Wednesday, September 29, 2010

Health, wealth & happiness

Little Teadrinker has had an ear infection this week initiating us into the wonders of US health care. Having taken our lead from, we chose a recommended pediatrician down the road who works from a primary care clinic. The clinic is open 7 days a week and has specialists from 35 fields, all available at short notice. An impressive array of educational toys and a tropical fish-tank kept us entertained in the waiting room, although within 5 minutes we were whisked away by a nurse in Mini Mouse scrubs for a temperature check and a weigh-in.  Next it was straight to Dr Kim for an unrushed and comprehensive examination.  After writing a prescription for antibiotics she typed up a detailed note containing a number of practical tips for managing the pain until the antibiotics kicked in. We were asked to come back in ten days for a follow up,  and booked in for comprehensive 9-month and 12-month check-ups.
It seems that for those able to access it, US healthcare provides a top-rate service. Contrasted with the sort of treatment we have been used to on the NHS, it is nothing less than luxurious. Obama’s Health Reform Bill, much of which came into force last week, promises millions of less well off American families access to such services for the first time.  
Stunning as it might seem to a Teadrinking Mom from the old country, the Bill is proving one of the most divisive in years. The latest polls show that over half of the country are opposed.  A majority believe that it will benefit the poor exclusively, and that they’ll pay the price in taxes. Two thirds don’t think it will benefit them at all.  Most shockingly, 1in 3 elderly people still claim to be influenced by the ludicrous socialist death panel accusations which were put about by some of the rightwing press and members of the Tea Party last year.  The Republicans say that if they do well enough in the November Mid-term elections they will repeal the Act.
Its tempting to put this down to a political culture that is instinctively more individualist and hostile to the state than we are used to in Europe, where the ethos of collective responsibility is generally an accepted wisdom. (See Seymour Lipset’s 1996 book on American Exceptionalism for a brilliant explanation of the roots of these values). Wasn’t Obama always going to struggle, as Bill Clinton did before him, with a Bill that prioritised state regulation as a means for helping the poor?
There must be more to it than this though.  After all, America voted for Obama only two years ago and healthcare reform was one of his stated priorities.  The proposed reforms are small fry compared to welfarist policies successfully sold to the American electorate in the past such as the introduction of social security. 
What’s more, the Democrats have made a good crack of ensuring that the reforms benefit the many and not just the few.  Their analysis shows that the estimated $940 billion outlay will be more than recovered over 10 years through a package of measures in the bill, although some contest their figures.  And there will be a serious clamp down on the most ruthless practices of insurance companies that anybody can fall prey to. No longer will US parents have to endure sleepless nights because they can’t get cover for a daughter with a minor long-term health issue, or can’t foot the bill for a chronically ill son who’s been dropped by an insurer who deems them too costly.  
A quick Campusville dinner party poll reveals a good deal of consensus about what’s really going on: the Democrats are failing to get their message across to “the squeezed middle”.  A plethora of books have come out on the subject in the last couple of months penned by US politico-celebrities such as Arianna HuffingtonRobert Reich and Joan Williams The thinking is that majority in the middle of the income distribution, and most particularly the white lower-middle/working class, have seen their lifestyles and opportunities decline over the last 30 years and are now being pushed to the limit by the economic crisis.  They are in no mood for listening to reasoned arguments by mainstream politicians, least of all Democrats. 
A little more scrutiny is needed before we accept this theory.  Nonetheless, it is unusual for Americans to make a class analysis - more often they seem to think of class as a quaint British habit, that has no meaning the Land of the Free.  The fact that they are arguing now that a significant class fault-line has emerged seems worth focusing on. If they are right, the Health Reform Bill won’t be the last we see of it.  One for Teadrinking Mom to return to...


  1. Hi TDM, thanks for the interesting post. You didn't mention what you had to pay for the excellent service you got from the doctor there!

  2. fantastic article! i agree the healthcare there is wonderful if you can get it. I went into a doc's office there once and said just give me some antibiotics and the doc was so shocked! he was like, let me at least give you a medical once over as this appointment will cost you 80 bucks. I said, oh. ok thanks.

  3. Hi Hadj, that's a good question. We pay just short of $100 per month for health insurance for LTD and myself. It covers 80% of the cost (or 100% after the first $5000). Waiting for the bill to find out how much our 20% will be...

    I've been digging around though and the average premium for family coverage in 2007 is around $12,000. Those lucky enough to be in jobs with coverage tend to get over 3/4 of the bill paid by their employer, leaving them paying something near $3,300 directly.

    Most shockingly though the major polling agency says that since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent.

  4. Hi Tashy, Glad you liked it :-) Yup, I was slightly tempted to make the blog post about profit incentives and over-medicalisation (did they really need to weigh LTD? Is a follow-up necessary?...). But tried not to be churlish!

  5. It certainly is different here, that's for sure. But as a 14 year veteran of the US system, I much prefer it US-style. I also have to say that we can afford it. With preemie babies and some very challenging medical conditions over the years, we've received world class medical care the like of which I wouldn't have expected to receive at home in the UK. There are certainly downsides - being shoved prescriptions in your faces every visit and many many visits when they are young and more but overall, if you can pay for it, it's good. We'll see how it evolves.

  6. Your comment raises what I think is one of the most difficult things to get used to about the US health system. You really have no idea what you are signed up to. What is covered by insurance or not seems fairly random, and whether medication is covered, or what percentage of it is, is hard to predict. I suppose this is in the nature of insurance, but it's hard to live with, when your health is in question, and the sums of money involved are potentially large. It took me a long time to work out that when a health professional says "it'll be covered by your insurance", you still end up with a bill - and it can be a big one.

    We are covered through my husband's job, but this year, he was told that his contribution has gone up by 20%. What he couldn't understand was the way all his colleagues just accepted that without question, whereas if it was announced that taxes were going up by 20% out of the blue, there'd be an outcry. Everyone seems to accept that insurance is expensive, that the insurance companies have the right to make changes as they go along, without notice or consultation, and that the patient bears the cost.

    Great post.

    By the way, they weigh everyone at the beginning of a medical appointment, every time. I don't know if it's to do with working out drug dosages, or whether it just gives the nurse something to do, but it's standard. Weight and height, and blood pressure if you're an adult. And well done for not starting out churlish - that won't give you any place to go!

  7. Nice post Tea drinkin' lady! - really interesting.
    We've been asked twice if we want the doctor or the nurse to administer the immunisations. When we asked what difference it makes (such naive europeans!) they said 'the cost'. Lucky for us it didn't matter as we're covered by German insurance and don't have to deal with invoices at all.
    They also asked us if we wanted to weigh our baby ourselves or a nurse do it, for the same reason.
    At least they asked and didn't just go ahead and do it and then slap us with the bigger bill (had we been insured differently).
    Our doctor is less prescription trigger happy too, which is also a bonus.

    Keep up the good work!

  8. Thanks for the comments Alison, Iota and Becky. This is clearly a subject that gets all of us Brit mums in the US going! Seems like the over-prescribinb/medicalising might be an issue to follow up on. Also, you make a fascinating point Iota about people's general willingness to be dictated to by the Insurance companies, in a way they'd never accept from the state when it comes to taxes. It'll be interesting to see whether Obama's bill of patient rights makes a difference to people's expectations here.