The GirlAlive Blog

Health Care from both sides

September 14, 2009 on 12:40 pm | In Current Events, Life In General, Scotland | 8 Comments

So, it’s about time for me to weigh in on the whole “health care debate” (a.k.a. “health care screaming match”) in the US.

Before I moved to Scotland, I worked in health insurance in the US. After moving here, I worked for the NHS. Besides working in both sides of the debate, I’ve been a victim patient under both systems. I have asthma and PCOS and possible/probable bi-polar disorder. I’ve seen more than my fair share of doctors.

Someone has to pay for health care. We all know this. But the current system in the US is not the most cost-effective and efficient way to do this. Right now, the insurance companies are setting the prices for how much treatments cost. An insurance company will pay let’s say, $50 for a 10-minute doctor’s appointment. So the doctors charge $80 per appointment. That way the patient pays their $20 copay, and the insurance company pays their $50. Why the extra $10? Because the insurance companies set their payment rates based on what they doctors are charging, so the doctors will always charge more to keep the rates going up.

What does it actually cost for a 10-minute doctor’s appointment? No one really knows anymore. There are facilities costs, doctor and nurse salary, and of course the team of insurance billing specialists that need to be paid. An easier cost to look at is prescriptions.

I was on Paxil back in the US for a while. Without insurance, it would have cost me about $75 a month at Walgreens for the generic equivalent. That’s $900 a year for just one prescription. With insurance, I paid $120 a year for that prescription. However, there is one very special pharmacy in my hometown. This pharmacy refuses to deal with insurance companies. They set their prices based on actual cost of the drugs, not on what the insurance companies say to charge. At that pharmacy, that prescription cost $96 a year.

Let’s look at the UK. I’m on 5 different prescription drugs right now. With the average $10 copay for generic drugs in the US I would be paying $600 a year for drugs. Know how much it costs here? £48 per year. Which at the worst of exchange rates is about $200 a year for as many prescriptions as I need. Five prescriptions, eight, even twenty is still just £48 a year. Insurance companies are ripping off American consumers by inflating prices.

But what about the higher taxes in the UK? Frankly, I haven’t really noticed. You see, the income tax I pay is slightly higher than income tax in the US, but is about the same as what I had to pay for health insurance. And at least I’m covered for anything here.

From working in health insurance, I learned all the double-speak and trickery that goes into an average policy. You aren’t covered for as much as you think you are. Think you have mental health coverage? Maybe not. I used to process claims for policies that paid out for a total of 20 visits with a deductible of $5000. By the time you have paid the deductible, your 20 visits are used up, and you’ll never get a single psychiatric visit paid. But technically you have mental health coverage.

Right now a friend of my family is dealing with her second round against cancer. She’s in her 20’s. Assuming she survives this round with cancer, she will probably be uninsurable for the rest of her life.

Last week my cousin was in a motorcycle accident. She may be walking around on a broken ankle, but she can’t afford to get an x-ray to find out because she doesn’t have insurance.

A friend of mine died of cancer last year. During his last months he was dealing with the prospect that he would be losing his job and his health insurance because he had taken “too much sick leave” for his chemo treatments. He worked for a hospital.

My dream is to one day own my own bed and breakfast on a small farm in Wisconsin or something, where I can host craft weekends and teach spinning and knitting and weaving and my husband can fling pumpkins with a trebuchet in the back 40. The main thing stopping me is that I will never qualify for individual health insurance. As I mentioned, I have a history of PCOS, asthma and mental problems. If I move to the US, I will be forced to spend the rest of my life chained to a corporate cubicle just so that I can afford my medications.

The health care system in the US is killing people. When it doesn’t kill them, it leaves them bankrupt. When my friend was dying, he spent his last few months under a cloud of worry that his wife would lose the house after he was gone because of medical debt. In any other country in the developed world, that would never have had to cross his mind.

The health care system in the US is also destroying small businesses. Wal-Mart didn’t kill main street. Health insurance did. Small business owners can’t afford to offer health insurance to employees, so no one can afford to work for a small business. So the businesses close down and everyone ends up working for a corporation. Every shopping center and business district in America is the same homogenized collection of Starbucks, The Gap, Office Max and The Olive Garden because health insurance costs have driven all the unique and individual shops and restaurants out of business.

Is the UK system better? In a lot of ways, yes. I am unemployed right now and I have a massive tumor on my right ovary. I don’t have to worry about how I’m going to pay for surgery. I won’t be in a private hospital room, but that’s a small price to pay. Yes, I’ll have to go on a waiting list to get the surgery (because it is a benign tumor). But if it was serious and life-threatening, I would never have to hesitate to get treatment. I will never have to weigh whether chest pains are bad enough to warrant the $50 ER copay.

Right now my husband and I are weighing whether or not to move back to the US. The health care system is the one thing keeping me from moving back. As I told my senator in a recent email, my tax money and I are probably going to stay over here until the US catches up with the rest of the developed world when it comes to health care.