My experience being sick in foreign countries

In the current conversation about health care in America, I find myself thinking of what I experienced being sick in England, France and Switzerland. I don’t have a detailed understanding of the health care system in any of those countries, but all of them were more or less the “socialized medicine” that is the bogeyman of right-wing Americans.

It wouldn’t do to draw big generalizations from my particular experience, so I’ll avoid that. I will say that the care I received there persuades me that we would do well to institute universal care, either a single-payer system as in Britain and France, or an insurance-based system as in Switzerland. Nothing I’ve experienced abroad makes me think doing that would result in inferior care or higher cost. (Authoritative research supports my impression.)

And — just guessing — I’d say that the politicians who are opposed to “socialized medicine” have experienced little or none of it first hand; most are against something that is little more than a mental construct.

I’ll start with England, where I lived for almost four years. There was plenty to dislike as well as to like about the National Health Service.

To use it for nonemergency needs required me to register with a G.P. in my neighborhood. I don’t remember clearly, but I seem to recall that I had little, maybe no, choice about who that person was. Then, he took control of all my care. He was a gatekeeper.

Want to have, say, a vasectomy? You don’t go directly to a surgeon. You start by seeing your G.P. for a chat, and if she thinks that’s a good idea, she’ll give you a referral. Such a delivery system has some merit, but I didn’t like it at all. From the time I registered and was made a part of that particular G.P.’s patient inventory, I felt a loss of autonomy.

Another problem with the NHS is that it often requires long waits to see specialists.

When my back acted up, I tried to get treatment the British way. I got a referral from my G.P. but had to wait longer than I wanted for the appointment. Then when I showed up, I was surprised to find that it was for the sole purpose of scheduling an MRI and that I would have to wait a month or so for that and then another extended period before seeing someone who would actually treat me.

If this had been my only experience with the British system, I would have serious reservations about it. It was not my only experience.

English friends told me that in emergencies, the NHS worked more satisfactorily – quite well in fact. “Have a heart attack,” they said. “You’ll see.” I skipped the heart attack, but I did develop a sudden-onset, severe infection from a cat bite. The elapsed time from incident to a hospital bed and two IV drips was about four hours. I was treated first by an E.R. doctor who was on duty and then by a cat-bite specialist who happened to be in the building.

When it was time to check out a few days later, my wife and I went in search of the office where you pay. It’s one thing not to be charged to see a G.P., but surely a hospital stay was not free. For a while, no one understood what we were asking about. Finally, realizing we were Americans, they explained, “There is no charge.”

The American knock on free care is that it’s not really free; it’s supported by high taxes. I paid English taxes, and I don’t recall feeling burdened by them. In any case, if they were higher yet, maybe the wait-time problem could be fixed. (They might even be able to buy a few more MRI machines.)

For those who find the NHS unacceptable and can afford insurance or are wealthy enough to fund their care personally, fee-for-services private care is available. Some Brits I knew used the NHS happily but purchased insurance anyway just in case they had some reason to use it, as I did with my back problem.

One more anecdote. About ten years ago, I had an accident in the French Alps – banged my head pretty good on an I-beam while crawling under a railroad trestle. At the nearest hospital, I was seen by a nurse who cleaned up the wound, and then I was examined by a doctor. I paid in cash — 22 euros — at the time about $30.

“Yes, but they have high taxes and their economy is shaky.” Neither bothers the French nearly so much as it does Republicans. (On the other hand, I expect the French would be outraged if they had to pay the American-level cost for insurance policies with their high deductibles and many shortcomings.)

The Swiss have a system like Obamacare but without the problems. Everyone is required to purchase health insurance — from birth. The requirement is enforced, so the pool of insured includes healthy people as well as sick thereby holding down the cost. Those who need help paying for it get a subsidy.

Care is state-of-the-art. The longest I ever had to wait for an appointment was about one hour. I would just show up at a clinic, sign in and see a physician. Most lab work and X-rays were done on site. Treatment, including drugs, was affordable.

The foreign systems I have experienced are imperfect, but they are not as imperfect as the American system — especially if you are poor or uninsured.