Sunday, July 30, 2006

In sickness and in health insurance

Being from the world of tea and cucumber sandwiches, I am familiar with those standard conversation topics us Brits tend to stick to. The weather, public transport, "kids today", and so on.

One subject in particular is the NHS, or National Health Service. Funded by taxpayers' money, it entitles Brits to free healthcare and extremely cheap prescriptions, usually a flat fee of about £6 for each refill, last time I checked. One of the upsides is that you don't have to worry about insurance or paying for treatment. One of the downsides is that there are excrutiatingly long wait times (anything up to and over 18 months, even for important surgery).

I didn't get employment authorization when I originally arrived here, instead waiting for my green card. As things were a bit tight financially, I didn't take out medical insurance, deciding to simply wait it out. The last medical procedure I'd had was having my wisdom teeth taken out a few years ago, surely it'd be fine.

Famous last words.

Sometime around August, I was prising some brownies out of a pan -- and no, they weren't "special" brownies, smarty-pants -- with a knife. A very sharp knife. In hindsight, it was a very silly thing to do, and my hand definitely agreed with me when I slipped and stabbed myself through my left palm. Cue a large pool of blood, me almost fainting, and a panicked drive to the local hospital. The triage nurse saw that the bleeding had stopped and after a six hour wait, they finally took me out back and stitched me up. No permanent damage, five stitches and some gauze (and a lovely sedative because I really don't like needles) and I was off home.

Imagine my delight to receive a hospital bill to the tune of around $1500. No offense to them, but the care wasn't that good! It was paid off eventually, with help from my Dad, but it really did bring home just how important insurance is. In particular, how much worse it could have been. What if I'd been at home with no one to drive me to the hospital? I'd have to pay for an ambulance. And what if there'd been permanent damage and surgery costs? The amount could easily have spiraled into tens of thousands of dollars if it had been just a few milimeters deeper. Not to mention what if I didn't have a willing relative to help with the costs?

There are free options, though they are not easy to find. The Venice Family Clinic is a local center funded entirely by charity donations. They serve the homeless, poor and even those who manage to survive but can't afford insurance. By offering free healthcare and prescriptions, they offer hope to those who might not otherwise afford the antibiotics for their chest infection, for example. While a place like this is invaluable to those in need, they can only afford to offer limited services; low-grade painkillers, antibiotics and basic prescriptions. If you need anything stronger, you'll have to find somewhere else, and pay through the nose for it.

According to "Living and Working in America", 42.5 million Americans do not have medical insurance, and a further 65 million have inadequate coverage. These statistics are alarming, and unfortunately not exaggerrated. Complete coverage is expensive and can be difficult to obtain if there are any pre-existing conditions. Many live in fear of contracting a long-term illness or being involved in a serious accident and being bankrupted.

What's the solution? I don't know. Perhaps Americans should look to Western European private medical practises, or perhaps there should be stricter controls on pharmaceutical company profits and insurance costs.

While living in Germany for a while a few years back, I found that healthcare was mandatory; my workplace insisted that I choose a provider, and they would automatically pay a certain amount of my wages to them every month. The one time I visited a doctor, I simply paid a €10 introduction fee, and a small sum for my prescription, around €5, I believe. Though my experiences were limited, the impression I got was that Germany had the medical insurance system neatly arranged and implemented. If my observation was correct, it makes me wonder why the same idea seems to fail so badly here in the US.

Thought-provoking stuff, but unlikely to be resolved anytime soon without drastic reforms. As for me, I start a new job on Monday and plan to arrange insurance ASAP before I bake any more brownies. And if anyone asks about my scar, I tell them aliens abducted me and put an implant in my palm to contact Elvis from beyond the grave.

Well, it's a bit more interesting than "attacked by baked goods", don't you think?

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