My Close Encounter With The NHS

photo by Rob Brewer

I was excited about our family vacation to London over the New Year’s holiday.

In theory the big draws were cultural events, namely “Harry Potter and the Cursed Child” on the West End stage (a ticket that is about as tough to get as “Hamilton” here in the States), and the Royal Philharmonic’s musical performance accompanying the film “E.T.” at the Royal Albert Hall.

Who am I kidding? The best thing about a visit to London is the meat pies served at Pieminister, above Nellie’s pub in Soho. I am a patriotic American, but we just don’t have an answer for British meat pies.

Of course there was also shopping, which is especially attractive right now with the British pound at near-record lows, and the ease of getting around London on the Tube – we managed to miss the strike that hit the underground this week. And my wife had the foresight to get tickets for our daughters and their boyfriends to see the New Year’s Eve fireworks spectacular along the Thames. I’m a watch-it-on-television New Year’s Eve reveler, myself.

So I was in good spirits when we landed at Gatwick on the day after Boxing Day (which Americans know as “two days after Christmas”). And when we left the hotel the next morning to buy food and check out the scene at Borough Market. And even when, as we walked to the market, I started coughing – a lot.

Yes, just as we began our family holiday, I came down with a nasty cold. I stocked up on over-the-counter remedies at Boots pharmacy, which is as common in London as CVS or Walgreens over here. Something called Day Nurse seemed to offer relief for a day or two, and I thought I was getting better. But then the big hacking cough set in and kept getting worse.

We kept to our schedule. I made it to “E.T.,” took a day off afterward to rest at the hotel, then made the Harry Potter performances. (Don’t miss this when it inevitably comes to the States.) I enjoyed my meat pies and trudged through the shopping expeditions. I watched the BBC cover the fireworks on New Year’s Eve. But by the following night, it was pretty obvious that I needed some medical attention for what was now, clearly, bronchitis.

Britain has a government-run, single-payer health care system – its beloved National Health Service, or NHS. There was an NHS walk-in centre, as they call it, just a block from my hotel. So on the Monday morning following New Year’s Day, a legal holiday in Britain, I walked into the walk-in centre to see what they could do for me.

There was certainly nothing fancy about the place. There were perhaps 30 or 40 plastic seats in a large waiting room near a reception desk. Perhaps 10 people were waiting ahead of me. I signed myself in, providing only my name and birth date. In about 15 minutes, I was called in by a triage nurse with a strong Irish accent, who asked me what was wrong and said she needed to know that I wouldn’t “keel over” while waiting to be seen. I promised to remain upright, and she sent me back to the waiting room.

Maybe 40 minutes later I was called into an exam room to be seen by a senior nurse practitioner – a kindly gray-haired lady who took my blood pressure, listened to my lungs, checked my ears and throat, and agreed that I had some form of infection. It might have been viral or it might have been bacterial, and on the chance it was bacterial she handed me a seven-day supply of amoxicillin, a penicillin-based antibiotic. I had to pay the equivalent of about $11 for the antibiotic; the exam itself was free, even though I am an American. Foreigners need to pay for certain NHS services, but the U.K. sensibly reasons that it makes no sense to let foreigners wander about spreading communicable illnesses to the locals, so the sort of basic primary care I received is free for everyone.

It was very pleasant, considering the circumstances, and a little embarrassing; had I been a Brit who came down with the same symptoms while visiting America, the process – and the cost – would have been quite different.

A couple of months ago one of my daughters had a severe allergic reaction to something she ate. She went to a local emergency room and was given a dose of Benadryl. Shortly thereafter she received a bill for about $1,600 – reduced to about $800 because the hospital in question was part of her insurer’s network. Because she hadn’t come close to meeting her 2016 deductible, my daughter paid the $800 out of pocket.

Britons are well aware that medical costs over here are far higher than in their own country. They can buy health insurance policies from U.K. and U.S. companies that provide some coverage, but the benefits can still fall far short of the costs.

For example, had a British man my age bought a policy from one U.S. vendor I checked online, the cost for $25,000 of coverage would have been about $39, which isn’t bad. But it would have been hit-or-miss whether an in-network urgent care center (with in-network staff) would be convenient to where the British traveler needed service, and the basic policy would only cover up to $200 of emergency room service per visit – far less than many emergency rooms would charge to see someone with my symptoms.

This is the situation that exists today, with the Affordable Care Act in place. Any regular reader knows that I think the law has been a disaster; this situation illustrates how little it has done to actually make care affordable, whether for foreign visitors or for Americans. But it is improbable that any of the legislation that is likely to come from the new Congress and administration is going to radically change this outcome any time soon.

We Americans seem perfectly comfortable with “single-payer” education systems, or highway systems, or national defense. This is true even though we have private schools and colleges that operate alongside our publicly paid options, and private toll roads and high-speed toll lanes alongside the free facilities. (We do all get the same national defense.) We just don’t seem ready to establish any broad-based, publicly paid, primary health care system like those that exist in many other parts of the developed world.

It is really something of a mental block. We have public medical payment for the elderly (Medicare), the poor (Medicaid) and other subsets of the population such as military veterans. It may not always be as good as it should be, but even for Republicans and other fiscal conservatives, it is not really such a big leap to establish publicly operated health centers that could operate alongside private counterparts. We are already paying, but we aren’t getting very good value for our money.

And meanwhile we’re happy to let contagiously sick people, foreign and domestic, walk among us untreated. How does that make sense?

Somewhere in the process of replacing the Affordable Care Act with something that actually makes sense, we could benefit from having a conversation about how to deliver basic, cost-effective medical treatment to people who aren’t getting it right now.

As for me, I am feeling much better, thank you. It may have been the antibiotics or it might have been my body eventually fighting off a virus, but the infection cleared up right around the time the amoxicillin ran out, after I got back home to Florida. Now if I can manage to get another one of those meat pies I’ll be all set.