A picture of your future, UK?

In regards to the upcoming United Kingdom General Election, there are some strong opinions being thrown around. The loudest one I’ve heard, is the many people who believe that there isn’t a viable opposition. The opinion is that even if voters hate Theresa May, effectively there’s no point in voting against her.

I beg to differ. I have no idea whether a certain other candidate could gather a functional party around him, but I wouldn’t be surprised if he managed it. Grassroots support is important, and he has a lot of that. I will vote for his party, whether he’s likely to win or not because he opposes privatization of the NHS (National Health Service) – the UK’s socialized healthcare system.

I was a user of the NHS for the first 31 years of my life, and a worker within the NHS for years, both as a HCA (CNA) and as a Registered Nurse. I love the NHS. I loved it for myself, as a person living with several different medical conditions; and as a nurse caring for patients in a very low income area. I liked that both myself and the NHS as a whole paid comparatively tiny amounts for medications compared to other places in the world – the nationalized system effectively makes it a buyer’s market for patients and their healthcare providers, rather than a free-for-all cash making machine for the pharmaceutical companies. I liked the fact that if you did need to seek care privately, that the existence of the NHS caused private healthcare providers to have to make their prices relatively competitive – I had a surgery privately once, and it cost a total of around 3000GBP (my American keyboard doesn’t have a pound sign and also autocorrects spellings to American English!). I like the fact that I didn’t have to ever turn anyone away as a nurse because my workplace didn’t take their insurance. I liked the fact that I didn’t have to comfort distraught people (or experience being that distraught person) who were facing overwhelming medical bills. I liked it A LOT.

I found it difficult also. Over-stretched and under-funded NHS departments failed me on several occasions, particularly in mental health services. Lack of continuity of care, and the absence of long-term access to counseling/therapy led to mental health symptoms regularly reaching crisis point. It also led to me being wrongly labeled as having multiple episodes of “reactive depression” rather than getting the correct diagnosis of Bipolar disorder that made sense if you pieced together my history and looked at the overall picture. It was necessary for me to have surgery outside the NHS, because that particular procedure was not being offered on the NHS at that time (although 3 years later I had the same surgery on the NHS – likely at that point it had been proven that it was value-for-money). Rationing meant that I never got more than 6 counseling/therapy sessions at one time, when I was trying to process childhood trauma and medical trauma. If I had stayed in the UK I would have been allocated 6 (possibly 12 with an extra application for funding) sessions of ECT and would likely be dead now. I knew of people who could not access the extremely expensive new drugs for their medical conditions as they weren’t available through the NHS, or weren’t recommended by NICE for treatment for that particular indication. It’s not some kind of utopian system.

The system here is different. My husband is American, and for the last three years we’ve been living in the North-East (read: one of the most ridiculously expensive areas) of the USA. It’s not perhaps where I would choose to live, but it does have some advantages over the UK, particularly when it comes to healthcare. In this country, IF and when I have had the right insurance, I have been able to access some healthcare that has been critical to me being able to recover physically and mentally enough to be able to work again, parent my children better, and overall not live a miserable life. The two most important of these were long-term therapy, and LOTS of ECT. 30 sessions to be specific. It is no exaggeration to say that these things saved my life.

However, in this country, before the Affordable Healthcare Act (and sometimes in spite of it), due to healthcare costs:

  • People have been forced to abandon their families and move back overseas in order to get the healthcare required because of being uninsurable due to pre-existing medical conditions (yes, this was me – 6 months apart from my husband, 4yr old and 6yr old. 3 months separated from my baby, who was 11 months old when Peter brought him back over here).
  • People have gone bankrupt.
  • People have had to choose to get divorced in order to not lose their houses, or pretend not to be married in order to get the healthcare and support needed to deal with disabilities.
  • People have had to choose treatment options based on cost, rather than on their relative merits.
  • People have had to ration their medications (including those for life-threatening or very painful conditions), because the co-pays are so high.
  • People wait until their symptoms become severe before seeking assessment and treatment.
  • People die.

The Affordable Care Act has improved this, but not for everyone. Those I am particularly thinking of are several friends who are small business owners, and who despite having a good income and good standard of living, still find it prohibitively expensive to afford health insurance. They live at risk of bankruptcy constantly. Outside of people with medical backgrounds, it’s not well understood quite how expensive medical treatment is, which makes the incentive to take out an expensive policy that you have no plan on using (if you’re lucky enough to be a healthy family) is very low. I sometimes wish I could show people an invoice from 1 day of an ICU stay in the US, or the overall bill from my ECT (around $85000/70000-ishGBP).

Even with good insurance, the treatment (particularly non-emergency) you can choose from is very much limited by your income and ability to pay co-pays/co-insurance (the parts of the bill that you are still responsible for even after paying your health insurance premiums). The year that I had ECT, our overall health costs were probably $13000. This felt crippling. That year we had good insurance, so for my ECT bill we paid around $5000 of it out of pocket. This time last year we made a decision for my husband to leave clinical work due to it interfering severely with family life (his shifts somehow fell in a way that meant the kids didn’t see him for 6 entire days), and to take on a “9-5” job. We hadn’t had any experience of having a less than top of the range insurance (We had a great Anthem Blue Cross Blue Shield policy because my husband worked for Yale New Haven Health). The new job came with health benefits, so we figured we would be ok. We were not. The new insurance cost more than twice what our old insurance cost, and covered a fraction of what the other one did. It changed co-pays on medications from $6-$30/month to $20-350/month (in fact I currently have just a discount card and no prescription insurance, and the medications are CHEAPER than on the plan we paid for). It changed therapy appointments from $30 co-pays to $93.53 copays PER SESSION (for most of us – Maya’s appointments were a $156 co-pay because she sees a more senior therapist). It caused me to end up with a $1000 bill for two physiotherapy (physical therapy) appointments. It caused me to not seek treatment for many symptoms because I simply couldn’t afford it. It means that several significant health issues have not been addressed which should have been. These costs are in spite of us getting much of our healthcare at “not for profit” institutions.

Our full outgoings medically for 2016 were $33914.72, broken up as follows:

Insurance premiums  $15,226.77
Payments to FSA/HSA (for prescriptions and appointments) $7,340.53
Extra medication costs not covered by HSA/FSA $3602.12
Debt payments from medical debt carried over from 2015 $3,016
Appointment/procedure/treatment costs not covered by HSA/FSA  $4,729.30
(HSAs and FSAs are tax-free plans which you can pay in to for medical expenses)

 

Our overall combined income for 2016 was around $90000 gross, which seems like a huge amount, but those medical bills are a full 1/3rd of this gross income, therefore much more than that when you figure in us paying regular tax! We also live in a state where houses are expensive and property/car taxes are very high. We have to pay for full time childcare for the little boy (kids start school a year later here, so we have another 18m of this, and part time for the girls. We should have got a large tax return because of our healthcare bills accounting for more than 1/3 of our gross income, but because we sold our UK house (mainly because we couldn’t afford our medical bills even with the good insurance), we got taxed on the profit (they don’t care if it went paying off medical bills or not!), we actually ended up with a $15500 tax bill, which has taken the very last of our savings and now means that we can’t use that to pay off the bills we incurred from the point in June when we had managed to get back to $0 outstanding debt up until December.

This year, we’ve been even more unlucky with medical bills. Five out of the five of us have had a trip to the ER (A&E) this year. Each of the first two cost $3000 out of pocket, the third cost $833, the fourth we haven’t received theand the fourth was my 3 day stay in hospital, which included a CT with contrast, echo and gastroscopy. I am dreading the bill for this, it could be 10s of thousands of dollars. Even without all of the bills arriving yet, we’re over $20000 of healthcare costs IN THE FIRST FOUR MONTHS OF THE YEAR. We have not earned this much yet this year!. If we could both work full time we could cope, and have a plan to pay back this debt –  RNs get paid well in this country, but we can’t. I’ve been getting sicker just working the 2-3 days a week which I current do. It’s such a hard dilemma – if I don’t work, Peter gets sick working too many hours to try to support us and pay the debt (the kids also don’t see him, and I might go mad with boredom and lack of mental stimulation). If I do work, I’m getting sicker and incurring more medical bills. I’m so far from being alone in this, and we’re in such a better situation than so many people. At least at the moment we have enough credit to not lose our house. But it’s hard, and it breeds resentment in me, because not everyone has to deal with this, and the reason that we need to is because the healthcare system here is based on unbridled and unregulated greed. My husband’s trip to the ER was simple – he went for severe abdo pain, had some basic investigations, fluids and painkillers. He was there for a few hours. the bill was $4500 total. WHAT.THE.FUCK. I remember reading a while back about the cost of a trip to A&E in England. I think it was around 300GBP. There is no excuse for that disparity. It is greed, pure, pure greed, exploiting people who cannot live without the care. It appears that hospitals are allowed to charge anything that they want to for people’s care. Another couple of horrible examples of this are the $700ish bill we received for an AP & lateral (front-to-back, and side views)  chest x-ray for Amelie when she was being investigated before we knew she had glandular fever (mono), and the $537 bill we received for blood tests for the same issue. Those are the without insurance costs, thankfully these came down to around $300 after insurance, which is still absurd.

I would be happy to pay for my healthcare, if it was charged at a reasonable rate. I earn more here than in England, I would be able to pay medical bills. But not these. Here, we feel like we are drowning. I feel like money runs through my fingers like water. Our income is enormous, our outgoings are bigger. And it’s hard not to go down this route of thinking – that with this money that I give to line the pockets of insurance companies and high up management in healthcare, I could have started saving for retirement, or for my kids’ college fees. I could pay for the post-grad study which I may never be able to do due to debt, or we could have come out of last year with some savings remaining, not in at least $20000 extra debt (much of it on credit cards, leaving us even more vulnerable financially, and some that is still outstanding and we haven’t got the details of yet). We could have the possibility of moving out of our tiny house, which would help my mental health a huge amount (I’m very aware that I live with huge privilege and that these are very much first world problems!). I love giving, and could give SO much more, and  I could live with less fear of going bankrupt if I get sicker again and am not able to work.

It scares me that the UK is going down the route of privatization, because it will be great at first. There will be posher/fancier buildings, there will maybe be better care. Then the private providers will increase their costs, and the NHS will no longer have the infrastructure to return to providing the services themselves. You will be trapped, and will be at the mercy of people who can charge exactly what they want for services, and you will have to pay, even if it means that you lose everything. You may need healthcare that you cannot afford. You may have to choose between co-pays and basic day-to-day needs. You may die because you couldn’t get care.

So I’m not here to convince you to vote for any particular candidate, but I am here to paint a picture of my experience as a chronically sick person and healthcare worker in both systems, and to ask you to consider it very carefully before you vote for a party who is committed to a plan of privatization of the NHS. It puts your future and your children’s future at risk. Now excuse me, I have to go and work my job helping sick people to get better, and hoping that working this job doesn’t make me sicker.

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~ by jennkeast on April 29, 2017.

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