LONDON - A few weeks ago I found myself curled up in a hospital here in London, my feverish body shaking violently back and forth. The pain in my side and back made it hard to straighten my torso, and I’d thrown up in a friend’s car on the way to the hospital.
The hospital couldn’t find an extra hospital bed, so I spent my first night hooked up to an IV on a gurney in the middle of a row of men and women, my sweaty skin sticking to the plastic. A shriveled woman in the bed to my right issued loud and largely unintelligible commands to nobody in particular. A steady flow of patients visited the bathroom right in front of my bed. A shouting match broke out between some of the nurses and nurses aides until a man at the other end of the room yelled, “Could you please take it outside? I’m trying to rest.”
Sometime in the midst of this I was diagnosed with pyelonephritis, a severe urinary tract infection that had spread to a kidney, and ended up in the hospital for three nights. I had already been on two courses of antibiotics, but that hadn’t cleared up the initial infection. Finding myself sick and alone thousands of miles away from my mom was bad enough, but scarier still was just how familiar the illness felt.
I’d been sick with the same thing almost 10 years ago when I was in my 20s and still living in the United States, where I’m from. In both cases, my side and back hurt and fever shot up. And each time, I recovered after serious doses of antibiotics and lots of bed rest. But apart from that, my experiences were a world apart.
The biggest difference: Money. Getting sick in New York City decimated my bank account. In London, I didn’t pay a pence. I should note, however, that a full 9 percent of my gross pay goes towards the equivalent of a health tax. (For comparison’s sake, according to the Commonwealth Fund, in 2007 about half of working-age Americans spent 5 percent or more of their income on out-of-pocket medical costs and premiums.)
And while I recovered fully in both cases, the care I received felt quite different. In New York, I never feared that I would be overlooked. At my doctor’s office in upscale Gramercy Park, he and his nurses took their time seeing me, and were always at pains to reassure me. On my first visit, the receptionist let me sit in an empty consulting room so that I wouldn’t have to weep in the waiting room. She checked in on me and brought me water.
But unlike the personal care I received in the U.S., in London, I felt like I was on a vast and often creaking conveyor belt, and there was a big risk of falling through the cracks. British care is socialized — and feels that way.
Affordable, but at what cost?
Amid the fever and pain, and the crushing boredom of my London hospital beds (I spent each of my three nights in different wards of the huge Royal Free Hospital), I couldn’t help but compare my two experiences and think about the presidential campaign happening back home and the growing impetus for health care reform in the United States.
Would the elderly woman in my ward in London who repeatedly pleaded “Can someone help me please?” after being left on her dirty bedpan for almost an hour, recommend a version of the National Health Service to Americans? What would British patients who are denied certain drugs because of funding constraints or because they’re deemed too experimental say about it?
And how about Professor Paul Goddard, one of the England’s senior doctors, who said recently that thousands of hospital patients are “starving” because over-burdened nurses don’t have time to feed them?
I saw what he was talking about. In the third ward, I spent a day next to an ancient-looking woman who refused to touch her food. A few times the harried nurse tried unsuccessfully to get her to eat. Mostly my neighbor sat with her eyes closed, her chin resting on her chest.
Being mouthy and mobile, I felt confident that I could cajole the hospital workers into paying attention to me. As it turned out, I had to be very, very patient. Nurses paced the corridors all the time and we could call them from our beds, but doctors were a bit harder to come by —unless there was a real emergency everyone had to wait their turn. And about twice a day a pack of lean and well-dressed physicians clutching clipboards would lope into the ward, pull the flimsy green curtains around our beds and ask us to share intimate information within earshot of the other patients. Being shameless and forthright, I got along OK — I pressed the doctors for answers and they sent me for a battery of tests to make sure that there wasn’t anything else wrong with me.
But I wasn’t so confident for some of my companions. One of my three roommates in the second ward was a woman who said she had a dislodged stent in her chest and was waiting for urgent heart surgery. She gasped for breath when hobbling across the room to the bathroom, and rarely spoke to the doctors except to say “thank you.” She confessed to me through tears that she had tried to kill herself a few weeks earlier. At one point the nurses left her in a corner in a wheelchair for about two hours as they looked for a bed for her on the cardiac ward.
Going broke to pay for clean bill of health
Complaints about health care straddle both sides of the Atlantic, of course.
With both Republican John McCain and Democrat Barack Obama devoting time to the issue of reform, politicians in the United States are responding to the feeling that something fundamental has to change when it comes to taking care of Americans’ health.
That’s because “the system is breaking down,” says Jacob Hacker, a professor of political science at the University of California, Berkeley, whose work on health care reform influenced Obama and his former rival in the Democratic primary, Hillary Clinton.
“We have people who are facing financial ruin even if they have medical insurance,” says Hacker, the author of "The Great Risk Shift: The Assault on American Jobs, Families, Health Care and Retirement — And How You Can Fight Back.”
Ten years ago, while living in New York, I was out of work and paying more than $200 a month out of my meager savings into a group plan for health insurance. Still, I put off going to the doctor until I was quite sick, fearing that things could get out of control and I would end up paying for something I couldn’t afford. By the time I did go, I was in a waiting room doubled over and weeping from the pain.
During the first consultation in a small, neat but spare clinic on the West Side of Manhattan, I asked the nurse to call my insurance company. She informed them of my condition and there seemed to be no payment concerns so they were able to turn their attention to my health. My fever was very high and the doctor wavered on whether to send me directly to the hospital, but instead decided to send to a specialist downtown. Unlike the clinic, with its plastic seats, cramped waiting room and harried-looking staff, the specialist’s office in a brownstone was warm and inviting. A fleet of nurses busied themselves with paperwork and smiled at the patients in the waiting room.
The doctor immediately put me at my ease with his twinkly eyes and a hand on my shoulder. After an ultrasound, the doctor sent me home, armed with prescriptions for painkillers and a potent antibiotic. It was good to be at home instead of a hospital but I was knocked out and slept much of the time. I soaked the sheets as I sweat through my fever.
I saw the doctor two times during my convalescence and he called my home several times to check on me. After several ultrasounds, he determined there was no permanent damage to my kidneys.
After I recovered, I was hit with another shock: my insurance company refused to pay the roughly $4,000 I owed. There had been a mix-up with the nurse in the first clinic; my insurance company now said they would have paid for a hospital stay, but not at-home care. The company also blamed the mix-up on me as I did not call them directly when I was first diagnosed.
Had I been older and more self-confident, I wouldn’t have dropped the issue after a couple of incredibly frustrating calls.
Unable to pay the bill, I felt guilty for years that the doctors who had cared for me had been left holding the bag. With my family’s help, I finally was able to pay what I owed, but by that point my finances were a mess and my credit record had taken a hit.
I was far from alone. Americans are hemorrhaging money into the health care system. According to the World Health Organization, the U.S. spent 16 percent of its Gross Domestic product on health care in 2005, almost two times that spent in the United Kingdom and other wealthy nations. And Americans are not healthier for it. By many measures, in fact, we are markedly worse off, something widely agreed on regardless of where you fall on the political spectrum.
“If you ask Americans if they are in favor of reform, you get everything from diehard Republicans and diehard liberals saying yes,” says Robert Moffitt, the director of the Center for Health Policy Studies at The Heritage Foundation, a conservative think tank.
A 2007 Center for Studying Health System Change study showed that one in five Americans surveyed reported going without or delaying health care in the previous 12 months, up sharply from one in seven doing so in 2003. The cost of care was the main reason for not getting medical attention, the organization says.
In my case 10 years ago, I ignored the initial illness and just drank a lot of water and cranberry juice and took over-the-counter painkillers. If I had gone to the doctor with my initial complaint — a simple urinary tract infection — it may have cost me around $200 for a visit and drugs, even if insurance hadn’t paid. Waiting for it to get really bad ended up costing me thousands instead.
U.K. the way to go?
Most agree there’s a problem with health care in the U.S., but is the United Kingdom’s system the way to go? Certainly, the U.K.’s health care system has been held up as an example of how to go about things.
Polemical documentary maker Michael Moore took on the issue in his 2007 movie “Sicko” and gave the NHS, established in 1948, a glowing review. He interviews a number of people to show that the NHS is in good shape, with everyone from brand-new parents to family doctors giving it rave reviews.
My take was more mixed than Moore’s. The good part was that my local doctor is part of a cooperative that allows patients to see someone after-hours instead of resorting to the emergency room. The doctor who saw me first seemed to take a real interest and helped admit me to the hospital within minutes. The obviously over-worked nurses treated me gently, calling me and everyone else on the wards “dearie” and “love.” When they saw me, the doctors focused on me intently and made sure I underwent a series of tests to make sure nothing was overlooked.
But as I was being rotated through different hospital wards, it didn’t always feel like I was benefiting from a gold standard of care. I had to be alert to any opportunity to talk to a doctor and nurse about my condition — it wasn’t that I felt the staff didn’t care, only that they had so much to do and so many people to look after.
So, I looked out for myself. I made a point of showering, washing my hands often and getting a clean gown every day — nobody else seemed to be paying very close attention to my hygiene or anybody else’s. I thanked God every day for lovely friends who visited and made sure I ate properly.
The wards were always noisy, making it impossible to get a good night’s sleep. Visitors wandered in and out throughout the day and late into the night. On my second night, I woke up to find that the woman across from me had fallen out of bed. She lay on the ground moaning while I dragged my IV down the hallway to look for the nurses.
The NHS is relentlessly picked apart in the media here, and the government is under enormous pressure to fix its problems, such as high cancer death rates, deadly infections flourishing in some hospitals and alleged understaffing and incompetence.
Medical care is extremely variable across the service, says Vanessa Bourne of the Patients Association, an advocacy organization, with the care and treatment highly dependent not only on what part of the country the patient in lives but also on the quality of individual family doctors, or general practitioners, as they are known here.
These highly independent professionals wield enormous power because they’re responsible for referring patients to specialists and tests. If yours is good — and mine is great, for the record — then your health is in safe hands. But if she or he is lazy or incompetent it can have a serious impact on your health. And there is very little recourse if you have a complaint because you’re pretty much stuck with whatever GP practice is in your neighborhood.
One friend here refuses to visit his GP’s office because they don’t listen to him and assume he is only there to get a pink slip off of work. He has tried raising a number of issues to deaf ears. This cannot be good for his health in the long run.
The NHS is often criticized for being unresponsive to the regular user and instead largely answerable to its own enormous organization.
And we are talking humongous: The NHS is the largest employer in Europe, with about 1.3 million people on its payroll. It has an annual budget of around 90 billion pounds, or roughly $160 billion dollars.
Another criticism is the practice in some parts of the country of stopping care if a patient pays out of their own pocket to get a treatment that is not on the NHS. In other words, if you have cancer and can afford an experimental drug that has not been approved for general use, the NHS will force you into totally private care.
The system’s problems, real and perceived, are such that the best jobs in this country offer private insurance. A few of my friends have paid thousands of dollars extra to get private care when they gave birth. For this private care you get your own room instead of sharing a ward with other new mothers and their babies, and extra care from doctors and the nurses.
This frightens me. Certainly, I’m nervous about depending on the over-stretched and arbitrary organization if I have a baby or when I get old. I can still hear one old woman next to me in the hospital crying “Mummy, Mummy,” when she realized no one would come to comfort her. Still, even if the system here is riddled with problems, I’ve come to appreciate the U.K.’s efforts to care for the health of all of its people, including me.
When I got sick I wasn’t afraid to call the doctor because of money. I was run through myriad tests and attended to by a fleet of nurses and doctors. I am now fully better. I can and do make appointments at my neighborhood doctor’s office a five-minute walk from my house, without ever having to worry about being bankrupted.
Brinley Bruton first came to Great Britain to live and work as a journalist in 2002. She had previously lived in New York City. Earlier this year, she became a dual citizen.