This is a real biggy isn’t it, especially with privatisation of the NHS being sold as a change from being a provider to being an insurer, or to put it another way, “We provide the insurance and it’s up to you what you can get from it”. Key to this will be the notion that this will put health care into a competitive market where the quality of provision is driven up and the cost is driven down – a bit like buying a new computer which costs less than you paid a three or four years ago and yet can do so much more. Well, my so far relatively short experience of a health market driven by insurers here in the USA might give the lie to some of these presumptions.
Let’s start at the beginning. My wife is employed by the local education department and the quality of the insurance provided by the employer has gone down year on year – one of her colleagues actually insures through her husband who gets his insurance from a private school employer because it is better and cheaper. The cost is much greater than NI contributions in the UK. There is a need to actually understand and interpret your policy and have informed discussions not only with your health provider but also with your insurer to make sure that your provider is actually on the approved list as otherwise it will cost more to see them, or possibly, if I understand this correctly, the insurance company will not contribute a cent. So, here I am an Englishman in Miami and diagnosed with possible cancer. Do I understand the health insurance? No, not really. Am I in any kind of mental state to start understanding it? No, not really as I’ve just discovered that I may or may not have something fatal growing inside my body. Luckily my wife does understand these things and has been able to check out who is, or is not in-policy and believe me it takes time to do that. If you ask the doctor’s office they may or may not be correct when they say they are or are not in-policy, if you check the insurer’s website for the “latest” updates you find that it may be the latest which has been posted but that it is not necessarily up to date so you still have to talk with the insurer’s office which, it seems to me is an unnecessarily complicated process especially when a discussion with two different members of staff can give two different answers. There have been times when my wife’s conversations seem to have lead to some kind of formula to the effect that the number of answers is equal to the square of the number of employees questioned. All this, by the way, was after we’d overcome the inertia caused by our initial Primary Care Physician (PCP) who was intent on sending us to some organisation with which she was associated despite being told by my wife that the organisation was not within policy. Not only do you have the problem of finding someone who is in-policy but you also seem to have your own specification for what that doctor should be able to perform. We needed someone capable of doing a biopsy on the swellings in my neck. A simple task you’d think wouldn’t you? Well, the ENT doctor’s referral turned out not to do them though there was someone else in the office who did do them but we’d have to wait until he came back from holiday, sorry, vacation! My wife then got involved in perhaps a dozen phone calls to other offices before we could find an oncologist (whose office confirmed that he did not do biopsies though it turns out he does actually do bone marrow biospies) and another doctor whose office told us that he did do biopsies of the kind I needed. A good job we mentioned to the oncologist who we were going to see as he knew that the other chap “is the same as me. He does what I do.” Had Doctor Tache not known this then we’d have wasted more time in going to see someone who couldn’t do what we needed and being charged for the privilege. Instead Doctor Tache called Dr Dumorney who agreed to see me the next day, despite that being a day on which he would not normally have seen patients, and a couple of days later he’d had me in surgery and carried out the biopsy. Suddenly, in Doctor Tache we’d spoken with someone who knew and understood the situation and could help to organise things and we’d discovered him more or less at random from a combination of his being in-plan, having good reviews on the web and being available to see me quickly. I could see the relief on my wife’s face as the weight or organising and driving forward my medical care was taken from her. The NHS does that sort of thing without even thinking about it but it won’t if it becomes an insurer, instead it will come to function as the insurance companies do over here – after all they are the ones who are being set up to make bids for the new look health services – and will presumably make comments along the lines we heard of “We can’t make a recommendation. You need to see who is available on your plan and choose from them”. So, it will be up to you instead of supporting yourself or your loved one through a serious crisis to make all the enquiries and co-ordinate everything and to spend your time on that instead of giving the love and support you want to give. Don’t get me wrong, my wife has given me all of that, but I know she has found it exhausting to do so, and I also know she wanted to give me more.
Next let’s look at cash. The NHS is free at point of delivery. How long is that likely to continue in a market where companies compete to offer a better quality service. You will discover that treatment A is available within the insurance provision but treatment B is available for only fifty pounds more while treatment C which is the most effective or in the best respected hospital or uses the latest imaging machine is available for only another three hundred pounds. What this means is that as well as doing the research, organising the diary, supporting your loved one, trying to do your job and find time for you to deal with the impact on you, you also have to start juggling the money when, quite frankly, there are more important things which you should be doing, like looking after yourself and your loved one. Although we have, so far, only been seen by people who or in-policy, or rather, on-plan, each visit has been accompanied by a payment from my wife and it soon adds up to a considerable sum. Let me tell you that quite frankly those who are on low incomes cannot afford the co-payments even if they were insured.
I’ve spoken with quite a few people over here about the proposal to introduce a private insurance scheme in the UK, and those people, including doctors, nurses, receptionists and the general public, have, unfailingly been shocked because they envy the UK’s NHS. They envy the ability of anyone in the UK to go and see a doctor when they need to in the full knowledge that the patient won’t have to wonder about the cost of getting treatment. One of my wife’s colleagues recently refused to allow an ambulance to be called for her when she was at work because if would have cost her $500, instead she drove to the hospital, in pain and a potential road traffic accident.