Wednesday, September 09, 2009

Your money for your life

Much debate is to be heard especially over on the left bank of the Pond regarding President Obama's proposed reforms to the financing of healthcare. I shall try to put aside Michael Moore’s Sicko, in which he sought to portray the British National Health Service as a charity and its French equivalent as the same but more so, and the American system as being populated solely by money grabbers who would rather see people die than pay medical insurance claims.

First, I’d like to establish that medical practitioners, including doctors, surgeons, nurses, anaesthetists and pharmacologists do a lot of college, carry out hugely difficult and responsible jobs, and deserve to be remunerated appropriately. There is no justification for paying a doctor a pittance. British general practitioners seem to do all right under the NHS system. ‘The average family doctor earning over £100,000...’ does not seem to me to be a pittance. Yet this is what we’re told is the inevitable consequence of social medicine.

Any attempt to finance healthcare within the taxation system must, we are informed, surely produce under-resourced, third-rate medical care that has barely progressed beyond leeches and amputations without anaesthesia. Witness Fox and Fiends trotting out cases where MediCare failed, and we're to infer that if the poor unfortunate had only paid for his treatment, things would have turned out better. That the individual is poor and can't afford to pay isn't discussed. Neither are cases where top-quality hospitals screwed up.

The only way to ensure a decent level of healthcare, we’re advised, is to pay for it at its point of delivery. Actually, it’s paid for up front as medical insurance, with the insurance company ultimately footing the bill.

The problem as I see it with medical insurance is that the insurance company is a commercial enterprise. And like all commercial enterprises it exists ultimately to make money. Frankly, that company which promises you a first-rate healthcare plan has absolutely no interest in any individual’s fate. Provided that on average the premiums received exceed the claims paid, the insurance company and its shareholders are happy. The year the shareholders don’t get their payouts is the year everybody’s premiums go up.

And to this end, the insurance provider gets to set a few rules, such as:

    “We won't insure you if you have any of this long list of pre-existing conditions”

    “The Insured is not covered for any pre-existing condition that he didn't declare”

    “The Insured is not covered for kidney dialysis because he didn't tell us he had his tonsils out 30 years ago”

    “The Insured has to pay the first $2000 per year”

    “The Insured has to pay 20% of each and every claim”

    “The Insured is not covered for the consequences of HIV/AIDS howsoever caused”

    “The Insured is too fat/has diabetes/suffers from spina bifida/is haemophiliac and is therefore not covered”

So what do you do if you have some medical condition that is treatable but expensive? Go broke or die.

I did a little on-line research. I was offered medical insurance in Virginia at rates ranging from $170 to $294 per month, with various conditions and copayments. As these are the advertised rates gleaned off the Interwebs, I suspect that the actual amount spent by Muggins would creep up.

Compare these rates with the British National Health Service, whose current annual budget is around £90 billion. That means a monthly cost of around £200 ($320) per taxpayer, or £125 ($200) per person living in the UK. And this compares I think rather favourably with the above American insurance quotes. Particularly when you consider that there’s no pre-existing condition exclusion, no copayment, no consultation fees and no annual deductible. And it includes dental and (if you live in Scotland or Wales) prescription medication.

The NHS is not answerable to any shareholders. All the income can be directed at healthcare, without an annual rake-off given to people who are essentially profiting from the victims of illness or injury.

I guess the concern and alarm being expressed in the States is based on the difference between every individual paying the same number of dollars for medical insurance, versus taxation-based funding where the rich pay more and the poor pay less.

Where the NHS system goes wrong is when a particular specialist works part time for the NHS and in his private practice the rest of the time. My uncle was incensed to learn that he’d have to wait for over six months for his new titanium knee, yet if he were to go private – that is, to pay many thousands of pounds in cash immediately, that same consultant would carry out the same procedure in the same hospital within the week. The waiting list for NHS treatment was being caused in part by the consultant busily using the facilities for private jobs.

I think a doctor should either work in a private practice, funded by client payment or insurance, or the doctor should be salaried and work exclusively for the NHS.

That said, I have never personally experienced any delay in medical treatment. Perhaps I've just been lucky.

A final thought. My medical cover is a company insurance scheme and is fairly comprehensive with only a Dh50 deductible per visit. What I object to isn't paying the Dh50. Neither is it having the premium paid whether or not I make a claim. I object having to argue with the clinic, and potentially with the insurance company, about whether or not my condition is covered. Surely how poorly I am and what constitutes appropriate treatment is best decided by a doctor, not an accountant. If I’m ill, I just want to get better, not argue the toss from my sick bed.



Anonymous said...

Grumpy, this was very informative and show a pretty good understnding of our situation in the U.S. However, the quoes you received are a little low. Our insurance is partly paid by the provider, yet still costs us beteew 6K-7K annually for two. It is true that we have good coverage and people who are younger/healhierould get cheaper plan. But many in the U.S. "independent conractors" pay much higher premiums that do we. tmil ps..forgot how I was todo the idntity thingy.

Anonymous said...

Personally I don't have a problem with a doctor working for the NHS part time and privately part time, but I don't think the private work should go on in the UK NHS hospital, that should be carried out in a private hospital. Where I live we have some excellant NHS hospitals and we also have one that is part of a chain of private hospitals. The surgeon that operated on me did so in the private hospital, but he also works for the NHS and those operations he carries out in an NHS hospital. Thus the private work did not stop other NHS surgeons from using the NHS facilities. It may be that the ability to work in this split way between NHS and private is what is keeping some surgeons working in the NHS and not going completely over to private work and being lost to the NHS.


The opinions expressed in this weblog are the works of the Grumpy Goat, and are not necessarily the opinions shared by any person or organisation who may be referenced. Come to that, the opinions may not even be those of the Grumpy Goat, who could just be playing Devil's Advocate. Some posts may be of parody or satyrical [sic] nature. Nothing herein should be taken too seriously. The Grumpy Goat would prefer that offensive language or opinions not be posted in the comments. Offensive comments may be subject to deletion at the Grumpy Goat's sole discretion. The Grumpy Goat is not responsible for the content of other blogs or websites that are linked from this weblog. No goats were harmed in the making of this blog. Any resemblance to individuals or organisations mentioned herein and those that actually exist may or may not be intentional. May contain nuts.