Socialised Medicine vs Private Insurance

“Are people’s teeth in Ireland as bad as the rest of the UK?”, my child’s larger than life dentist asked me. We were meeting him for a consultation to see if our daughter needed to get braces. He admitted that he was quite shocked at how crooked teeth were in the UK. He said it was all he could see when he visited London. He even mentioned the beautiful British actress, Keira Knightley, as someone he had seen on TV who had crooked teeth. He struggled to comprehend why people wouldn’t get their teeth fixed. Then, as if a bolt of lightning had struck him, the answer came to him. “Socialised medicine!” he exclaimed, “It’s because of socialised medicine” he confirmed to himself. However, as someone who happens to think Keria Knightley is gorgeous, I don’t imagine having access to to the NHS (National Health Service) in the UK would stop her from using a small piece of her $60 million fortune to “fix” her teeth if she so wished. Keria Knightley will still be a much sought after actress and one of the most beautiful women in the world without perfectly straight teeth. Nevertheless, my child’s dentist and many Americans reject the idea of a national health service.

Healthcare is one of the perennial topics of discussion at election time in the US. The Democrat’s tend to worry about all the people who haven’t got insurance and the people who go bankrupt paying the drug companies for the medicine to keep them alive. They say that most other countries have a public healthcare system and they argue for programs like “Obamacare” or “Medicare for all”. The Republicans, on the other hand, are very concerned that “socialised medicine” will lead to “government death squads”. They argue that the government will choose your doctor for you and that the government will choose what treatment you can or can not get. They suggest that a government-run health service would limit peoples choices. They also warn about waiting lists.

Waiting lists are a problem for the health service in Ireland. Ireland has its own version of the NHS, the Health Service Executive or HSE. While it is not as comprehensive as the British NHS, it does provide access to public hospitals for all its citizens. The GP’s in Ireland are privately owned and managed. It is quite expensive to visit a GP (€50-€75 per visit). People on low incomes have access to a medical card, that means they can visit the GP at no cost to themselves. People who are sick enough to need hospital care usually speak highly of the quality of the care they receive once they are admitted to hospital. However, there are often long delays in trying to access the system, particularly for elective or non-emergency issues. It is, for example, not unusual to wait hours for an x-ray and weeks for an MRI scan. For this reason, despite having access to the public system, many people in Ireland also have private health insurance.

Unfortunately, last spring, I found myself with a need to access the US health system. I hurt my back, doing a gymnastics style cartwheel to try and impress my daughter. I went to an urgent care clinic. As I had health insurance, I had to pay $20 as a co-payment for each visit to this clinic. We are lucky enough to have insurance as it is very expensive; the average cost of a family plan in California is about $1,100…….per month! The doctor felt that I needed to get an x-ray and an MRI on my back. From the time I entered the clinic to get my x-ray until the time I walked out the door, with the images on a DVD in my hand, was less than 15 minutes. The longest part of the visit was filling out the insurance form. The MRI scan was also very efficient. I was in and out with my scan in less than 40 minutes. I booked both the X-Ray and the MRI one day in advance of the appointment. I was impressed.

The results of the MRI required that I had to have a further consultation with a surgeon to see if I needed an operation to cure my back problem. It was a week before I met the surgeon- the delay was mostly my fault- and by that stage, the back pain had eased off quite a bit. The surgeon examined me and quickly concluded that I did, in fact, need surgery. He said he was going to refer me to a pain clinic so that they could prescribe me an epidural injection and that he would book me in for surgery three weeks from that date. I told him that the pain was much better and that I was moving with much more freedom. Also, I was flying home to Ireland for a family wedding, and so I could not have surgery before then. He advised me to get the pain management organised and to take the MRI scan and X-Ray with to Ireland in case the pain flared up when I went home.

The pain was much improved, so I didn’t feel the need to get an epidural. I didn’t contact the pain management clinic. By the end of the following week, I felt good enough to play a round of golf with one of my friends. We walked the 18 holes and had a most enjoyable round. As we were having our lunch in the clubhouse, I happened to mention to my mate that I needed surgery on back. He looked at me with incredulity and said: “Dude, you do not need back surgery”. I protested that my doctor told me that I did, but he countered that ‘You have just played 18 holes of golf. You do not need surgery”. My friend is a veterinarian he lectured me about the risks of unnecessary surgery. By the time I returned from the family wedding, I was feeling completely normal (maybe it was the partying at the wedding), and all thoughts of surgery had disappeared. I did not have the operation. I listened to my vet rather than my surgeon.

I had been impressed with how quickly I had been seen and how efficient the services were. However, as my back now felt better without any surgery, I was left wondering how many unnecessary procedures are carried out just because people have insurance. As each medical professional referred me on, I contemplated the cost. The urgent care clinic referred me to the X-Ray and MRI clinics, both of whom billed the insurance company. I was referred to a surgeon who also had to be paid. He was referring me to a pain management clinic which also would have cost money. Is this a case of professionals looking after their friends? Healthcare as a business. Healthcare for profit. Are the professionals “wetting their beaks” at each stage of the process? I do not doubt that each person can stand over the decisions that they made. I am sure that the surgery would have helped my back. It may be that at some stage in the future that I may need to get the operation. But was it worth the risk when rest, golf and dancing seem to have sorted me out? At least I had the option to decide not to risk the surgery; however, my experience demonstrates one reason why healthcare is so expensive.
The issues in the healthcare debate are around access, choice, outcomes and cost. There are things that the private system can provide very well but at a price that puts many households under tremendous financial strain and leaves millions of people without coverage. Although national systems are far from perfect and can have long waiting lists, it seems, from a European perspective, crazy not to have a national service option so that everyone has access to the healthcare that they need.


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