Comparative twin study: Access to healthcare in the NHS and the American private insurance system

[muriel_volestrangler]

Moving to the UK from the US in 2008 aged 55, Nora enrolled in the NHS, with the understanding that if needed, for-profit, private healthcare was available. This was not necessary. Assigned to a local GP, in an initial check-up, Nora reported a medical history that included a strong family history of breast cancer. This initiated a referral to a genetic counsellor and the local hospital’s breast clinic, where she received annual mammograms starting in 2009. In 2012, a routine mammography identified a lump and she was called back for a needle biopsy. Identification of cancer led to two lumpectomies (two days in hospital per lumpectomy) however there was difficulty in identifying margins of the lesion and after consultations with her surgeon and surgical team, Nora elected to have a double mastectomy. This was undertaken in 2014, during a six day hospital stay. Nora took six weeks off work, (and had the option to stay out longer), her time off covered by her employer. She continues to have routine follow-up including anti-cancer medication, annual check-ups, and bi-annual bone density screenings. Current status: In remission.

US based Nancy works in Washington, DC, but retains an apartment in her hometown of New York City. In part, this is because prior to the 2010 Affordable Care Act, (widely known as Obamacare) a previous bout of breast cancer in her early 40s meant she had a “pre-existing condition.” [6] She was therefore ineligible for healthcare coverage in many American states. Since New York was one of the states that did not exclude Nancy from coverage, she retained it as her primary residence despite working hundreds of miles away. In other words, access to health insurance has been a factor in determining her job/career options since 1994.
...
General taxation and mandatory salary deductions pay for the NHS, which supports not only healthcare, but also some dental care, some social services, and public health initiatives. All treatment is free at point of delivery. For Nora this ranged from her initial genetic counselling to her most recent annual check-up. No bills were sent or presented to her at any point. Because Nora was over age 60, all medications also were, and continue to be, free. (Under age 60, England’s NHS now charges £9.00—US $ 11.75—for any medical prescription).

In the US, although Nancy was “fully covered” by her employer’s insurance plan, she was still responsible for 40% of the annual insurance company’s enrolment premium—$3,500 per year. Other expenses were covered on a complicated, opaque formula arrived at through negotiations between her healthcare providers and insurance company. Significantly different from the NHS plan, under the US private healthcare system, Nancy is largely responsible for sorting out all payments at point of delivery. Some procedures and physician visits were fully covered; others were covered at varying percentages of the total cost; and occasionally, were disallowed. In theory, the highest amount Nancy was responsible for should have totalled no more than $5,000 “annual out-of-pocket maximum deducible.” Since her diagnosis and treatment extended over two calendar years (December-March), she should have paid no more than $10,000 towards uncovered charges. In the end, however, she paid more than $14,000 over and above the substantial amount already paid by her insurance company and her annual $3500 premium.

https://blogs.bmj.com/bmj/2020/02/17/comparative-twin-study-access-to-healthcare-services-in-the-nhs-and-the-american-private-insurance-system/

They go on to explain the hassle Nancy had to go through - multiple bills that she had to question or later claim (not always getting what she appeared to be entitled to from her insurance, and once getting a bill for $40,000 - an error it took weeks to correct). And this is 'good' insurance through the federal government.

[catrose]

1. I am Nancy. We all are Nancy.

[hunter]

2. The "maximum" out-of-pocket expenses are a lie, even when you fight.

I've still got $6,000 to go on medical debts we accumulated above and beyond what our "out-of-pocket" expenses were supposed to be.

We've also been sued for medical debt and had judgments against us.

All while insured.

I just don't fucking care any more. I used to get anxious when medical debt collectors called. Now I'm like "whatever..."

This was all for stuff that could happen to ANYBODY, random shit falling out of the sky.

Sometimes I imagine what life might have been like if my wife and I had moved to a true first world nation when we were young. Instead we stayed in the U.S.A..

One thing I will say is that Obamacare gave us a peace-of-mind we didn't have before. At one point before Obamacare we had run a COBRA plan to the bitter end while my wife was still ill and any interruptions in her medical care might have seriously endangered her health. She was accepted to our state's "high risk" medical pool at the last possible minute but it was a terrifying experience.

It's cruelty that we expect people to navigate the U.S.A. health care "system" when they, or someone they love, are suffering a serious illness.