The Highs And Lows Of National Health Care

From Those With International Perspectives

By Nancy K. Crevier

“The true measure of a society is in how it cares for its weakest members,” said Georgia Monaghan Wagner, who with her husband Darren Wagner, and two children moved to Newtown just over a year ago from Australia. “Health care should be a right.”

“Health care in France is a medical right,” echoed Bernadette Rutte, who grew up in France and lived with her husband, James, and family in England, Scotland, and Luxembourg until 1983. “In Europe, people are not afraid to get sick,” she said.

“Health care is social security [in other advanced countries],” stressed Mr Rutte, an employee of American Bank until his retirement. “It is medical care with a social conscience and a right of every citizen,” he said.

Nationalized health care is one solution to the looming issue of health care reform in the United States, said many who have experienced health care both here and abroad. Canada, Great Britain, Germany, France, Australia, and Japan are among the countries that provide basic health care to all citizens, believing it is a right rather than the privilege it is the United States.

According to the 2007 US Census, 46 million Americans under the age of 65 do not have health insurance. The Agency for Healthcare Research and Quality, a US Department of Health and Human Services division, estimated that number to be 54 million, with a potential of 57 to 60 million being uninsured by the year 2010 due to the recession. The majority of the uninsured are native or natural born Americans, with eight in ten coming from working families.

Premiums for health insurance have leaped 119 percent for employers and 117 percent for employees since 1999, according to the National Coalition on Health Care, a nonprofit, nonpartisan alliance.

The mission of House Resolution 3200, “America’s Affordable Health Choices Act of 2009,” is “to provide affordable, quality health care for all Americans and reduce growth in health care spending, and for other purposes.” It is a daunting task. But as Darren Wagner pointed out, “Congress does not have to reinvent the wheel. There are a lot of models out there. Find out what doesn’t work, and what does work in other countries.”

President Barack Obama has recommended mandated health insurance for all, a government-run public health care option, and the end of insurance company abuses, to make health coverage affordable to all Americans. The suggestion of a national health care insurance program is opposed by some who say that the government would be an unfair competitor, driving private insurers from the market.

There is also the underlying fear for some that a universal health care plan is a stepping stone to Socialism.

“Australia is a democracy,” pointed out Georgia Monaghan Wagner, as are Germany, Canada, France, and Norway, all of which provide health care through national programs. “To me, Socialism is the government taking over commercial productions, not health care. I think most other developed countries are a mixed government now of socialism and democracy,” she said.

A Sometimes Rocky Road

A national health care plan is not without its problems, though, cautions Newtown resident Sherri Davis, a native of Canada who has been in the United States for 22 years. “The Canada Health Act mandates medically necessary care, with each province responsible for operating its own system, within the national guidelines,” she said. The road to quality care in Canada can be a rocky one, she said.

Nonurgent care may mean a wait of several days to get an appointment, and the doctor’s office determines the urgency of the situation. “The problem is the wait for the appointment, then the wait for the tests if the doctor needs tests done, and then the wait for the written report to be sent to the doctor,” Ms Davis said. The patient must then make yet another appointment to hear the results of any tests, and if a specialist is required, an appointment can only be made by the primary doctor and involves yet another wait. “It starts all over again if the specialist wants testing done,” she said. “This is where you see people representing poor quality of care. They are not getting the care they need while they are waiting for all of that testing,” said Ms Davis. “You have no control, like here, if you want to see a specialist. Canadian emergency rooms are overwhelmed because of the people trying to get care more quickly than they can through the primary doctor, and it is hard to get doctors for rural areas,” she said. Diagnostic machinery is at a premium, meaning that patients may wait up to a year for services, such as an MRI, that Americans take for granted.

What she wonders, is what will be in place to accommodate the sudden influx of previously uncovered Americans should a national health care plan be put in place. “Will there be waits? Will there be enough doctors, hospitals, and equipment?” she asked.

“Because we are fortunate enough to have health insurance, hands down I would choose the American health care system,” Ms Davis said. “Perhaps the US could use the Canadian model to see what is not working.”

Brian Amey, Newtown Main Street branch manager for Newtown Savings Bank, lived in England until 1995 and still has many friends and relatives there, subjected to the lack of management and funding of the National Health Service. “We hear horrific problems with long waiting lists for those with nonemergency issues,” he said, some of those waits being one to two years long.

How good or bad care is depends on the health district in England, said Mr Amey, with large inner city hospitals prone to errors, long waits, and poor efficiency. From the point of quality care, he feels the American service is probably the best.

Mark and Fran Ashbolt both grew up in the south of England and moved to America in 1997. While they agree with Mr Amey that waits can be problematic for nonurgent issues, their experiences and those of family still living in England were positive, said the Ashbolts, and the government is addressing the issue of long waits. “They do know it has been a problem,” said Ms Ashbolt, who worked for the geriatric department of the National Health Service for several years.

According to statistics of each district in England, said Mr Ashbolt, just 1.3867 percent of patients are waiting for the first outpatient appointment following a primary care physician’s referral, and only .0005 percent are waiting more than 17 weeks.

Along with health care being provided from cradle to grave — and even before birth through a maternity support care program — the Ashbolts praised the NHS for quality primary care, house calls, little to no paperwork, no out of pocket expenses, and a system that frees UK citizens from worry about paying for good health care.

“No one goes bankrupt over medical bills in the UK,” said Mr Ashbolt, “and people are not so likely to ever sue a doctor. Nor have I ever heard of anyone dying while they waited for care.”

They do believe that many of the issues with the National Health Service are direct results of underfunding by the government. “The areas are funded by government trusts and through charitable fundraising,” Mr Ashbolt said, so that may mean that not all of them have top medications available, and it might mean a wait of weeks for an MRI or CAT scan. Centralized, megahospitals have replaced small, regional hospitals, and the Ashbolts feel that this means inconveniences for those not living near the larger hospitals.

“We were fortunate when we came over to America to have a very good health plan through Mark’s work,” said Ms Ashbolt, “and at the time were paying very little out of pocket. But Mark’s company has turned over three times and each time we have had to pay more for our premiums and co-pays.” The costs above what insurance covers always come as a surprise, they said. A good insurance policy was part of what enticed the family to make the move to the US, said Mr Ashbolt, and if he were to lose his job and insurance here, he would have to consider moving back to England. “There is no way we could pay for the insurance here ourselves,” he said. He believes it is not really the cost of health care that is expensive, it is the cost of health insurance. “The insurance companies are businesses, and are there to make money,” he pointed out.

He would “absolutely” choose social medicine over the American plan. “It’s a shame that people make a link between socialized medicine and Communism and ‘Reds under the beds.’ If you asked anyone in the situation of not having health insurance here, I’m pretty sure they would want free care,” said Mr Ashbolt. “There needs to be a change here,” he said. “There are almost as many people uninsured in the US than there are living in the UK. It seems morally unjust.”

Peter and Linda Lubinsky have lived overseas in France, Japan, and England, and have used doctors in those countries and others when traveling. Both of their children were born in Japan. For the simple needs that they had, they found health care easy and quick. “Exams were thorough,” said Ms Lubinsky, “the doctors asked good questions, medicines were explained, and I never felt rushed.” She was particularly impressed when another expatriate’s child was staying with them and needed medical care on a Sunday night. “Not only did the doctor and I talk, but he came to our house to examine this boy and gave us additional medicine for him. While I don’t remember the exact amount of the bill, I remember that it was very reasonable,” she recalled. The boy was not a regular patient of that doctor.

Good If You’ve Got It

What all of those interviewed for this article did agree on, was that the American health care system is good — for those who have it. While Bernadette Rutte was covered under her employer’s plan, her care was top notch, she said. But when a medical disability required that she retire and she was not yet eligible for Medicare, medical bills started to become an issue.

If not for Kevin’s Community Center in Newtown, when her medical insurance was cut off she would not have been able to afford care. It was then that she especially missed the care she had experienced as a citizen of European countries. “We go back often enough that we are current on what is going on in the health care industry in Europe,” she said. “You have excellent care everywhere. A family will have medical care if a hardship happens. You never have that acute stress that people have here,” she said.

Though he sees problems with the UK’s NHS, Mr Amey, too, puzzled over the high cost of insurance in America. “There should be a plan developed similar to the Medicare/top-up concept for all those who don’t get employer-based coverage or who are unemployed,” suggested Mr Amey. “It could be that every employed citizen would be required to make a national health contribution, but very small, on a sliding scale. I believe the cost of health care needs to be reviewed and controlled….by an independent body… who works for the consumer, acting as cost and standards controller with enough clout to be effective. Am I asking too much?” he wondered.

The cost of health care in European countries and Canada is covered primarily through individual taxes that range from a 1.5 percent medicare levy on income in Australia to a much higher percentage paid by employees and employers to the National Health System in the UK, and to the Canadian health system. “In England we probably pay 11 percent on earnings up to what would be $60,000 American,” said Mr Ashbolt, “and then it is different for those earning more or less.” The purchase of private insurance can raise the cost that Europeans and Canadians pay for “free” health care.

People in the US do not understand that while health care is available for all, it is not entirely free in Canada, Ms Davis said. “It is paid for through a higher rate of income tax, and some provinces may charge additional fees for the insurance card.” Once doctors are seen, however, the upside is that the quality of care is on equal footing with any received in the United States, and there is no cost.

As adults living in Canada, the Davis family purchased additional private insurance through their employer. It allowed for upgrades such as a semiprivate room should hospitalization have been necessary and coverage for prescriptions not covered by the basic health care plan. However, the additional premium does not mean expedited care for those who choose to buy it.

“Care is equitable in Canada between those who are poor and those who are rich,” Ms Davis said.

It would be worth the risk of having somewhat reduced benefits in America, said the Ashbolts and the Wagners, to know that everyone had access to health care through the implementation of some kind of national plan.

“I don’t see national health care as being bad,” said Mr Wagner. “I would never put my family in a substandard situation. We always had quality care in Australia.”

“I would rather pay five percent to the government than 25 percent of our income to a private health insurer that we have to struggle with all the time. No one has a problem that education is a public option, and health care, I think, is a much more basic need than education,” Ms Monaghan Wagner added.

It is important for people to be aware of what is available to the aged and uninsured wherever they live, said Ms Rutte. “You have to educate yourself,” she said.

“I think we have as many complaints or more in this country as you hear about in Europe,” Mr Rutte said. “If medical care was accessible for all here, there would be prevention. Prevention means less cost, and saved lives. Reforms,” he said, “are needed now.”