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).
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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