Thursday, February 11, 2010

Why the US Really, Really Really Needs Single-Payer Universal Health Care - or how Ciel went to the doctor in Scotland and was once again amazed at the British system

I take a lot of drugs - uh, meds.  So many in fact that I actually have a two-sided zippered case in which to carry the pill bottles and a separate thermal thingie for the injectable interferon. When going through airport security or customs I am always nervous that I will be hauled off for smuggling or something but, you know what, I have never even been asked about all the pills and needles and little bottles of liquid and stuff. Proving yet again  how TSA is keeping us all so very secure.

But, just in case, I carry photocopies of all my prescriptions and those print outs you get from the pharmacist about what each drug is for and a list from my doc about what I take and why and a copy of my medical records, including the pathology report from my cancer surgery, a disk with the results of my most recent MRI and a print out of my latest blood test results.  I never know when someone is going to want to know something  about all the many, many parts of my body  that are missing, broken, plastic, or not in proper working order and what chemicals are required to keep me functioning day-to-day.  Best to be prepared, right?

Before we left the US last fall I visited all my doctors (I have 7) and got new year-long scrips for everything I take - daily, bi-weekly and monthly.  Then I called my insurance company and asked, no begged, for an override so I could bring my medication with me.  After explaining that I would be out of the country for at least 6 months I was told that I could get 3 months of meds to take along.

 Hello, can you count?  I am going away for more than 6 months.
Don’t you have one three month supply already? 
Well, yes, but I have been using it for the past month- and-a half so there won’t be enough to last for the trip.
 Are you going on business?
 Oh, that’s too bad because if you were going on business we could give you up to a year’s supply in advance. 
So, if I am traveling on my own and BTW pay for my own insurance, I can’t get approval to take medication with me for the entire trip but if I am working and my employer is paying for at least a part if not all of my health insurance, I can  get meds for a year? Oh now it all makes so much sense……

But if I buy meds overseas I can file a claim when I get back right?
 No, you aren’t covered outside of the US unless there is an emergency.
Oh, if I run out of my anti-depressants there will definitely be an emergency alright.
(Then I’ll just take it off my taxes.  Wait, it has to total over something like 7% of my income to do that.  Good ol’ IRS)

So, this morning I am up at the crack of dawn  -on the morning after my birthday celebration so you know I really needed to sleep in - but I am up to go to a Scottish Doctor so I can get a prescription to buy meds in Edinburgh. Mind you, I pay over $400 a month for health insurance in the US ,even though I am not using it ,because there is no way to put it on hold (like there would be under a tax supported plan where if I go out of the country I am not paying taxes for that period, understand? ) and if I stop it I will be considered uninsurable by US health insurance companies  and denied coverage when I return because I am one of those people who actually needs health insurance because I have MS, cancer , hypothyroidism, hypertension and hyperlipidemia and did I mention need a lot of meds to control it all and, oh, keep me alive.  I know this because my 24-year-old healthy as a horse son can’t get insurance because he is -are you ready for it- short.

So, here I am in Scotland, about to run out of thyroid medication and having gained 30 pounds since this ridiculous condition was diagnosed I dare not go without it. I call the local surgery (clinic) and ask if I can see the doctor.  But , I am not on the NHS (National Health Service) because if I was I would go to the doctor and pay NOTHING, NADA, ZERO, A BIG FAT GOOSEGG.  Because in Britain they believe that health care is a right not an option and everyone is taxed equally to pay for it so no one can be denied and everyone gets care when they need it.  Novel idea don’t you think. ( and don’t tell me “but it’s rationed because the only thing you wait for here is elective surgery like boob jobs and sex change operations - seriously. And if you are  sick you will be seen by a doctor on the same day- guaranteed)

Actually, I have an NHS  card from 2003 when David was a student here and we were paying taxes here but try as I might it can’t be renewed.  So I am a private pay patient.  That will be 40 pounds for the visit, 15 pounds for having a prescription written and 40 pounds for the blood test.  Even though I do not have a card the NHS will pay for my swine flu jab (shot) because it is cheaper for  them to give me the vaccine since I am living here than it is to treat all the people I might infect were I to get the flu.  Wow, someone is actually thinking about health care costs and WELLNESS here. 

 SO, I will pay more than my co pays would have been in the States but I am paying for the full price of the service.  How much would it cost an uninsured person in the US to see a doctor, get a prescription, have blood tested for kidney and liver function, blood sugar, thyroid hormone levels and the regular stuff like hemoglobin?   The blood test alone would cost more in the US than my entire visit in the UK. 

And if billed to insurance the US charge would be even higher. Did you know that?  US doctors and hospitals bill insurance companies more than the actual cost of the service. Why? Well, there must be enough to pay for the doctor, his/her staff., the medical transcriptionist (sorry Cynthea), the lab, the building owner, the decorator, the art on the walls, the person who waters all those plants or feeds the fish in that big tank, the cable bill for the waiting room TV, magazine subscriptions, cleaning service, and then there is a cut for the insurer, to pay the lobbyist, to donate to the candidates. And if it is medication that is being billed, there is Big pharma’s cut and the cost of marketing prescription medication

What is that about anyway - marketing prescription meds? Shouldn’t the doctor be the one who decides if I need a medicine?  Isn’t that why he went to med school and gets the big bucks?  Am I really supposed to make an appointment to tell him/her that I saw an ad on TV and think I need that new drug “what’s it called” for that condition I didn’t know I was supposed to be worried about.  BTW you still don’t need to be worried about it because chances are Big Pharma created the disease to fit some drug they manufactured that didn’t work for what it was designed for and now they need to sell the stuff to somebody with say, restless leg syndrome which Does. Not. Exist.  No surprise, there are no drug ads on TV in Britain.

But I ramble….

At the Scottish doctor’s office, I checked in with the one receptionist  who worked for 6 docs. (For the sake of complete accuracy, there were also two medical file clerks working.) The receptionist took my payment which she had previously quoted to me on the phone so I could bring cash because they do not take credit cards (something  else US docs pay for) and asked me to take a seat in the waiting room until “the DOCTOR comes for you”(more on that in a bit)  On the wall was a sign “ If you have waited longer than 25 minutes for a booked appointment, please inform the receptionist so she can remedy the situation.”  I don’t know about you, peeps, but I have never seen a sign like that in any of my US doctors’ offices where I have sometimes waited an hour or more. And all that was on the rest of the walls was posters about health care and information about the doctors. No pictures. No TV. No plants. No fish. No corner for the kiddies filled with germ covered toys.  There were a lot of reasonably comfortable chairs but no plush sofas and on the tables were the magazines that come free in the Sunday paper (expecting this perhaps, most people had brought a book) and, you know what, I neither got sicker nor felt better as a result,  Imagine that.  The waiting room décor did nothing for me in terms of my health care.  It was a clean, comfortable well-lighted space.  What a concept.  And if you had flu symptoms they asked that you tell them at check-in so you could be placed in isolation.  I was particularly fond of that bit since I can’t tell you how many colds I have contracted while waiting to see the doctor with sick people sneezing all over me in the well-decorated  waiting room.

Now it gets scary.  In a few minutes, like 5 minutes after my appointment time, the doctor came to the door and called my name.  Yes, THE DOCTOR.  He led me down the hall to the one room where he sees patients and asked that I take a seat in the chair by his desk,  On one side of  the desk were a full-page size flat computer screen and keyboard which he later used to verify my prescription drugs, on the other end next to my chair was a blood pressure gauge and a gainst the opposite wall was an examining table.  All in one room.

  THE DOCTOR put the  blood pressurecuff on and pushed the button while HE asked questions and made notes about my medical history.  Where was the nurse that would have been there in the US to do all this and then left me there with an old magazine until the doctor showed up maybe 15 or 20 minutes later??? THE DOCTOR was actually hearing what I had to say and writing it all down.  No chance that he might not have the time to read some nurses notes made before he arrived in the room so that he might not know that I am allergic to doxycycline and surgical tape or that I have high blood pressure and since my Mom, Dad and grandmother all had strokes it sort if freaks me out. And THE DOCTOR took my blood pressure not once but three times and sort of averaged them out and then said I should come back once a week for three weeks so he could see the trend since one time is never sufficient.  Has that ever happened at a US doc’s office. NO!!

He asked if I smoked or ever had but not if I drink.  This is Scotland.  He assumed I drink.  He asked if I have more than 21 drinks in a week.  I asked how much that was and he told me 21 pints of beer (are you kidding - I would be floating or living in the bathroom), 21 - 6 ounce glasses of wine (that’s like 6 bottles all by myself) or 21 large whiskies (who could afford that or still be standing) Uh, no, I don’t think so.  And my screen name is martinis2nite!  Ok then he said, the booze isn’t hurting me. Hooray Scotland!  He didn’t even seem to think that not drinking was going to help me lose weight.  What?  Someone pass me a glass.

Then he ordered blood tests and they  did them right there, right away.  Well, actually I had to walk down the hall with the “lab nurse” who took me into a doctor’s office where her “trolley” (cart) of supplies was located.  Rather than a big ol’ expensive room with lots of chairs where people sit and wait their turn, she lets them wait in the waiting room and each day uses the office of whichever doc is on hospital duty,

Are you seeing the pattern here?  Think of all the waste in the US healthcare system. The Scottish doctor had a laugh when he had to determine how much to charge for the blood tests.   He said “We doctors are lucky here.  We don’t have to think about money like  the Americans.  They actually need a business management course in medical school.  What does that have to do with practicing medicine.  I have to think it affects their patient care.”

Can you imagine??

P.S.  My prescription cost less than 10 dollars to fill.  That is the actual cost of the drug.  My US co-pay is $20.

No comments:

Post a Comment