Friday, April 20, 2012

America's crazy healthcare system

As an outsider here, one of the things that is wryly amusing to me is how many Americans are convinced by the vast superiority of their own healthcare system. I've even been told how awful the British National Health Service in Britain is and actually pitied by a grandmother at a Rick Santorum rally.

This idea, that Brits are suffering under the NHS, besides being funny, is actually part of a meme that was promoted in the US in order to attack the new healthcare laws. The British NHS, so the story goes, is awful "socialised" healthcare. I know the NHS has many flaws, but the longer I spend in the US the more I realise how utterly brilliant it is at delivering pretty universal coverage to the entire population at far less cost than in the US.

Why are healthcare costs so high? Americans will sometimes say that the quality of their healthcare is higher and they have better service. On the latter point, they are almost correct. It is easy to shop around for doctors and each doctor is far more specialised. We don't have a family GP any more, we have an internist, pediatrician, and an "obgyn" (women's things).

On the subject of quality, I am not so sure. For one thing there is the problem of "too much choice". In many ways, life would be far easier if the entire family could go and visit a local GP for everything and get referred as necessary. The family is an health ecosystem in itself. It doesn't make sense to me that if I and my son catch the same flu  that we both have to go and see different doctors. One tends to form long-term relationships with the family doctor--and this is very helpful. On top of this there is NHS Direct, a telephone  helpline that means you can speak to a nurse 24 hours a day, and if necessary be referred to a doctor or hospital.

It is also clear that in the US testing is overdone, and medical bills are greatly inflated. On the matter of tests, my son's dentist wanted to give him routine X-rays (there are no problems with his teeth). He is five. We objected and she said she wasn't sure if she could treat our son without doing routine X-rays. We said we would go elsewhere and suddenly it was possible after all. Dental X-rays are not a good thing, especially if you are a young child. I've since read more about  the link between dental X-rays and brain tumours.

On the subject of medical bills, now that I've seen the cost of the same treatment in different countries I can see that the costs doctors charge insurers are ludicrously high. We've paid privately for work on my back in the UK and received something similar under insurance in the US. The cost of 20-30 minutes of spine manipulation was about $145 at a posh private hospital in London, and $490 in a downtown corporate office.

Similarly, our pediatrician charged our insurers $1,600 to register and do a check up on two children. I can't say whether or not her time was worth this, but I can say that having the same job done on the NHS would have been a fraction of the cost. Of course the $64,000 question is whether all that extra expense was necessary--a question that is far more difficult to answer.

Updated: This blog was tidied up on 24th April.