Category Archives: NHS

NHS V Private Health Care

I’m English so I’ve been able to rely on the NHS, which, much to the surprise of many Americans I have spoken to is “free at point of service”. This doesn’t mean we get it for nothing, oh no, no, no. We pay a National Insurance contribution from our wages which means that when we need a doctor we go and see one or alternatively the doctor comes to us. It means that when we need a hospital we go to one. It means our medication and drugs and scans and tests and a whole battery of other things are paid for already because of our National Insurance contribution. It also means the unemployed are covered to the same level as everyone else

Over here, in the US, it is different. If you work for a good employer you may have an excellent health insurance package. A less good employer and a less good package and so on, but many people have no medical insurance at all and this causes fear. Even people with insurance policies are terrified of losing their home because of the size of the bills which very rapidly mount up. If you are too ill to work then you’ll lose your insurance through your employer just when you need it.

In England the parties are coming together to fight the proposed changes to the NHS, and with good cause too I think. For those of my friends in the UK who are in any doubt whether the NHS should be kept or privatised please read this blog by the wife of a cancer patient who, with colleagues, left his job as a matter of principal. For those of you who may not read it I’ve copied the horrifying bit below:

“He’s going to die from this, all because he quit his job almost 5 years ago. If he hadn’t walked out, he’d have insurance. He could have seen a doctor when he noticed something wrong. He wouldn’t be going to die.”

Please read the comment from nadeaucaron which explains just why her husband finds himself in this position.



Filed under Cancer, Health Insurance, NHS

If this had been happening a year ago.

Something made me think, last night, about how different this entire cancer experience would have been had it happened twelve months ago.

A year ago I was living in England with my mother who was, and still is, suffering from both Alzheimer’s Disease and Dementia while sustaining a very long distance relationship with my fiancee in Florida. A year ago the process had been started for assessments to be made of Mum which would, ultimately, lead to her being placed in full-time residential care. I was working at a job which I didn’t find particularly satisfying, which, in winter, meant leaving the house before dawn and returning after dark. The pay was poor (though in line with other companies) and I did the job basically because it was undemanding, as I had little energy left to do anything after long sequences of broken nights and energy sapping arguments with Mum, who was clearly slipping into the other world of dementia.

Had the cancer been identified at that point in my life then I would have found myself having to deal with it in a very different way to the way I can now. Now, I can rely upon my wife, had I been living with Mum then she, my mum, would have been relying on me and there would have been no way of getting her to understand and remember anything about the cancer. Perhaps the situation would have speeded up the reporting and evaluation process needed for Mum to go into care but these things seem to have a life-cycle all of their own, and I can’t say that I have any belief that things would have progressed more quickly on that front.

From what I understand, the treatment for Hodgkin’s Lymphoma is pretty standard, which, I presume, means I would have been prescribed the same course of drugs and infusions in the UK as in the US. One of the instructions which goes with that treatment is that I shouldn’t mix with groups of people, e.g. in a theatre, as the chemotherapy drugs will suppress my immune system. So, it’s very doubtful that I would have been able to continue working, particularly as my journey to work involved a peak time commuter train in both directions as well as a tram ride. Then there would have been the difficulties of working with groups of people, shift rotations of staff and an appreciable number of visitors to the site as well. It seems pretty obvious that I would have had to leave the job as being, physically, not capable of doing it. This would have left me without an income. Mum going into full time care would have left me without a home, so I would have had neither home nor job. Not a great prospect!

I am sure my daughters would have given me all the support, both physically and emotionally, which they could, but they each have their own lives to lead and family commitments to meet, as well as working themselves.

Instead of all the above problems I’m being looked after by my wife who is the one who goes to work and is making no real demands upon me other than that I put my energies into recovering as quickly as I can.

The only downside is that in the UK my treatment would have been free under the NHS, whereas here, in the US, we have to pay for every visit and every treatment.

It may seem strange to say it, but, I think I am a very lucky man for a number of reasons:

  • I have Hodgkin’s Lymphoma which, statistically, is unlikely to kill me;
  • I have a home and the love of a really good woman;
  • I have the love and support of my daughters;
  • I have the support of friends;
  • My wife’s job includes health care which minimises the costs borne by us though they are still substantial.

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Filed under Alzheimers, Alzheimers Disease, Cancer, chemo, chemotherapy, Dementia, Health Insurance, Hodgkins Lymphoma, NHS

Is cancer cuckoo?

If you’ve read any of my earlier blogs you’ll have picked up on the facts that I’m an Englishman in America, have Lymphocytic Classic Hodgkin’s Lymphoma (well, probably, that’s what I have) and that, without the assistance of my wife, I’d be lost in this maelstrom of insurance cover, co-pays, insurance authorisations, private hospitals, doctors’ offices and so on. The more of this I experience the more I appreciate the NHS and its simplicity. Today has, once again, reinforced that appreciation.

It’s now a full week since I last saw my oncologist at which time he, or his office, were to request that my biopsy be sent to Washington for a definitive second opinion and were also going to get clearance of from my health insurer that the drugs programme would be within policy – or whatever the phrase is. I’m a US Health Insurance virgin and am beginning to feel that, rather than losing my virginity to someone I will remember all my life, I’m being heavily mauled by a biker gang prior to sexual assault. It’s not the fault of my insurer, they’ve responded relatively speedily to every request, well, with my wife chasing them they’ve not had much choice but to be speedy. It’s just that the system is so seemingly random with nothing being co-ordinated anywhere along the line by anyone other than us, and by ‘us’ I actually mean my wife who has taken on the burden of chasing all of this up and keeping on top of things. It’s a destructive and brutalising battle for her as she wants to give me time and support, and, indeed needs time to recuperate herself and deal with other issues in her life, but instead her time is often taken up in conversations with the insurer and with doctors. Today, a week after seeing my oncologist, it turns out that the results of the biopsy have yet to be received by the oncologist’s office from Washington where they were sent for a second, or third, or fourth (depending upon how you define these things seemingly) opinion, at least we were told a week ago by the hospital that the request had been received from the oncologist’s office. Will the opinion be back before I start treatment next Tuesday? Who knows? The next fly in the ointment, though it’s not ointment and the thing which is in it is far, far too big to be a fly, is that the insurance company hasn’t yet authorised the treatment. After several phone calls my wife seems to have been able to track down the reason that there is as yet no medical insurance approval: one the drugs (I think, rituxan) has yet to be given FDA approval and so the request will sit with a different department within the insurance company. We are now back in a position of racing time for the treatment to start, although the doctor’s office assures my wife the remainder of the cocktail will be given to me on schedule even if there is no approval for redoxin. Will the results be back in the next three working days? Will three working days be sufficient for the doctor’s office to send/re-send the information to the insurance company, deal with any queries which the insurance company might wish to raise and still get a positive response from the the insurance company? I don’t know, and the really scary thing is that no-one can tell me. Should I be concerned if there is a further delay or not? It’s human nature to worry about this sort of thing isn’t it? I mean, after all, I have something growing inside of me which is feeding off my body and which is intent on killing me. It’s a little bit like being a bird which has a nest full of eggs destroyed by a cuckoo and yet has to go on feeding the cuckoo. It’s all very well to tell me “It’s a slow growing cancer”. While it is good that it is slow growing it is not at all good, perhaps even fatally bad, for me that it is growing at all!!

Unlike the bird unable to distinguish the cuckoo from its own eggs and chicks, I am all too aware of this cancerous mass in my neck, of the still red scar from the biopsy, of the incisions for the port in my chest and the triangular mass of the port itself, of the resistance in my neck every time I turn my head to the right. It’s hard not to be so aware. Whenever I touch my neck I feel the remainder of the cancer mass, when I wash I see the still raw marks on my chest from the insertion of the port, I put my hand to my chest in an habitual movement and pull it away quickly as my fingers encounter either the enlarged vein where the “pipe” has been placed, or the mass of the port itself. When I awake in a morning I can feel where the unhealed wounds for the port have rubbed against the bed-sheets. On top of this my symptoms seem to be progressing. A short while ago I listed symptoms and mentioned that I seemed not to be having these: well things are changing. I’ve gone through a period where my feet itched badly at night and I’m now getting night sweats most nights. On top of that I tire very quickly. For instance yesterday I visited the educational center at which my wife works, to say my farewells to some of the students I have worked with down the years who will have left education and moved, hopefully, into gainful employment by the time I am next able to mix with groups of people. I also wanted to say “see you later” to the other students whom I will, hopefully, see in six months or so. It’s important to say these things so that these students know that I haven’t just turned my back on them and walked away as many others have done in their lives. The class teacher has worked hard to build a feeling of community, family if you will, and one doesn’t just disappear from a community without a goodbye. I really did nothing physical at all, interacting slightly with a group discussing friendship in the morning and then for perhaps thirty minutes in the afternoon at the party, but when I got home I went to bed and slept for two hours.

I was very touched to discover that I was guest of honour at the monthly birthday party, and that some of the students had written me good luck cards. I’m sufficiently egotistical to want to share some of the comments!

“I am sorry that you are sick. I hope that you feel better soon. Your wife will take good care of you. Take good care my friend.”

“I heard about your illness and I hope you get better soon. We love you.”

“I am sorry that you are sick. I wish that you feel better soon so that you can help us.”

“I hope that you come to see us soon because you are a really cool teacher and you showed us your really cool experiences. I’m glad you came kayaking with us and hope you come back soon.”

“I hope you feel better soon. We miss you.”

“I am sorry that you are sick. I hope that you feel better and come back soon. We miss you so much. Feel great.”

“I hope feel (sic) you feel better soon you are a nice man and we miss you very much.” This one is from the student who’d previously asked me if I’d been shot when I’d shown him the incision from the biopsy.

They really are simple words for the most part, but, perhaps, the more touching for all of that. Most of these students are simple people – not in the sense of being stupid, but, rather, in the sense of seeing things in an uncomplicated and simple way. All of these students have learning difficulties in some degree and I know that the effort which went into drafting and then writing their message and then their envelopes was much greater than the number of words themselves reveal, and that the time taken to draft and then write the messages and the envelopes was substantially longer than it took me, or probably you, to read them and record them above. What I can say, however, is that I’m sure the amount of time I give to remembering these words, particularly when I feel down, will match and possibly exceed the time given to me by the students. It’s good to know that you have touched someone’s life isn’t it?

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Filed under Cancer, chemotherapy, Health Insurance, Hodgkins Lymphoma, NHS

NHS Part 3

A friend of mine in the UK sent me this link to an article in The Guardian “NHS plans for credit rating agencies to vet hospitals” – it’s an interesting article and well worth reading.

So, what’s it all about? Perhaps it is my own personal view of politicians being unwilling to accept responsibility but, it seems to me, that this is another one of those “we’re only responsible for the funding and not the quality of the delivery” moves. My guess is that we’ll see hospitals declared to be a financial risk by organisations which Joe Farrington Douglas (an Associate Fellow of The Institute for Public Policy Research) termed “key enablers of the financial meltdown” and then what? Surely the options after such a declaration are few and far between.
(1) The Government could simply say “So what? It is doing an excellent clinical job and we will fund it regardless of the financial risk as assessed by these bodies!” Yes, you can just see that happening can’t you?
(2) The hospital is closed, staff loose their jobs and patients have to travel to a hospital in another town or city. It has to be said this sort of thing has happened before and politicians have ridden out the storm, but then it’s generally just been a department that has closed, such as the stroke unit at Darlington. The headline in The Northern Echo is “Darlington hospital stroke unit closure ignites fresh row“, or residents of Rochdale being told not to go their own hospital in an emergency but to one in Bury, Oldham or Manchester.
(3) The private sector might just be invited to step in and take over the facility along the lines of “failing schools”. This extract from a NASUWT publication is, perhaps, an indication of the way things might also progress in the NHS
“Currently, in the state education service, the private sector is involved in:
• sponsorship of and direct investment in schools and their activities;
• the provision and management of local authority services;
• the provision of services for schools;
• Private Finance Initiative (PFI) and Public Private Partnerships (PPP);
• the management of state-funded schools – Academies”

So, which of these are possible in terms of NHS hospitals? Clearly sponsorship is a possibility. With that sponsorship could well come a specialty within the hospital, such as, cancer, or diabetes or pretty much anything else. Would that be good or bad? As with most things, it may depend, and we should perhaps not make a decision too early. It would, surely, be “a good thing” if there was increasing expertise within a hospital, but if that expertise came at the expense of a reduction in the width of other provision, say the Accident and Emergency facility, would that still be a good thing? Presumably it wouldn’t be a good thing if, like the citizens of Rochdale you have to take your injured child several miles further than you otherwise would, particularly if, as is often the case, time is of the essence in effecting a treatment. Paramedics are very well trained and do an excellent job but they simply don’t have the resources of a hospital available to them as they make the 5 miles journey along the B6222 on a wet February night. Maybe it would be the provision and management of the hospital services themselves, but, isn;t this already something that can happen? The provision of services for the hospital might well an alternative along the lines of “We no longer provide x-ray scans here madam, please take your child to the XYA clinic five miles away”. It sounds ridiculous doesn’t it? Maybe but that’s effectively what my wife’s health insurance policy provides for us. We can use an in-hospital facility but if we do then we are charged significantly more than our co-pay in an in-policy but not hospital facility down the road.

My guess, and that’s all it can be as I am certainly not aware of ongoing government thoughts on this, is that there will be two main possibilities, the first being that the hospital is simply taken over by another provider which charges the NHS for the services it renders, or that expensive services are contracted out and the hospital/NHS is charged accordingly. Is there anything really wrong in this? In one sense, no, there’s nothing wrong with it as might well enable a higher standard of care than the NHS is funded to provide at the present time, but in another sense, yes, there is something very wrong with it, and, until you’ve experienced the wrongness of being told you have a potentially life threatening problem and you should go home, consult your insurance company, the internet and then make an appointment to see a doctor, you probably won’t think of it, but believe me, that scenario is about as wrong as it gets. I couldn’t have done it – well I suppose I could but as a total novice in this system I freely acknowledge that I was out of my depth.

Something of a follow-up

This report by the BBC caught my eye yesterday. It seems to be clearly stating that the NHS got a bad report because only a limited data-set was examined! No-one seems to have been willing to stand up and criticise the original report. I wonder why?

Something more of a follow-up

Here’s a petition you might like to check out

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Filed under Health Insurance, NHS

NHS v Privatisation Part 2

A while I go I wrote about the controversy of privatising the NHS and I made reference to the financial implications of insurance which expects the insured to make, in American parlance, a “co-pay”. So, I went for a biopsy which naturally involved the surgeon, anesthetist, nursing staff and the use of the hospital facilities, so, naturally, you’d expect to make a co-pay wouldn’t you? The question is, how many co-pays would you expect to make for one operation? To my, naive mind (I’d never call it an innocent mind!) I’d have expected to make just the one co-pay of $40 but it seems it isn’t going to work out that way and the bills will be individual to make it easier for us to make the several co-pays.

Don’t let them dismantle the NHS and replace it with American style health insurance. The increased choice and competition you get seems to me to be more apparent than real, the problem is that those pushing the changes would most probably subscribe to the phrase “Perception is more important than reality” – now doesn’t that just sound like a typical government approach?

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Filed under Health Insurance, NHS

NHS v Privatisation

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.


Filed under Health Insurance, NHS