For the second time since I moved to the US 15 years ago, I had to call 911 this week. The first time, six years ago, was when smoke billowed into the elevator from a fire in the laundry room and four fire trucks arrived within minutes. This week it was to call an ambulance for a sick neighbor. Between dialing the number, and a gurney and two paramedics materializing in our hallway, approximately seven minutes elapsed. I found myself thinking something I used to think about the NHS: what an amazing service.
I understand, at this distance, that most ambulances in the UK don’t show up in less than 10 minutes, even when the emergency is serious. A friend who had a heart attack on the street in London this year, he told me, was lying on the pavement for 40 minutes before the ambulance showed up. This is terrifying, and yet marginally less terrifying than the common American experience of emergency care, in which gratitude for efficiency is undermined by the dim but exciting possibility of losing the house when the bill comes.
All of which is at the forefront of my mind as we move through the season of health care renewal. I have to stop talking about this, I know. Short of moving to Canada or joining a powerful union that I don’t qualify for, there’s nothing to do about it. Still, the sheer punitive opacity of the system has never surprised me more than now, when, after years of renewing an existing policy, I finally decide to go shopping.
“Do you know how this works?” says a sales agent. I just asked if you could send me a breakdown of the coverage and exclusions for a policy that costs about $10,000 a year. “How it works, we can send you the full policy details after you’ve signed and paid, and then if you want to cancel, you have 30 days.”
There’s a pause while I digest this. “Isn’t that…pretty weird?” I say. She laughs nervously.
“I mean… that’s how it works.” Lighting up, she says, “But you can ask any question about politics and I’ll answer it!”
After calling three other agents expecting a different response, I understand that no one here is acting in bad faith; that’s, as she says, exactly as it is: an Alice in Wonderland system where you only know what you’re buying after you’ve bought it. And so we went through the preliminaries. No pre-existing conditions; no one smokes; No interest in maternity coverage. All of which makes the broker happy to no end, as it results in a relatively attractive listing.
I ask the only question that is vital to ask in New York when buying health insurance for your family. “If someone has cancer, can we get into sloan kettering?”
His voice sharpens instantly. “it does Does anyone have cancer?
“No. Nobody has cancer.”
“Well then, yes. It is a PPO (preferred provider organization), will be accepted everywhere.”
But of course, that’s not the whole story, and when I ask him why the provider he’s flogging isn’t listed on my doctor’s table of accepted insurance, he gets testy. “We are accepted by 80% of medical providers in the US.” ah You can guarantee, in this scenario, that the 20% of doctors who don’t take this sketchy insurance are in New York, where you can’t cough without someone sending you a bill for $350 (£290).
In the midst of all this, I visit my wonderful primary care doctor for my annual physical. She takes pity on me and tries to find a solution to thwart my existing insurers. In the US, public health policy recommends routine colonoscopies for everyone age 45 and older. Ha, you wouldn’t get that in Britain, I thought, when she told me about it last year, before checking my policy to find it wasn’t covered. A colonoscopy costs more than $5,000 (£4,130) in New York. “They just want you to die,” my doctor says grimly, a starker statement than she expected. But I guess on some level, right.
So there you have it. Broken Britain or this hell? It is a difficult decision. I’ll be on the phone again today to try to find a loophole in the system, a unicorn policy that covers both routine exams and major medical events; one that, in the event of an emergency, will bring an ambulance to my doorstep in 10 minutes, assuming I’m not too terrified to call.