It seems Steve Silberman was in England and got sick. His experience – far from the Kafkaesque horror show described by American conservatives – was incredibly positive and incredibly cheap. It’s worth reading his whole account, but several passages in particular struck me powerfully.
The calm, tidy waiting room presented a vivid contrast to the huge Kaiser complex on Geary Street back home, where frail seniors shuffle from waiting area to waiting area, taking numbers from machines and clutching their all-important forms to deposit in seemingly unattended baskets, before they’re herded to an examination room to wait 20 minutes for their harried physician to make a brief appearance. Though most of the Kaiser staff I’ve dealt with have been pleasant and good at their jobs, they often seem beleaguered and exhausted by the sheer workload.
The subtext of nearly every interaction with a health-care provider in the U.S. is: You’re lucky to have this coverage. Don’t push it. There are thousands of patients waiting behind you who are in even worse condition than you are. Let’s get through this as quickly as possible so the whole bloody machine doesn’t come grinding to a halt.
I’m aware that my little adventure in socialized medicine is no more than a trivial anecdote — one tourist’s experience with a minor affliction that was easily dealt with. I expect that many Londoners could furnish horror stories about their ordeals in the NHS. One renowned health-care expert who grew up in England recently explained the difference between British and American medicine to me by saying that if he was very rich and had cancer, he would rather live in the U.S. But if he was poor and had cancer, he’d rather live in the U.K. and be guaranteed at least B-minus care.
That’s the sort of nuance that gets lost when the framing of public debate on health care is socialized medicine versus free-market capitalism, the feds vs. private insurers, or the GOP vs. “Obamacare” — and when we allow the tone of that crucial national debate to be set by ill-informed voters yelling Fox News talking points in staged riots at townhall meetings.
Or imagine a society committed to providing access to health and wellbeing for everyone, rich and poor, rather than playing childish semantic games about “death panels” and “socialism.” The cost of calls to my insurance company to get permission to see an NHS doctor who didn’t charge me a penny will be six times what I paid for the medicine that cured my infection.
I find myself despairing at the depressingly low level of public debate in the US. There are valid criticisms of any proposed reform of health care but hysterical cries of socialism and death panels and killing granny had no attempt at making valid criticisms and were intended to do one thing – block any rational discussion. And succeeded in doing so – terrifying both sides in the debate, transfixing the morons in the media and scuttling any attempt to engage in rational discussion.
The second insight Silberman provides is an insight into mindset. In the US, health care is brutally rationed but done so in hidden ways. Everything in our system operates from position of scarcity, an assumption that creating universal health care access would bankrupt the system, destroy its ability to deliver care and leave us worse off. Fears about individual loss of control over health care are inflated because most of us don’t recognize the ways in which we actually have no control over our health care. Because the fear that we might be denied health care is realistic, many Americans are terrified that any changes will hurt them – most of our experiences have to do with decreasing benefits so we have experienced what happens when health insurance changes. That these changes have been delivered almost exclusively by private companies and the operation of “free market” is glossed over. The result is an experience scarcity. Even people with insurance know they can be denied coverage and that having treatment paid for by their insurance company can often require a long and bloody fight.
It’s also noteworthy that in no nation with universal health care have voters been willing to give it up. Even the much maligned British NHS is so much a part of life that even conservatives campaign on making it better not getting rid of it.
Our degraded, coarsened public debate hurt all of us. We could have a better system and instead we ended up with a marginal reform that tinkered around the edges. It was political malpractice all around.