‘My collarbone pointed out of my skin’: a Briton and an American talk healthcare

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Whats the difference between the healthcare systems in the United States and Britain, and whats it like to move to America and adapt to a different system?

Amanda Holpuch: Hello Adam, Ill start this off: how long have you lived in the United States?

Adam Gabbatt: Ive been here almost six years now.

Amanda: When was the first time you were confused about American healthcare?

Adam: I suppose the first time was when I went to see a psychologist, who was working from a little office after spending 45 minutes attempting to pour my heart out, she called time then said: OK, thatll be $30. I only take cash.

I hadnt got much money on me and I ended up paying much of it in quarters and bar-soiled dollar bills.

Amanda: Quarters? So you didnt come to a doctors appointment with cash? How did you think you would pay for it?

Adam: Work told me I had insurance! I thought I was completely covered. In fact, Id drawn up a list of ailments I planned to get fixed in America.

Amanda: What wouldve happened if you were in the UK?

Adam: A firm handshake, and Id have been on my way. Id have been referred to a specialist through my doctor, gone to the appointment, used some of their Kleenex, then left. I wouldnt have had to pay a thing.

Amanda: That is weird to me! So, thats routine appointments. Have you ever had a medical emergency in the US?

Adam: Yes. I broke my collarbone pretty badly about three years ago and it was terrible. It was nearly coming out of the skin. It made for a good Instagram but it was very sore. Anyway, yeah, that was made 10 times worse by the saga that followed

Amanda: Im guessing you werent swiftly patched up.

Adam: No! After the accident, a very kind woman at the local clinic, who I think was actually a volunteer, cut me out of my clothes, and they did an x-ray that showed my collarbone was very much broken. But there was no orthopedic surgeon there who could actually do anything about it, so they told me to go home (this was in Pennsylvania; I live in New York a three-hour journey from where Id busted myself up) and call up some specialists once I was there. I was horrified! And in a lot of pain. And immobile. My friend had to take my pants off for me. And you dont want to know about the bathroom.

Amanda: No, no, I dont. Ill stop you there. So you went home, saw a doctor?

Adam: I got home, but obviously I didnt have a regular doctor who deals with broken bones. So I sat at my table and went through about 10 people on ZocDoc a Yelp-like app which shows doctors and specialists in your area. Collarbone pointing up out of my skin like a tentpole the whole time. I think the first six couldnt do that day or the next. Another one seemed weird he looked a bit like Trumps doctor. I finally got one who would see me that afternoon, so I got a cab up and shuffled in to see him.

But then I got confused again.

Amanda: How long after getting injured is this? And why were you confused?

Adam: At this point it was two or three days. Id broken it on a Saturday morning and no one was around at the weekend.

This guy did another x-ray, prodded and poked me, and then listed several options on how he could treat me. Well, we could just leave it, he said. Or you could have surgery. Its up to you.

I was nearly in tears. I said to him: Yeah, but Im not a doctor. Tell me what I should do! He just repeated the options. I hated him.

Amanda: That sounds awful. But it doesnt surprise me at all. Hes worried about a malpractice lawsuit, and he doesnt know your financial situation. One of those options was going to cost more, and you might not have been able to afford it. Every time I go to the doctor, Im prepared to say: Well, how much will this thing to make me feel better cost? So what did you end up doing?

Adam: I got a cab back to my house, and had to get back on the phone. I remember speaking to one doctors office who said I could come in in 10 days. Ten days!

Id been covering the 2012 presidential election and was familiar with the Republican talking point about how people should be able to choose their own doctor, etc, etc. I was thinking: screw that I just need a doctor to tell me exactly what I should do! The last thing I wanted to be doing was sitting in agony trying to select someone, then having to decide how I was going to be treated. And at the same time worrying if the doctor was in my network (many doctors will only accept certain types of insurance. If they dont accept your insurance type, theyll still treat you but it will cost a lot more) and how much everything was going to cost.

In the UK Id have gone to casualty (ER), sat there for a bit, then someone would have seen me, said: Im going to do this to you, then packed me off home. And obviously it would have been free.

Anyway, I eventually got an appointment for the next day with another doctor. Thank God this guy basically told me my injury was a mess, and that I needed surgery.

I couldnt believe how relieved I was.

Amanda: But I understand why the doctor gave you those choices. A natural follow-up comment in the doctors room is: well, how much does that cost?

Adam: Well, since then, people have told me about the fear of malpractice suits. But theyre medical professionals! What about the Hippocratic oath? Arent they obliged to give me the most appropriate treatment? And I am now more aware that I can ask about the cost. At the time, I assumed that was something that was all on me to deal with my insurance company.

Amanda: Do you feel like there is a difference in the quality of care youve received here v what you get in the UK?

Not really. I went to the dentist the other day and they gave me a little bag with some freebies in it. But then they charged me $1,000, so I didnt feel it quite offset the difference (that said, you do have to pay for some dental work in the UK.)

The thing that struck me since the collarbone incident is that I feel much more likely to put off going to the doctor here than at home. I feel like I have to research the cost before I go, which often seems daunting. And Im lucky I have healthcare. People who dont have coverage must be not going to the doctor all the time. And presumably for some serious stuff.

Amanda: One thing Ive learned from you and the other British people I know is that avoiding healthcare because of the cost is a very strange thing to be happening in a wealthy country. I cant remember a time when I didnt think: Oh, you should only go to the doctor when youre very ill, or it wont be fixed by ibuprofen or cough medicine.

Adam: Yeah, that was completely alien to me. I had a sore back the other day, and after some extensive research on Yahoo Answers I learned it could be a serious kidney problem.

My first thought was: well, if it is, Im going straight back home. (It wasnt a kidney problem. Id hurt it cutting some grass.)

But god forbid I got a serious illness. I would be on the first plane back.

Amanda: That would be a good place to end it but I do have one more question! Do you have any sense, as a person who has an employer-based healthcare plan in the US, what the Senate plan could do to your healthcare?

Adam: To be honest, no. Ive focused on the bits everyone seems to be talking about the people who would lose their healthcare, the potential for people with pre-existing conditions having to pay more. As someone who is lucky enough to have a job I guess Im going to be OK. But thats the whole point, isnt it? Its the less fortunate who are going to suffer.

Read more: https://www.theguardian.com/us-news/2017/jun/24/united-states-healthcare-britain-insurance-confusing

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