Who's afraid of socialised medicine?

By popular demand...

For someone who hates the sight of blood, I sure enjoy talking about healthcare. Health and healthcare are things you take for granted until they fail you, and then they become the axis of your world. As someone who's 'enjoyed' American, Japanese, and British health systems I have a lot to say.

Socialized and market driven healthcare systems aren't as black and white as many politicians would like them to be; both systems have pros and cons. What is black and white to me is that in the US, the richest nation in the world, that spends $505 billion of taxpayers money on defense, 50 million people (16% of the population) have no healthcare (as of 2005). This is a sin. In the richest nation in the world, healthcare should not be a stress or a luxury, but a right and a priority.

In my life growing up in America I've been blessed with excellent health coverage. I've been fortunate to have been given top quality treatment and not need much of it. I've appreciated going to clean, new clinics where I have been treated like a queen. But I also am aware that my America is not everyone else's America, and this standard of treatment is not nationwide.

When I first arrived in the UK 2 1/2 years ago I had high hopes for the NHS. In some ways I wasn't disappointed- I was able to register with a local general practice as soon as I arrived and even get my prescriptions for free. Awesome. But I also attended a practice in one of the most impoverished areas of Birmingham and my views were jaded. From an American point of view, the standard of quality was mediocre at best. The building was dire and the customer service skills were lacking. BUT, as a foreigner (albeit with the correct visa), I was still treated, without having to jump through any hoops. This is how it should be. I've been to other doctor's offices in the UK that have been nicer and I have never had any problems getting what I've needed. I've found the NHS to be grittier than what I was used to beforehand, but still very accessible and helpful.

I always feel the need to correct people when they tell me that the NHS is a free healthcare serivce. This isn't true at all as someone does pay for it, and a portion comes out of my paycheck every month. The distinction however is that even if you aren't earning, you have the same access. So effectively my paycheck outgoings are paying the healthcare of those not working. Outrageous to many, yet merciful and humane to the poor, vulnerable, and 'regular' people between jobs or with unorthodox employment.

The beauty of the NHS is that everyone can access it. This reduces the stress of not being able to afford it (or able to prioritize it anyway). It stops people from getting into debt over medical bills and gives them freedom.

I don't have any policy recommendations for the US (!) and I recognize that America has some of the best healthcare facilities in the world, but at what cost? Does the fact that they aren't accessible to those who really need it offset their existance? Most policy makers in the US have excellent health insurance; the poorest and most vulnerabe aren't always the biggest consideration.

For me what it comes down to right now leads back to our consumerific monster of a society we've built in the US, based on individuals working hard to get the best for themselves. We have the biggest and the best, but still can't take care of those who slip through the cracks, those that the market fails. Our healthcare service works for the strong and makes them stronger (patients, insurance companies, and pharmecuetical companies) but doesn't work for too many people. I've heard that you can judge a nation by how it treats it's most vulnerable, and in that case what we have now doesn't cut it.

I've been thinking a lot since moving to the UK about how much I want vs. how much I need. I believe that ambition and excellence are great qualities that America has, but often they come with a cost. Do I need a higher quality healthcare system that costs vulnerable people any healthcare? Do I need cheap gas that costs the environment? Do I need cheap food as a result of US-based trade agreements and agricultural subsidies that push the poorest countries deeper into poverty? Do I need cheap clothes that cost people their basic human rights? How much do I need when I realize the far reaching consequences of my 'needs', and when what I 'need' is so far removed from what the rest of the world gets.

This I could flesh out for days. In the end I know the NHS wouldn't work in the US. Instead I think that regional or state authorities could be the way forward, with a mix of public and private healthcare. Again, this isn't a policy document but rather my observations.

The NHS is no perfect model by far. But it is a fair model and we would be wise not to fear it. I'd love to hear other people's thoughts on this, especially Amy's as she's endured a broken leg at the NHS!