Living with 'socialized medicine'

In general, American people are very friendly – well on the West Coast where we live they are.  If they hear us speaking, in a supermarket queue, in an ice cream parlor, in a bookshop, we are invariably asked where we are from, and what we are doing in the US.  It doesn’t take long before they find out that I am working in health care.  The next question is then along the lines of: “so what is it like having socialized medicine?”

Not having ever thought of the NHS as socialized medicine before, the first time I was asked this I was a bit taken aback.  However, I have got used to explaining the basic tenets of the NHS; free care at the point of delivery, paid for out of general taxation, regardless of ability to pay.  This is quite a revelation for many of the Americans I talk to, we often then go off onto a discussion about their perceptions of the problems with the current insurance system here.  All of them have stories about friends or relations who cannot afford insurance, or who have health care debts.  In general, the idea of affordable health care is something they want from the new administration, what we pick up is their anxiety that this will not be achieved.

We also get asked other things: “Is it true that you can’t get kidney dialysis on the NHS?”, “Is it true you have to wait for two years for an operation?”, and “Is it true that some care is rationed?”  In general, the answer to these questions is relatively straight forward – with the advent of targets it is true that patients are, in general, waiting less time for the care they need.  I can also discuss the benefits of NICE with confidence. But are they the answer to delivering quality care?

I have had to reflect on this considerably over the last few weeks.  Just before we moved to America my father was taken into hospital with severe acute pancreatitis.  After 10 days in a high dependency unit and 8 weeks in hospital he was left with a large cyst on his pancreas, and needs surgery to remove the cyst and the gall stones that caused his illness in the first place.  He was transferred to the care of a specialist centre for his surgery, which according to the clinical practice guidelines issued by the British Society of Gastroenterology should have been performed within 2 weeks of his discharge from hospital. This is because he is at increased risk of developing a further episode of ‘potentially fatal’ pancreatitis.  He was discharged from the specialist centre at the end of August without having had his operation.  He is still waiting for surgery, which is unlikely to be performed until the new year, coincidentally just inside the 18 week referral to treatment target set by the Government.  So, the hospital will meet its target, but from our point of view my father is not receiving good quality care.  He is living with constant discomfort and the anxiety that he may get another episode of pancreatitis, from which he may not recover. So, targets and guidelines are not the whole answer to improving care, though they have obviously made things better for large numbers of patients being treated by the NHS.  In the US, if he had no health insurance, or was not covered by his insurance policy (the problem of under-insurance) he may also be waiting for surgery.  However, sometimes I am at a loss what to say to the people I speak to; on a national scale I know the NHS is improving and delivers high quality care to the majority of patients, but on an individual basis at the moment it is failing my father.