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American healthcare is in truth already rationed

Growing up sick in the US, and being treated by a humane NHS here, has shown me that Britain's system is far better


o Bee Lavender
o guardian.co.uk, Sunday 16 August 2009 20.30 BST
o Article history

I grew up in the US with a series of mysterious health problems, not least two different kinds of cancer. Everything in my life – education, choice of career, job mobility, decisions to marry or divorce, where I lived, who I knew, what I wrote or talked about – all of it – was determined by the paramount need to maintain health insurance.

In the United States there is no basic protection for working people. My fully employed, doubly insured parents were pushed to the brink of bankruptcy four times before my 15th birthday. I exceeded the "lifetime maximum" coverage before I was old enough to vote. My family paid huge sums for insurance, then 20% of the cost for treatments, without assistance from any public entity.

And I never received more than essential services, on large wards, in grim hospitals. My most significant childhood memory is knowing exactly how much I cost, and regretting the expense. I can tell you that it costs at least $200 to ride in an ambulance regardless of distress or distance. The price goes up for every lifesaving procedure ­ performed during that journey. Extrapolate from that the normal charge for every test, procedure, blood draw, and dose of radiation – the costs of staying alive can be extreme. One day in the hospital can easily total more than an average person earns in a year.

The truth is, healthcare is already rationed in the states – by individuals struggling to afford even basic cover, by companies negotiating (or refusing) benefits, by government agencies trying to balance budgets. For many years I lived in a state where the legislature ranked and rated, by price, procedures people on aid could receive, and refused to cover anything deemed too expensive. Even if, as the papers frequently reported, it meant letting adorable little children die. But since it is America, you can shop around. Just across the border in a different state, the legislature decreed that pre-existing conditions could not be excluded or made the subject of increased charges under insurance plans, leading me and many others to migrate a few miles to get a better deal.

This underscores the inherent problem – that there is no consistent federal policy, and therefore no protection for the most vulnerable citizens. Or, if you pause to think about it, for anyone.

Medical bills are a leading cause of bankruptcy. It is common to engage in fundraisers for adults diagnosed with something treatable but expensive, children who need wheelchairs, or in the worst cases, someone who has died, leaving behind huge bills their family cannot afford. In the US, the greatest restriction on personal freedom that I have ever encountered in my own life, or witnessed in the lives of friends, all comes down to health insurance. Creative, innovative, talented people are unable to change jobs because they need the insurance. Small companies collapse because they cannot afford employee insurance. People die because they do not have insurance.

I am healthy now, yet my background means that US insurance companies can refuse to cover anything related to events that happened over 20 years ago. Because I take prescription drugs every day, and because I need blood tests a couple of times a year, this will never change. The last quote for insurance I got exceeded my salary. This is one of the trickiest parts of the current healthcare reform debate in the US: lots of people would like to stick with the status quo, working hard and letting an employer look after the details, but this desire is largely based on nostalgia for a past that never quite happened. Medical care is more advanced now, people are living longer, care is more expensive, jobs are less secure, and the economy itself is not healthy.

Five years ago a friend called me in a panic, desperate to borrow an inhaler because she could not afford to go to the emergency room with an asthma attack. That night, I decided to emigrate to a country where everyone has access to basic medical care. Moving to England was worth it. My experiences with the NHS have not been perfect, but they have been superior to the services received in the first 33 years of my life.

In the US I devoted a huge amount of time to chasing appointments, finding specialists, fighting with insurance companies. With the National Health Service I have never had any trouble getting referrals, nor have I ever had criticism of the services rendered. If anything, I have felt spoiled – especially at the start of the recent flu crisis, when men in hazmat suits showed up in the middle of the night to take my temperature. In fact, though I have private top-up insurance here in the UK, I've never had cause to invoke it.

The current proposal for US healthcare reforms has fallen victim to a misinformation campaign causing needless confusion and controversy. The plan is neither radical nor far-reaching, offering a bandage instead of a cure. It isn't enough, but it is necessary.

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