Why 'Free' Health Care Costs So Much

With the debate about Health Care being quietly shoved onto the back burner over here in America, it's ironic that the failure of so-called 'free' health care in Britain has never been more apparent.

The latest? An article in the venerable Hampshire Chronicle linking the outrageous waiting lists for doctor's appointments with the thousands of 'no shows' at the doctor's office.

MORE patients are failing to turn up for hospital appointments in Winchester, costing the NHS hundreds of thousands of pounds. New figures show that in 2008-09 an estimated 22,000 appointments were missed. Full story here.

As much as I've come to question the privately-funded health care system in America, this is one example of how the right-wing critics of 'socialized medicine' actually make a legitimate point about how 'free' health care is excessively expensive and wasteful.

Case in point? How thousands of people are making doctor's appointments, but never showing up for them. That's why it's so difficult for legitimate patients to get an appointment in a realistic time frame. I remember going to the doctor back in England and having to make an appointment a week, or even two weeks, in advance. In America, they can generally see you the same day.

The difference is, of course, that in America you have to pay for your doctor's appointment. Generally, it costs you about $20 'out of pocket' and your insurance company pick up the rest.

However - and here's the good bit - if you make an appointment and fail to show up, your insurance company still gets billed for it. You booked an hour of the doctor's time and he charges you for it whether you're there or not. However, if you're a 'no show' the insurance company turns its nose up at being expected to cover the cost of your missed appointment and charges you the full whack.

Anywhere from $50 to $250 dollars, payable within 30 days.

As you can imagine, it's an incredibly effective incentive not to miss a doctor's appointment - or, if you do, at least cancel 24 hours in advance.

This is the problem in Britain. Because the doctor's appointments are 'free' there's no value attached to them, so people blithely skip showing up. Then those same idiots complain that there's such a long waiting list.

If you made every NHS patient pay a tenner for a doctor's appointment, I can guarantee that people would think more seriously about whether they really need to see a GP or not. And if you charged them £100 if they missed an appointment they'd made, I bet you'd find attendance improving dramatically.

So instantly; a new revenue stream for the cash-strapped NHS, dramatically shorter waiting lists and probably fewer patients to see overall (only the ones with something actually wrong with them would pay the £10 to go and see a doctor.)

Gordon Brown? David Cameron? If either of you want to adopt this proposal, feel free. If the American health care system has taught me anything, it's that you get what you pay for. In the case of the NHS, that's unfortunately nothing.

Ask Militant Ginger

It's that time again! When I trawl through the 'keyword analysis' to answer the questions that somehow drove search engines into recommending this blog:

Why are so many Americans against the NHS?

Lies, damn lies and statistics. Depending on who you go to, you'll find that the majority of Americans want to keep the health care system exactly as it is, or adopt a single-payer system like they have in most industrialized countries. In February, polls put that figure as high as 59%.

Recently, the National Health Service of Great Britain has received a lot of flak, being held up by conservatives as an example of how 'terrible' a single-payer system would be if it was implemented here in the United States. Admittedly, there are some horror stories about the NHS, many of which I've perpetuated right here on Militant Ginger!

But conservatives neatly side-step the fact that the British health care system is ranked considerably higher than Americas - and the UK has a lower infant mortality rate and higher life expectancy. While American health care at it's best is undoubtedly superior to that of Britain - at it's most mediocre, it's arguably worse.

Sadly, there will always be a compromise between quality of care and breadth of coverage. In many ways, the NHS and the American system are the two most polarized examples of each philosophy - and many Americans will rail against 'nationalized health care' simply because of that reason.

How does the American private health care system work?

Very, very confusingly.

In America, health care is 'private.' That means, unlike in the UK, the government don't own and operate hospitals, ambulances, doctor's offices or laboratories. They're all independent businesses out there to make a profit.

When you visit a doctor, or get a test done, you get billed for it personally. As these medical bills can add up incredibly quickly, most people buy 'health insurance' to pick up some or all of the costs. For example, health insurance will generally cover as much as 90% of the cost of an operation, with the private individual paying the 10% difference.

The problem is that health insurance itself is quite expensive, since the bills are so high. It can easily cost $300 or $400 a month to cover a small family. Therefore, employers often offset the salary they give their employees by offering health care coverage instead. They can get group discounts for using the same company to insure all of their employees - and that means the individual gets a keener rate.

Companies cover either the entire cost of health insurance, or a portion of it.

If you're self-employed you can buy your own health insurance, although you have to pick up the entire cost, instead of a company covering all or part of it. Also, because you don't get the 'group discount' you tend to pay a higher rate.

Finally, health insurance is like car insurance - it costs more or less depending on your coverage. For example, you can get cheap insurance that only covers emergencies, or more expensive coverage that covers the bulk of medical costs. Likewise, you can adjust the percentage of the medical bills you're expected to cover 'out-of-pocket' with higher or lower premiums.

The problem with this system is that health care costs are continuing to rise. In the last decade, health insurance premiums have doubled. That means more and more of a percentage of people's salaries are going towards covering their families.

Even worse, more and more coverage is being dropped by the health insurance companies to keep their costs down. This means the consumer is paying more and getting less - and it's a generally accepted fact that there's not enough competition between health insurance companies to keep prices keen.

It's a system that has both major advantages and serious flaws. The problem with 90% of the people who argue about how to improve the current setup, however, is that they're not fully cognizant of both.

What is a derogatory term for a life-long politician?

A 'Democrat'*.

America's longest standing Senator - and former Ku Klux Klan member - Robert Byrd

*Nod to Tom - Editorial Bear

How do you start writing erotica for money?

Let me get one thing straight- nobody got rich writing erotica.

The opportunities for making money writing sauce, smut, erotica and pornography are increasingly elusive, as more and more people attempt to get in on the act. There's a misunderstanding going on that writing erotica is somehow easier than writing anything else. That's really far from being true.

I have made my fair share of money writing smut - but it quickly lost it's novelty value. The pay is low, the competition is high and it's a fairly thankless task.

But the opportunities are out there. A good place to start is with Hustler Fantasies, who publish about twelve or fourteen stories every month (and pay $25 for each one.) You can find out more here.

Alternatively, you can aim for a higher-brow audience, by submitting something to the queen of Erotic fiction, Alison Tyler, or a high-class magazine like Jacques. Just be aware that they have excruciatingly high standards and you'll either be expected to submit your first few works for free, or share royalties with dozens of other writers.

If I haven't talked you out of it, though, I still recommend writing commercial erotica simply to become a better writer. Why? Because it's surprisingly good training for 'real' writing.

1. Magazines like Hustler have a specific style - and getting a story accepted involves developing incredibly self-discipline to keep within the expected guidelines.
2. Erotic teaches a writer brevity. Exposition isn't foreplay. Word limits can be brutal. Keeping your writing focused, curt and efficient is an excellent habit to get into.
3. Most readers are looking for a specific genre - sometimes a specific sex-act - so writers need to learn to cater to their audience. This is the single most important lesson a writer can learn.

It's also excellent training for the simple habits of writing commercially - letters to editors, keeping track of submissions. If you take up writing erotic for money, I can promise you two things. Firstly, if you sell even one story, you will have become a better writer. Secondly, by the time you've sold that story, you'll probably have grown utterly, utterly jaded about how 'easy' and 'fun' writing erotica really is!

Why do women die their hair red?

Because unlike in the UK, where red hair is seen almost as birth defect, most civilized countries consider red hair to be attractive and distinctive, especially on a woman.

In France especially, many women dye their hair red (or some close approximation thereof) and 'the redhead' is a staple of film noir and hard-boiled fiction over in America. A redheaded woman, like the one Bruce Springsteen wailed about, is seen as passionate, sexy, emotional and just a little bit dangerous.

The only problem? You really can't fake it. Because red hair is normally accompanied by pale skin and beautiful green or blue eyes, most women who attempt to mimic a natural Titian end up failing. It can look pretty, but it never looks natural.

And, as I've found out by going both black and blond, that is true the other way around, too!

(This beautiful redhead is Kristen Carter, whose profile on Model Mayhem can be found here.)

What’s the connection between Erica Henderson and Pete Abrams?

Pete Abrams is the incredible brain behind Sluggy Freelance, my favorite webcomic and my first port-of-call when I do the Internet rounds each morning.

Erica Henderson is the sublimely talented cartoonist, artist and all-round everything from I Fail At Life, who I just think is the Bee's Knees.

For a short time, Erica stood in as 'Saturday girl' for Pete's webcomic - allowing him to take a day off from Sluggy to concentrate on his family.

The result was some wonderful artwork that took the wonderful creations of Pete's comic and put Erica's unique spin on them.

Sadly, she's not doing the Saturday art any more - but those filler strips certainly stand out as some of my favorite of all time.

Redux: NHS vs. American Health Care

A reader pointed out that my post yesterday was very, very long - which is fine, apart from when you painstakingly dissect facts and figures and suffix it all with a statement like 'but that's all irrelevant to the matter at hand.' So, because Shakespeare said that 'brevity is the soul of wit' here is the same column with the fluff removed:

72% of NHS patients complain that the stethoscope is too cold

Comparing the British NHS to American Health Care
Now with 50% less superfluous exposition!

Comparing the NHS and the current health care system in the United States isn't really fair or helpful.

On the one hand, the American system can be criticized for being monstrously expensive and not covering enough of its citizens. Per capita, it costs twice as much to offer health care to the population of the United States - yet Fox News reports that 13.4% of Americans are still left without coverage.

The United Kingdom, on the other hand, has universal coverage, a lower rate of infant mortality and a longer average life expectancy. The cost of giving medical coverage to Britain's citizens is also several thousand dollars less per person than in America.

But while Britain's health care is cheaper and covers the whole population, many people argue that this is only possible thanks to the indirect benefits of America's privately funded system.

It's a fact that many of the worlds leading pharmaceutical companies are based in the United States - and most of the new and exciting drugs and treatments emerge from the American health care system. The US system absorbs the related costs of researching and developing these new treatments (perhaps explaining why their health care costs so much more.)

And without having to pay for 'inventing' them, British patients benefit from these new drugs and treatments - just not immediately. Most commonly prescribed medication is as much as a decade 'behind' the new and exciting drugs available in America.

But at least British patients don't have to pay for that development - and that cuts a huge chunk out of the related costs of running a universal health care system.

Perhaps that's not a fair analysis - but it does offer an explanation for the gross disparity between the costs of universal health care in Britain and America's privately funded system.

America's race to develop new treatments also explains why some areas of medicine - like the treatment of cancer - are notably 'better' in America than in the UK.

Some British people have to come to America to get the medical treatment that's simply not available to them at home. Meanwhile, drugs developed in America make a huge impact when they're eventually adopted by the NHS.

So it's fair to argue that the two systems are inextricably linked - and the discussion about changing the way America looks after the health of her 300 million citizens actually affects far more people than just those with a US passport.

How much does 'Private' medical care cost the taxpayer?

The Economist blew me out of the water today with their analysis of the American Health Care system. In acknowledging it's strong points (like excellent cancer recovery rates) it exposed something I think most Republicans would find surprising.

Compared to other countries - including countries with entirely 'socialized' medicine like Great Britain - the American tax-payer pays just as much to treat people (and sometimes more.)

The American tax payer is already funding a public-medical system that exceeds the British NHS

For example, the average health care costs of an American individual are $7,000 dollars per year. Of that, private health insurance and out-of-pocket expenses cover just $4,000 of it. The rest is picked up by the tax-payer.

Compare that to Great Britain, where our (admittedly inferior) health care system spends just $3,000 a year on each individual (with people picking up about $500 out-of-pocket.)

What does that mean?

It means that the tax-payer burden of providing 'free' health care to every individual in Great Britain is actually LESS than the cost of providing 'privately funded' health care in America. What's even worse, is that on top of the American tax-payer paying more than enough to fund a system like the NHS, they're then asked to pay $4,000 on top.

They're basically paying for health care twice. And as good as the American health care system is, it's not that good.

I've argued before that 'socialized medicine' and universal health care already exist in America - but I can see that I grossly underestimated the problem. We, the health care consumer, are being fleeced - and Republicans who demonize so-called 'socialized health care' are unaware that they've been contributing to it for years now.

British Gnashers and American Tooth Doctors

Americans take dental care very seriously. That's why this Monday, Tina dragged me off to the dentist, for an hour long experience my gums are not soon going to forget.

It was pretty horrific. Fifteen or so years of tartar and plaque, scrapped off by a detirmined little Italian woman who worked like she should have been wearing a hard hat.

After forty minutes of anguish, I gargled and rinsed a mouthful of gristle-flecked blood and wondered how Tina had ever talked me into this miserable experience in the first place.

But the doctor came in and gave me the thumbs up. When it comes to my pearly off-whites, I am apparently very lucky.

I guess that's because, when I was growing up, my parents took me to the dentist and made me brush my teeth. Living on a farm also meant I had lots of fresh milk and cheese to eat which helped develop the fine set of crooked tombstones lodged in my jaw.

But even good foundations are prone to crumble, the dentist warned. I wasn't really in much of a condition to argue, witnesing the amount of calcified lumps I'd just had hacked and jackhammered off my enamel. Apparently fifteen years is not an appropriate length of time to leave between visits to the dentist!

Why had it been so long? Well, looking at it philisophically, I think my attitude was the same as the average dogs. Given the choice, he's not going to volunteer for a visit to the vets.

But it wasn't just that. Once I'd flown the family coup, seeing a dentist in the UK became a pretty daunting proposition.

The National Health Care service theoretically provides all British subjects access to nationalised dental care. In reality, this system has utterly collapsed.

In order to receive subsidised dental care (which you still need to pay for) you have to register with a dentist who has openings in his limited rota of NHS customers. Finding such a dentist is a real challenge - since there's no 'catchment' area like for NHS general practitioners. You can wind up having to sign up with a dentist who lives an hour or more away.

As an article in The State revealed:

Brits gum up the works with super glue
Few health service dentists leads to resourcefulness

By THOMAS WAGNER - The Associated Press

LONDON — A shortage of National Health Service dentists in England has led some people to pull their own teeth — or use super glue to stick crowns back on, a study says.

Many dentists abandoned Britain’s publicly funded health care system after reforms backfired, leaving a growing number of Britons without access to affordable care.

“I was not surprised to hear those horror stories,” said Celestine Bridgeman, 41, of London.

“Trying to find good NHS dentists is like trying to hit the lottery because the service is underfunded.”

That's why, when Tina and I lived in the UK, we never actually got around to signing up with a dentist. We didn't have access to the NHS care and couldn't afford to go private. We just brushed religiously and stayed away from the rock candy.

When we came to America, though, things were different. My job included dental care for just a few dollars per month - which covered visits to the local dentist (within walking distance of our house) who was open over the weekends and up until 9pm.

What an astounding proposition. Simply unheard of in the UK. A dentist near where you live who can see you at a time convenient to your schedule.

That's how I got conned into the appointment - and emerged with tender gums and strange obsession with licking the back of my newly-ridgy teeth.

All things considered, it's probably a good thing that I'm braving visits to the dentist. I just think it's kind of ironic that access to dental care is cheaper and more convenient in Big Bad America than it ever was in England. The biggest complaint British expats make about the Land of the Free is that healthcare isn't - free, that is.

But when it comes to dental work, the 'free' service in the United Kingdom delivers exactly what you paid for it - nothing.

Selling Drugs

At the moment, I'm employed selling a drug called Oxytrol.

It's the Trans Dermal Patch for Over Active Bladder - basically it treats people with incontinence or 'urgency' (as in, a strong, powerful need to pee more regularly than other people.)

Now this is quite a cool drug. As part of the training I undertook to sell it, I learnt how it works and how it stacks up against the rival drugs on the market, Detrol being the best known.

Because Detrol is a pill, 90% of the effective drug (oxybutynin) gets metabolised through the liver and most of it gets turned into a less effective metabolite that doesn't just target the problem (the over active bladder signals) but switches off other receptors in the body too - giving the patient an unbearably dry mouth and often very bad constipation.

Oxytrol, on the other hand, delivers the oxybutynin directly through the patch, which means the liver doesn't get to metabolise the bulk of it before it hits the bloodstream. That means the side effects are much milder (only slightly more than a placebo.)

It's a brand name pharmaceutical drug that is legitimately better than it's rival. Unlike the pharmaceutical companies who are ripping us off (flogging repackaged generics, like paracetamol and ibuprofen, marketed as expensive Tylenol and Nurofen) Watson Pharmaceuticals actually give you a better product - you do indeed get what you paid for.

However, for many insurance companies and health care companies (including the NHS, back in England) the fact that this pharmaceutical drug is better than it's rival doesn't necessarily mean it'll get prescribed.

The NHS recently announced that they're 'going generic.' In order to save millions in prescription drugs charges, they'll prescribe only generic drugs. That means a patient with overactive bladder would get regular, oral oxybutynin tablets instead of Oxytrol because the trans dermal patch is still under licence and would cost the taxpayer more.

This isn't good for the patient. A significant percentage of those prescribed Detrol or generic oxybutynin abandon their course of drugs due to the dry mouth and constipation caused. It might save the tax payer or the insurance company money - but is it the best choice for the patient?

That's why the American health care system does have some advantages over the British one. Okay, it costs money. If you can't afford insurance, you simply don't have access to medical cover. But when you do, you go into a doctor's waiting room with an advantage. You're a consumer, not just a warm body on a cold table. When it comes to decisions about your health, you can make choices that an NHS patient sometimes can't.

If my brief time working in the health care industry has taught me anything, it's that.

I've always been very angry at pharmaceutical companies ripping off consumers with expensive brand packaged generic drugs. However, I now know that sometimes, brand name drugs can offer you what their generic cousins can't.

Private health care is driving advancement in the field of medication. That's something that stagnant monsters like the NHS simply don't do. Going private means you get the best health care your money can buy - if you're lucky enough to afford it. If you can't afford private health care, you're going to have to put up with the generic NHS prescriptions.

However, in the long term, the discoveries made in the name of private health care eventually do filter down through the system. Licences expire. Costs are driven down. While private health care still continues to drive the industry forward, old dinosaurs like the NHS are eventually going to reap the benefit by offering generic versions of drugs that were groundbreaking ten years ago.

I hate to get ripped off - but working in the pharmaceutical industry has helped me understand how private health care has an important part to play, whether you're lucky enough to have private medical insurance or not.