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Tuesday, March 18, 2014

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!

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