Let's Do It Better

The Rude Pundit thought he might be crashing while on a visit to Liverpool. And it turned out to be a rather pleasant experience instead.

An American in the UK National Health Service

It had been a stressful few weeks, with far more than the usual amount of fuckery and frantic frenzy, and I arrived in Liverpool last Friday on a total of about 4 hours of sleep in two days. Walking around the Liverpool One area shortly after dropping off my bags, heading towards the Tesco to get some supplies, I realized that I was sweating like Nicholas Cage on a meth bender and my heart was racing like, well, the same. I felt a tightness in my chest, short of breath, needing to sit down, and I thought, "Well, fuck, this would fuck up the next week or so." When your Dad dies of a heart attack at 46, you take that shit seriously.

So I found a National Health Service walk-in clinic just around the corner from Tesco. It was in the same space as the NHS's sexual health office, which offered free morning after pills, among other things. I went in and there were maybe twenty people sitting there. I don't know how many needed sex-related attention and how many needed regular medical help. But a very nice receptionist took my name, date of birth, and phone number, and then she asked what was wrong. I described my condition without the mention of Nicholas Cage or meth, which could have confused the whole situation. She very nicely told me to take a seat and that triage would be with me shortly. The triage nurse, I learned, examines everyone to see who might need to get in sooner than others. Apparently, I was looking terrible enough to be bumped to the front of the line.

After a few moments, I was called back to see the nurse practitioner, Niamh (pronounced "Neeve" because, well, Irish names). I can honestly say that I've never been treated with as much care, patience, and good humor by a medical professional as I was by Niamh. She asked permission every time she wanted to do anything, from take my blood pressure to listen to my pulse. Even as I kept insisting that I was probably just exhausted and whiny, she took everything about my condition incredibly seriously and assured me that I should just follow through with what she was recommending. "It won't cost you anything," she said more than once, as if understanding the anxiety that Americans have about health care spending. "Unless you're admitted to hospital." She laughed and joked, and we talked like we're human beings having a conversation, not a transaction.

Niamh asked me a few questions about health insurance in the United States and shook her head at it. "I'm afraid we're going to head to that kind of system," she exclaimed. She told me a story about when she and her family - husband and five children - visited New York City the previous year. Her youngest, a toddler, had gotten an ear infection, so they went to a walk-in clinic, just as I had come to this one. She told the receptionist that they would pay out of pocket for expenses because they would be reimbursed when they came home. "Now, they prescribed my little one a medicine," Niamh said, "one that I know is in that locked cupboard behind you. And I know that it costs about three pounds. Do you know how much they charged me in the states? $354." She laughed, as one can when they get the money back for outrageous expenses. I told her that her experience is pretty typical.

This is more than some tiny example of Anecdote-over-Evidence. We hear versions of this story all the time, and we need to understand that a Profit-Centered approach to healthcare is not just a shitty way to treat people - it's costing us gazillions of dollars we don't need to spend on a system that delivers the world's 37th best outcomes.

By every measure, our system makes sense to nobody but Rent Collectors.

It doesn't have to be this way. We don't have to do it the way we're doing it. We're getting stuck in the same kind of ideological straightjacket that the USSR was in as we all watched that whole system crater in on itself almost 30 years ago.

We keep insisting on maintaining a blind faith in the Unfettered Free Market. And we're pushing it to the point where we plunge into the Logical Extreme - which is where good ideas go to die.

You don't build a durable form of government based on an economic system - not without ending up very close to that old Yakov Smirnoff bit, "We pretend to work and they pretend to pay us."

The version here in USAmerica Inc is fast becoming: "They pretend we're buying their shit and we pretend we have a choice."