they get a job and get the company insurance plan. Then, on top of the monthly payments, you have an amount to pay before your insurance even kicks in. For us, that amount is more than we can really afford off our own backs, so we would have to borrow it or travel back to the UK if we got into big health trouble. With all of this, as if it is not bad enough, you have to send your own tax rebate form to the government every year – essentially doing your own taxes even though you pay them a stupid amount of money in the first place, seemingly for not very much in return.

Is This How It Works?

In the US, once you have paid your health insurance monthly bill, you are covered for whatever that entitles you to, much like any other insurance policy. The more you pay per month, the more you will be covered for and the less you will have to pay before the insurance helps you out with your medical bills. If you want to go and see a doctor, you pay the doctor’s office for their service, which could be anything above $100 per visit, even if it is just for a check-up. You also have to make sure that you go to a doctor that is listed in your health insurance scheme, or it will not count towards your insurance money. You even have to pay for the ambulance service that gets you to the hospital if you are sick.

In the UK, your NHS payment is made automatically in your pay check so you have nothing to think about. If you have more income, you will pay more tax (and so, more money towards the NHS) and if you don’t have any income then you will not pay tax, and so will not pay anything towards the NHS. The NHS is there for anyone in the country, even non-citizens and visitors – however there is a limit to what a non-resident of the UK can get for free, and usually the free services include prevention of diseases and emergency treatment from accidents. Citizens will have a local doctor’s office that they will be registered to, but for everyone else there is a doctor at a walk in clinic at every hospital. Your name will be taken and your health history, but anyone can be treated and most treatments (depending on the seriousness of it) will be free. If you are a resident or citizen of the UK and you have the money, you can pay health insurance for a private healthcare scheme such as BUPA– where you will be treated in fancy private hospitals and have the best possible care, pay for it, then claim it back from the insurance much like you would in the US.

Negatives and Positives, What’s Your Result?

The NHS is a big subject for popular complaint in the UK, for not having a good standard of care, for not hiring enough staff, for not having certain non-essential treatments covered for free, etc. I never really understood this argument when I was living in the UK because I am a sickly person and use the NHS a lot – and it may be slow and not the most perfect of healthcare operations but it is still available without charge or complaint if you become ill. They have the general attitude that I have always believed in strongly, that your health is the most important thing and nothing should be more important than getting treatment if you need it. Now that I live in America, I feel even stronger against the NHS non-believers. To all of you who have ever said a bad word about the NHS, imagine this world: you have to pay the same amount (if not more) of tax that you do now, you also have to pay an expensive monthly fee for health insurance, when you want to go to the doctor you have to pay for their fee upfront from your own pocket, you will not get a large amount (if any) of the money that you pay for medical fees back because you have a deductible out of pocket amount before your insurance kicks in, you are restricted to which doctors you can see, the doctors and hospital and ambulance fees leave you with no money after a big illness – I can carry on painting this image for you but I think you get the idea.

Doctors in the UK are not paid a lot at all, considering the vast amount of training that they have to go through to get their titles and the lifelong dedication to work that means most will not have much of a personal life throughout their career. They can go private, however the private sector only seeks out the best and for most, this will not be an option. In the US, doctors are paid a fortune and can afford a very lavish lifestyle. So much money goes into hospitals and medical professionals – everything for the average Joe is so expensive and they can get away with charging a fortune for something that could rip a family’s fortune apart. However, because of that, there is a lot of money in the medical industry and people who end up there will do very well for themselves. This is of course not taking into account the crazy amounts of student fees that they have had to pay for their qualifications – 4 years in university (which can cost around $200,000), 4 years in medical school (which can cost around $300,000), 3-8 years in a residency programme, and 3 years of a fellowship programme. And we complain about our student fees in the UK! I wonder if they would have any new doctors at all if they created an NHS?

Medical Mentality

I have spoken to lots of people here about their health system and most of them agree that it would be better not to have to worry about payments for health insurance. However, through these conversations I have come to understand the mentality of why, in America, it is the way that it is. America is the land of the free, and as we have seen in previous blogs (and I dare say will see in future ones), the mentality here is very much every man for himself. Free speech and the freedom to have your personal independence is a huge deal here and you can see how that relates to their opinions on health insurance. Why should one person pay for a collective to have health care – the money that they make shouldn’t go to keeping someone else healthy. If you are doing well financially, you have worked for that and you should be able to reap the benefits of that hard work – having good health care is one of those benefits. The American people grow up to know that they should always have the money for their medical insurance’s deductible fee saved up and available, just in case they need to use it. So, there essentially should never be any issue with having to pay medical bills. I have to pose the question though, do they know where any of their tax money goes? If there is one thing that I have noticed about the people of this country it is that I have never met anyone who really knows what the hell is going on with their tax. Would they even notice if part of it went towards the NHS? I suppose that would mean that this portion of the tax would be taken from something else that the tax money is spent on – but no one seems to know what any of it is spent on in the first place! I understand that the country of the US is much bigger than the UK so more money needs to go into it, but there are also more people to fill that country and pay its tax, so even that argument is invalid. I am afraid that I must once again resign myself to being stumped. I can’t find one good thing about the US medical system.

Healthcare Is Not Healthy

The main thing that frustrates me is that when you get sick, it doesn’t matter what illness you have, it is common knowledge that being mentally stable and strong plays a big part in your recovery. Do you think that being in the situation that I described above is a way of getting into a positive and healthy mind frame? Whenever I am sick in the US, the first thing that comes to my mind is dread. Not because of the sickness, but because I am not sure if we can afford to see a doctor. You have to really think about it and consider if it is worth it – you can see how many people die here because they have un-diagnosed illnesses that could have been easily treated at the first signs and needn’t have killed them. It is like living in the dark ages.

Obama Care

As you have probably heard, the Healthcare Reform or Obama Care has been put into place and is finally in the beginning stages. There has been so much controversy over it, half of the people loving it and eventually wanting a proper healthcare system, and half hating it and wanting it to fall.

I suppose these things always happen to anything that is new, and true to form, there have been a few issues with it that the Obama Care haters have jumped on. New things always have issues – think about the first IPod! The important thing is that the issues get ironed out and everyone works towards a better future.

Now I don’t claim to know a lot about Obama Care, in fact I really know very little. To learn more about it, I went onto an information page and there I found a lovely little video with YouToons (little cartoon Americans that walk you through political and government issues).

Click here to go to the video

From what I can tell, it is nothing like the NHS really (not that it promised to be, but I am just stating facts!)– what it seems to be is a general healthcare plan to make the little things a bit easier for certain people in certain groups. For the poorer people, elderly people and some other selected groups things will be a little cheaper, then for the richer people things could get more expensive. To allow for the poorer people and the retired to get cheaper health care, corporations will be paying more – corporations such as healthcare organisations themselves (who, if you ask me, are raking it in with the past arrangement).

We’re Going Through Changes…

So, even with Obama care, the US still seems to have a long way to go. I know that changes must always come slowly, but this is true even more so with America. Change seems to, for a large section of Americans, be a bad thing. It seems crazy to me because they descend from such devotees of change. Maybe that is another topic for a future blog, but for now, I would like to leave you with this dominating feeling that I have about this subject. I feel that the American supporters of the original healthcare don’t want to change what they know for reasons that don’t seem to make any sense. They don’t know how it can work and they don’t know what they are paying tax for. I would agree if it would be an extra tax on top of what they are paying now – God knows they are paying enough. But we don’t pay more tax in the UK and we have the added benefit of knowing that what I consider to be a basic essential right for a human being is offered to everyone with no bill coming through the post afterwards that makes your stomach wrench in knots. To me, that isn’t a privilege, it is a right – and I am thankful that I am from a country that understands that.

Next Time…

As you can probably tell, I feel very strongly about this issue and if I am completely honest, it is one of the main reasons that I know that I will not be staying forever in the US – and I will surely not be bringing up my family here (I wouldn’t be able to stomach the maternity fees to start with!). So, I apologise again if I have offended the American side – it is not my intention. I wanted to express how I feel about it but also explain to you why I feel this way so that you can understand not only how my country works with healthcare, but also maybe understand a little bit more about your own country and its choices in this subject. I know that I have learned so much about my own country – the bad and the good – by living here in America and I hope that I have given you the same opportunity! Next time, I want to talk about how each side feels about personal family history. I promise that it will be much less biased! See you then!

TRAIT 4: History – Proud but Empty VS Neglecting but Plentiful

History is my favourite thing. Ever since childhood, I have been fascinated with the past and the abundance of fascinating stories kept within it. I remember learning with amazement about the countless kings and queens that have ruled over my country, the abundance of battles and wars that the British have gone through to keep their lands, the magic of the medieval people, the horrific but fantastic take overs of the Romans, the Vikings, the Celtics, the Germans, the French, the Normans, the Danish, the Anglo-Saxons (who I think are a mix of the Anglo or English people, and the Saxons) – the list goes on. I even remember learning about the earliest people to be in Britain, the hunter gatherer types who enjoyed the vast amount of fresh water that flowed in the land and the seemingly endless supply of green vegetation. Anyway, my point is, in this blog, even people like myself who are fascinated with history are examples of the ‘typical’ British person who in some ways, take the huge amounts of history in their country for granted. Let me explain…

My happy place

As I mentioned, I grew up in the UK with a great fascination for history. I would make myself sick with excitement when we were to go on a school trip to a historical site or a museum – I can even feel the excitement now that I am recalling it. I would imagine the people who built them, imagine the characters that lived their lives there, imagine the stories that the walls could tell. I always get swept up in history like some sort of magical spell – my creativity would flow and my mind wouldn’t be able to stay in the present. Of course, I got very good at pretending that this wasn’t happening to me – as if I didn’t get picked on enough at school, I didn’t need them to laugh at me about this as well! I knew how silly it was. It was cooler to think that history was stuck in the past and that there was no relevance in it. I think I even remember myself once agreeing with a kid that history was the most stupid subject because it doesn’t mean anything to us now – what use is it to know the names of Henry the eighth’s wives over learning a language or learning how to add up your Freddo’s (for you Americans, Freddo’s are Cadbury’s frog faces and they are amazing) and divide them by how many days you have left in the week? The truth is, I find that a lot of people in England feel that way.

History is just a walk in the park

One day, back in Britain, I went for a nice lunch with my mum. It was a beautiful day and we found this quirky little café in the middle of a national park. We ordered and decided to sit outside (in Britain you have to make the most of the nice weather because it only comes around for a few weeks in the year!). After basking in the sun for a while, I noticed that in the next field was an old monastery or abbey ruin. I asked my mum about it and she said, “Oh, I don’t know. Go and have a look at the sign.” I walked over to a tiny sign, nestled in the bushes with a picture of the monastery on it. I couldn’t read the writing so I sat back down again and carried on the conversation about how good the food was. That monastery must have been at least 500 years old, probably even more, and it wasn’t a tourist site, it didn’t have guides walking around it with an overtired but enthusiastic crowd of sightseers, it didn’t even have a very good sign. I didn’t think too much about it then, but since I have been here in America and anything that is more than fifty years old is a historical landmark, I am beginning to rethink my outlook on the history of Britain.

*Note: the abbey in the photo is not the one I spoke of, because I didn't bother to get a photo of it at the time. I guess that backs up my theory!*

 

 

Is there too much of it?

The advantage that we have in Britain is that there is an astounding amount of historical sites that have been well preserved for us to appreciate. However, I have known many people (including myself) that will live in an area their whole life and have no idea about its history. History is very much like a whimsical tourist activity that you appreciate when you are visiting somewhere, but we do not really instinctively think to appreciate it in our own town. I used to visit lots of places in the UK growing up and all of them had some sort of historical element (because it is really hard to go somewhere in the UK without a significant amount of history). However, in my hometown of Chester, one of the most preserved Roman cities in the UK, I had no real clue about its past. I had never gone on a bus tour, I had never read the signs on the cobbled roman street, had never walked the Roman wall without it being a necessity to get somewhere. I don’t think I even noticed the archaeological site of an amphitheatre in the middle of the city until I took one of my foreign friends on a tour one day (see photo above, taken on said day in Chester in the amphitheatre - back when I was experimenting with my hair colours... you should have seen it during the green stage...). Well, I have to admit, I noticed that the site caused traffic every so often and I didn’t appreciate that, but I didn't really think anything of it or get excited about it.
Could it be that we are so rich with history where ever we go in Britain that we forget to appreciate it? In America, there is little in the way of preserved history – so what they do have, they cherish and it is the highlight of the town. Dover, Delaware for example, the “city” that I live in at the moment (you would understand the quotations if you ever visited this tiny village-like city) proudly calls itself a historic city. It appeared in the early 1700’s, founded by a man named William Penn and houses were built in the next hundred years – some of which are still around today. These houses are classed as historical and are seen as important history. The only thing that I can think of that is classed as history nearby my village is Plas Teg Manor House, which was built in 1610 - but to be fair, if it had not been a grand house built by someone important, I don’t think we would know about it. On that note, I don’t think many people who live in the area do know about it. I certainly can’t imagine a normal house built in the late 1700’s by an unknown person still being around today, and if it was, there wouldn’t be tourists admiring it, that’s for sure!
I also found it bewildering when I realised the extent to which Americans build structures that appear to be old, with all of the traditional old stonework that you might find in a historical landmark in Europe, but it was built two years ago. My local post office in Dover Delaware is a prime example of this, a new building that looks like an ancient Greek temple from the front. Baffling.

Maybe in the UK we have no need to take care of the everyday people’s history because we have so much famous and flashy history – maybe we have just let the other stuff slip through the cracks. It could be because we are such a small country so we need the space for new and functioning houses to put a roof over our citizens heads – America is in no way short of land space to simply build somewhere else rather on top of an old house.

Why not the natives?

I found it hard to understand when I arrived in America, why they don’t seem to count the Native American history as their own. The Native American people have been on this land ever since there were humans on this land, and they have just as much history as we do in Britain. Yet, Americans go crazy for a hundred year old house that is still standing, and state that their oldest historical site is a structure that was built when the first settlers came over in in early 1600’s (but have been heavily modified to make it structurally sound, to the point of little original recognition). I understand that to Americans, their blood is everything. Where they came from and who their ancestors were are paramount to their idea of history. I will discuss this in a blog post in the future, but in terms of this discussion, I wonder why the history of settlers coming over is so important to them, and why they seem to value every speck of that history so much here – when it can be considered quite recent. And why, even though the Native Americans might not be in their blood line, they have not taken on their history as much as the settlers? I feel that in Britain, we do not consider our blood as a mark of our history quite as meticulously – there are many civilizations that took us over, just as the Europeans did in America. There is no way of telling what is in my blood, and whether I have the same lineage as the person next to me. We just see the general history of our country as it is, rather than concentrating on one part of it and one civilization who settled. So, in that sense, America says that it is a young country, but is that really true? Why isn’t the history of the land classed as the history of the American people, rather than just the history of America?

Nostalgia

In America, everything seems so new. It might be just me being accustomed to ruins and wreckage in our history, but the atmosphere of the historical sites here just don’t feel the same. It will definitely have something to do with the fact that the historical sites are not as old as ours, but even with the Plas Teg manor that I mentioned before, it is around the same age as some sites in America but it just has this feel to it that makes me go weak at the knees. You can smell and touch the past in the sites in the UK – it just happens all around you. Why do I not get that same feel from American sites? I feel that the desperation and passion for history here, the same emotions that allow small working-men’s houses in a village to become historical sites, force the sites to be overworked and unintentionally modernised. The need to preserve and share a rare site might erase the very thing that I love the most about history. Of course there is the issue of building materials. In the UK, the historical sites are all made from stone or a hard substance – much like we use to make our houses today. The historical sites in America tend to be made from wood or such substances, much like they use to make their houses today. The settlers would have come to the new world and found an infinite amount of wood, free for the taking. It would have been a perfect choice for house building, as it still seems to be for them today (I am writing to you from an apartment in a building made from wood). However, as good as wood is for a cheap and quick build, it is not good for preservation so the historical sites of buildings made from wood would be hard to protect without modernising it sufficiently. Still, I miss that feeling of my happy place – the whirl of excitement and possibilities, the smell of the past, the cold feel of ancient air on my skin and the promise of lives come and gone before me on this very spot. I feel so lucky to have this in my homeland and wish I could have understood what a rare thing it is to have it in this world without having to see it for myself.

*Note: The photo was taken at Louisa May Alcott's Orchard House (the Little Women house) in Concord, considered a historical area just outside of Boston. The house was occupied by the writer from 1858.*

Next time…

Well this post was quite a trip down memory lane for me, wasn’t it! Next time I am going to tackle a subject that has frustrated me from day one of living in America and I dare say, apologetically, that it might be slightly biased because of that. I think that it might be the only subject that I will face on this blog where I truly think we British are doing it better. So, next time my dears, I am going to talk about the somewhat currently relevant topic of healthcare. See you then!