Expat comments on Crisis of Abundance Posts

I have finished chapters 3 and 4 of "Crisis of Abundance"; I will be preparing a post soon. Meanwhile, I will share comments from a reader who has experience with both the U.S. and U.K. health care systems and who has perceptive observations, which I am sharing with her permission. My reader is an old friend from college days who moved sometime ago to rural Scotland, and who renewed contact with me via stumbling on my work blog. The internet is a great thing. Her comments:

The topic of health care really gives food for thought. The US healthcare system is probably the one largest reason I will not be returning to the US to live. Not out of protest, but because I know how hard it will be to get insurance. We’re all still healthy, but the premiums, even for healthy people are crippling.

When I lived in Iowa City and was working at a small law firm, they couldn’t offer my health insurance. There were just two lawyers and the business couldn’t handle the burden. I had to get private health insurance for myself and the two boys. When I looked into it, I discovered that the premium each month for one adult and two healthy boys was larger than the rent on my house. I tried with higher deductibles, but the bottom line was, I couldn’t afford it. I was just an office worker and a single mother. With no child support coming from their father, it was all I could do to keep the rent paid, utilities, car insurance, food and clothing. There were times when the phone was off because the cash just wouldn’t stretch. I could have packed in the job. Then I would have had help with rent and state medical cover but that wasn’t my style. The point is, I am sure there are more working poor who are in the same boat. People who need to work but whose employers are small businesspeople.

Granted, I am not as dirt poor as I was 15 years ago but from what I gather, the situation isn’t improving. I’m just looking for some sort of solution in Crisis of Abundance. Yes, it’s terrible that doctors won’t just treat illnesses. They feel they must refer up the ladder either because they are afraid of being sued OR they know that they will make more money by referring to a more expensive specialist. Are specialists getting annoyed by all these referrals or do they just line up the patients and watch the cash roll in?

Over here in the UK, the GP (general practitioner) or family doctor is the work horse of the National Health Service – NHS. They see the bulk of the pathology that comes in to the NHS. They will treat the problem then and there to the best of their ability. They have diabetic and asthma clinics a couple times a week to care for the patients with chronic and specific problems. At these clinics, practice nurses will be aiding in the bulk of the work. If there is a patient who requires more treatment than is provided by the local GP run health centre, either because the problem has gone beyond their capability OR the health problem has become more acute it is then that the patient is referred on to the hospital where the specialists practice their arts.

In my job as a pharmaceutical salesperson, I speak to GPs every day. I also speak to the hospital specialists. I know that most GPs will prefer to treat at the primary level. Specialists hate to get spurious referrals they feel it wastes their time when they get a patient through there door, referred from GP who really should have treated the patient himself. But for the most part, everybody gets taken care of. From my perspective as a former US resident, I think the system is brilliant. Naturally there are holes and problems as with all human run systems. Slick US style diagnostics are kept for the large teaching hospitals and centres in large cities. Shame for us folk out in the sticks but we’ll get to see them if our conditions warrant shipping us in to town.

I am reading your current thread with great interest and hope that in the end you will be throwing a ray of hope on the situation. If I ever move back to the US, I don’t want to be panicked about health care.

My correspondent notes a U.K. medical culture that seems to disfavor U.S.-style "premium care. I believe Mr. Kling would say it's just such cultural differences that make it impossible to transplant Britain's NHS over here. In a recent post on his blog, though, he suggests that it would be good for one state to try a single-payer system as a laboratory test of how single-payer might work in the U.S. medical culture:

Right now, single-payer represents a "grass is greener" model, where advocates are free to tell us how wonderful everything is in Canada, the UK, France, or wherever. I want to see a state in the United States implement it, with our culture and our technology. Then we can talk about how the system really works, instead of people's fantasies about how it works.

Any takers?

Previous Crisis of Abundance posts:

Premium medicine in action
C of A: "Three Health Care Narratives"
Crisis of Abundance: "Premium Medicine"

May 20, 2006
May 16, 2006