Adventures in Socialized Medicine

Its been a long time since I've updated but I wanted to as I've been seeing the doctor and I thought it would be appropriate now that the Health Care Act is being passed - if only so people in the US could stop trying to compare what's happening there with socialized medicine. You should be so lucky.

Last week I had some weird pain attack which woke me at 4am on Sunday morning. I had no idea what was causing it but it was incredibly excruciating and debilitating.

I almost called an ambulance and went up to the ER. But as it was the weekend I decided to wait.

First thing Monday morning I called the GPs office and was seen by 11 am. I not only didn't wait for more than 10 minutes but there was a medical student visiting her who got to "have a go" asking me questions first. This extended the usual 10 min appointment time with my doctor to almost an hour.

At the visit she asked all the right questions and gave me a test which confirmed that I had a bladder or a kidney infection (which explained all the horrible traveling pains). She gave me a prescription and told me to return two days later if not better and to make an appointment to come back and see her today (after one week).

As I'm a homeopathic practitioner who really doesn't like to use orthodox medicine when not entirely necessary, I treated the infection with lots of cranberry juice and homeopathic remedies (prescribed by another homeopath). I was better within a day or two.

Today I went back to her and we spent about 15 minutes or longer discussing all my concerns. She was very thorough and caring given my particularly stressful circumstances and made very well thought out recommendations. She sent me for a full set of blood tests to monitor a chronic condition and I left.

None of this cost a dime. Not the office visits. Not the prescription and not the diagnostic and blood tests. Had I called an ambulance and gone to the ER it would have been the same.

Oh and she told me it would be good for me to come back every few weeks to talk to her so she could monitor my situation as we go along and that I can have an appointment with her any day of the week except Thursday. The procedure at the practice is that 70% of visits are for advance scheduling and the other 30% can be made on the day, if necessary.

I also just wanted to add that the offices are well appointed, bright, modern, ultra clean, cheery, and the waiting room is light, airy, large, and has a play area for children (in case anyone thinks the NHS offices resemble communist Russia!)

You can look at what a modern British doctor's practice looks like here:

http://www.manorsurgeryoxford.co.uk/index.htm

My uncle wrote this letter to the editor about the treatment he and my aunt experienced at the hands of insurance companies. It was published in the Sarasota Herald Tribune:

‘Death panels’ operate now

The “Free-market death panels” described by op-ed columnist Froma Harrop (Aug. 20) are not unusual. My wife endured a similar calamity when we moved to Florida. She was denied authorization for an expensive drug therapy for her liver disease by Blue Cross of Florida, even though the Maryland branch of Blue Cross had approved of and paid for the same treatment. We appealed the decision and were told that no appeal was allowed. Her physician appealed with the same result.

We requested an explanation of the decision and were advised that a panel of doctors had determined that the proposed treatment was inappropriate for her disease.

We asked for a transcript of the panel’s deliberations and a list of its members’ qualifications. We were denied. Finally, we asked for a contact in the national Blue Cross organization which could resolve the discrepancy between the two Blue Cross policies. The answer was that no national policy oversight existed.

In the meantime, my wife’s physician was forced to prescribe a less effective and more intrusive treatment. I can’t say that the cost-reducing medical decision by the bureaucrats of Blue Cross of Florida caused, or even hastened, my wife’s death, but it certainly made the last months of her life more uncomfortable than they had to be.

Those who are afraid that health reform will result in end-of-life care rationing should be aware that for-profit insurers are already implementing such control. The “free-market death panels” affecting a terminal patient’s quality of life are a reality.

As printed in the Sarasota Herald-Tribune August 23, 2009

Babies

I gave birth to two babies courtesy of the NHS. The first was almost 20 years ago. I had regular prenatal care from the start with a team of "community midwives" at my GP office. There were 6 midwives on the team and the point was that you got to know most of them as they would be the ones at the birth. The beauty of community midwives is that whoever you go into the hospital with or stay at home with, they stay with you for the duration of the birth - they are not traditional shift workers. Plus they've got to know you over the duration of your pregnancy.

There are also hospital midwives, and they operate on a shift system so may change over during the birth.

The midwife visited me several times at home to determine whether it was time for me to go into the hospital or not - so people were not encouraged to just drag themselves up to the maternity ward and home again when it wasn't time.

Even 20 years ago I was encouraged to go into the hospital with a birth plan - this obviously was flexible and would change in an emergency situation -but it meant that the midwife who went in with me knew exactly what I did and didn't want and would consult with my husband or myself as we went along in order to obtain our permission if any deviation was recommended.

While the first birth was highly medicalized in the end (after 26 hours of non-progressing labour), I was never giving any medical induction drugs at any point - it wasn't even suggested - nor did I end up with a c-section.

I spent 5 days in the hospital to recover from this labour and was visited by my GP, midwife both in the hospital and at home on my return (several times in fact), and over the weeks and months by a community health visitor.

The second birth was 16 years ago. I had a water birth at home, with a community midwife. The midwife had visited my home a few times in the week leading up to the birth as I'd had some false labour. I was 2 1/2 weeks early when my daughter was born, but this was still well within the realm of normal so there was no question that I would need to be admitted.

When I having my home birth I was still written up on the board at the John Radcliffe Hospital as I was still considered in the system - so where those on the ward would have their room number by their name up on the big white board at the nurses station, my name said "at home" next to it. This way the midwife and the patient are still both accounted for.

I did have some complaints about the hospital when I gave birth - mostly around the no-frills aspect of the whole event - i.e. I had to bring all my own diapers, nighties, and necessities for myself and the baby. It was noisy in that I shared a large room with 4 other women and their babies (but again there's no question that a baby would be taken from its mother unless there was an actual need). I didn't dig the whole experience of my baby being exposed to hospital germs - so for all those reasons, I had my second daughter at home, in our own environment. I'm so glad I did as that was one of the greatest experiences of my entire life.

Women's stuff and GPs

I was having some bleeding in between periods.  I rang my GP and got and appointment the same day.  My experience with the practice I belong to is that if you ring on the day and are unwell that day you always get an appointment.  If its an appointment where you want to go talk about something that's not pressing or have some sort of check up then you have to book for something in the future.  In other words, most daily appointments are held for people who require attention that day.

As my GP was a man, he referred me to his female colleague in the same practice who does "Well Woman" appointments and that was just a question of going back out to reception and booking in with her for later that day.   There was no question at this point of needing to refer me to the ob/gyn.

She examined me, did my pap smear which was due, and referred me over to the hospital for an ultrasound scan.   That came up the same week and the scan showed that I had a small fibroid.  The results were told to me as they showed up on the screen - there was no waiting and the report sent back to my GP.

I know that how quickly I got seen depended on which GP practice I'm signed up to.  In the old days (the 1980s and before) who the doctor was depended in where I lived.  Now there is a choice about which practice I join and its up to me how much traveling I want to do.  There are 82 GP practices in my county.  Within each practice there can be several doctors and I was encouraged to pick the doctor I wanted within that practice.   Mine has 10 to choose from - 6 women and 4 men.

I chose my doctor because he's the one I went to when I was first pregnant with my oldest daughter 20 years ago.  I like his practical, no nonsense sensible nature.  I liked the fact that instead of constantly trying to push antibiotics on my family he'd say things like "well that's a virus and will clear up in a week - why would you want to take a drug for that?" 

Our practice has very young doctors (who are great and enthusiastic and take their time and ask a lot of really useful questions) and older doctors who have been there many years and are sensible and experienced and a good mix of men and women.   There are several doctors I think personally are useless (I liken seeing them to going to a bakery for health care) who I always avoid.  But this is all within one practice.

The Barking Cough

What it used to be like when I got sick...

Every year I would get this cough. Usually it would begin around Thanksgiving and it would carry on at least through the New Year. I first had it as a small child - around age 7. Sometimes it seemed like I coughed most of the year. Like a barking dog.

By the early part of the new millennium, I was living with the girls on my own in a small town near NY city. Thanksgiving rolled around and I got the cough. I usually managed to cope with it using alternative therapies but one year it was particularly bad. I felt like it was dropping down too low in my chest and I worried that I had pneumonia.

Of course I had no insurance and no doctor and also, after 9/11 caused a huge drop in my business, no money at all. A friend in England was paying my rent for a few months. Friends in NY were covering the utilities bills so we had heat. There was no child support. Living without a safety net is not an uncommon place for Americans who fall on hard times to find themselves.

The cough was so bad I had to stay in bed. I was fearful and had nowhere to turn. I started to phone people who owned a stethoscope and could listen to my chest for me. Finally I found a friend, a physician's assistant, who could do me a favor and listen to my chest. Another time a midwife who was also a friend listened for me. A third time, the girl's pediatrician agreed to have a listen when I brought one of them in.

I didn't have pneumonia but I was very debilitated. It was at this point that I found a Tibetan acupuncturist and herbalist who was amazing and agreed to treat me for hardly any money. The first season she treated me my cough was cut short by weeks; the second and third year it was cut even shorter and since that third year it has only recurred once in this chronic form and I saw an acupuncturist and it resolved.

I don't know how people with less resourceful natures and less skills in networking would go about having the outcomes I've had. That practitioner treated me for for so little because it was a professional courtesy. I was very fortunate.

A couple of points about me...

This blog is personal, not political

This is a place, as I said, to share my own personal experiences of the health care systems in the UK and US.  I am not going to use this space to express any political opinions I might have - its just personal.  I have had good and bad experiences with doctors and hospitals in both countries.

I rarely use doctors in either country

I also want to point out that I rarely use either system for treatment.  I am very much a believer in alternative therapies and 9 times out of 10, whether I have an orthodox diagnosis or not, that's the way I go for the treatment.  So if my back or limbs hurt I go to the osteopath or massage therapist.  If I have any long standing chronic issues or acutes I will use acupuncture or homeopathy or herbal medicine.  Where I choose to spend my health care dollars is to give them to these practitioners and so far, they have kept me healthy and I haven't needed more expensive options.

I am very choosy about the practitioners I use and I'm sure that's why I've also had very good results with myself and my family.  I'm not averse in any way to using allopathic medicine when its needed - especially for diagnosis.

The fear that I had, living in the US without insurance, was that I'd get appendicitis, or a burst ovarian cyst, or a broken leg or hip, and I'd be stuck - really stuck.  

Why wasn't I insured?

How did an educated, middle class, sensible, intelligent woman end up without insurance?  Simple, I became self employed and then divorced, and no longer could afford coverage.  

My husband had a job with health insurance which only covered himself and me.  Our children were on Child Health Plus in NY State.  This worked for about 18 mos and then he left the country in April 2001.  On leaving his job he was offered COBRA* for me.  The COBRA, which I then had to take over and pay for myself was over $1200 a month.  He sold a valuable guitar amp from the early 1960s and this covered two a couple months of COBRA - then the money ran out.  So I had two months of coverage (which I never used) and then nothing.

The children remained on the Child Health Plus until renewal time.  My income dropped significantly after 9/11 and when I went to renew I was sent to an office in Spring Valley New York.  A translator was brought in to speak English to me.  I was informed that my income was now too low for CHP and that the kids would have to go on Medicaid.  But what about me?  According to their income calculations I earned $100 too much in that year to be considered for any state coverage.  Yes - $100 over for the year. So again, I was left with no coverage in case of a catastrophe or any other health crisis.

A year or two later, my income rose - by $10,000 in a year (gross).  This lifted me up out of the Medicaid threshold but then into another no man's land where I couldn't afford any other kind of coverage.  There was a period in this time where none of us were covered.  Again, because I was using mostly alternative practitioners, I was paying out of pocket for everything anyway - but there were still some emergencies.  More on that next time. 

*Consolidated Omnibus Budget Reconciliation Act (COBRA) allows Americans the right to privately purchase their employee provided healthcare once they leave a job - for a limited amount of time. This can be up to 102% of the cost of the plan. 

Where we start...

Hi friends and welcome to my blog. I've been living back and forth between the United States and the UK since 1975. I became a dual national in the 1990s and have spent years at a time in both countries since then.

In 2005, while very happy living in the US generally, I felt forced to leave and go back to Great Britain because after four years trying to raise two children without any proper health insurance I felt too insecure to stay.

I've started this blog because friends in the US have asked me to share my experiences of health care in both locations so that they can pass the information onto their friends.

I will start first by telling you what is happening close to my family in the present. In subsequent posts I will go into detail about what happened in the past 12 years. Once I'm back up to date I will carry on blogging about what's happening as it comes.

At the end of January 2008 my ex husband (the father of my two teenage daughters and my oldest friend) was diagnosed with colon cancer (Dukes stage D, which means it had already metastasized to his liver). He lives near us in Oxford about 5 minutes away from the John Radcliffe Hospital, a major teaching hospital, allied with Oxford University.

He was scheduled for surgery in the third week of February which was then moved forward to the 14th - basically about 20 days after his diagnosis. The 20 days allowed him time for not only all the pre-op testing and other stuff but also to organize his own life enough as he's self employed and needed to take a long leave of absence.

His surgery was a success, he was released from the hospital after 6 days and came home to our house to recuperate and stayed with us for another month.

Cost of the surgery and the week in hospital = £0.

Paperwork other than relating to recuperation instructions and medication information = none.

At the first hospital appointment after his release the options were explained for chemotherapy and he decided to go down that route. He was offered a place on the COIN trial, which was looking at a new treatment in combination with more traditional chemotherapy.

He then spent the next 6 mos having both the traditional chemotherapy and participating in the COIN trial. Because 6 months into the trial his liver cancer shrunk completely, he was able to carry on in the trial on a weekly basis once his chemo ended -and so had the experimental treatment for a further 10 months.

Cost of the chemotherapy = £0

Cost of regular scans (8-12 weeks) = £0

Blood tests and other monitoring and doctor visits = £0

Cost of parking at the hospital for chemo treatment - £0

Cost of drugs for side effects etc = £0

I believe that not having any financial strain with regard to decisions about his treatment has gone a long was towards his generally decent state of mind and ability to handle what's been happening. All he has to think about is getting better and his work - but "how will I pay for all this" is not something he EVER has to think about.

I did some calculations for a friend last night and tried to estimate what all this would have cost had he remained in the US and been treated in NY State. By using several services that calculate the cost of various medical treatments I came up with the following:

Colon Resection Surgery plus 6 days of hospitalization – $24,500

Folfox 17,584

IFL/FOLFIRI 38,027

Erbitux 255,000

Scans 12,000 (CAT)

Scans 5400 (MRI)

Colonoscopy 2,000

The estimated total so far, not counting any doctor's appointments or regular testing or monitoring, or all the meds that are regularly prescribed for chemo side effects (including doxycycline, anti histamines, pain killers, anti sickness drugs etc) = $354,511

(disclaimer - this is an ESTIMATE based on my findings looking up sites - it could be under or over but its an approximation)

Oh boy...