In Praise of Private Healthcare
I’m writing while waiting for an angiogram in a comfortable chair provided by Britain’s National Health Service, the NHS.
It’s an heroic institution that provides healthcare of equal standard—from cold treatments to lung transplants—to everyone in the United Kingdom, almost entirely for free (prescriptions cost about 11 bucks). Shortly some of its unimpeachable staff will put a tube up my arm-vein all the way into my heart, at absolutely no cost to me.
I love the NHS, but I also love private healthcare. Explaining my new admiration for paid-for medicine—capitalism versus the hallowed health service (socialism?)—will require some time, but I’m waiting in a comfortable chair, so…
Queuing for Health
I last saw a doctor from my “surgery,” the local NHS clinic which holds the lifetime warranty card for my physical well-being, back in April. I was queuing to enter to make an appointment, like a Soviet-era Russian in desperate need of toilet paper.
Lineups are great for rationing limited resources. They protected the Soviets’ limited supplies of consumer goods, just as they limit the distribution of precious medical care by my local NHS surgery. I make no political parallel; instead, my point is economic. Queuing excludes from treatment those individuals who can’t be bothered to line up (because, for example, they have convinced themselves that their heart arrhythmia is probably nothing much to worry about).
In any case, that morning the doctor told me that the well-established early-morning queuing system at my clinic had been canceled for COVID. I went home.
I’d hoped to avoid the usual hour’s dialing time under my surgery’s new, mightily efficient form of rationing. Patients start calling at 8 a.m. and keep dialing until they get through (hopefully before the surgery runs out of appointments, c. 9 a.m.). I was able to relate these cardiac concerns after just 50 minutes: my heart doesn’t always beat evenly, and I am short of breath after minimal activity.
After a later call with a locum, I was prescribed blood work and an ECG and was called for the results in due course. Nothing is wrong, I was told. The report from a distant lab declared, “No further action required.” That was it. My case was resolved. I was dealt with and expunged from my surgery’s to-do list.
But my heart remained as syncopated as a Cuban café band. Last year, aged 53, I was cycling 10 miles a day. Now I get short of breath going up the stairs. Something clearly isn’t quite right, but because two tests have suggested I am OK, the NHS regarded me as another case cleared. I was sent to the back of the queue. It seems the vaunted National Health, at the front end at least, now puts clearing cases ahead of treating patients, box-ticking before healing.
I became increasingly anxious as my heartbeat continued to fluctuate more than the price of bitcoin, but my surgery didn’t seem to care. I wrote to them in May (eloquently, as you’d imagine) and was promised a response “as soon as is practicable.” That time, it turns out, is never, since no one there has had time to respond. I’d never made much use of our country’s health service (annual cost: $292 billion), but now that I need it—after nearly three decades of paying about a fifth of my taxes towards it—the shutters are rolled down.
Frustrated and infuriated, I made an appointment to see a general practitioner at a private hospital ($220). My call to book the appointment was swiftly answered, and an appointment tomorrow offered. The efficient doctor referred me both for a chest X-ray next week (negative, $250) and to a cardiologist. My initial consultation with the specialist ($300) resulted in a non-NHS prescription ($25) and referral for the angiogram test I am waiting for this minute:
Me: “How much does that test cost?”
Doctor: “About £2,000 [$2,750].”
Me: “Can I have it on the NHS?”
Me: “How long is the wait?”
Doctor: “The bottleneck is to see a cardiologist. The angiogram will be in the next few weeks.”
About two months later (after the NHS shuffled my referral papers for a while), I was in the very same chair I am sitting in now, back in the arms of the NHS, awaiting the procedure. After an hour or so, I was led into theater and positioned on the operating table. The angiogram machine just needed rebooting, I was told. After half an hour on the slab, the incredibly caring cardio team brought me a blanket. Later still they declared that the machine didn’t seem willing to work today, so they sent me home with a sandwich and a promise to reschedule.
That was two weeks ago. When I came back to the hospital today, I was told with a smile that the machine has been “pretty good” for the past week (and if you see no obituary on page 5, dear reader, you may assume the test went off OK). As further reassurance, the cardiologist who will perform my test is the same doctor I paid to see privately. That’s not unusual. Many NHS doctors moonlight in private practice, since NHS salaries aren’t enormous, even for top cardiac surgeons.
I am grateful for the free angiogram and for the excellent personal support. But as I wait, I cannot help wondering: if I’d paid to have the test at the cardiologist’s shiny new private hospital, would the machine there have broken down?
Insurance & Politics
I’ve just had a conversation with an incredibly positive nurse who has health troubles of her own. I confessed that I had (in effect) bribed the cardiologist to get into my chair at the front of the angiogram queue. Much to my surprise, her response was supportive. “You’re lucky,” she said. “I can’t afford to go private. But I’ve learned that, with the NHS, if you push and push, you can eventually get what you need.” This taught me two things: (1) if you work for the U.K. government health service, private medical insurance isn’t one of the perks, and (2) if you’re bloody-minded enough, you can get around the rationing.
I intend to purchase private medical insurance right after my test. No health insurer will cover me for cardiovascular conditions, I’m sure, but that will just bring down the price of the policy. It will still cost a bundle: most cover comes as an employee benefit, so your loyal freelancer will have to pay over the odds. But I have seen the light. I love private healthcare.
I also love the NHS (still). It has been stressed to near breaking point in recent years—even before COVID—by political mismanagement, wrongheaded priorities, increasing human longevity, and the inexorably rising cost of more and improved treatments. But the principle of free healthcare for all in a wealthy society strikes me as fundamental. A hybrid system that allows those with more cash to insure for better service seems like the best of both worlds. It would alleviate the bottlenecks by encouraging those who can pay to pay and by reducing the need for those who can’t to push.
Right, I’m going in. Wish me luck!