You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.

IMG_8896Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abby. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought I was torturing him).  Despite an extensive search and rinse mission no object or relief was to be found. I fretted about going to the hospital. It wasn’t the prospect of navigating a slightly foreign ER, but simply the prospect of the wait. While I am a staunch supporter of the British NHS in the back of my mind I envisioned a paralyzingly full emergency room and an agonizing 18 hour wait only to find he had nothing in his eye (the basic antechamber of Hell scenario). To ensure we really needed to go I gave Victor a choice between the emergency room and a toy store (Gunter’s 3rd rule), but he declined the toys so off we went to St. Thomas hospital, conveniently right over the bridge.

The hospital was on the aging side and a little drab, but clean and well-marked. I didn’t have to ask anyone for directions. We had to take a number to be registered, but waited less than 5 minutes. I gritted my teeth a bit in preparation for the we-are-not-from-the-UK conversation, but it wasn’t an issue at all. I offered my US insurance number for billing, but was told they didn’t need it. The clerk was, however, impressed with the fact that I flipped his eyelid and irrigated his eye before coming. “Well, you did all the right things,” and looking at his red and watering eye she smiled and said. “Looks like you are in the right place.”

Registration completed, we waited to be seen by the children’s part of the ER. A registrar (resident) did a quick triage within 5 minutes of our registering (also impressed with the eye irrigation) and then a nurse did his vitals and took a history. After that we waited less than 15 minutes for the registrar to do a formal assessment. He wanted ophthalmology to do the evaluation. I was a bit surprised the ER doc wouldn’t do it, but every facility is different and when they found out that Victor was born at 26 weeks and had retinopathy of prematurity they got a bit jumpy. Everyone does. I was ok with ophthalmology checking him out. What I have learned from years of medicine is don’t mess with the local order.

We were walked over to the urgent care clinic and were warned that the ophthalmology registrar was covering the whole hospitalIMG_8897 so it might be a while. This was our longest wait, about 20-30 minutes. She was very nice (also working on her PhD). Dr. Katie Williams (she gave me permission to use her name and her photo) diagnosed Victor with a corneal abrasion and easily snagged the offending speck of dirt wedged under his eyelid.  Once removed Victor exclaimed, “It’s gone!,” and within a minute or two the redness cleared up. She put in antibiotic ointment and gave us a tube to use at home.

“So where do I pay?” I asked Dr. Williams.

The answer: you don’t. Perhaps they might bill us, she just wasn’t sure.

I was about as dumfounded at her answer as she was at my asking.

I protested that it wasn’t fair. We had used services and I was very prepared to pay. I also have insurance that covers emergencies when out of network, so I was pretty sure I would be reimbursed at least some of the visit. However, we were just sent away. They do have my address so it is possible I will get a bill in the mail.

 

Victor and Dr. Williams
Victor and Dr. Williams

 

I am very curious what similar care would have cost in the US. The saddest commentary of all is that it is really impossible to tell as billing practices are so bizarre and opaque. My guess is it would be a minimum of $1000 in America for cash (which is egregious). If I ever get a bill from the UK, I’ll post a follow-up. If anyone has had similar care in the US and received a bill please do post in the comments. You can remain anonymous if you like.

But what of this idea that national health care means DMV-purgatory worthy waits, Dementor-staffed death panels, Saxon-age medical equipment, and incompetent care? Well, I can tell you we had great care at St. Thomas and Dr. Williams was fantastic. The slit lamp wasn’t brand new, but it worked just fine. Sure it’s an N of one, but I’ve been to the ER more times than I can count with my other son and this was as smooth as the best care we’ve had in the United States.

We could have hit the ER at an opportune time, but to expand my N I’ve also asked many people about their medical care while I’ve been in the UK. Not one person wanted to abandon the NHS. I’ve heard of excellent care and some care that was lacking, but the bad care has nothing to do with the “national” part. Rather it was diagnostic errors or a full hospice unit, things that I hear about with the same incidence back in the world of commercial insurance. Take away the accents and I could easily have been listening to a group of Americans discussing their care. With one exception, no one in the UK is left wondering what the price will be or gets an egregious bill.

It makes you wonder exactly what frightens Americans about the NHS?

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955 Comments

  1. Excellent post. I took my son to the local ER when he was hypoxic due to a reactive airway event. After labwork, a neb treatment, oxygen, and an X-ray, a woman came in to give my son a teddy bear and then handed me a bill that said my portion after insurance for treatment thus far was going to be just over $900. I was asked if I wanted to put something toward this balance right now? They accepted credit cards…

    1. I am totally mystified by Jen Gunter’s assessment of how favourable her view of the NHS was, which was rather condescending. Was she expecting a third world experience in an impoverished country? The UK is a rich country for one, and the (“socialist” as the Americans call it) NHS is a highly developed and an inordinately complex organisation. We pay comparatively very little for our health care in the UK AND we get an awful lot for our money. The NHS is still regarded by many as the envy of the world, despite its difficulties. I teach nursing at the University of Birmingham, and our students have elective clinical placements in countries all over the world, including the US. The one message which I constantly hear from them following their experiences overseas is “I will never complain about the NHS ever again”.

      1. and yet we get a lot of doctors from the UK coming to work in Australia and want to stay here because they can’t stand the NHS, so it can’t be that great !

      2. There is no mystery or condescension intended, I believe. Anti ” Obamacare” agents of the status quo attempted to vilify the NHS and similar healthcare systems to preserve the employer based for profit system they have in the USA. Ridiculous propaganda abounded and many believe(d) it. Jen Gunter demonstrates that even a discerning, well educated person can be duped by that misinformation campaign. She has now been enlightened by reality – unfortunately millions of Americans have not and continue to embrace a system that does not always operate in the best interests of the consumer but does generate an awful lot of money for some.

      3. Mark, you need to understand that in the US we are constantly bombarded with messages about how horrible NHS and any other non-commercially based health care system is. Certain political groups in the US have worked long and hard to make ‘socialism’ synonymous with ‘communism’ and to label systems like the NHS ‘socialist.’ Which creates and association train of “NHS? That’s socialist–so it’s gotta be like the horror stories we heard of the USSR, right?”

        This worked for long enough that most people from the US just assume systems like the NHS have to be bad. In recent years (especially since Obamacare) some of the reality of the NHS has started leaking through the US consciousness, but because we’ve been so wellindoctrinated to “Socialist=Communist=automatic disaster” the usual response is “Well, okay, so they pay less money and everyone gets care, but there has to be something wrong with it right? There’s no way everyone can get good care, and pay for all the high tech equipment, and…”

        The NHS may be the envy of the world, but it isn’t the envy of the US because of this decades long propoganda. This reaction may come across as condescending, but what it’s saying to a US reader is “all that shit we’ve been fed about the horrors of the NHS? We’ve been lied to. Here’s the reality.”

      4. The narrative in the USA from those against universal health care is that it leads inevitably to 3rd World conditions. So yes, Jen probably wad expecting a pretty dire experience.

      5. I feel it is disourteous in the extreme of Mr M Hughes to label Dr Gunter’s.posting as “condescending”.
        What utter – and rude – rubbish.

        Dr Gunter was grateful for the extent and depth of treatment her child freely received,
        And coming from a country where heath care is highly commercialised to the point where a majority of the population have no access to it, Dr Gunter was then astonished that there was no commercial aspect to it.
        She wanted to do something to express her gratitude and did so by her post.

        I find no condescending tone anywhere in her post.
        Instead I am ashamed on behalf of us all that Mark Hughes should respond so boorishly – and so unnecessarily rudely.

        Thank you for your post Dr Gunter, it was so kind of you.
        Yes our NHS is amazing, staffed by so many people as dedicated as those you met that day.
        It is a lifeline to us, and many of us are currently feeling that we are going to have to fight to keep it that way..

      6. Note the sentence “The NHS is still regarded by many as the envy of the world, despite its difficulties.” Exactly, “despite its difficulties”! The writer of that article has a good experience (and they do happen), so tries to equate that to the rest of the NHS system. Live in the UK for a while and you will lean that you are more likely to have a bad experience than a good experience.

      7. Had you lived in the US, you would not be at all mystified at someone’s fear of the NHS. Especially in the last few years, as Obamacare (a drop in a bottomless pit, but at least a first step) got talked about, and, thankfully, passed and made into law, the NHS was demonized. The US so-called experts painted the NHS as something worse than medical care in a Soviet Gulag infirmary. In addition, they played upon the ubiquitous and overblown American insistence on personal responsibility….which is just fine if you have a great job that pays the inordinately and obscenely high premiums for your health insurance. Of course, these days, there are very, very few of those jobs left in any sector of the economy, except banking and stock brokering–and government itself,of course. Americans have no idea how incredible the NHS really is. I left the US four years ago and live permanently in the UK now, by virtue of my Irish citizenship (thanks, Grandma, for being born in Donegal!) I renounced my US citizenship because the insularity and concomitant idiocy of Americans was just too much to bear, and I wanted to ensure that I could never go back there to live. A drastic step, perhaps, but–having had need of the NHS at 6 am on cold, sleet-dampened February morning, and as well the excellent NHS ambulance service–you will find no greater advocate for the NHS than I, a former American who basically doesn’t even use allopathic medicine, preferring homeopathy. But when one is in a physical emergency of any sort….give me the NHS. And fortunately, they WILL be quick about it. This is one former American who, both theoretically and empirically, has nothing but good to say of the NHS.

      8. Carlos – We get a lot of Australian doctors, dentists, physios, etc come to the UK to work and want to stay here, so perhaps it is that great!

      9. Mark, in the USA, the wait and the paperwork for that situation would really be what the propaganda in the USA says it is in other countries (projection is good propaganda). When one is raised in an abusive family, it’s hard to deal normally with non-abusive situations.

      10. Would have been an entirely different story had he come to my local ER. The difference in care received in a metropolitan area compared to the rural is sickening. I waited ten hours in A&E with a dislocated ankle, I’d already pushed it back in place myself but they insisted it was still dislocated so I had to wait around for an xray with nothing but a few paracetamol – I was right, it wasn’t dislocated so they sent me straight home after I BEGGED for crutches.

        My partner was told he needed emergency surgery, but because he was still relatively mobile they refused an ambulance for him, instead making him take public transport 40 miles to the hospital. Once there he received the surgery, but had to go back six months later because they’d done such an appalling job. He waited six hours in A&E and was then operated on behind a curtain IN the A&E! Don’t tell me our system is great because it’s so depends on what area you live in whether you can get proper medical care or left to die on a bench in a hallway.

      11. Condescending and patronising, yes, but not that surprising given the media presentation of the NHS in the UK (never mind having the right-wing opposition to nationalised health care that’s endemic in the US media I’ve sampled).

        There’s a real swell of anti-NHS feeling that’s been growing as long as I can remember, fed by frequent news reports of long waiting lists, poor sanitisation and incompetent staff. The good work is never usually reported.

        I was astounded the other day when I went to sign a petition to halt the privatisation of the NHS, and saw several comments (with a number of Facebook “likes”) claiming that the NHS was broken beyond repair and in need of privatising. One of the more popular commenters suggested he’d rather pay for his own medical bills than risk having to pay for hordes of immigrants piling into UK hospitals looking for free care.

        I’d love to conclude with a proposed solution but I don’t have one – I cannot see how this level of ingrained anti-NHS doctrine can be countered. I’m not blind to the faults of our health service but God it’s better than so many of the alternatives.

      12. Hi Mark, I am American, but lived in Scotland for two years and have spent the last fourteen in Spain, where we all also socialist (oh no!! haha). Many people in America have no idea about how wonderful and up to date medical care is across the pond. They just don´t know.

        I had a terrible ear infection that lasted three weeks when I lived in Edinburgh. I was treated by my GP and then sent to hospital for a specialist consultation. Excellent care all round.

        I was diagnosed here in Spain with type 1 diabetes as an adult. Correct diagnosis and started on insulin right away. My cousin, diagnosed in the USA, given the run around, try this pill, try that pill, a year feeling awful. I get great care here. Not enough test strips, but that is the only thing I can complain about.

      13. As a Brit living in America I can assure you that there is no good publicity about the NHS over here! Everyone thinks its awful and tell me repeatedly how lucky I am to be out of it?? even when they have never even been to the UK! And as a nation we don’t publicize it well either – Brits are always the first to complain about it and put it down. We are our own worst enemy. Mostly I think because they have no idea how expensive and difficult health care is in other parts of the world where they don’t have an NHS. Its a shame really – you don’t appreciate it at all until you don’t have it.
        Drs go to Australia because I am guessing they have a good socialist health care( I have no idea) – maybe also as the pay is no good , or maybe because of the weather! When we talk about the NHS being good , its not necessarily good for the staff – but good for the patients. You don’t get many UK Drs coming to the US- well I never met one anyway.

      14. Im glad you have such a high opinion of your NHS. But you talk of an American being condescending, how about yourself? I am an American, I also work in the field as a Respiratory Therapist for the past 11 yrs. I have worked Trauma in Denver, Colorado, peeds therapy in the desert etc. I have worked it all except for NICU. We triage from crirical to non critical, our wait times are long on occasion but if you live in Orange Counry, California like I do, that’s not always the case. We do cost a lot of money in terms of what private ins. Companies will pay, less the deductibles etc. But our network has alwaya given my family and I excellent care. We have not had an iasue for the exception of expensive meds at times. Its a malignant nightmare, However, as a fellow Healthcare worker, I work my tail off to make sure our care is given in a timely manner. I often go home barely able to get out of my car when I get home. But we work hard, give care and compassion to all of our pts. to make sure the pt. has a hat they need and are taken care of. I won’t disagree with you that Americans sometimes have a short sided view of govt. healthcare. But we have had this system in place since I was born and now we have a President forcing every citizen to have Health ins. I understand the reasons for it, but I, myself, went about 5 mos. Without ins with which I paid cash for every doctors appt. I ever went to, but because we were unable to pay for private ins. at that time and my husbands ins. from work wasn’t due for open enrollment for another 5 mos. from the deadline, we got slapped with a fine. So now, come tax season, we owe a fine of over $100.00. This is a system (Obama Care) that we don’t even qualify for. We make too much money to qualify but not enough for Private ins. I am the richest poor person I know!!! I’m truly not trying to be offensive, I just want you to understand that it’s not all black and white in either nations healthcare system. Yes, Americans are a stubborn people and they think they have an idea of what they think is true about NHS, but anyone with common sense would know thats not true. An NHS cannot be effective with 3rd world tech. However, your people in the UK have labeled us wrong as well. We dont like someone coming in and forcing us to do something that goes against our constitutional rights as a “Free” nation. Ee arr very prically about that. I know that people in the UK think of us as uneducated, greedy, and uncivilized. I’m sure thats old world thinking, but none the less, I have heard 1 too many “Brits” complain about how we do things, but they are happy to work in our hospitals and make a lot of money. We don’t have a great system but if you walk into any US ER with or without ins. You will get the care you need and a social worker will hook you up with free health care while you are in the ER. So to say that American pts get care based on what they can pay is not always the case. I have never seen a pt in the hospital get turned away based on what they can pay. That’s all stuff you see on popular TV shows like ER, or Greys Anatomy. It’s all for drama. Well, I think I got way off topic, it’s just a very sore subject!!

      15. You’re missing the context. The narrative pushed by the Republican media and vested interest groups in the US is that the NHS IS a third world service with long waits, poor care and rationing (the irony being that the insurance system in the US leads to a far greater degree of rationing than here). This is a political myth to sustain the status quo, but it is pervasive.

      16. Mark,

        I have to challenge your assertion that the assessment is condescending. I’m a Brit who moved from the UK to the US aged 40 and have lived here for a little over 19 years. I can testify from personal experience that the picture presented by Jen of the American view of the NHS is spot on. There are a lot of vested interests who perpetuate this view of ‘socialized’ medicine as draconian. To me the real offense is the indentured servitude created by the employer dependent healthcare system the US.

        The NHS is free at point of access and almost exclusively funded through taxation but consider this; on moving to the US both my Car and House Insurance, after converting pounds to dollars was a FULL order of magnitude higher despite, in the case of driving, having documented proof from my last UK insurer of a 8+ year driving record in the UK with zero claims. The vast majority of the addition cost was effectively medical insurance, add to that the Employee contribution to medical cover, along with co-pays, deductibles, co-insurance and items not covered by Insurance then while it is impossible to make a clear cut direct comparison; if I consider all these components effectively as ‘taxes’ and, for that specific year, compare my US tax rate as a percentage with that of my brother, still in the UK and doing a comparable job in IT, my effective taxation was about 20-25% higher than his with the added ‘benefit’ that if I were to lose my job for any reason I’d have very limited access to any health care. It is very easy to say taxes in the UK are higher than the US, taken out of context this is probably true; however, given the NHS is a significant proportion of the UK budget, the only reasonable comparison has to be a holistic one.

      17. The stat I always like in that regard is that Americans pay more tax per capita for healthcare than the British do – and in return, the vast majority of them get zero healthcare and have to pay for their own insurance and out-of-pocket expenses.

      18. Your observation is very astute. If you explained it to the American public, there would probably be a lot more Bernie Sanders supporters.

      19. Well, if they went to a Canadian ER, they’d still be waiting, the eye would have become infected, and the kid would have gone blind, and they’d have been billed $3,600. So yeah, expectations probably wouldn’t be high.

      20. The way I read it was that she was impressed with the speed of treatment and the lack of a charge. It did not come over as condescending at all.

      21. The press in the US is so relentlessly anti-NHS, anti-Canadian Health Care, etc that there are literally no fact-based descriptions available from commonly available media. We don’t need Murdoch or Pravda, the propanganda is firmly in place as it is. She’s not being condescending, she’s acting as a North Korean defector would on a visit to Seoul.

      22. I loved reading your comment. Dr. Gunter’s assessment was not, in fact, condescending, but was addressed to United States citizens who have been led to believe (and most still do believe) that ANY medical treatment received outside the U.S. is far inferior to ours. It’s not until we (U.S. citizens) read or hear from actual people who have received care in other countries that we can get a glimpse at just how distorted our view is – and still most of us will not change our minds.

        Reading your views on her article demonstrated again the extent that we (citizens of the U.S.) are out of sync with the rest of the world. Thanks for sharing them with us.

      23. Yes, there are people who are adamant that only the U.S. system provides good care but who have never experienced (or heard firsthand accounts of people who have experienced) care in other countries. I had the worst healthcare experience of my life at an NHS hospital, but I also received 7 years of top-notch care from NHS GP’s – without consideration for my ability to pay. No system is perfect – not even (especially?) ours in the U.S.

      24. What do you expect? From a country where you can spend thousands dollars and even be bankrupt for medical treatment. You are an assholl? She complimented our system. You are the problem

    2. I had a similar experience with an insect bite near my eye which was infected. It cost $800 to be treated in US ER, for an hours attention, which I claimed and was paid for on my travel insurance!

      1. To Laura: I think renouncing your American citizenship was a bit over the top. I’m an American living in the UK, and I think the NHS is amazing. However, your making a broad generalization about the close to 350 million Americans as being wrapped in insularity and concomitant [oooh, BIG WORD] idiocy is idiotic in its own right.

      2. Carlos-as a British doctor working in Australia I can tell you we come over for the change in lifestyle and weather. Not because we don’t believe in the nhs. I can’t say as of yet I’ve been able to offer better access to care for my patients here than I have been able to offer back home, through the nhs. Actually given the part private system which is useless at the front door apart from nicer rooms and food I honestly cant see benefit in a private admission.

    3. St Thomas’s has long been my local hospital. It’s almost invariably been excellent in my experience as both outpatient and inpatient. However there is one important caveat. It is the local hospital for the Houses of Parliament and not necessarily representative of all NHS hospitals. Though probably not significantly better than most.

      1. When I was a child I had a lung disorder and also a ruptured appendix and peritonitis. For a large part of my life I had Wolff-Parkinson-White syndrome, an irregularity of the heart rate, until it was cured by a cardiac ablation. I have had two heart attacks and coronary artery by-pass surgery.
        As a result I have experience of about 20 hospitals, some of which no longer exist.
        St Thomas’s is one of these and I have not noticed any difference between the treatment there and at any of the others.
        This week I had an out-patient appointment at King’s College Hospital. I was seen on time and I was very pleased with my treatment.
        Last week my wife had an out-patient appointment at Lewisham Hospital and again was seen on time and she was very pleased with her treatment.
        Last month I went to Edinburgh for a long weekend for the festival. Unfortunately, I collapsed and was taken to Edinburgh Royal Infirmary by ambulance. I was an in-patient from Saturday to Monday. Again, I could find no fault with my treatment. After my return to London, the Edinburgh consultant phoned me to check that I had arrived home without problem and was feeling well and to make sure I had booked a follow up appointment with my GP.
        Of course, people are people, and during my many hospital experiences, as in all walks of life, I have met wonderful people and not so wonderful people. But I certainly have not found that the people or the facilities at St Thomas’s Hospital are any different to those which I have encountered at other hospitals.

      2. I think the significant thing about St. Thomas’s, where one of my children had an operation at 8 weeks, is that it’s a teaching hospital. Not proximity to parliament. Teaching hospitals tend to be a cut (pun intended) above the others

    4. There are so many comments here that I doubt I can add much more. I can only say that I am a U.S. Citizen, but I’ve been living in the UK for the past 7 years. I have two children. One was born in the States. One was born here. I had a sister with a serious, chronic illness that she was born with, and prior to her death 5 years ago, received quite a lot of medical care in the States. I have friends and family who have had cancer in the States. I have friends who have had cancer care in the UK. My son has asthma, which started in the UK. My niece, who lives in the States, has asthma. My husband and I have received genetic testing for the disorder my sister had (in the States). Basically, I have experiences, both direct and indirect, of healthcare in the U.S. and the UK. I can say this. No system is perfect. Big surprise. The things I liked about U.S. healthcare? When I had good health insurance (and there were many years when I had rubbish health insurance or no insurance at all), I loved the health care I could get. We had loads of choice (we had a gold standard model from a large University). We could go to the local smaller hospital for small emergencies (read – smaller A&E, fewer very ill people, shorter waits – compared to the very large Uni hospital A&E (read – tertiary care hospital for the State, VERY ill people, very long waits). But, if anything was REALLY wrong with us, we could go to the large Uni hospital and get world class care from experts in the field. I loved having an OB for all things feminine, and I like having a pediatrician for all things child. I was happy with my internist for everything else. But, I was also used to being offered meds and tests for nearly everything. Once our pediatrician, an excellent, caring and kind doctor, offered to have our son get an fMRI just because I was scared he might have a tumor (totally unfounded, new anxious mum fear). I think he knew I’d turn it down, but STILL, what if I hadn’t come to my senses? Sometimes, in the UK, I suffer moments of doubt because I fear that our GP isn’t really that up to speed with children’s or women’s specific issues. And yet, I need to get over it, because our care is just fine – most of the time. We have had our moments. I’ll be honest. But, ya know, we had our moments in the States too. What I LOVE about the NHS is that you just get care. You just do. It’s that simple. Like the blogger, I too nearly passed out when I took our son for our first visit to the GP and went to check out and fill out forms and pay some co-pay, and…… nothing. I had to do nothing. Here, you just go see your GP and that’s it. Nothing else. Hospital? Same thing. You just get care. Period. Now, there are things you have to figure out. There are ways to “work” the healthcare system – just like the States. And the way to work the system is different here. It’s taken me years to figure it out with the help of my friends. I still don’t totally have it, but I’m getting there. The trick in the NHS seems to be getting to the consultants (specialists). Once you’ve gotten to them though? Oh lord, the care is EXCELLENT. My asthmatic niece sees a specialist pediatric pulmonologist. My son sees an asthma nurse. If we have more specific problems, we go to the pediatric asthma clinic at the hospital. If I have concerns in the interim, I can ring them and they’ll consult over the phone. The asthma nurse is good, the pediatric asthma clinic is excellent. between the two, my son is well cared for. I know which system is cheaper though……. In the States, our excellent insurance offered to pay for ME to get genetic testing for my sister’s genetic condition, but wouldn’t pay for my husband to be tested. I thought this was ridiculous. I had a 75% chance of being a carrier. We both needed to be carriers for there to be any risk. Why pay for me? Just pay for my husband to have the test. He was the unknown. They wouldn’t. We got to the UK. No questions asked, they tested us both. Thank you NHS. My sister needed a transplant. There was a hospital in the State in which she lived that did the transplant, but it wasn’t in her insurance plan. Nope. The hospital in her plan was in another State. So, my very ill sister had to make numerous 8 hour trips to another State for evaluations for a transplant. She was very ill. She wasn’t working at the time and was on disability. It wasn’t like there any money to make those trips. My parents paid. I have a friend who’s son was diagnosed with cancer when he was a baby. It was a rare cancer. He was cared for as much as possible in his hometown (a small town) but for specialist care he went occasionally to a specialist hospital 1 hour and 40 minutes away. When his case became particularly complex, a national team of specialist consultant doctors met in the city 1 hour and 40 minutes away and had a case conference about how to best treat him. A whole TEAM! they travelled from across the UK. They came up with a very specialist treatment plan for him, and he was then treated in that hospital and in two hospitals closest to his home. That’s pretty good care if you ask me. And the out of pocket cost to his family? Nothing. My sister? After her death my father spent a year going through her bills and trying to pay what could be paid. when my sister was alive, any time that she was awake was often spent going over her bills and trying to pay them…. until she was too ill to do so. What a waste of precious life time. So, in sum, yeah, I’d like quicker access to specialist care sometimes in the UK, and I detest the 4 bed wards (when I had pneumonia and pleurisy once and my GP wanted to send me to the hospital, I refused, knowing full well i”d get more rest at home – even though I had a 4 year old and a 1 year old at the time), but other than that, I am SO grateful for the NHS. I’ve worked within it’s structure as well, and yeah, it’s bureaucratic as heck, but I’ve also worked within the medical structures in the U.S., and there i was being killed with paperwork. So, one half dozen or another. Here, it’s easier to get care. Period. That’s a very nice thing and a more humane thing. It’s not communism. It’s not evil. It’s better. It’s more humane.

      1. The only thing wrong with the NHS is that they DON’T charge people who, strictly, are not entitled to the service. And this does cause NHS tourism, which is a terrible drain on resources. But as a UK citizen I would rather that than for sick people not to be treated.

      2. That’s a Worldwide responsibility for the NHS then?
        In the UK we pay an “insurance” called National Insurance that goes toward funding the “free service”.

        Unfortunately if one provides a seeming free service, people come to feel entitled to it.

        One of my patients (as a nurse) commented he felt aggrieved because he could not obtain permission to bring other sick members of his family to the UK. He was a really pleasant person but myself a mother of adult children who have not had support for autistic spectrum disorder and chronic fatigue syndrome in the UK, I feel my family should have priority within a country into which I pay a large chunk of National Insurance and Income Tax.

      3. Cathy, Health tourism is a problem. However, I would rather live in a country which people like to visit for treatment, than live in a country which people like to leave to get treatment.

      4. @Lynne, actually the NI contributions goes to things such as the welfare system and pensions not the NHS. Practically everyone that has money effectively paid taxes, even tourists. How? VAT being one of them, duties from fuel etc, etc.

        To say that there are “health tourists” exploiting the system is wrong. It’s mostly gutter presses such as the Daily Fail and The Scum that spread misinformation. It also doesn’t help that there’s already a bill passed without most people’s knowledge of the NHS being currently privatised no thanks to the Selfservatives. Labour started it, the Conservatives are finishing it.

      5. I am a Sister in a very busy Emergency Department. Thank you for saying this.
        We do our best, it is not a perfect system, there are problems but there is a will to try and solve them.

      1. Wrong, Bill. As non-life-threatening, eye problems (as such) come well down the list. On first attendance all patients are seen as quickly as possible so that their condition may be assessed (it’s called triage) after which they will be seen asap based on several factors related to the threat posed to their wellbeing. So one might be seen within moments of arrival at ER, but then wait a considerable time for treatment. As eyes are a specialist area, the wait may often be short because the specialist is available, whereas other (in fact more urgent) cases may wait simply because the necessary team is already committed.

        Such sweeping (and often ill informed) generalisations are what cause the urban myths about poor Grannie who lay on a trolley for an hour with a broken hip, while some drunk with a “simple” bump on the head was cared for.

    5. I’m afraid my earlier post may have fallen on deaf ears, which is not surprising. Perhaps I can simplify?

      We do still have a pretty good healthcare system in the UK but reading many of these comments it strikes me that we are losing our way in the UK where healthcare policy appears to be driven by NHS trust managers. The example given by Jen, and by many other contributors, confirm that we still offer an excellent emergency service and, although I dislike centralisation, even the most highly resourced service cannot afford experts other than in centres of excellence. Hence my comment about over investigation and costly specialist fees.

      I recently suffered serious injuries in an RTA and was airlifted from rural Suffolk to our regional trauma centre in Cambridge (Addenbrookes) and, like Jen’s son and other contributors, I received excellent care at no charge. The one thing that worried me slightly about this is the air ambulance is not funded by the NHS and like so many NHS-associated services relies on charity. Thanks to the helicopter I arrived at the trauma centre within “the golden hour”, which had significant implications for my recovery.

      In the UK we have an increasing number of charities bolstering the NHS, including Marie Curie, Macmillan, St John Ambulance, The British Red Cross and many more, which reflects on the generosity and altruism of the great British public . Do such organisations exist in the US, do the corporate medical providers (with their powerful political lobby) permit them and are they being used in the UK to reduce costs?

      As for the provision of medical care in general in the UK those currently in work pay the the care for those who currently need it via taxation so the NHS as a system relies on high levels of employment to function. This is the highest form of altruism since there is no guarantee that when an individual comes to need care towards the end of his/her (working) life there will still be an army of workers, paying taxes to fund it.

      Perhaps this is what frightens the American establishment? (it worries me!)

      As for the original story praising our NHS, I would suggest it is far more useful to compare the cost and the provision of care to the chronically ill. I gather one of the largest bills faced by the NHS is the current cost of more than £2M per day in drugs alone to treat the current escalating epidemic in type 2 diabetes.

      What care does the average 50-year-old American diabetic receive if not insured?

      Do we have the resources and the political will to continue funding such care in the UK?

      I am really not so sure.

      1. A small correction to THEICENI who says ‘in the UK those currently in work pay the care for those who currently need it via taxation .’ No. The NHS is funded from general taxation so anyone or company (there must be some!) who pays any tax helps fund the health service e.g who like me is retired but pays income tax or buys anything that is taxed.

      2. Air ambulances etc are not funded by the NHS: when the NHS was set up, the idea was that patients went to the doctor, not that the doctor went to the patient—house visits by general practitioners excepted. After, say, a road traffic accident, patients were simply transported by ambulance to the nearest accident and emergency dept; the idea that care began at the roadside came much later. And although we now have paramedics, these are a recent innovation; the original concept, as far as funding is concerned, is still in place. So, the idea of taking services to the patient remains outside the NHS.

    6. that was a great use of my tax..a guest in our country a child as well.needing medical treatment and getting it……best news i had all day…sometimes the uk still rocks…

    7. People, meaning politicians with axes to grind, vilify the NHS. But the reality is that it is a great concept. Underfunded, but run mostly by people who care. It isn’t perfect, but it is great and the British public, for the most part, really want to keep it. We pay, we pay in taxes, whether income or on goods we buy, but that is always preferable to having health care run as a business. How can you have a business that makes a profit out of a child’s hurt eye? And if they haven’t got insurance and are poor then tough shit. Not a world I want to live in.
      For the person from Australia about the doctors who go out there….you only get a minority. Most doctors and importantly nurses, give their working lives to helping people in the great British NHS

    8. It’s very simple – those in power in the US – by that I mean the rich pulling the strings – are heavily invested in private Health companies of all varieties including the Insurance side. Create an NHS in the US and they lose big time – as they will when clean power takes over from fossil and nuclear (which is also why they deny climate change).

      1. Kudos to the most accurate comment Ive read to date regarding healthcare in America. The rich have a deeply rooted, vested interest in getting richer at the peril of the poor and working class which they obviously could give two hoots about except for the labor and taxes we provide. The rich also have an entirely different healthcare system afforded to them than do we, the working class and poor, so they cant fully grasp what we truly go through, nor do they care to even bother. You shouldnt have to go bankrupt over an accident or illness yet this is exactly what happens thanhs to our jaded system which Big Pharma and insurance companies own. #pureevil

    9. We are British, my daughter developed conjunctivitis whilst on holiday in USA, thankfully we were insured through travel insurance, they wouldn’t look at her until documents were shown, received good service, cost insurance company over two hundred pounds, we paid excess – not a lot. I do love the nhs, my son has had a kidney transplant I really don’t think we could afford to live in the states!

    10. Hi, Given the current political climate here in the UK, I’m afraid our very greedy government is about to sell interests in the NHS to US corporations and the excellent service you experienced, which is free to anyone, you shouldn’t get a bill or invoice, will sadly disappear. A comment about your post, love it you explain the experience perfectly and you unknowingly highlight the problem. You see children here in the UK in terms of medicine, are given priority over any other social demographic, so the moral of the story is, if you are young enough, this service is quite simply the best in the world. However, as you get older, the service begins to fail, because the risk goes up and then the beurocracy builds up and the depression levels go up in the HCPs and all spins into a waiting hell when it fails, that’s not to say it fails all the time because that’s not true either, and to finish, if you’re old, you’re done for. The NHS does not know what to do with old people and the government won’t help them out with so it’s easier to let them occupy a bed and starve them and ignore them until they want to die. Sorry about the dark ending. I’m glad you got to experience our wonderful health care professionals, and your son was ok.

      1. Sorry but I don’t recognise the last post at all from my recent experiences with my old mum who lives in Cornwall, a mainly rural area in the SW of England. She has just had her third hip replacement, at the age of 87. Obviously she doesn’t have three legs! One of the replacements she had a decade or more ago had given way and from time of visiting her doctor on a Friday afternoon to her referral appointment to the consultant at hospital, was one week. Unfortunately, she became ill with cellulitis in her legs soon after a date for her hip op came through, and she wasn’t able to have the operation. However, she was treated as an emergency with the cellulitis and admitted to hospital by ambulance after oral antibiotics couldn’t bring down her temperature and had excellent aftercare at home after a week in hospital. She had the hip replacement op after her legs cleared up.

        Occupational therapists visited her home before the hip replacement op to make sure she had the equipment she needed and that her home was trip free. They did things like pull up rugs, tape down loose ends of carpets and order grab rails for the toilet, shower and front door, a perching stool, raised toilet seats and various walking devices.

        After the op, the NHS also threw in 6 weeks of 3 times daily visits to get her up, make her meals and put her to bed as she was classified as vulnerable due to her age and the fact she lives alone. I don’t think this is usual but is a local initiative to prevent readmission. In addition, she had visits every few days from a district nurse to check her wounds and a physiotherapist, to get her moving again. Cost for all this? Nothing.

        I love our NHS. In my own family, one child had an op for grommets as he kept getting ear infections and was hospitalised for a week for persistent diahorrea at age 1. Another was hospitalised at 4 weeks for bronchiolitis and a few weeks later had an op for pyloric stenosis. The treatment for these scary events was prompt, professional, effective and humane. The third child was referred at nursery school to the school service ed psychs and diagnosed as being dyslexic and dyspraxic. He received NHS physiotherapy for the dyspraxia – much rolling around on a giant ball – and although he still barges you off the pavement and doesn’t know August in the list of months, he is successfully doing a BA at university.
        I do think the NHS can be patchy in its performance – I have also had to complain about waiting time for one incident, a broken arm – and I know for sure it’s under threat from idiot politicians that know the cost of everything and the value of nothing. But overall, it is so valuable and such a brilliant thing. Somebody said it’s the nearest thing the British have to a religion. And that’s absolutely right.

      2. Mat,
        You live in a parallel universe.
        Children are not given greater priority, they are simply treated separately by specially trained paediatric staff in paediatric units and those units exist because paediatric illness and treatments have their own specific peculiarities.

        Old people are not abandoned, at least I don’t feel abandoned, by the NHS I have my own age related health problems and I receive very good treatment and support for them. Walk on to any cardiac surgery ICU ward in the country and enquire about the age of the typical patient and you’ll discover that it will be between the mid sixties and early eighties.

        The NHS does not let old people occupy a bed and starve to death.
        You are simply perpetuating the damning apocrypha churned out by the cynical right wing media.

    11. The Tories have been strangling the Nhs with red tape in order to cripple it and prepare it for an American style insurance system that most people aren’t sure about.
      UKIP have been pushing for privatization of the services and the previous Labour government under Tony Blair put laws in place setting up the ground work for private services, from Ambulance drivers to cleaning staff.

      It’s a dirty game they’re playing and I hear too many of my American Facebook friends complain about health problems and as soon as I mention go see the Doctor I get the response “Can’t afford it”.
      To deny a Human Being the Right to be healthy is immoral.
      I don’t know why American’s put up with it, almost as dumbfounded as those over here that complain about waiting times and bad service.
      70 years ago, they left our ancestors to die on the streets, only the rich parasites were entitled to healthcare in the UK.. We don’t want to go back to that.
      All the problems in the Nhs can be solved with new laws and better funding, but the Tories, Labour and UKIP don’t want that to happen, they serve their lobbyist friends who want the money the UK pays in taxes in their pocket; and good luck getting those people to contribute taxes back into the system.

      1. Ron, I agree with everything you say about the prospects for the NHS, truly frightening.
        But historically healthcare was available to just about everyone in Britain from the 18th century onwards through charitable, local council, and church hospitals, and workhouses. . From 1911 people who paid National Insurance got healthcare as a right. This covered most men, but few women and no children who still relied on charity until 1948. So healthcare wasn’t a right and wasn’t that great but thankfully no one was dying in the streets 70 years ago.
        But I share your fears that if the vultures circling our health service get their way, we will end up paying twice as much for half the service and risk people losing their homes to pay for it all, which isn’t a whole lot better than dying in the street anyway.

  2. I’m not a proponent of NHS-style systems but I’m not surprised at your experience–that’s not the sort of thing I’ve heard much in the way of trouble about. The problem your son had was something that can be directly observed (not something a drug seeker or malingerer would choose to fake), there’s no question of what to do about it when the problem is identified, what to do about it is very simple and will cost them very little to provide. Thus you got good service.

    Now, if the issue was expensive, not so clear cut and something elective things tend to go differently. (For example, when do you do the joint replacement? How aggressive are you in going after the cancer?)

    The basic problem with NHS-style systems is that you have the same people paying the bills and defining what constitutes good care. That’s a big conflict of interest and the patients in the grey areas tend to get bit by it.

    There’s also the fact that they basically rely on the regulators rather than lawsuits to deal with bad doctors–and they don’t do much except in the most egregious of cases. (Not that ours our better.)

    1. Loren, living in the Uk as a medical student, what is often forgotten is that even though we have the NHS, if people want to choose their own health care and get treatments not offered on the NHS, then we have a private system too. So there is genuinely the best of both worlds. And you don’t have to opt out of the NHS to qualify for private health care, you can do this for individual areas or aspects of care.

      1. Loren, that’s really silly comment based apparently and entirely on a perceived conflict rather than real-world delivery. The NHS generally just works, albeit with the occasional or locally systematic cockup. I am one of those people who has supplementary health insurance but that’s only because, as I run my own business, being seen in a week rather than a month can make a big difference to me. But if anything critical were to happen, I’m sure I’d be seen just as quickly in either case. In fact, I’d be horrified if private insurance made any difference to care quality and treatment in serious illness.

      2. Its worth noting that a lot if not most private care is carried out by moonlighting NHS staff. As well as the fact that whenever any major surgery is being carried out privately there is always an ambulance on stand by incase anything goes wrong to take patients to an NHS hospital. I consider myself extremely lucky not to live in a country that’s been conned by their insurance companies that universal health care shouldn’t be a fundamental right. Though we may be heading that way if we dont defend it.

    2. “The basic problem with NHS-style systems is that you have the same people paying the bills and defining what constitutes good care. That’s a big conflict of interest and the patients in the grey areas tend to get bit by it.”

      Could clarify what you mean by this? In the UK, care provision (what drugs to fund, etc) is decided by local bodies (CCGs, for example), with a big emphasis on cost-effectiveness – certainly much more so than my, albeit limited, understanding of the US system. This means not all treatment options get funded, but generally the ones that do are the most effective.

      Unlike in the US, the treatment you get is decided by qualified doctors and health specialists, rather than by your insurer – that’s surely less of a conflict?

      1. Under the US system the insurance company can be held accountable for unreasonably denied treatment. With the NHS there’s no recourse and therefore no reason to behave so long as the number of upset people aren’t too high.

        There also have been several posters in this thread about the other problem with UHC systems–the chipping away at benefits that occurs to keep costs down. If the NHS system actually worked properly there would be no need for the private pay other than for the non-essentials that aren’t covered in the first place.

        My fear of UHC isn’t irrational: America has three systems that approximate UHC for certain segments of the population: Medicare (the elderly), Medicaid (the poor) & Veterans care. UHC proponents need to fix these before they advocate putting all of us on something similar. Fix them and most of the opposition to UHC will go away.

      2. Lauren, I am in a minority but see major ethical problems with this. Giving doctors the (limited) funds to provide care for their “population” changes the role of the doctor from acting as the patients abvocate – acting in his patient’s (singular) best interest into a rationer of care, acting in patients’ (plural ie the system’s) best interests, which makes them little different from NHS or fund managers with no medical credentials or professional obligations.

        IMHO it is worse since these doctors can now be blamed for systematic failings and will in time become compromised.

        Rationing should be left to the politicians who should be more honest.

        Surgery currently denied to smokers, obese, (unemployed?) because they “caused” their condition?????

      3. Medicaid ends when you’re 19 if you don’t continue to go to school, which most people can’t afford, not to mention you basically get shamed in america for signing up for any form of government assistance. So please don’t bring that shit up on here. Its legit being told “You’re not going to train to make a company money, we’re not going to offer you help when you need it.” Every sanction of US healthcare is a scam, and not only that but just another boundary placed around the sense of community. Plus money is a concept, the world only needs money because everyone thinks we do. Running out of money is like running out of inches. It’s running out of a concept.

    3. Loren, you also have one party deciding what care may be provided and paying for it: for-profit insurance companies.

    4. Loren – you talk about ‘NHS-style systems.’ Do you have actual experience of the UK NHS? All the comments that follow yours suggest something’s going right! Also, I’m not sure what you mean by ‘the same people paying the bills and defining what constitutes good care.’ The taxpayers (ultimately) pay the bills but they don’t define what constitutes good care.

      1. whatever way people want to point is all well and good when they want their own opinion to be counted as the ‘correct one’, but at the end of the day the NHS is better than no NHS.

        Do I have experience of the UK NHS? Very much so, and very extensive too.

        Following a devastating RTA ( road traffic accident ) in April 1990 I was hospitalized for 21 months. During this time I spent 9 weeks ICU, and following being finally settled into a private room, ( private in that it was a single closed hospital room as opposed to a ward ), I then spent 19 further months being tended to day and night by underpaid and under valued nurses and doctors ( and a whole host of additional members of staff all of whom I am eternally grateful too )

        Listing my lengthy procedures and their explanations would take too long, so perhaps giving you all a list of my injuries would be easier so that you may all understand and appreciate that I didn’t have to go BUPA’ to get decent health care:

        ( starting bottom to top )

        Severed Tendon Achilles ( keyhole and micro surgery…complete success )
        Right Leg: 3 fractures
        Left Leg: 2 fractures and kneecap/tendon damage

        Broken Back =
        Spinal Injuries: Lumbar severely damaged Ganglia and Trunk damage as well as the lower sacral vertebral body

        8 broken ribs ( five right and three left )
        Bruised Kidneys ( heavily pressured on impact and the subsequent rolls of the vehicle )
        Left side collarbone broken in two places
        left arm broken in two places

        Fractured skull ( heavy brain swelling )

        Psychological issues arrived post-accident and meant treatment for shock and post traumatic stress disorder

        After being kept alive ( my parents arrived under escort by the local police who had flown them in from home, as they entered the A&E suite and ICU area the priest was administering the last rites ) my parents then had to make the decision on whether or not they wanted to turn the machines off….as the damage to multiple organs and parts of the body had left the doctors not knowing if I would be paralyzed from the waist, or maybe the neck down…or even if I would not be severely brain-damaged. Under the advice of the surgeon they cluing to his belief that I had a 15% window of coming out of the accident walking and talking.

        I thank them all every day for having this belief, not only in me….but in their own strength of conviction and in the talents housed in the fingertips of Dr Easton.

        Two years ( almost ) later I was ultimately and finally discharged and went home for the first time since the crash.

        All of the wonderful care, the first class medical treatment and second to none team of doctors, nurses and surgeons who had all worked tirelessly and selflessly round the clock for a full 21 months of their lives just to save mine, and grant me the best quality of life that they could possibly afford me, came to an end and the bill was handed to me by my ‘main nurse’, ( Alison thank you so much xx )

        It read as follows……..

        From all the team on Ward 2 have a wonderful life. We told you that you’d make it

        For all those people claiming elitism from the NHS, I am an ex-soldier now working as a journalist. I was not born into an upper class family, Hell, not even middle class. I am a normal guy, with bills and banks charges like everyone else. But one thing I have that it would seem many who do not appreciate the massive job that the NHS do is this…..

        GRATITUDE

        If you ever find yourself in the unfortunate circumstances I did, and have a fully laden, refrigerated 14 wheeler hard back slamming into you at 55 miles per hour because the driver is late for work due to sleeping in because of a late night heavy drinking session then I say to you this; I hope and pray that it happens ( if it has to happen at all ), in a country that does not first check your insurance and bank details before dispensing the huge amount of medical attention required just to keep you alive, let alone the enormous task of putting you back together again.

        Some people claim here that the NHS is only good for minor ailments and injuries, this in itself is a pathetic belief. You think you have a choice of which hospital you go to following an accident? You go to the nearest. Not the one with the best care if you can afford it.

        Once again, to all of the nurses, domestics, staff and doctors at the three hospitals and convalescent unit attended I can but humbly offer my most heartfelt gratitude, appreciation and thanks.

        My wife sends her warmest wishes also, ( we met and married after the accident. I was only 20 when it happened and so everything since was given to me by those dedicated men and women)

    5. An example: I found a lump and had achy groin, went to see my GP (not strictly NHS, more of a contractor for NHS), who claimed it was probably nothing. I didn’t want to wait a couple of months for a routine ultrasound, so paid a princely sum of £100 (insurance excess) to get a scan privately. A tumour was found, and 2 days later, on the NHS, had radical unilateral orchidectomy, and within a couple of weeks started the first of 2 rounds of chemo, followed by 5 years of surveillance. I have nothing bad to say about the NHS other than it relies too much on goodwill of its amazing staff.

      1. I agree with this about the goodwill. I have just started work as a junior doctor on a surgery firm. I’m doing less than part time (80%) because I’m a single mum. I did four days last week that constituted a 62 hour week (actually illegal) and on one of these days I left three hours before one of my fellow junior doctors. The day is a hectic round of jobs, constant bleeps with everyone wanting their job prioritised, no lunch break. I’m miserable and I’m not convinced patient care is optimally provided by a team totally overstretched. My registrar went on holiday this weekend and stayed up literally the whole of Thursday night. Lip service is paid to European working hours time directive but it’s very disingenuous. We are told if we start at 7.45 we must leave at 4.45 but this is in the realms of fantasy. Without goodwill the NHS would collapse overnight. Also the culture of patients and relatives complaining and agitating to sue only increases. I think many of these people don’t realise we work our socks off and what a grim life it can be. You should see the state of the doctors’ mess, the grotty offices, the crappy and limited computers to use. Plus as a doctor you don’t even find out your hours or pay until you start work. It’s all very disillusioning but I will still be staying late next week and the week after and the week after…

    6. It’s really not as simple as ‘the same people’ paying the bills and defining levels of care. http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx explains the structure in England for funding. http://www.nice.org.uk/About/Who-we-are NICE defines care and http://www.cqc.org.uk/ the CQC is the independent regulator. The first two are public bodies but not the same body.

      We get short waits and high quality care even when the problem is not simple or clear cut, and this is reflected in the third- to-last paragraph of this story where a comparison of 11 healthcare systems in developed nations put the NHS top :

      http://www.theguardian.com/commentisfree/2014/aug/13/brits-dont-be-fooled-the-nhs-is-brilliant-and-aussies-dont-let-your-guard-down

      Emergency care is free to everyone, so Dr Gunter won’t receive a bill.

      1. Samantha, the NHS is not strictly free for ALL. It is if you are living/staying in the UK for a minimum of 3mths. All EMERGENCY care is free for all (including overseas visitors). So, strictly speaking, non-resident foreigners should pay for non-emergency care, but in reality we’re really bad at actually charging them!

      2. The NHS doesn’t deserve the bad rap it gets, especially if you compare the cost of it to other healtgcare systems (<half the cost of the USA!)

      3. I beg to differ i too was on holiday in England when my knee got very swollen, concerned because i had recently had my knee replaced i went to the ER and was admitted to the hospital where i stayed for 5 days my knee was indeed rejecting they gave me iv antibiotics and blood thinners i got a visit from their trust who told me i needed to pay for my stay. I told them i was a British citizen to which they replied no you are not you have been out of the country too long!! when though i showed her my British passport she still insisted i was no longer British. I got home and had my knee replaced much better now but i did receive a bill for my stay in the hospital. Why all these years i kept my citizenship i don’t know!

      4. Actually the rules are often broken with respect to emergency care. NHS tourism is rife in London. I saw it as a medical student. A foreign national not entitled to NHS care who had had allegedly clear CT/MRI head at home, had flown to London and suddenly developed a ‘severe headache’. He had a third nerve palsy which had to have been there a while from a cerebral aneurysm. He claimed he couldn’t pay for private care and in the end he went to a specialist hospital and was given neurosurgery that would have cost the NHS £30-40K, paid for by British taxpayers. Strictly speaking this was not emergency treatment but it is hard to condemn a patient with such a serious problem to a ghastly and possibly fatal event by refusing to treat and health professionals err on the side of compassion. I’ve also seen women pitch up in maternity units in labour having recently come to the UK with no medical notes. By definition high risk owing to no maternity history and using up resources owed to UK and EU patients. It is unsustainable and overseas governments are tacit in this practice.

      5. He obviously didn’t go to A&E on a Saturday night then. Waiting rooms at weekends are a mess of drunken thugs with split eyes and mentally ill patients having missed their medication. One of my recent experiences in a hospital ward was the equivalent of an overpacked pig squaller with 90% of the ward being elderly and/or deranged. Nurses were being worked off their feet and sometimes forgetting what to do next or missing patients.

      6. Sorry just found this … having read down to here,,,despite it being an emergency Dr.Gunter did have insurance,,there should be someone in the hospital to administrate payment..makes sense to me!

    7. ‘same people paying the bills and defining what constitutes good care’ – In the UK, these people are the patients who use the service every day and the doctors who treat them / In the US, these people are giant disconnected insurance companies with shareholders and dividend payments. I’m truly offended by what some Americans say about the NHS. It’s sensible, efficient, safe and most importantly free healthcare for everyone, based upon who needs it most. It is inhuman what the American system puts tens of millions of people through for the very slightly faster than average and likely overzealous care of the rest.

      1. Hear hear. Tell me the Queens an owld posh cow as much as you like but don’t say a bad word about my NHS.

    8. Loren,
      “There’s also the fact that they basically rely on the regulators rather than lawsuits to deal with bad doctors”

      In 2011/12 the NHS litigation authority paid out £1.2 billion in claims (may include legal costs). I say that not as praise or blame the NHS, just to point out doctors do get sued.

      I have no idea how it compares with the US or others, and I’m not sure it covers GPs – whatever they are in US – family doctors?

      1. In the US doctors routinely take out malpractice insurance to cover lawsuits of several million dollars, though it varies from state to state and depending on the doctor’s specialty. When I lived in New Jersey, many obstetrician/gynecologists were dropping their obstetrics practices and offering only gynecology because the cost of malpractice insurance was driving them out of business.

        As far as GPs, there is some difference between a GP and a family doctor, but for most purposes they are the same. Very few doctors are going into general practice in the US because they don’t make enough money to cover the cost of medical school and insurance fees.

    9. The thing that astounds me here is that you think lawyers are a better regulator than a panel of experts in the field. For many of us outside the US this is exactly what is wrong with your system and why it’s so expensive for no real gain.
      My Father in Law has just had a tumour diagnosed on his leg. Two days later he had an operation to have it removed, another 4 days for the skin graft and now he’s home. It wasn’t a particularly aggressive tumour (no chemo or radio required to follow up) it was just dealt with that quickly. Now it’s not always that good and non-emergency appointments with a GP can take a while but I wouldn’t trade it for a system of insurance that will refuse to pay out if there’s the slightest excuse.

    10. When I was 17, it was discovered through a fairly unlikely sequence of events that I had a congenital heart defect, a coarctation of the aorta and associated bicuspid valve. That was discovered at the end of March and surgery was scheduled for the beginning of August (it was not life threatening and therefore did not require emergency surgery). The surgery to fix the coarctation was completed on a Thursday afternoon and I was home by the Monday morning. Ever since I have had annual checkups, which have now been changed to 18 month checkups to monitor my progress as, at some point, the valve will have to be replaced. I am currently on perindopril for my blood pressure, the prescription charges for which I pay £8.10 a quarter. I have received an MRI (during which I also found out about an incredibly rare and deadly serious allergy to gadolinium which means I no longer receive MRI scans), several CT scans, several echocardiograms, a few exercise tests, several electrocardiograms, a 24 hour electrocardiogram and a 24 hour blood pressure check. I have also had blood taken for tests more times than I care to count for various tests. So far, those prescription charges are all I’ve had to pay.

      My mother was diagnosed with breast cancer in 2006, which became terminal at the beginning of 2008 during which she was given a 3 to 6 month prognosis. Happily, she is still with us in no small part due to the excellent care that she has received on the NHS. She has sad a few bouts of radiotherapy and several of chemotherapy. Sadly she’s also had to be hospitalised several times due to related ailments (usually due to her weakened immune system and a few times because of gall bladder issues). At one point she was in hospital for nearly a month straight.

      I’m not telling you all this to brag about the greatness of the NHS, I’m aware that there are problems with it, but for both myself and my mother we have received excellent care. I’m sure that we could have received care of a similar quality under the American health system, but I’m fairly certain that my health insurance costs would be pretty expensive and that my parents would have been bankrupted by now.

      1. For an interesting head-to-head comparison, I also had a congenital coarctation of the aorta (but no associated bicuspid valve) while living in the Boston area. This was over 20 years ago, and I was 9, so my memory is a bit fuzzy, but I too waited something like 6 months in between diagnosis and surgery. I was in the hospital for a couple of weeks following surgery (although that might have had to do with what procedures were available then versus now). My followups have also included only one MRI, and that was part of a special study on coarctation repairs that a grant paid for. There were about 10 years when I would get an annual echocardiogram, but these days I have no followup treatment whatsoever except for my GPs listening a bit more carefully than they might otherwise.

        So at the very least, it’s hard to say that my care, in one of the top pediatric hospitals in the United States, was any better than what NHS provided. And my family had excellent health insurance coverage at the time.

      2. the “allergy” to the contrast agent is not that rare. search around and you will find it happens a lot, and a lot of times the patient/victim is not as lucky as you were.
        that stuff is poison, flat out deadly. you sound pretty smart and aware of your condition, good luck in the future

    11. I worked in nhs for 8 years then transferred here here in America.. in nursing prospective the care is a big difference.. In uk we actually cared our patient.. We can shower them blew dry their hair.. Reposition every 2 hours… Skin breakdown and wound infection is way low compared here in America….here in America as a nurse we spent 50 percent computer 50 percent with patient …. How aggressive their treatment.. We’ll as a patient, me and my husband tried to have a baby for 1 year and I can’t went to my Doctor, did all the test and found out that I can’t have a baby.. Put me in a waiting list for IVF,, waited for 2 months.. Did my IVF for free.. During pregnancy I develop ovarian hyper stimulation.. Off sick the whole pregnancy, I still receive full salary paid my nHS hospital ,my employer…then I have my Caesarian section and my son was in NICU for 5 days… Everything is free… I own a lot with NHS UK…. I’m a happy employee and happy patient…

    12. Loren in nursing prospective the care that we provide to out patient with heart surgery is fantastic…our care not only during hospitalization but include when they go home… When a patient will be discharged we give them 1 months supply medication that’s included with their discharged.. And then we give them prescription that they can get from the pharmacy after one months for free.. The only thing they need to do is signed the prescription and the pharmacy will give the medication for free…we call the community nurse and their GP for follow up if they need inr check or wound care.. Community nurse will nurse will go to their house they get the blood or wound dressing…rehabilitation in the community is also provided… I also experience community health care after Caesarian section..when I was discharged they give me a medicine for my pain medication, and also medication for my son… Even pampers they give me a box of pampers… After hospital I don’t need to go to phamacy .. The community nurse visit me every day for 2 week for education on breast feeding , how to take care of my son washing umbilical care and she also do my wound dressing….they 2 times weekly for 4 weeks until every is okey…no money involve….

    13. I agree with you regarding pain seeker patient here in America.. A lot of patient just go to hospital for chronic pain.. In UK they don’t tolerate drug seeker…after heart surgery they will just go home with cocodamol when they are discharged… Morphine is the highest pain medication that I know they give day 0 to day 1 after surgery then they give oxycodone until day3 but after that cocodamol…. Patient are not used of pain medication that’s why we don’t have problem to controlled pain.. But here in America.. Even the patient had surgery for years .. They are still on dilaudid… That’s is a shame… NHS doesn’t work here

      1. Actually, I’m a couple of weeks into a bone graft and hook plate on my clavicle. I was prescribed oral morphine initially for when the nerve block wore off and then Tramadol. The NHS has done fine with addressing my pain management post op.

    14. Hi Loren. I misread your sentences “The basic problem with NHS-style systems is that you have the same people paying the bills and defining what constitutes good care. That’s a big conflict of interest and the patients in the grey areas tend to get bit by it.” I think it’s because I immediately thought you meant the people who pay the bills meant the British tax payer. Which is true. We do pay the bills and indirectly decide on the level of care through the cultural history of the Welfare State. You are right about different approaches in the case of end of life care and decisions about levels of, for instance, cancer care. I think these are cultural issues, though: from our side we might question the appropriateness of insurance companies deciding on the level of care based on ability to pay. You are also right about issues such as joint replacement and elective treatments. This situation has improved a great deal simply because resources are saved by swift treatment rather than delayed treatment. It is an issue, but one which is somewhat mythologised and exaggerated in some quarters. Another real problem facing our state organised/tax funded system is the increasing age of our population and attendant healthcare requirements. The more healthcare we need and expect, the more we (taxpayers) need to make the decisions about how we fund it. Sadly, our current government have decided to dramatically accelerate privatisation plans without a national discussion about whether we as a people want to discard our mutual covenant to care for each other as a society. “The closest the UK has to a religion” is an oft quoted truism about the NHS, and there’s a reason for that.

    15. As opposed to (for example) the US style system, where the person (company) paying the bills knows that every penny they don’t pay out they get to keep for themselves. Now there’s a real conflict of interest.

    16. To your comment about conflict of interest: IMHO we actually have the same issue here in the US, it’s just obscured, chaotic and profit-driven. The insurance industry largely pays the bill for #healthcare, and so wields a great deal of power over treatments and physician practices by determining what it will and won’t pay for, not always bothering to justify either case to patients or doctors. When it does, it cites cherry-picked “studies” (most often by ordinary physicians, not research MDs, carried out on their own patients most usually involving 45 cases or fewer) or designer research it has paid for to achieve its desired outcomes. Even in the case of government sponsored programs such as Medicare and Medicaid, insurance and healthcare industry lobbyists wield a great amount of influence over those healthcare systems as well.

    17. Loren, do you have any experience of these “NHS-style systems” of which you speak? Yes, her son had something in his eye which got dealt with quickly, but when I had a mystery illness as a child it was also dealt with quickly, a very close friend of mine died from leukemia and he received treatment second to none. I recently broke my ankle and have had outstanding service from the minute I walked into A&E, right the way through to receiving physio to enable me to return to running. All for free. And if I think I need more physio then my GP will arrange it. When/If I decide to have the pins removed from my ankle, my GP will arrange it. I might have to wait a few months but it will happen. For free. I have also spent a number of years in the US and my experience of hospitals there is “Check they can pay” first then treat. If you can’t pay then you can’t be treated. The NHS may be flawed but it is accessible to all. It is a basic human right to have access to medical care and that should not matter how privileged or wealthy you are. If you need medical care you should get it.
      We have regulators who are medical professionals -surely that is better than a lawyer?
      I honestly don’t understand why America is so against access to free medical care.

    18. I find it so bizarre that you would come to any kind of conclusion based on hearsay and hunches. Have you, for instance, done statistical analysis? You might be shocked. As for this: “Now, if the issue was expensive, not so clear cut and something elective things tend to go differently. (For example, when do you do the joint replacement? How aggressive are you in going after the cancer?)” it’s just complete and utter nonsense. As someone who has had joint surgery (as a young man) and whose wife was very aggressively treated for cancer at the age of 31, ALL on the NHS, I know I’m not alone in calling out your ignorance. And when I call you ignorant, I’m not doing so to insult you. I’m doing so in the hope you see it for what it is and actually look into the thing you are so ready to dismiss as dysfunctional.

    19. Bullshit. Total and utter bullshit. My mum is alive today because of the excellent care she received at the hands of the NHS. She got cutting edge treatment sponsored by smith kline beecham because the teaching hospital she was treated at has a state-of-the-art oncology research centre funded by SKB. NHS Drs give you the best that they’ve got, actually, as in my mother’s case, better shit than you’d get privately.

    20. Just as an extra example. Last year I had some acute pain in my lower abdomen which pain killers didn’t deal with. I called up the out of hours GP, it being 3am. This is a non emergency service provided for all UK residents where a doctor triages you over the phone. I was recommended to go to accident and emergency, ER, as soon as I could. I went to my nearest hospital, luckily quite early in the day, about 9am, got registered with the admin nurse, triaged by a senior nurse after a 10min wait and sent in. They took some blood and urine samples as a first check and after a brief wait was told that I would need a CT scan. Although I wasn’t booked in, which would normally have taken another day, they didn’t need to do a full body scan just a lower abdominal scan and were able to slot me in. Interestingly enough I had a nice little chat with an American nursing student. After another 5min wait I had my CT scan and sent back to the ward where I was sent to a room where I could have been checked into but the doctor quickly came in just as I was settling down and said that I had kidney stones, one of which was large enough to block a ureter but small enough that it could pass on its own without surgery. She prescribed a muscle relaxant to help me pass it and I was sent home. I got in at 9am, was seen to, had blood and urine tests and a CT scan all done by 1pm. I was told that I need to come back the next day to pick up the drugs as they were hospital issue only. So I went back the next day to pick them up. The stones cleared up after the course of drugs. If I had all that in the US, I’d have no idea how much that would have cost. In the UK, all it cost was £8 for the drugs, everything else was covered by the NHS. I even later spoke to my GP and requested that he book me in for an ultrasound as a follow up. That was booked in for the following week. I went in and got it done late in the afternoon, just walked in, got the scan, and walked out again. All charged against the NHS which my taxes were paying for.

      Sure there are grey areas but those are covered by specific guidelines, but on the whole the NHS is an excellent system. Australia, where I’m from, has a similar system called Medicare but it also has a very strong private health insurance system. The public health system covers most things but the private health insurance allows you the flexibility to have elective surgery when you require it without going on the public waiting lists. Having experienced both systems, I can definitely say that it is far, far superior and a whole lot less costly than the US system. Never have I heard of anyone in either country that has been so burdened down by health costs as to declare bankruptcy.
      I would go so far to say that it is the main reason that I would never choose to work in the US.

    21. Your talking out of your arse, with all due respect. There is massive growth in litigation in this country with the wonderfull American import of no-win-no-fee. We actually have a transparent system where problems can be seen, rather than hidden in court rooms. WE pay the bills, not government, and the public voice regarding standard of care is huge and growing. This from a country where infant mortality is one of the worst in the western world, and your politiants see the poor and dying as a waste of money. Even our private health care is probably half the cost of the US. Where do think half your advances in surgery come from, transplantation, bi-pass. I can’t image a member of my family becoming critically ill and worrying if they wonderfull medical insurance system might cure them, and then leave them on the street when they take the house. World class American health care, keep it!

      1. Having a transparent problem where the problems can be seen doesn’t mean squat if they aren’t addressed when they’re seen. Our lawsuit-based approach isn’t good but it’s better than the medical boards that do almost nothing unless somebody dies. If the boards would do their job I would be happy to get rid of our lawyer-based approach.

    22. Interesting you say that it entirely relates on the regulators. I spoke to an NHS anaesthetist today who was complaining on the number of lawsuits OBGYNs and Anaesthetists are subject to on the basis of a twinge of pain whilst under an epidural in labour. Realistically epidurals are not a magic bullet so this has more to do with circumstance of biology than malpractice and yet it does change the manner and speed in which epidurals are dealt with under the NHS. So, as an example, I think you can see there are many opportunities for accountability under the NHS, expedited care being a consequence of lawsuit not regulators for examples. We are not immune to the same factors that influence care in the US, the regulators just add an extra layer of accountability on the side of patients by offering evidence rather than profit led care (another example being NICE guidelines on Group B Strep testing and treatment in pregnancy).

    23. Loren – “Drug seeking fakers” are unlikely to be successful as no one has an incentive to prescribe them what they want without obvious need. And even if they did, for example, want to get a troublesome patient out of their hospital by giving them some drugs, they would simply prescribe the smallest dose, which would still be subject to the standard prescription fee (around $10, most English taxpayers (i.e. not on benefits, retired, or under 16) have to pay this, regardless of the actual cost of the medication) so it’s hard to get ‘free’ drugs out of the system.

    24. As a cardiologist in the nhs I would entirely agree.
      Great comments.
      The nhs does well in these situation and also in hyper acute v sick patients (once recognised). Mostly the rest is completely sub-standard.
      The quicker we get rid of it the better…

    25. Loren, we all pay the bill from our National insurance contributions, we pay the same percentage of our wage so if you earn more you pay more. I’m lucky enough (touch wood) to say I have hardly ever needed the NHS in my 44 years so I have in effect paid for a lot of other peoples care….and I’m happy with that, it’s a great system and as to regulators rather than lawyers…that isn’t even an argument as far as I’m concerned…I’m surprised your doctors aren’t too scared to touch anyone! No thanks!

    26. Here we have the classic response from someone who has no idea what an ‘NHS-style system’ actually means, or how it operates. Decisions along the entire length of your care are taken solely by medical doctors who are treating you. They make every decision based upon clinical reasons and are sworn to do no harm and to preserve life. If a doctor in the NHS wants to give you the most expensive course of treatment available to man, because it works, then they will give you that treatment. No bureaucrat or insurance provider has any say in the matter, ever. Thank you, I’ll keep our allegedly compromised system, and you can continue being a proponent of a system where a corporate insurance claim assessor gets to pick and choose what they will and will not pay for your treatment, based upon cost and your assumed ability to survive and pay for it. I’m sure they will do a wonderful job of clinical diagnosis and treatment. Of course, that all assumes that you actually have insurance that covers it at all. Who needs savings and a home, eh?

    27. The NHS is pretty good in all aspects although sometimes a wait for surgery and seeing a GP will take a week if its not urgent but that’s not so bad. see the commonwealth fund assessment(American) of 11 developed countries NHS came top USA came last. The only problem is people abusing it cos its free hence expect everything for nothing and it is being overwhelmed currently and not great if you are one of the people working in it. Currently the UK government is trying to close/sell it off to private companies and perhaps the NHS will soon be no more and people will wonder why they complained.
      Unfortunately it if over regulated one of the stressors to work in it there is so much paperwork , targets and inspectiions from so many organisations it is being strangled and doctors have too little freedom but this is meant to keep costs down but probably does the opposite. The UK is pretty litigious as people here love to complain, perhaps not quite as much in the US but more than many other places.
      I just hope brits stand up for their NHS and realise whats important = patient care not gov targets and convenience although this would be nice we must get priorities right.

    28. Are you from the UK? My 87 year old grandma was diagnosed with breast cancer. She got her results on the same day as her tests were done and was told that it was not aggressive. She was told what her options were and was scheduled to return within a week to discuss what she wanted to do. They wanted her to have a double mastectomy and to have her lymph nodes removed.

      When she returned, they had scheduled her surgery the following Wednesday however she declined the treatment and decided to accept the medication that they had also told her was another option due to the receptors in her body. She took these for the next 3years.

      My grandma died in April at the age of 90 from a sudden heart attack following a fall in her kitchen, not from cancer.

      My mum’s friend was in remission within 5weeks of being diagnosed after she had stem cell therapy.

      My uncle’s wife had a lump removed after being diagnosis with an aggressive type of breast cancer. She had surgery 4 days after her diagnosis and anyone who presents at their doctors with lumps have to be seen at the diagnostic department for cancer at their local hospital within 7 days of their doctors appointment.

      A hip replacement is supposed to take 16 weeks from first presenting at the doctors and then having the actual surgery. During this time you attend 2 workshops where they show you what the surgery involves and what the new hip looks like and how it works, and then also to teach you how to dress yourself, pick things up etc. You are also given equipment at home to raise your toilet and couch so you don’t cause injury during your recovery.

      The NHS may not be perfect and definitely has some flaws, but I lived in the UK until I was 28 and have lived in the US for 4 years. I have absolutely no complaints about the healthcare I or anyone in my family has ever received from the NHS, and hate the drug-pushing medical system here that gives a almost every child under 12 an ADHD diagnosis, makes you get a prescription to treat a UTI infection, and tries to prescribe a 10day supply of vicadin to my husband because he sprained his thumb with a hammer whilst laying laminate flooring, despite him not being in any pain!

      When a government has an investment in the health of a country it is also less likely to allow companies to use carcinogens in its products, hence the reason there are so many products that are still used in farming and beauty products in the US, despite being banned in the EU because they are known to cause cancer.

      Every system has its strengths and weaknesses but the US health care system is far from perfect and I have much more trust in the NHS….because I know that they don’t just see the $$$ signs when I need help or treatment!

    29. Loren, in the past 5 years, my father has had excellent ongoing care for both primary and secondary cancers. My mother has had a hip replacement and my youngest daughter was born healthy after a complicated pregnancy requiring fortnightly trips to have her progress monitored sometimes by up to 5 consultants at a time.

      In the US, the medical bills for any one of these family members would be astronomical and crippling without very good health insurance. Here in the UK, all this treatment has been provided free, (paid for of course out of our taxes.) I am eternally grateful to the existence of the NHS and will fight tooth and claw against the neo-liberalists who want it privatised.

      The only thing I can see to be grateful to the US system for is that it gave us Breaking Bad.

    30. Loren – in the US, those paying the bills (insurers) are the sole decision-makers in what will be reimbursed, regardless of whether or not it constitutes good care. Do you not see the conflict of interest there? And are you actually suggesting that lawsuits are a better way of regulating quality of care than actual evidence-based government regulators? Lawsuits are a large part of the reason that healthcare costs in the US are so disproportionate with the rest of the developed world, along with the strikingly inefficient model of healthcare reimbursement via private insurers. I’m American but have lived in 8 other countries – 4 European and 4 developing countries. The only place I’ve lived where I would be more wary of receiving healthcare than in the US is Papua New Guinea, and that’s really not saying much at all.

    31. Loren, you make a great point. Having experienced both systems, it was just a difference of who was telling me what I couldn’t have.

    32. *Any* emergency operation would be undertaken just as quickly here as in the US and without any quibbling about payment, even for tourists (the Tories are considering changing that so it excludes non-residents but I think they’ll fail). The really huge difference between here and the USA is here the NHS treats all mental health cases rather than the system waiting tp make money from them when they offend and are put in jail.

    33. I am a UK citizen who is chronically ill with fibromyalgia. Unfortunately it seems this is a genetic thing as both my father and his brother and my niece have it. We also have joint problems – my father, his brother, their father and myself have all had to have operations on our knees. My father has had both a hip and knee replacement within the last 2 years and needs both other joint replacing as well. Was their and my own care of a poor standard? absolutely not. Long waits? no. Probably longer than they would be if we wer rich and lived in the states but what difference will a coupld weeks make when it’s not a life threatening issue? Does the NHS have a downside? Yes. Sometimes the wait is long – especially for ADULT A&E waits but would I prefer to wait so anyone with a more serious injury gets seen first? YES. I’d rather the wait is dependent upon the seriousness of injury than who can and who cannot pay. One day I might be that person with a more serious injury! I have known people who’ve had their operations and treatment in private centres – both through choice and via the NHS – and yes – there is definitely better faciliies for the patient in private centres but NOT any that would make a difference regarding care. I mean things like having a private room and more choice of a menu if you pay privately but nothing in my opinion that would make a difference to a patient’s medical care. Sometimes it takes too long to get a condition diagnosed in the NHS because it’s harder to just go straight to a specialist but NOT if that condition was potentially life-threatening. I have a friend whose sister married an american and has lived in america with him and their children ever since. She works in healthcare. Her healthcare insurance is around $1000 a MONTH! and she still can’t afford to get her child’s wonky teeth sorted! Many of my nieces and nephews have had braces and it’s all free, very quick service and excellent aftercare. My friend’s sister was thinking of moving back to the UK just so she could get her child’s teeth sorted out. I am amazed that anyone could afford to pay so much just for their healthcare! I hear stories of people left to die in the states because they haven’t any insurance or not getting anything other than emergency care. Of being sent massive bills and being make bankrupt because they can’t pay. How can anyone think a system that depends on your financial status for medical care is a just and humane one? I can no longer work as am so ill and have to take over 30 pills a day and have had numerous treatments like hydrotherapy and acupuncture and lost and lots of x-rays, MRIs and CT scans – there’s usually a few weeks to wait for an appointment for one of those as not life-threatening and another couple weeks for the results but that’s nothing. There’s lots of choice here about where you have your treatment and excellent facilities. I love knowing I can call an ambulance and it’ll be there within 5 mins (albeit I live in a city not rurally), same with he police or fire service. Most UK citizens are absolutely terrified at the thought of our NHS going private – one of the reasons UKIP (UK Independence Party) is doing so fantastically well here because our existing and previous leaders have been slowing selling it off. And once the TTIP is signed then that’ll be the death of our NHS. Yes the NHS is haemorraging money via health tourism and fraud etc but that can all be fixed and the majority of the british public would happily pay a premium to get it fixed to save our NHS. I live on benefits (welfare) and although am luckier than most as I get all the disability benefits (in total I get nearly £300 a week including my housing costs and disability benefits) so am not struggling. I would happily pay out of those. It would be harder for my nephew of course who only gets unemployment benefit though (about £70 a week). Are these benefits time-limited? no – of course there are regular reviews on disability benefits and yes there’s been a LOT of problems recently with those – largely because it’s been contracted out to american firms and the Dept Work & Pensions (DWP) have got it all wrong. But again, this is fixable and it’s improving. Do I feel guilty that my benefits are higher than some people in work get paid? No. why? because I am sick and disabled as a result. I get worse each year. I live in constant pain and HAVE NO CHOICE. No opportunity to change my job for a better paid one or HOPE that in 5 yrs I will have been promoted and got more money. NO CHANCE to one day own my own home and take 2 holidays a year or have a nicer car. This will be my income (I hope) for the rest of my life and I know things can never be better, only worse, as I get sicker every year and ever more disabled. I can get very little more in benefits as my condition gets worse and by then I will need assistance to function. I have little freedom left to me because of being so restricted in what I can do – I can’t go out for a days shopping with friends anymore or day trips or holidays or theatre or a meal. Both because I have no spare money and because of the problems anything like that presents in terms of my condition. I lost my dream of being a Science Teacher because of this illness but worked since I was 11 yrs old and never not had one or more jobs in all my working life until I became too ill to sustain a job 4 yrs ago. I paid into the system all those years and still do via VAT and Tax on everything I buy or every bill I pay. as did and do my family and ancestors so that I could and would be cared for by the state if I became too ill to work. But now they are talking about making our welfare state more similar to the american one: “Smart Cards” akin to your food stamps and disallowing some groups from some benefits like 18-21 yr olds from housing benefit and unemployment benefit if they won’t work for free for the government. Again another reason for UKIP’s meteoric rise. Do I want to see families with kids sleeping in tents under bridges? People begging in the streets? People starving or forced into a situation where the state controls how they spend their benefits? People penalised for life because of a poor decision they may have made? or their parents social class or their religion, gender or ethnicity? NO!!! Yet because of the horrendous actions on the welfare state our current government have done over the past 3 years we have people starving to death, an a monumentous increase in begging and homelessness, of people NOT being supported by the state. But we only have one more year of the Tories in government so there is much hope and maybe this lesson will have taught those who think our system is too “generous” the folly of that belief. Hopefully this has proven to those that say our system was broke that this is what happens when you try to change it too fast – people die; people’s lives are forever impacted in a negative way. My friend who visits her sister in Florida tells me of the “tent cities” and how awful they are. What kind of society allows children to have no home? Allows people to die if they cannot pay? or makes them bankrupt because they got sick? or provides vastly differing levels and quality of care for those who have but not for those who have not? We get a lot of stick for our system encouraging young pregnancy but thats rubbish. Young pregnancy is as much about lack of education and opportunities than anything else. My 16 yr old niece chose to get pregnant not for a “council flat” (i.e social housing) but because school was finished & she had no idea what to do now and all her friends were getting pregnant – get pregnant and you don’t need to worry about what to do and not being able to afford to live independently etc as the state will look after you and your child – you’ll get a lovely flat (very good quality), your rent paid and plenty of money, free education for your child and some for you. Does that mean our benefits are too generous? No! because regardless of the reasons EVERY CHILD has a right to good quality housing and excellent quality & free healthcare and education and other social services and a mum who isn’t living in destitution and who can be supported in training etc so when that child goes to school she can further her career. Improve our educational system, provide contraception in schools so they don’t have to go somewhere else for it, grow the economy and provide more career opportunities to youngsters and teen pregnancy rates will drop. My nieces friend didn’t even know at the age of 16 how a girl got pregnant for crying out loud! Would I prefer for young mums to be prioritised over childless social housing applicants than to see kids being taken into care because their mum has no home or worse yet! see that mum & child homeless and on the streets – tent or otherwise: of course I would! I see clips on tv and films showing the kind of housing poor americans have to live in and I thank God I live in the UK! My flat is a high standard – not the best of course but then I don’t expect it to have a £3000 kitchen – and my landlords excellent. They offer free courses for tenants – some to get them into work and others to improve our quality of life e.g first aid training and healthy cooking classes; they are always there for advice on tenancy issues or financial assistance with benefits or budgeting or debt. They give to their communities with community projects and investments and their residents’ panels and committees have a huge say in how their money is spent. I’ve just had free cladding upgrades to my property so my heating bills will be reduced which they are doing to all their properties. Annual gas and electricity safety checks, new windows and if anything breaks they fix it with no charge. They have done loads of work to adapt my home for my needs and soon I will have off-road parking because there’s limited parking and I need a space close to my door. Did I have to pay for this? No. Did I have to pay for a wet room to be put in for me? or a hard-standing and widened and leveled path for my mobility scooter? or the outside plug socket to charge it? or the widened doorways or the shower stool and kitchen perching stool or crutches or walking sticks or supports or hand rails and grab rails and raised toilet seat? No. Do my parents have to pay for their adaptations? No. They are now being given a stairlift by the NHS so they won’t have to move. Do they have to pay? no. Would the larger adaptations have been done faster if we’d paid for them? of course. But then we couldn’t pay so they wouldn’t have been done at all if we’d not been given them. Like most UK citizens I thank God I’m British and was born in the UK. A truly humane society that cares for it’s citizens health & well being before anything else. Could our systems be better? More efficient and quicker maybe? Of course. But they are better than nothing and so much better than anywhere else in the world (that I know of) – to complain is like moaning that we’ve been given 18ct gold instead of 24ct! We are in a recession after all and the needs of a population change over time and change takes time and money. We all moan – it’s human nature to always want more as it is human nature to always want someone to be worse off than yourself – but sometimes people you need to look around you and compare your society to others and think about what life would be like for the most disadvantaged in your society (because one day fate could make that person YOU, or your son, daughter, grandchild, niece or nephew or mum or dad etc etc) living in THAT society and then you will realise just how lucky we are to be British.

    34. To Loren,
      Wrong, the people who pay the bills do not define what constitutes good care. You are not very well informed about healthcare in the UK, are you?
      Have you ever heard of the CQC? Have you heard of the King’s Fund, or NICE.

      The people who provide healthcare ignore any of those three at their peril.

      As for litigation, that’s a growing trend in the UK and every hospital waiting room ironically displays advertisements placed by ambulance chasing, sorry, medical negligence lawyers.

  3. You might get a bill, but I’d be very surprised if you do; all emergency care in the UK is normally free. Elective treatment, unless you qualify for it, may well be charged for. The NHS, however, is not really set up for billing.

    I’m curious about one part of your story; how did you do an eye wash-out, what fluid did you use? It’s hardly the sort of thing that most of us are prepared for.

    Does it matter if the slit lamp wasn’t new?

    1. I bought a bottle on Evian for his eye!

      I commented on the slit lamp as a lot of equipment in ERs here seems the latest and greatest. The point is if an old slit lamp works just fine, that’s great!

  4. I’m an American doctor with quite a bit of NHS experience. I did part of my medical school training in Scotland in the early 90s, a health policy fellowship in England in the late 90s and have spent fairly long periods there since working and on holiday. Nothing but good experiences to say of the NHS. An ER visit with my very ill mum was pretty much as you describe. A multi-specialist, months long, diagnostic enigma for myself was better than same event repeated in the US by a long shot. When I’d call to get an appointment with my GP and they apologized for not being able to get me in that day (“would tomorrow do?”) I would just laugh and say I was actually thinking about a couple of weeks hence. And the care was great. So, in my N of 1 personal experience of acute, chronic and diagnostic care I’d say they were pretty darn good. I’m willing to say that I’ve probably gotten different care in the UK because I’m a physician, but that is also true in the US.

    1. American doctors rarely work in the NHS, I have not come across one since I qualified 30 years ago. Whereas my hospital has many doctors who originate from all over the developed – and less developed – world. It would appear that US doctors, healthcare planners and politicians are inculcated with a doctrine that all is for the best in their best of all possible worlds and that there is nothing that they have to learn for other healthcare systems.
      Others have pointed out the Commonwealth Fund (which is based in US) report that the evidence rates the NHS top and the US system lowest.
      The core thing to understand is that the NHS is a capacity limited system. It acknowledges that the state’s (e.g. the taxpayer’s) resource is not infinite. So measures have been put in place to ensure that treatments are effective – the role of NICE. Further regulatory measures are in place to assure the quality and timeliness of the delivery of treatment.
      Whereas in American style systems the system is demand limited – it will deliver “healthcare” to the extent that the market will bear. This results in gross inequality with poor access for the poor and those with chronic conditions such as diabetes. It comes at huge personal cost to individuals, hospital bills are the commonest cause of personal bankruptcy. And it promotes an inefficient system where excess expensive investigations and inappropriate surgical and treatments are rife. Hence the huge spend to little good effect.

      1. To Loren and others as one who lived in UK most of my life but last nine years employed in US. I do get good treatment in US but I have good insurance. Even so, what others have failed to mention is that the insurance companies come directly and frequently between doctor and patient, and they do this financially. An insurance company can directly influence or even refuse a drug that a doctor has prescribed (I have seen several very serious incidents of this since being here). Mostly they do this by putting the co-pay for the drug at 25% or even 50% of the drug’s cost. In one friend’s case this meant $600 a week for a life-saving drug. Without his church’s help he would have gone without and perhaps died! Co-pays are the mechanism insurance companies limit what care people seek in US. Just one example, when I return to for vacation I usually buy 2 Ventolin inhalers prescribed by my doctor for asthma. I buy them privately (not NHS) since I am no longer under the NHS. I pay around $40 for the two. In US the insurers allow a maximum of one per month, and my co-pay for one is $55!
        Another issue is the way the insurers never tell the whole truth. This may be TMI, if so sorry. But under the new health care policies preventative treatment is largely (and finally!) “free” in US. So my insurers write and say “free colonoscopy, time to get one”. I did. Small polip (is that how it’s spelt?) was found. Doctor says about 30 seconds extra to what he had planned to do! I wake up to find it is now coded as “diagnostic”. With doctor and nursing and hospital and other bills over the next six months, I finally found I spent the whole of my $3000 insurance deducible and at no point did I ever give permission for this … but I find permission was not needed. In fact six months later after long calls to the insurers they persuaded the hosiptal to bill it as “preventative” and the insurance did pay. And so it goes on. The last three visits to specialists have resulted in “wrong coding”, .. another half hour on phone to insurers who tell me to phone the hospital and get it recoded so the insurers will pay. Hospital takes weeks. I call them again. Finally a collection agency. Call insurers they then call hospital and all is put right in the end. But most of our friends here see that as the norm for their health care. I love the NHS and specially that I do not worry about whether I really need that prescription because the co-pay is so much!
        Great discussion on this thread!

  5. Another American here. I was on a semester abroad in the UK when I became ill – very ill. My college had advised me that I was not entitled to NHS care, so I made an appointment with a private doctor, who diagnosed flu. I got worse and saw the private doctor again, who said I just needed to keep taking my flu medicine. Less than 48 hours later my alarmed flatmates phoned the paramedics, who brought me into an NHS hospital where I was immediately diagnosed with pneumonia which was now at an advanced stage. Had I continued to follow the private doctor’s advice, I would likely have died. I remained in the hospital for 8 days, received absolutely wonderful care from an extremely attentive and professional staff, and made a full recovery. I was never billed for anything, except the non-NHS doctor who nearly killed me.

  6. Hi Jen , this might sound a bit rude – not intended to be , but , being near Westminster and the Houses of Parliament it is probably visited by MPs and they don’t like to be kept waiting . It’s one of the hospitals they are not going to close down , where as many are with A&E ( ER ) unit closing as well . I’m glad that Victor had a nice experience and all stays good for him .

    1. Hang on! They don’t keep a full teaching hospital in place on one of the most expensive pieces of real estate in London just to treat 650 MPs. They treat the local plebs, too, including me when I lived nearby.

      There are two sets of people contending at the moment. There’s the ones who actually believe in the NHS and believe it should be be funded by the taxpayer, as it has been since 1948, and cover all the people all of the time. Then there’s the ones who believe, against all the evidence, that a health service run as a set of barely connected for-profit operations will magically produce something better. Or if it doesn’t, at least their friends will make a bit of money.

      The second set are the ones going about trying to close A&E departments – they are trying to do it near me – on the rather dodgy premise that if there’s no A&E people will be “diverted to other, cheaper facilities.” These other facilities do not yet exist and there are no firm plans to create them but the closures are imminent. The phrase smoke and mirrors springs instantly to mind.

      1. You were right the first time; the NHS began on 5 July 1948—began in the sense of treating patients. The necessary legislation had been in place for some time before this.

    2. I don’t think you know St Thomas’s catchment area very well! It’s got one of the most socially-deprived multi-ethnic populations in the UK. Huge teenage pregnancy rates. The idea that it’s kept up just for the sake of a few MPs is ridiculous. If anything STH is a great place because it’s one of the main teaching hospitals in London and attracts excellent clinicians as a result. But you’d still expect the same response times in any local hospital too. I think the NHS is increasingly being asked to bill foreign nationals for medical care as part of efficiency drives, although doctors and nurses have little or no role in this process. It’s generally done by admin clerks.

    3. That is ridiculous. St Thomas is for the local population which is ethnically very diverse. My girlfriend and her family are in the catchment area and her sisters were all born there. Last year I fell and thought I may have broken my wrist. I was in and out of St Thomas’s with a splint within 30 minutes. Staff and service very efficient as I have found it in most hospitals I have visited.

    4. I didn’t live in the catchment area for St Thomas’, but I chose to have my maternity care there. Throughout my pregnancy, which involved many day visits, plus several spells as an in-patient. When the proverbial hit the fan and the health of my baby – and I – were at risk, the medical attention we got was fantastic.

      If all that is because the hospital’s located the other side of the river from parliament, I’ll take it.

    5. St Thomas’ is actually in the borough of Southwark, not Westminster – it’s paid for by a different part of the city. MPs, particularly the more wealthy ones, generally have private medical insurance and would be unlikely to go to a hospital for the proles. St Thomas’ is my local hospital – I’ve had both good and bad experiences of care there, but I remember once when I was very sick and had to be admitted, I called my GP to my house, my GP sent me to hospital by ambulance, and when I was discharged they sent me home in a taxi which they paid for. I told my American friends about this and they said “omg how much did this all cost?!” We are very lucky to get a fantastic service, all included in our taxes.

      1. St Thomas’s was in Lambeth last time I looked, in Bishop’s Ward to be precise. (Guy’s is in Southwark; they are now the same health service trust.) And Westminster Hospital was even closer to Parliament, but was closed some years ago. There used to be even more teaching hospitals in central London, but St George’s and the Charing Cross got moved further out as the concentration was not sensible.
        You can’t die in the Houses of Parliament. Even if you leave the premises not breathing, you don’t die until the ambulance has got moving.

    6. Actually, because it is opposite the Houses of Commons, the Big Ben, Westminster Abbey and in central London the ammount of tourists and passers by this hospital attends is greater than other hospitals in central London. Their A&E (ER) is efficient and I have never experienced a long wait over 30 minutes to be seen first by a triage nurse and then by a Registrar.

      There are systems in place at this and many other NHS hospitals to continously live monitoring patient’s waitings times and prioritize their attention based on triage and appropiate use of the resources and it’s FREE from point of delivery which makes the attention HUMAN!

      If you need to be admitted to the floor for treatment overnight, specialised tests or the OR it is common sense you will have to pay however, prices are based on covering costs rather than maximising profit which makes a HUGE difference with the American system.

    7. St. Thomas’s has been around a long time (as has Parliament), but the geographical nearness of Tommy’s has nothing to do with it’s level of care or the fact it’s not due for closure. “The hospital was described as ancient in 1215 and was named after St Thomas Becket — which suggests it may have been founded after 1173 when Becket was canonised.” (Wikipedia) Parliament roughly as we know it dates from 1295. Our local hospital did close its A&E but replaced it with a Minor Injuries Unit. I had my head stitched up there after colliding with a kerb (curb). When I went in, the nurse practitioner had a look, said she could do it but she was worried that her work might end up pulling up my right eyelid a bit. She said if I was willing to wait 20 – 30 minutes, the chief plastic surgeon would be finished operating and “do” me. I waited, he did, and now I can’t tell where I split my brow wide open (our local hospital specialises in maxillofacial reconstruction, so I got genuine gold-standard treatment).

  7. I’ve always maintained that an NHS A&E (ER) is one of the best places to be if you require urgent care or are seriously ill. Certainly better than a private UK hospital, many of which are glorified hotels with distinctly patchy quality of medical & nursing care if you become acutely unwell. Glad you had such a positive experience.

  8. Dear Jen,

    My name is Rafael and I’m a 4th year family medicine resident from Portugal (which has a kind – of – NHL-like healthcare system). Back when I was a med student I went to London o a Christmas vacation and started feeling a pain in my leg. Being a med student I immediately wanted to make an Housesque diagnosis so I said to my mom, “this is a DVT”. After walking with that pain for almost 48h I thought I might get that checked out as I wasn’t feeling too sure about it.
    I went to St Mary’s (might as well…) and the rest of my story is just like yours. I waited less than 10 min for triage (mind you it was around the 27th of December on an adult-ER). Got examined by a couple of doctors and they scheduled an US for the next day. I ended up having a DVT and by that time they started talking about a follow up consult. The words charge, insurance or anything of the like we’re never present.
    Being from Portugal I was used to having “free” healthcare, but it still amazed me how efficiently the NHS worked…

  9. The wait was short for the NHS, but many hospitals do now fast track kids. The care was as I expect: thorough. I love the NHS, but our government wants it to be more like the US at a time when the US has finally woken up to the fact that this is more than a little disfunctional.

  10. The system is not dissimilar here in Australia (though there are strong moves from our present, conservative government, to move to a more insurance-driven US-style system; the powers help us, no!).

    Over many years, I can think of a dozen Casualty (same as A&E or ER) visits across my family for complaints as minor as a dislocated finger, through broken bones from sporting accidents, to my Dad’s heart attack and stroke in consecutive years. Every time, we’ve been treated rapidly, with respect and dignity, and even told by hospital staff (subtly) to insist upon public treatment (as opposed to treatment under our private health insurance), as we’d receive the same care, in the same bed, from the same specialist. Not once have we been presented with a bill.

    Of course, our system also supports things as mundane as GP checkups and regular visits to the optician.

    It’s for this reason I remain baffled by many in the US who insist that a functional publicly-funded health system is some kind of socialist plot.

  11. I had my tonsils removed in the UK while I was a student over there. I didn’t pay a penny for anything – they even kept me overnight because they wanted to keep an eye on me post surgery. It was an amazing experience.

  12. NHS is the best.
    You will not receive a bill.
    Hope you enjoy the rest of your stay without visiting any more nhs facilities.

    All nhs trusts do have ‘friends’ charities that raise funds for the hospitals.
    People do not realise that many things in hospitals are not bought by the nhs! Incubators, beds, chairs, play equipment, scanners.

  13. You should not get a bill! Emergency care in the UK is free regardless of nationality, visa, asylum-seeker status. Even so-called “health tourists” only account for a tiny part of the NHS budget.

    1. Exactly (FWIW, sexually transmitted diseases are also treated free of charge on the same basis!). Here’s the details http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx

      The person above who had her tonsils taken out probably should have been charged as it’s not an A&E treatment, but lots of hospitals don’t bother because it’s more trouble than it’s worth to deal with the billing process. In principle if you could find a GP to register you as a temporary patient while you were on holiday that would be free too, but I cannot imagine anyone ever bothering with this.

  14. This is such a refreshing read. As a General Practitioner (Family Physician) who trained at St Thomas’ Hospital I’ve contemplated leaving the profession as a result of the media onslaught on GPs and government meddling. Its good to hear the positives sometimes!

    1. Please don’t leave Dr Rehill! We patients need, and value, Doctors, and the majority of us know that the NHS do a fantastic job, you are just understaffed and underfunded. Ignore the Conservatives (and Labour) it’s all just politics. Most people moan about waiting lists for treatment, that seems to be the main gripe, but that’s because of the shortage of staff and funds, and an increasing and ageing population.. The only other thing that wearies some people is the length of time it can take to get a correct diagnosis, but I am sure most people realise that a particular symptom, or set of symptoms, can have a myriad of causes, and that trial and error takes time.

  15. I suffered from severe bilateral sciatica caused by two ruptured discs. I decided that I would prefer to have two vertebrae fused and the other disc cut back than suffer for a further indefinite period of time. I was referred to an orthapaedic surgeon and seen within a fortnight for assessment, then booked in for the operation a week later (I was fortunate that he had a “light” list at the time and could fit me in easily rather than having a 3 month wait). Surgery done, in hospital for a week, treatment with Occupational Therapists/Physios to make sure I could manage when I went home, then District nurse visits at home to change dressings and check progress. Cost? Nothing up front and no bill. I won’t say it costs nothing because we ALL in the UK pay towards things like the NHS whenever we pay any kind of taxes. I can’t recall who I am paraphrasing… we judge a society on how it looks after those who cannot look after themselves. The NHS and Social Security make sure that those who need care or who need help to live get it regardless of their level of income – and most importantly, are allowed to retain a level of dignity at the same time.

    In Australia, they visibly seperate out the tax amount that goes to Medicare (their NHS) – not sure what it is now, but a small percentage of your taxable income is listed as your Medicare Levy along with Income Tax on your tax return – I believe that if you have private health insurance (which does not cover primary care, GPs etc, they are all Medicare) you can get a reduction in the Medicare Levy. But I haven’t lived in Aus for 17 years (though I visit family there frequently) so the nitty gritty has probably changed.

    1. I think you’re probably paraphrasing Aneurin (Nye) Bevan, the Labour politician who as Minister for Health 1945-1951 was in charge of the foundation of the NHS:

      “…no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

      (In Place of Fear, 1952)

  16. Jen might have had a longer wait if she’d come at a busy time; but her experience is typical of UK medical care.

    There’s a lot of bad press about it. But routinely good medical care isn’t newsworthy; the examples of poor medical care are. Politicians are trying to sell off the NHS, and trying to make people dissatisfied with it to “justify” doing so (of course, it doesn’t and wouldn’t justify doing so, but that’s their spin); and they create a lot of the bad press, often based on the sort of examples that are bound to occur occasionally in a huge system, or very often on plain misinformation.

    Thanks, Jen, for sharing an example of typical, routine, good NHS care!

  17. St Thomas’ is one of the best hospitals in the country. Unfortunately not all NHS hospitals are equal…

  18. Back before the latest government got in we had a case where both my father and a friend of ours had the same diagnosis of gallstones at the same time. Our friend had private health insurance cover which also provided cover for lost earnings. The outcome was that my father was treated on the NHS in 3 weeks, for free, while the friend spent 5 weeks before she could be treated privately.

  19. You will not receive a bill, the NHS is free for everyone. Some NHS Hospitals are far better than others. My local hospital no longer has A&E or Maternity units. It sucks.

  20. Just to give a UK perspective on a similar situation in the US – We flew to New York a few years ago and on the flight over a spot on my ear lobe turned into a nasty abscess. During the first night the pain got so bad I decided I needed to go to hospital so we took a taxi to the ER that the hotel recommended. After checking in, I was sent to what I think was called the cashiers desk. There was a sign above the desk that said something to the tune of “Just to be seen by a doctor in this hospital costs $264”. I told them I had insurance but didn’t have the details on me. I was treated very quickly, they drained and packed my ear and gave me a few sticking plasters and a prescription for antibiotics. As it turns out, I was never charged for my treatment (I wonder if I am on a list somewhere), although I was shocked at the cost of picking up a prescription for 8 antibiotic capsules!

  21. I’m glad you had a good experience with the NHS. It has been my and my families’ experience as well. I would be very surprised if you got a bill – it would probably cost more to send the bill and pay banks’ fees than it did to treat your son. As for A&E waits, that depends on what’s wrong with you and when you go. If you have something not very serious and go mid-day then you’ll be seen fairly quickly. Turn up with the same condition on a Saturday night at 11pm be prepared for a longer (if interesting) wait. I suspect that is true for A&E/ER departments in most western countries.

  22. Thanks for this article – our healthcare system is incredible and three stories from relatively recent experiences with NHS care to further back up your points:

    1 – My mum suffered a brain haemorrhage a couple of years ago. She was fine eventually, but this was only down to the quick thinking and incredible care offered by our local hospitals. She recovered on a very small unit, overlooking a beautiful garden with round the clock care from some of the best nurses I’ve ever met. This happened at the same time our Tory government were starting to make headlines with their proposed cuts and dismantling of the NHS and all I could think of was “How the hell are families supposed to consider money at a time like this?”.

    2 – A year later, my appendix ruptured and had to be removed in an emergency operation. Again, amazing, quick and thorough care in a busy city centre hospital. The main difference? The horrendous strain I noticed the nurses were put under. They worked tirelessly, but there simply weren’t enough of them to properly look after the patients on my (fairly small) ward. At no point did I blame them, they were working 12 hour shifts and barely sitting down, I do however blame the government for weakening the NHS in this way.

    3 – A recent, long term, but not serious health issue that i’m currently living with that started with an ongoing cough. Again, amazing, thorough care from my GP who works in an incredibly busy city centre practice. At no point did I feel like he was rushing me through appointments or not taking things I said seriously. As a matter of course (because of the cough) I was sent for a chest x-ray and blood samples just to check it wasn’t anything serious. I was then given ongoing appointments to check the prescriptions I was on were working and whether his ultimate diagnosis was correct. Total cost? An £8 prescription. If I was in America, I’m unsure whether I would have even visited a doctor – that is an insane thought for me, that people may not seek the help and care they need because of money.

    We must do everything in our power as the people of this country to save the NHS.

  23. As another commenter said, your Emergency treatment is “free”. But, actually, for the duration of your stay, you are a taxpayer – most of what you pay includes Value Added Tax at 20%, plus duty on petrol, alcohol etc. So, you’re paying according to your ability & receving according to your need! I’m glad you had a positive experience. It’s not always quite like that eg Friday/ Saturday evenings.

  24. The reason why Americans fear NHS-style health care is all the propaganda we are fed on a daily basis. For 99 percent of all health issues, NHS is vastly superior to free-market health care (and 100 percent better than insurance-underwritten “sick care”).

    My son had a similar situation in Greece, where he had a horrid croup outbreak and could barely breath. We were on the island of Naxos and found the ER easily, more rundown and out-of-date than your British ER, but clean and well attended.

    In short, after receiving the “you’ll have to pay for your treatment” because we were American, he was treated (we were seen within minutes of the registration) by a doctor who was not a pediatrician; she called Athens TWICE to make sure she was treating and dosing my son properly. She then gave us a Rx for a steroid to pick up at the pharmacy across the street from the hospital.

    The entire visit took less than 2 hours and cost us a whopping €7 (roughly $9 at the time). He was better in a day, and we were able to enjoy the rest of our vacation.

  25. as an english woman with four children i cannot tell you how fantastic our NHS is and find it unbelievable healthcare is not free in all countries never mind the US. As you may of already guessed have had my fair few visits to A&E over the years and have always felt we received the best possible care. It is a shame our media tend to focus on the negative instead of the wonderful work done by our hospitals, healthcare workers & GPS. As for lawsuits, there seems to be a trend of adverts urging people to make a claim for unsatisfactory treatment, whilst i agree health professionals should be held accountable can only hope that we dont turn into a nation that claims just on the off chance we may get some money,especially as the money would be put to far better use going back into the NHS

  26. “It makes you wonder exactly what frightens Americans about the NHS?”

    What frightens Americans about the NHS is, well, other Americans. Specifically, right wing columnists, commentators, talk show hosts etc whose job is apparently to keep the public terrified of everything.

    I hope your family enjoyed the rest of your holiday. I work right next to Westminster Abbey so I’ll make sure to wear protective eyewear on the way to work from now on!

  27. Americans should not be afraid of an NHS type system. I’m not saying it’s perfect (far from it) but I (being a UK resident all my life) have had plenty of experience with the NHS, the most important of which was when my younger brother fell out of a 3rd story window suffering a severe head injury, fracturing his spine in three places, puncturing his lung and also losing a small amount of brain tissue through his ear. The emergency room and in fact all the professionals that helped my brother over the next 10 months whilst he recovered (yes, he did in fact recover) in hospital were outstanding, I can confidently say that without those people and services my brother would not be alive today and I cannot think of a higher commendation of a health service to be honest. All without costing a penny. We have paid for extra rehabilitation services (such as speech and language therapy as his speech was very severely affected by the head injury) but these were additional rehab services we wanted to use to try and help speed up his recovery (he did receive speech and language therapy on the NHS as well but it was only once every couple of weeks and it was taking a long time for him to make progress). The essential services which saved his life were all 100% free and as you may have guessed by now, I am a very staunch supporter!
    Surely it should not be that someone doesn’t receive the care they need because they cannot afford it, or finds themselves in massive debt through unavoidable medical bills (I absolutely shudder to think how much the three weeks my brother spent in intensive care alone must have cost!)
    Anyway I just thought I’d share that personal experience as a UK resident as I think the NHS is one thing we have actually managed to get right and I would definitely recommend people living in the US or other places where there is no national health care system should really consider supporting the development of one – as someone earlier pointed out there is always the option of paying for private healthcare or aspects of private healthcare if that suits your personal preference and/or budget!!

  28. I also had a very similar experience with an NHS A&E in Preston. I was over on a trip from Dublin visiting friends and ended up with a pretty nasty kidney infection in terrible pain, so off I went to A&E (reluctantly, as I considered my condition fairly minor and expected a huge waiting time). I was however, triaged within 10 mins, popped into bed in a coublicle and seen by a doctor within half an hour. After a couple of hours of IV fluids and some strong painkillers I was on the mend and sent home on oral antibiotics ( the only thing I had to pay for). I was never billed and my being from Ireland was not problem. The doctor who saw me even took the time to ring me a couple of days later to inform me that the particular infection I had was resistant to the antibiotic they prescribed and asked me to pop back in for a new prescription. In the end I ended up having to see an emergency weekend GP in Dublin which including a new prescription cost me just over 60 euro.

    I now work as a nurse in the NHS and no it’s definitely not perfect but it’s a hell of a lot better than some people give it credit for!

  29. As a child, I was a regular attender of A&E as I picked up various abrasions and even a lost tooth. I had wounds cleaned, closed, stitched and dressed. At one point, I had an emergency appendectomy and subsequent 7-day stay in hospital. Excellent care delivered and no bills.

    More recently, we’ve had three children, all fairly complex pregnancies, with consultant oversight and an ambulance call-out when number 3 was born unexpectedly in the house. That, combined with cardiology visits, CT scans, visits to the allergy clinic for my wife and one of the children, and a constant stream of asthma medication all virtually free.

    As for cancer treatment, both of my grandparents received excellent care from diagnosis right through to the end of their lives: for one of them, that was twenty years. Treatment was only stopped when they asked for it to be stopped. It would have carried on had they wanted it. Extended stays in hospital, surgeries, chemotherapy, scans, labwork, home visits, occupational therapy, medical devices, and everything, all funded from general taxation at no additional cost to the service user. Nothing at all like the story I read recently about an American man who died of cancer (aged under 30) because his insurance company decided that he’d reached his lifetime limit for claims.

    The NHS is, literally, a life-saver, and I am constantly bemused that this system is the exception and not the universal rule..

  30. On a previous holiday to Orlando, my mother broke her wrist badly. We attended the local emergency room at Celebration, in a hospital that was (as hospital’s go) beautiful. It had a full service restaurant, valet parking and everything looked brand new. There was only 1 person in the queue in front of us and my mother was escorted to a room quickly. What shocked me though was even though she was in pain, I was asked to fill out the insurance forms and our insurance company had to confirm that they would pay before anyone would see her. When we eventually got the bill I was amazed at the cost. Thankfully our insurance policy did not have a co-pay.

    Several years later in the UK, my mother was being treated for congestive heart failure. Towards the end of her life the NHS tried tirelessly to save her over a two month period. There were specialists, several intensive care stays (with one-to-one care) and a stay on the cardiac unit. The cost of the resources that went into this effort were never mentioned and never entered my mind. Although eventually there was nothing more they could do, I honestly believe that she had the best care possible.

    The equipment on the NHS may not be new and the waiting times can be a little longer, but I’d gladly take this over worrying about what I can afford at the worst time possible. It is shocking to read about the number of people forced into medical bankruptcy. Even when they have insurance.

    As someone previously mentioned, private healthcare is also readily available here on top of the NHS. Many employers (including mine), include it free as a perk. I’ve never felt the need to use it though.

    1. I worked in nHS in royal Victoria hospital.. They have beautiful hospital.. And now I am working here in celebration florida hospital.. We have the best hospital but of course you need to pay …and sorry for you experience.. But to tell you the truth celebration is actually the best compared to other hospital.. I worked in Maryland mercy hospital with 2 people in 1 room… So your lucky that you went to celebration….we try to be more patient friendly but of course nHS is still the best.. No comparison

  31. Unfortunately the experience you had is not universal across the NHS. I live in an area a long way from any large teaching hospitals, and where the local hospitals are in special measures. It is not unusual for the nearest A&E (ER) to be an hour’s ambulance ride away in this area, and for consultants in many specialties to only visit some hospitals once or twice a week. Some specialties (neurology, spinal) are not available at all in the county and need a 2 hour trip to other counties for any sort of assessment.

    The NHS is a fantastic organisation and I would hate to see the country adopt a more insurance-based approach which only the more well-off parts of society can afford to use. However, the level of care a patient receives is very dependent on geographic location. I honestly hope that should I ever need emergency medical treatment through serious injury or some serious acute event such as a stroke that I am not near home, and I am instead visiting a city where the specialists and equipment are, and where the standards of care are up to standard.

      1. Yes, I can attest to that. I live in rural Iowa and pretty much anything that isn’t run-of-the-mill is going to involve a trip to Des Moines, Iowa City or Omaha for care.

        My own NHS experiences were a long time ago and I never had to go to A&E, but it made me a firm believer in the system. I wish more Britons understood just exactly what it is they’re losing.

      2. Yes — my parents and a sibling live in rural Pennsylvania, and the closest trauma specialist unit is 30 miles away. Both parents went to Pittsburgh, 60 miles away, for cancer treatment.

  32. I’m a UK citizen and I needed an appointment to see my GP (family Doctor) and got one the same day. They took care of my two concerns straight away and asked pertinent questions triggered by reading my history on the computer about other complaints I’ve had over the years. It took one working day to get my non-emergency (but potential emergency) appointment to see a specialist and that appointment is 5 days after my initial consultation and on a weekend.

    Over the years my family and I have had hundreds of thousands of dollars of treatment for free at the point we got them. It cost me nothing to have my children in a safe clean fully staffed environment. Nothing at all. My taxes don’t cover that amount by a long shot (or the other services we get) and are covered by corporate taxes and government investments (which is why the citizens would quite like Starbucks, Amazon and Apple to pay their taxes at the same rate as my employer). It’s not a socialist plot to take over the world. Doctors at the top of their profession still live in million pound houses and drive fancy cars just like in countries that have exclusively private medial facilities.

    The main losers are the pharmaceutical and medical instrument companies who don’t get as much chance to push their wares when prices are fixed centrally and they can only be proscribed by the NHS for listed ailments. That doesn’t stop you getting a private proscription for off script use if you want it’s just not paid for by the tax payers.

    The NHS isn’t perfect and we love to moan about it but we are a nation of moaners anyway 🙂

  33. I love this. I have just been thinking about how brilliant our system is. I went to the GP with a long standing but non-acute problem two weeks ago. I saw the GP the day I rang. She examined me and sent some samples for testing, and referred me to a specialist. The next day, the hospital rang to make the appointment. They wanted me to com in five days later, but I was away so the appointment was made for the day I returned. Three days after the GP visit, I got a text with the test results.
    I did have a bit of a wait at the hospital, but that’s because I had two separate appointments – one for ultrasound and one for a hysteroscopy. But both appointment took place bang on time. Now I have my diagnosis, and my follow up appointment for treatment plans.
    All free (apart from my taxes I guess but like Lady Kayla says above, it’s a small price.
    Terrifying how politicians with massive financial interests in private health care are manipulating the debate to suit the privatisation agenda. Refreshing to remember that the NHS is truly the envy of the world.

  34. I broke a little finger in a fall in Lochcarron Scotland – was seen by a local Dr referred to a hospital on the Isle of Sky x-rayed advised (see hand surgeon when I got back to South Africa – have arthritis complicating treatment) strapped and even had follow up visit to check progress, Cost Zero,

  35. We love the NHS, we may grumble occasionally, but that’s just what people do. I’m glad you had a good experience and your little boy was okay. I grew-up in Ireland where it’s more like the US system and due to my parents not being well off nearly died of TB.

    The NHS is one of the things I solidly believe Britain can be proud of because it’s a shining example of compassion and common sense – if people aren’t worrying about their healthcare bills they’re happier and healthier, more productive members of society, and I gladly pay my National Insurance (UK tax that goes towards healthcare and benefits) for that to keep happening, whoever someone is, wherever they come from and whatever they need.

  36. I had the exact same experience after finding myself with a kidney infection while visiting the UK. You won’t receive a bill.

    However, the conservative government has decided that providing free healthcare for transient visitors is too much of a drain on the UK government. As of 2015, they’re going to start charging non-EU residents 150% of the cost of the care they receive. People who enter the UK with the intent to stay longer than a certain amount of time (a week or so, I think?) will be asked to pay a medical coverage fee up front when they enter the country. Between this measure and the special visa I have to acquire to get married over there, I suspect the targets are undocumented immigrants.

    In a sense, I understand. I felt an obligation to pay as well and was baffled when the nurse shooed me away, saying “It’s free. Consider it charity. Run away.” I’m not impressed by the extra 50% upcharge though.

  37. It’s so true what you say about nobody (neither doctors nor patients) wanting to lose the NHS. Sadly, it’s the same people that give you multi-$$$ bills in the US, and that have brainwashed large sections of the American population, that are responsible for screwing the NHS over: big US pharma and their useful idiots in the Conservative/Lib Dem UK government (many of whom have shares, cushy directorships etc. in those same companies). It doesn’t help that the NHS was in a parlous state in 1997 when the last government came into power, and, for all of their faults, and despite a host of questionable decisions (PPPs, excessive pay rises for GPs etc.) they had it in reasonably good shape by 2010. Sadly, it will only be in 3-4 years’ time when the consequences of the awful Health and Social Care act play out fully, even if a putative Labour government does come in next year and repeal it as they’ve promised.

    One thing, though, in my N1 experience that the NHS is not very good at is care of relatively straightforward and resolvable chronic conditions. My partner had a chronic neck condition (straightening of the cervical spine) which required fairly intensive treatment and six months off work. Thankfully she’s now better. But the NHS physiotherapy she was offered was absolutely dreadful: nowhere near intensive enough, insufficient numbers of sessions, a mis-diagnosis caused by an unwillingness to give her an MRI scan (presumably because of the cost) which wasted two months of her life. So, because we could afford to pay for the MRI, a serious programme of private physiotherapy, regular osteopathy and massages, and for her to take the time off work, thankfully she is now much better. I wonder how many people with relatively simple musculoskeletal (or even mental health) complaints – who, say, do poorly paid manual work and cannot take time off – end up suffering for much longer than they need to because the kind of intensive, short-term and then continuing care they need is just not available to them.

  38. The thing is, it’s not just those quick, easy, emergency visits that go so well, and it’s not just because you were in central London that you had good service. I do not live in London so there is very little chance of MP’s ending up in my local hospital, and yet the service here is impeccable too.

    I have had family members treated in NHS hospitals for pneumonia, cancer, heart problems, broken hips. I myself was in and out like it had a revolving door as an accident prone child with all sorts of broken bones. I have never had anything less than exceptional care. In addition, the out of hours GP provision is extraordinary – twice I have been very ill over the Christmas period when regular doctors are closed, and without them I would have ended up in much worse condition being treated next door in A&E.

    Are there bad people, bad systems, bad hospitals? Yes. Like any business, industry or organisation. My grandfather was temporarily placed in a different hospital to our local one when he required treatment best provided by a certain hospital. The worst hospital I have ever seen, with frankly dangerous practices. Are they the very tiny minority? Yes, they really are.

    I wouldn’t swap our NHS system for the world. It’s not perfect but it’s an amazing resource I am proud of, and relieved that I have access to such a great service when I need it.

  39. Thanks for such praise. Free at point of contact. We love our nhs and it must be protected so experiences like this are for everyone. Had amazing paediatric treatment for my newborn in A&E. Thank god for the nurses, midwives and doctors that work tirelessly for little reward, thanks and praise.

  40. This is very much the same story I’ve heard from others who have sought medical care in England – and rather than being presented with a bill, they were told “it’s on the Queen”. In 1985, I “popped in” to Queen’s Hospital in Russell Square just to have a look, as was working as an RN at Baltimore’s MIEMSS and wanted to get an impression of the hospital system in England. All was quiet and organized, and the DON happened to be passing through the lobby. She took me to her office, answered all my questions, and showed me around. They have a Florence Nightengale Museum there now that was good for a quick stroll through. Thanks for the post and happy travels!

  41. Last September, while on holiday in Cornwall to walk stretches of the South Coast Path, I slipped and broke my leg. We were in the middle of nowhere between Boscastle and Tintagel. After walking for another half mile and then deciding to ‘cry uncle’ and give up the walk, I sat by the side of the trail and my husband went ahead. He found a very kind farmer who came with his tractor and back end loader fitted out with a hay bale, loaded me onto the hay seat, and took me back to his farm yard. Through a series of hand offs we eventually ended up in the nearest A&E, which was up the coast about 25 miles. The care was immediate, gentle, kind with a good x-ray to show that the break was quite a mess. The physician and x-ray technician decided that I needed to go to the district hospital in Barnstaple where orthopaedics is one of their specialties. The ambulance arrived within 30 minutes, the drive to Barnstaple remains a bit hazy due to the excellent drugs for pain, and the time in the emergency room was short. My husband tells me that I was sedated and my leg pulled straight, then set with a temporary cast to allow for the swelling. I had surgery several days later, with excellent results–both legs are the same length, there is no remaining pain, and a very tidy scar. 6 days in the hospital with physical therapy, meals, meds as needed, personal care, daily visits from the doctor, crutches, good cheer,a nice ward full of other orthopedic patients, and we left to go to London for the flight home. The bill was $3,265, on one page.

    I only know because I saw the one sent to the travel insurance company who handled the travel adjustments and special needs of a person with a broken leg traveling long distances on a plane. As an American, i never travel without this insurance.

    Once back in the States, the orthopaedist that I saw for follow up care and physical therapy pronounced the job ‘really excellent’. The bills for his services plus the physical therapy amounted to more than $6,000–without a hospital or surgery.

    I am grateful to the doctors and nurses who cared for me so well under the NHS. Certainly, the price was reasonable. I only wish the same could be said for the care in the US.

  42. My experience? Emergency care in the UK is excellent but preventive care is not. Whe I lived in the uk on a tourist visa, st thomas took care of my emergency needs, at no cost, several times. As far as I know, it is the only medical facility in that area of London that gives free care to foreigners. With preventive car however, there are very long wait times to see a doctor and very little choice. All of my uk friends who can afford it have private insurance on top of the nhs because of how few their options are, how long the waits are, and how little is actually covered.

    1. Any hospital with an A&E (ER) would give the same care. I would never dream of going private unless timing was crucial (in the sense of avoiding certain dates etc) or it was vanity treatment – a nose job, for example. My family has had thousands of pounds worth of outstanding treatment on the NHS over the years. Preventative care is also good – you only have to compare the thorough programme of ante-natal and postnatal treatments and tests, and the organised programme of checks and vaccinations for children to see that. I know almost nobody with private insurance, even the better-off.

    2. I work in public health. The UK has very good preventative care, the statistics bear this out. What we have less of is routine unnecessary tests, which expose patients to harm without any improvements in mortality or morbidity. So for example we do much less PSA testing, so fewer older men get their prostrates operated on resulting in incontinence and impotence. Our death rates from prostate cancer are still comparable with yours.

      I have schizophrenia. When I had a really bad episode, I spent 5 months in hospital, and I’ve had really good follow up from a nurse for three years, and a year of therapy with a clinical psychologist. I also got money to live on and pay for my housing while I was too unwell to work. Now I have a job, my employer can access funding to help disabled people stay in work. No bills, all free when I needed it, so instead of being homeless and hopeless I got better and now work for the NHS.

      There are problems with the current government cutting funds, particularly to mental health. But the NHS and social security means the UK is probably the best place in the world for me to have schizophrenia.

    3. >>All of my uk friends who can afford it have private insurance on top of the nhs because of how few their options are, how long the waits are, and how little is actually covered.

      Wow, you must have really rich friends! Having private insurance is definitely not the norm. And what’s actually available privately tends to be much, much narrower than what’s available through the NHS, so I’m not sure what you mean by “how little is actually covered”?

    4. Hmm, not my experience. According to this http://www.theguardian.com/society/2010/jul/19/health-insurance-slumps about 1 million or so (out of 70 million) pay for their own health care. So less than 2% of people. (It looks like around 10% have private healthcare in total, but that includes those whose job pays for it).

      My experience was that the NHS put a lot of effort into preventative care, as it is cheaper than dealing with something once it becomes an issue.

  43. Being British and having lived in New York, I’ve seen both sides of the coin. My sister has MS in the UK and has wholly free disease modifying therapy treatment each month that costs over £5k. NICE (the national drug evaluation board) believe it is worthwhile as it arrests her disease and will cost the NHS less in the long run. And additionally has neuro, physio, GP, psychiatry appts and more each month.

    I lived in the US for several years and had what I was assured was gold plated medical insurance when I worked at Dow Jones. I had never come across a co-pay before, and naively thought that my ‘gold plated’ insurance meant that any medical treatments I had were free – there had never been an excess or any kind of co pay on UK work medical insurance previously, and of course I was used to the NHS.

    So imagine my horror when I discovered that I was liable for over $1000 in co pays after an eye problem (which was misdiagnosed at the Manhattan Eye & Ear Hospital initially, meaning a lot more cost for me). Of course if I had got ill again later that year I would have had treatment for free, as I would have reached my ceiling for co payments; but I was astonished to discover that basically my work health insurance was only worthwhile if I got really sick.

    I learnt my lesson: get on a plane home for anything minor. I had the same issue treated a few years later on the NHS for exactly nothing.

  44. Just to further increase you sample size, and add my own little twist, this is essentially the *exactly* same experience my wife and I had with a national healthcare system in Tokyo a couple of years back.

    My wife grew up in Tokyo (life-long American citizen…her parents were/are international school teachers) and we were there apartment-sitting for a friend of her parents. About two days before Christmas, my wife started complaining about a earache. Sure enough, come Christmas day she was in intense pain and running a slight fever. So, we decided we needed to get her treatment just to be on the safe side.

    Since neither of us speak Japanese (my wife can navigate Tokyo just fine, but certainly not well enough to work with a doctor), we sought out English-language clinics in the area. Of course, all of the gaijin were home celebrating Christmas and all of the clinics were closed. So, after much laboring and fretting we decided that we’d just have to use the emergency room…Certainly an earache is not an emergency, but I’d rather take her in when we don’t need to than not and end up with a serious situation.

    We hoof it down to the ER. We’re met by a large waiting room, panels with patient numbers and this long counter with various stations. It had a kind of sad 1970’s look to it, and I started to get this sinking feeling that this was going to be a complete disaster. We go up to the check-in counter, girl doesn’t speak English…but she promptly calls over a slightly older lady who speaks functional English and helps us navigate the check-in process, and sorta translates as we go (think that scene in Lost in Translation, where Bill Murray is doing the photo shoot…”You like Roger Moore?”). As we’re finishing up, she tells us that my wife is going to have to see an ENT specialist, and that because we’re not part of the NHS the bill will be *twice* what it usually is (in typical Japanese fashion, the lady was mortified to have to tell us this and apologized profusely). Being an American and having had to go to the ER without insurance, I immediately assumed this was going to cost us at least $3000. “But, we’re here and let’s just get through this and we’ll figure it out later.”

    We wait and finally get called up to the specialist. He sees her, writes her a prescription and sends us back downstairs to fill it at the pharmacy (the left-most station at the long counter). We fill it and get the final bill (while we’re waiting to get called up to pay the translator lady finds us again just to check on us…gotta love the Japanese!)…it was a completely absurd $200 (visit, antibiotics and an anti inflamatory/sinus medication). All told, we were there 45 mins.

    Allow me to repeat that. We went into the *emergency room,* *without insurance,” had to find a *translator,* saw a *specialist,* and picked up *two prescriptions* in *less than an hour* which cost us *$200* paying *twice* the normal rate. If this is what the damage to our health system would look like if we switched to a single-payer system, then I say smash the SOB…we are simply doing this wrong.

  45. Personal anecdote is important and heart-warming to hear. Statistics can also tell part of the story. These are from the World Bank at http://data.worldbank.org/indicator#topic-8 (latest figures)

    Life expectancy at birth – USA 79 years; UK 82 years
    Infant mortality ‘000 live births – USA 6, UK 4
    Maternal mortality ratio per 100,000 live births – USA 28, UK 8
    Total health expenditure as % of GDP – USA 17.9, UK 9.4

    I don’t repeat these figures from any sense of smugness and there are European countries with better outcomes than the UK.

  46. I’m glad you had such a good experience, and don’t get me wrong as I do love the NHS for many reasons. If this is how the NHS always worked it would be great! The problems is that yours is not always a typical experience. Last year I sat with my mother in A&E waiting for treatment for a serious head injury. I had stopped the bleeding from the 4 inch gash in her head by applying pressure. However as she no longer had blood streaming into her eyes it meant she became a non urgent case (despite the fact she had blacked out, possible concussion or internal bleeding). We arrived in thenA&E at 9pm and were finally seen at 7am when a doctor came on shift. For a 70+ year old lady who had already experienced trauma, this is sometimes the reality of the NHS. Unfortunately we were not the only ones in that emergency room that night waiting for urgent care in an under funded system. That’s what scares people about an NHS system.

  47. As a dual citizen (US/UK) I have experienced both systems as a patient and as a healthcare provider in the US. This article highlights the good parts of the NHS system that most Americans would want for the country. It’s fair to say a simple corneal abrasion shouldn’t set you back a month’s rent. Of course you’re going to have a glowing review of the NHS with this one encounter.

    What scares Americans( with private insurance) the most about the NHS is the wait and loss of freedom in their health care decisions. To see my GP takes about 2 weeks and to be referred to specialist took me about 2-3 months to be seen. In the US as long as I am insured I can see my doctor the same day, see a specialist without a referral.

    I hate to admit there is a level of urgency in a privatized healthcare system. They depend on your money and hospitals/doctors compete to give their patients the highest level of care. The decision on whether you have access to particular drug or treatment isn’t decided by the government.

    Before I get killed by commentary, The US can definitely benefit from taking a page from the UK on healthcare. But we have to take into consideration the American values and culture. Americans hate queuing and are very demanding. A universal healthcare system could not meet those demands and expectations.
    You can say have both, those who can afford it use private healthcare but then they wouldn’t want to contribute to a public system.

    Just my thoughts

    1. I live in a major UK city and we can always get day-of appointments at an excellent and popular clinic. The clinic we used to be in ran two drop-in clinics every day. It’s depressing that this isn’t the case everywhere, but please remember that your case isn’t necessarily the norm either.

    2. “As long as I am insured” speaks volumes here. I am a US citizen who has lived the the UK for eight years.

      The US system served me well as a child, uni student, and young adult with full time job. When I left that job, I could not afford COBRA, and when I temped after that, I could not gain insurance again because of pre-exsisting conditions (but if I didn’t tell them about my piles and my totally in remission depression I could have had that insurance voided!) and so in essence I was screwed by the system.

      I love the NHS, I don’t have to worry about whether my consultant is in-network, I don’t have to wait three weeks for an appointment with my GP and my child gets seen straight away the same day. Until the last year I didn’t take a lot out of the system, and though I have in the last year, they are fixing me and fixing me WELL.

    3. “In the US as long as I am insured I can see my doctor the same day, see a specialist without a referral.”

      This tells me you have PPO or POS (point of service) insurance, which is not the norm. Most Americans who have health insurance have an HMO, and you cannot see a specialist without a referral either from your primary care doctor, or sometimes an ER doctor.

      One thing that would be nice if we actually did have universal healthcare (meaning everyone has it, not that it’s a single-payer system like Medicare or the NHS) is that doctors and hospitals would not need to recoup their money from people who show up with emergency symptoms and don’t pay. In a single-payer system, there’s also no need for the staff who deal with the various insurance companies who don’t want to pay.

    4. “A universal healthcare system could not meet those demands and expectations.”

      I think once we stopped having to declare bankruptcy for medical costs we’d step off our high horses.

    5. I have had similiar wait times for non-emergency care in the US, or to get a specialist appointment. In more than one state, under more than one insurance system. Dont act like getting the appointment when you prefer is an expected thing in the US. Not in my experience.

    6. “In the US as long as I am insured I can see my doctor the same day, see a specialist without a referral.”
      This is not the norm in the US. I’ve good POS health insurance in the US and I cannot get a same-day appointment for any of the different docs I’ve seen. And, apart from a physical therapist, I need a referral to see a specialist, which means I need to pay a copay to see my primary (GP) (and wait a few days for an appointment) to get that referral (and then wait for that appointment)

      ” The decision on whether you have access to particular drug or treatment isn’t decided by the government. ”
      No it is decided by docs whose salary depends on treating you and who are afraid of their lives of getting sued so they over-test/treat. And it is decided by what health insurance you have. So, do any of those parties have your health as their primary interest?

      “But we have to take into consideration the American values and culture. Americans hate queuing and are very demanding.”
      It appears that Americans are demanding the wrong things with regard to healthcare.

      If you are very well off, the US system is fine. Over-priced and over-treated but fine. But if you are just a normal joe, or if you just care about the normal joes, then the US system is dire. I’m not British but I reckon you should hold on to the NHS and improve it where needed.

    7. I wonder where you live in the US? I have good healh care and live in Atlanta. I wanted a specialist for a particular problem who was recommended by my GP, … four month wait, … then great care and tests, … now 5 weeks till I can get in to see him for results. This is not unusual at all here in many different specialities. Good doctors in all systems (private and NHS) have waiting lists in large cities. It’s just in the UK they are required to post their waiting list times since they are required to be accountable to the people. Here you would never see any waiting times listed. Most of my US friends simply say “I have the best doctor for this need, and wonderfully he can see me in four months time!” They do not complain or see this as a “waiing list”. In UK we complain if we wait two weeks. By the way it can usually take 5 or 6 days to see my excellent GP here in the US, unless I am really badly ill when, like in UK, I can call early in the morning and be “fitted in” at some point. Others just like in the UK, simply go to ER for quick treatment, though here the huge co-pays tend to put people off doing this.

  48. I am delighted that you received good treatment. It is refreshing to hear good report about an experience within the NHS

  49. I’m an American citizen living in Germany. While I was visiting my family in the States last winter I came down with strep throat. I went to a stand-alone ER (believing it was an urgent care clinic) to get a prescription for antibiotics. I (stupidly) did not have travel insurance, so I was entered as an uninsured patient. During the intake process, the nurse told me the visit would cost around $350. That seemed steep, but I agreed. I then spent 15 minutes with the doctor who wrote a script after looking at my throat (ie, no labs or tests). I thought all was good until about two months later — I received two bills (one from the hospital and one from the doctor) totaling more than $1200. I’m still disputing them.

  50. One of my sons is a rugby player and that coupled with his asthma meant that we have spent many hours at local and not so local hospitals. The family opinion is that son as a small child thought it was a wasted holiday if we hadn’t visited at least one A&E during it with some injury. At almost 18 he severely damaged his shoulder (like Mark Cavendish recently did but worse), despite it being in the middle of an icy spell and fracture clinic therefore being on the full side – he was fitted in for urgent surgery, rehab and lots of physio without anyone ever (apart from me as his mother) telling him it was his own fault for playing rugby.
    Fast forward 3 years and his twin brother who up till then has mainly avoided A&E decided to go kayaking one winters day, he managed to kayak down a waterfall successfully, but then slipped while standing at the top of it. Fortunately instead of killing himself, he “mashed” his wrist and it needed a lot of time and effort to put it back together. The NHS excelled itself, originally they were waiting for the swelling to subside before they operated, but as his hand started to swell he had emergency surgery, done by the top consultant at 4am which saved the use of his hand. Now over a year later, he has almost full use of it and still goes kayaking. Again no one blamed him for being an idiot (apart from his immediate family) and we are all incredibly grateful for his care and support.
    A different perspective was when my elderly mother was seriously ill and needed admitting for 3 weeks care – she saw consultants, was given a total overhaul and the staff were incredibly caring and supportive. The ward staff were working under huge pressure, long hours, not enough resources due to the government cuts (eg one tub of talcum powder for the entire ward) but never forgot that they were dealing with real people, even if many of them were confused and not at their best.
    I am a chronic asthmatic and have joint and mobility problems, I currently get around 20 different items on prescription each month – for which I pay a bulk price of £104pa (so less than £10pm), I also have a wheelchair funded by the NHS and get 2 pairs of footwear made to measure as well – people often ask where they can buy a pair of boots like my fabulous purple pair!

    1. That reminds me of the one time the NHS (aka the British people) had to take care of me because of a case of terminal stupidity. I was 23, had a freshly broken heart and the last thing I remember before waking up in hospital the next day is opening a bottle of Whiskey I had smuggled into a London pub. Apparently I drank most of it, then tried to make my way to a party until I fell over on the sidewalk and couldn’t get up. The friend I was with panicked and called an ambulance which swiftly whisked me off to St. Mary’s Paddington. I’m not proud of myself and have never been blind drunk since, I’m not even sure they should have let me walk out of that hospital the next morning without so much as telling me off let alone making me pay, but the thought of what that stupid episode might have cost me in the states gives me the shivers. I was a penniless student, the bill would have brankrupted me.

  51. we’re a canadian – american couple with two kids born in the UK. can’t say enough good about the NHS. have had excellent emergency care, births, children’s eye care at specialist hospital, referrals to various specialists for conditions – twice so far this year. and free prescriptions, cause we live in scotland.

  52. I’m Canadian and grew up with the frequent childhood ER trips for broken bones etc. On a trip here to the US I managed to get a really fast acting ear infection (0 to 60 in 12 hours) with enough swelling that my jaw wouldn’t close, and my eye was swelling shut, enough pain to induce vomiting. A trip to the local ER was stunning to me… I was convinced I was brought to a swanky hotel by mistake and deliriously tried to tell my husband that he had to take me to a doctor instead.

    They wouldn’t give me an aspirin before I had completed paperwork (that I could only half see) my insurance card, my husbands’s credit card, my credit card and a call to Canada to verify that they would pay if a doctor saw me. The only wait time I experienced was while they waited for confirmation of their money by phone with my insurance company. The doctor literally stood by my bed and didn’t do anything until the attendant confirmed payment. They were concerned about ruptured ear drum and infection in my skull so I was whisked off for an MRI. I had an IV of fluids, pain killers and antibiotics and once they confirmed that my bones and brain weren’t infected they sent me packing. I was so doped up on pain killers that I was hallucinating and couldn’t walk, leaking fluid from my ruptured ear drum and unable to eat and move my jaw, but they had done the minimum and sent me on my way. I was wheeled to the door of the ER and crawled and was half carried by my husband from there to the car.

    My travel insurance from home covered all $7,182 of that 5 hour visit, but the hospital was not familiar with my insurance plan so they didn’t want to do more than the minimum care required. It would have cost me $10,052 if I was paying cash.

    But there was three Starbucks, five patient lounges with ESPN, a pingpong table and two restaurants…along with pretty/ trippy blue decorative uplighting in the reception room.

    1. Another British person here to extol the values of the NHS. I have been severely, chronically ill since the age of eight (I’m now 28). I have extremely severe Crohns disease that has required years worth of hospital stays (six months being the longest consecutive stay at the age of fifteen), multiple surgeries, stays in intensive care, multiple instances of community care, GP visits, A&E visits, psychologist treatments, stoma care, endoscopies, colonoscopies, NG feeding for almost all of the period between the ages of ten to seventeen, MRIs, Ultrasounds, X-Rays, Bariums, scores of medications (Anti-TNF treatment alone costs £12,000 per year), am now on long-term TPN (IV feeding through a central line), and much, much more. TPN keeps me alive now and costs £200(ish) per night (I also had TPN between 15-16) and, to repeat, will need this for the rest of my (shortened) life. I have also had kidney failure, have osteoperosis, am on fentanyl/oramorph, have gall stones, arthritis, and am seen currently by around four specialist consultants. I have paid nothing and, rather sadly, will never be in a position to pay the state back as I cannot work (unsurprisingly). In addition I should add that I am under a dental NHS specialist due to the impact Crohns has taken on my teeth and, perhaps more importantly, have multiple contact each week with medical professionals (from pharmacists, to GPs, to specialist nurses, to consultants). I am a high cost patient with no end in sight.

      It isn’t the best life I lead, and it is one most can’t imagine. There is one certainty though: in a country without a nationalised helathcare system it is likely that I would either be dead or my family would be destitute. I think that Crohns wasn’t covered under the old insurance system in the US, and Medicare wouldn’t have covered a good chunk of my related illnesses, and would have scrimped on treating the actual illness. I am, frankly, lucky to live in a country with a healthcare system like ours. I have been in multiple life/death situations which the NHS have carefully, speedily, dealt with. If I develop a temperature I am immediately hospitalised (after contacting one, or the other, specialist nursing teams), with blood cultures taken from the line and strong antibiotics immediately delivered. If I develop new pain I am sent for MRI/imaging test within weeks. If I need to discuss treatment with my team I can usually do so, with either the consultant or specialist nurse team, within a day. The nutritional team’s lead nurse has even given me her mobile phone number to contact her.

      I have my rectum left in situ (over ten years) so have yearly cancer screens. Talking to my consultant last month about arranging this years led to him deciding, under general anaesthetic, that we would scope my stomach/small bowel remnants, scope my large bowel through the stoma, and scope and biopsy my rectum (along with balloon dilation where required). In addition he wants me in the day before for multiple tests to assess my condition and to discover whether we can look at removing my gallbladder with relative ease (unlikely given the mess in there) and, if so, we could get the lead upper-gi surgeon in on the same day as the scopes to attempt to do so. The appointment took less than a month to arrange.

      Now, of course, I have had issues with care but, crucially, these have little to do with it being publicly owned but instead are rooted in the same problems that afflict any organisation. Generally this comes down to individual people who simply don’t treat the job seriously, or have inflated egos, or don’t have respect for their customer. These are in the minority but, quite obviously, privatising the system wouldn’t affect these issues in the slightest as experiences with any privately owned service will tell you. Even better though is the fact that each hospital is held accountable, and often has its own liaison team to deal with such matters effectively. My own experience being that any complaints are taken very seriously – even if you just take them to a member of senior staff. Accountability does exist in the system.

      In addidition my grandmother (76) recently began passing blood in her urine: within a month she had been tested, found a tumour in her bladder, was operated upon, and was back home with follow-ups every six months and given contact details in case any symptoms reappeared. My mother had a positive smear test and, within a month, had a colposcopy which gave differing results, this then was discussed at a multi-disciplinary meeting, and was brought in for removal of part of the cervix and biopsies (she has CIN-3, is awaiting cancer tests, and has been informed and treated with dignity at every step). My step-father needed a circumcision – once exercises stopped working he was sent relatively quickly to have the operation completed. I have many more such examples, from the NHS helping my uncle to beat his alcohol addiction, to my partners curved spine, that all bear similar witness to the efficacy of the NHS.

      The problems cropping up with the system as of this moment are ones created by our current government who believe (just as in education) that crippling the system and then finding the miracle cure in privatisation is a just, honourable, and -crucially- profitable crusade. It is shameful especially given that we pay less, in comparison with other public healthcare institutions, and get such good results. Certainly Labour weren’t beyond criticism but, silly financing excepted, the quality of hospitals, their equipment, and staffing levels caused a noticeable improvement even to my very young eyes! To see an attempt to slander the current system as justification for sly cuts, and piecemeal privatisation is frightening for me – I’m personally vulnerable to such changes obviously, but many healthy people will need medical treatment at some time and the NHS, whether people acknowledge it or not, is a very efficient system to deal with such things.

      The stats posted above really prove the point: we spend less om healthcare but outstrip the privately-run US market in most all key areas. It is so sad that care in the US is dictated not by need but by profit, and that the government is hamstrung by constant variations of the ‘red under the bed’ scaremongering practiced by the neo-cons making a pretty profit from all those bankruptcies. It is also sad that, as you will find on Youtube, Fox, and certain ‘experts’, peddle shameful lies about our healthcare system in the UK in order to frighten those who need socialised healthcare, into voting/campaigning against there own interests. If the US spent the same amount per head on public healthcare – not private – you can only guess how much better the system and the patients healthcare would be.

      And some of our hospitals look pretty nice too, after investment in new buildings (if that floats your boat) from smaller local hospitals (Manor hospital, Good Hope) to large hospitals (Queen Elizabeth, Birmingham Children’s) you’ll find new buildings (and older ones) kitted out pretty decently. The hospital in Newcastle-under-lyme even has bins in the main foyer that cost about £100! Though I will admit that’s a little wasteful ;-).

      Sorry for the length of post but I owe my life to NHS care and while I’ve had my share of problems (unsurprising given my years of treatment) absolutely nothing I’ve seen convinces me that they’d be solved by investing less (like the current government has done) or privatisation (which the current government wants). My treatment runs in to the millions, easily. I may not be deserving of it, but I’m very grateful for the fact it exists. And I didn’t even touch on the financial savings of getting those who can work, requisite medical treatment to get them back to work.

    2. A really great, honest and refreshing post. Really good to hear.

      There’s far too much NHS bashing and it doesn’t tally with the public view of quite how great a system it is.

      The insurance and right wing (fox news etc) lobby in the US have their own interests at heart- and they are mighty powerful. The politics of fear is compelling and when combined with the unknown such misinformation as I’ve heard/seen in (for example) republican campaigns linked to obamacare are simply terrifying.

      It is fair to say that we pay for the nhs- it isn’t right to call it ‘free’ but my god- if we can’t look after the most vulnerable and needy in our society then we need to look hard at ourselves.

      I am a litigation lawyer (commercial not clinical/PI) and have seen and experienced on many many occasions the commercial pressures that drive insurers to decline cover even when they’re obliged to cover an incident. We have a name for it- ‘satellite litigation’. Finding a contractual loophole, reason, excuse or variation- some failure to notify, contact, report to the insurer in a prescribed way, within a certain time etc- all too easy. The thought of extending that sort of litigation into the healthcare arena is morally repugnant-especially (not even) to me. A person getting the call to say they can’t/won’t be receiving further treatment because they didn’t pay the premium, or their cover has been max’d out. In a modern country? A wealthy country? A world leader? Unable to look after its own?

      I really hope the debate continues in the US, and that there is a slow continuing recognition that looking after those in need is a social and moral responsibility. You can afford it. It isnt that expensive when shared collectively. It’s a responsibility that comes with having won the lottery and being born in a wealthy country. You don’t leave men or women on the battlefield, but the folks at home don’t get the same recognition when they also need a hand.

      A little love goes a long way and I will continue to support the nhs and those that work in/for it as a national safety net that protects those most in need of care, including those from abroad in an emergency. It is something we can all be incredibly proud of- thanks for reminding us.

      1. Hear, hear, Alex. That sentiment of “looking after its own” is lacking in the states, which is a major part of the healthcare/welfare debate. Even from Democrats (never mind Republicans) there is a sense of “why should I have to pay for someone else? I can look after myself, they should look after themselves too”. It is very hard to stomach.

  53. “Not one person wanted to abandon the NHS.”

    Oh, trust me, the incumbent government do. And it’s doubtful if the opposition win the next election they’ll do much better. I booked a GP appointment three days ago and have to wait another seven before I can go

  54. I’m from the UK but lived in California for 6 years. I arrived in Redwood City in Jan ’95 with a terrible cough. When it got so bad I could hardly move my husband dragged me to the nearest clinic he could find – at the airport. I had pneumonia. A 5 minute assessment + prescription for antibiotics and cough medicine set us back $89. A follow-up was another $50.

    In ’96 I was expecting my first baby (by now we had insurance, via my husband’s job) when I noticed some blood at 23 weeks. 3 months of bedrest, most of it on various drugs; first 2 months at home (with a monitor) then into emergency hospital treatment, dilated 6cm and in full labour – magnuesium sulphate IV for a month (not fun). Son birthed at 34 weeks in the end and the final bill that we saw (there may have been more later) was $150,000. Insurance paid. Phew.

    Having kids may be a ‘lifestyle choice’ (though not in states that are anti-contraceptives, I’d suggest) but so many other things are impossible to avoid.

    NHS all the way for me.

  55. Three times I’ve taken ill while in the UK; in Manchester, the Isle of Skye and in Yorkshire. In all three cases I was able to see a doctor within a couple of hours of calling a local office. In all three cases, I got quick, professional care. In all three cases I was charged zero (although in all three cases I got an antibiotic prescription and had to buy that locally — at generic level prices). Although my illnesses were all routine bhronchitis-like ailments and not serious emergencies, I was always amazed at how efficient, friendly and competent the care was. I have lots of friends in the UK, and over many years I have heard the same message consistently. The NHS is a great thing. That’s an N of 3. But maybe a really good N sample.

  56. Very pleased to hear you had a good experience of the NHS. I’m in no way a medical person but am a fan of John Green’s vlog (wrote the book ‘The Fault in our Stars’ which is now a movie), and this is a very quick and informative summary of healthcare costs/setup in America vs the rest of the world

  57. As a doctor working in our NHS I can tell you that you won’t receive a bill. The NHS provides emergency medical care free of charge to all who walk through its doors, regardless of nationality. Had your son needed follow up or perhaps an elective procedure at a later date then perhaps your insurers would have been billed. You can rest assured that you son’s emergency treatment was ‘on us’, a present from a civilised healthcare system.

  58. To your last question “what frightens Americans about the NHS?”: Nothing. Nothing frightens the American (public). But it sure does frighten the big corporations!

  59. Thank you. I am one of the Consultant (Attending) team at St Thomas ED. This is a lovely story to hear and I’m glad things worked out so well for you. To answer a couple of the points raised by posters above:
    – We never charge foreign visitors for their care in the ED. That is a matter of national policy.
    – Visitors should be charged for admissions or follow up.
    – NHS charges are vastly less than the US. St Thomas will be reimbursed about £100 ($150) for the care Victor received. When no one else takes a cut, it doesn’t cost very much to treat people.
    I will pass on your story to the rest of the ED team!

  60. As an NHS midwife I am pleased you had good care. There is no charge for emergency treatment. But I have never personally ever met anyone from the USA (and I have met many having maternity care whilst living/working in the UK) who wasn’t pleased with their care, even though they may take a little while to get used to the fact that care is mainly delivered by midwives and not obstetricians in the absence of complications. It isn’t perfect and the NHS has many problems and challenges but there is an underlying soundness of approach and ethos that just about manages to carry it through. But in my experience Americans are intelligently appreciative of what is available and it is always interesting to hear their perspective. I have never had health care in the USA but my sister and family who live in Nevada appear to have an excess of it when they do have any health problems, just a lot more of it, stuff I think is excess to requirement and a little excessive.

    1. I am an American who was living in the UK when my first child was born. Our care was abominable. First, I went to L&D for an emergency one evening and was given a bathroom with blood all over everywhere. My daughter and I were neglected by ward staff in the maternity unit; she ended up dehydrated from lack of care. We asked several times if she was OK, but the midwives just said “She’s fine” without really looking at her. I saw some of the midwives giving my daughter their fingers to suck but felt powerless to complain because I was incapacitated due to a surgical delivery. Also, I thought that I could trust those people with the health of my family. I wrote a letter to the hospital to complain. I had a meeting with the maternity services manager in which she was more interested in deflecting criticism than in solving problems. One of the main reasons why I moved back to the USA was to have better treatment for my next child.

      1. I am sorry to hear that you had a poor experience at the hospital you attended. As with all large organisations – and the NHS is a huge organisation – it is difficult to ensure that the very highest standards are delivered universally.
        You don’t say how long ago this happened but in recent years there has been a concerted drive to improve the quality of the service delivered by the NHS. We now have a range of processes and institutions that have been put in place to ensure that good quality care is provided and to make sure that all hospitals and other healthcare organisations learn from patients’ experience and improve what they do.
        I assume you complained formally and hence your meeting with the manager? You should have received a written response after the meeting. If you are unhappy with this then you can write to the NHS ombudsman and explain your concerns. The ombudsman will investigate, if appropriate examine your notes or other evidence, and require a response from the hospital.
        http://www.ombudsman.org.uk/make-a-complaint
        The powers of the ombudsman are wide and include the power to award compensation for particularly poor service, for instance when the patient has been left out of pocket. Ombudsman’s rulings are made public (but the patient’s confidentiality is maintained) and often picked up by the press.
        Another option is to complain to the Care Quality Commission.
        http://www.cqc.org.uk
        The CQC inspect all healthcare facilities, public and private, and has considerable powers. Indeed a rating of “inadequate” may well result in dismissal of the hospital’s CEO and other executives. They are very tough on issues of poor practice especially in respect of clinical risks such as infection or where they identify failures to act in a caring or responsive manner to patients’ needs.
        As others have pointed out we can all find anecdotes to support a point of view – I have a horror story I could recite of the poor care in a Midwestern hospital that culminated in the death of my mother-in-law – but statistics are much more persuasive. And so far as childbirth goes the NHS has a much lower rates of both perinatal and maternal mortality than the USA.. This does not excuse the behaviour of the staff in the hospital you attended, far from it, but it does demonstrate the relative effectiveness of the two systems, to the credit of the NHS.

  61. I know this hospital and have been at a more busy time and I have to say they are pretty quick especially if children are involved. They prioritise on age and severity =) I would say the hospitals in London are fantastic as there are so many to choose from!!! I have never waited for too long, but if you are in an area where they have closed a hospital within the past 5-10 years even as a child you could be looking at a 5 hour wait. I have many memories of that as a child! But I would never give up the NHS as the thought of American healthcare scares me!!! As someone with a medical history I’m not sure I could ever afford to take care of myself =s

  62. No money needs to be paid in our hospitals, or at our doctors. I am glad you got the treatment you needed and that your son is fine 🙂

  63. Just so you know, you definitely won’t be billed. Unlike say Canada, the British health system is nearly 100% government-owned and directly taxpayer-funded. Non-emergency care from a family doctor may involve a token fee if you’re not a UK national but that’s at the discretion of the individual practice; emergency care is free to everyone regardless of status, for the same reason we don’t bill foreign tourists if their hotel burns down and they have to be rescued by fire crews.

    However, if you’d like to demonstrate your gratitude, you could make a small donation towards the upkeep of the London Air Ambulance. For some complicated historical reason helicopter medevac services aren’t funded by the government, and various charitable organisations have sprung up to supply them instead.

  64. I suspect our issues in the US are tied to how influential the insurance industry is in policy making. The ACA, far from providing affordable care, merely mandated that everyone MUST purchase some form of insurance, and mandated what was considered an acceptable minimum of coverage. The insurance industry has gleefully responded by canceling “substandard” plans and enjoying a plethora of new subscribers. Meanwhile, the cost for healthcare continues to climb for the average person.

  65. I am fortunate enough to have never needed much from the NHS in terms of long term care. However last year my wife an NHS children’s nurse, lost her grandmother and nearly her mother within a short period of time. My wife feels that the local hospital didn’t treat her grandmother very well. She was on the stroke ward and eventually passed due to a chest infection. Her mother on the other hand was a different story. She had life saving surgery at the same hospital after fainting at home and being admitted. The next day they discovered that she had an leak in her aortic artery (I think that’s where it was). Anyway she was rushed into surgery the minuet it was discovered. The chief cardio vascular surgeon was just on his way home when my mother in law was taken to theatre and he decided to stay and perform the operation. That man and this system saved my mother in laws life and has not cost any of us a penny.
    Yes the NHS has it’s problems, but there is no other system I would rather have. My work sees me having to go to hospital with people a lot and I am always in awe of the job that the doctors and nurses do under extremely challenging circumstances.

  66. Every health care system has its good and bad points. I have not only used but worked within the NHS and yes there are some aspects that could do with refining but when my daughter (16) was diagnosed with a brain tumour in Feb of this year I remember sitting at Great Ormond Street Hospital whilst she was in theatre wondering about the hideousness of life and what it can throw at you and thought carefully about what we would have done had we not had the NHS. To have to actually think about the cost of my child’s health at a time when I just needed to know that the best would be being done for her just doesn’t bear thinking about. I for one may have moments when I go on about the faults – isn’t that how improvements are made anyway – but I count my self lucky every single day that my daughters treatment is not dependent on my bank balance

  67. Great story, though it certainly is not free , I pay a decent amount out of my wages every week.
    If I got a wage slip out I could tell you what percent. 🙂

  68. I doubt you will ever receive a bill. The idea of free healthcare is so imbedded into the british psyche that I doubt even the medical staff would be able to create one for you. As a veterinarian working in the UK I find this mindset one of the biggest head aches in my job compared to my time in the US. Even doctors gave no concepts of the costs and overheads involved in providing care. I have often commented that although I believe in the NHS and the concept of free healthcare that all patients should be issued with receipts for their care (without charge), this may also go someway to helping with budget management within departments.

    1. It would make us with crohnic illness feel even more crappy. So no shaming the ones who need help the most is not a nice idea. Plus I think it would do bugger all for those who think they are entitled to same back care for coughs and colds. Speaking to someone with exactly the same issues as me and she has had 9 CAT scans while I’ve only ever been given one so I think some doctors obviously do give a damn about costs and saved me doses of radiation. My doctors never jump in with the most expensive drugs we always try the cheaper option first annoying but if they had worked it would save the NHS £

    2. As a patient who has, on occasion, received bills for certain drugs through the post stamped ‘approved’ I’d beg to differ. Apart from the very real worry of people becoming, as a result, closely tied to the idea of their treatment having a monetary value so being more willing to accept a monetary exchange later in time (a neat psychological trick) it also leaves the patient, in my case, feeling incredibly uncomfortable, guilty even – though that, in itself, ties in with the first problem I suspect.

      I simply can’t, having experienced this, see what benefit it would bring to the patient but can certainly see potential harm. If it is for inter-departmental reasons – those receipts and budgets already exist. The only way it could help budget management is by shaming the patient, through guilt, to refuse certain types of treatment because ‘they simply aren’t worth that much money’.

    3. Care in A&E is free. But if he’d been admitted to the wards finance would have come down and started tallying up his bill. If you get emergency treatment only its all free!

  69. I’m British, but I lived in the US for 12 years, and I have to say that in the past 30 years I have had excellent treatment in both countries. The difference was, that I had to pay around $700 a month plus a copay in the US. It used to make me scratch my head as to why some Americans were so adverse to the concept of free healthcare, which should be a right in any tax paying first world country. My only gripe with the NHS, is that when I was young, no-one diagnosed my scoliosis or the fact that I have a calcified heart valve. These were both found at NYU, after I had yet another back spasm aged 45, and was given a full check up. Early enough to resolve the heart problem, but not the scoliosis unfortunately.

    1. To be fair, if your scoliosis was so mild that no-one (not even your parents) noticed, you wouldn’t have been offered any treatment for it anyway.

  70. There’s no doubt the NHS is vastly preferable to the US system, however the treatment of elderly people and long term disabled/ill patents such as stroke patients in a few hospitals is utterly disgusting and it takes a great deal of effort to challenge and improve matters – or indeed, is impossible.

    Of course, that may well also be the case in the US – or perhaps such people would not be insured and would simply be left to die or not given any care in the US. Nonetheless, there are parts of the NHS system which have been allowed to deteriorate to completely inhumane standards.

    1. My father died following a stroke just over a year ago. The stroke unit at Bolton hospital was phenomenal. The staff were angels. The patients in the unit were exceptionally cared for. Family members have been in long term residential care and, again, it was top class care. I think the NHS is like all other large national institutions – some works, but not all. If we lose our NHS it will literally be the death of us. These stories need to be shared and celebrated.

    2. The streets of San Francisco are full of poor souls who are mentally ill and have ended up living on the streets instead of being looked after. These people obviously have no insurance and no chance of medical help at least the UK has social care.

    3. Way back in the 70’s a penniless Canadian artist friend of mine got similar wonderful treatment in a very old Edinburgh hospital for a STD, he was hospitalized for a full week, went home with antibiotics and was treated with dignity and respect . He, too, was never billed and recovered fully. He had hitched across Europe to get there and did not even know where he had picked it up – and they were still wonderful (although they wouldn’t let him leave without some educational booklets and rubbers to limit further indiscretions).

  71. Fantastic to hear you had such a good experience. Ideally, all non-British citizens should pay for their care, if you contact the hospital and ask to speak to their Overseas Patients department you will be able to do so.
    The doctors are often unaware of this as their main concern is making sure their patients are well.

    1. No you won’t have to pay (NHS doctor) – emergency care (This was, I would say) is ALWAYS free to all, no matter where you come from or how rich you are. One remaining part of a truly universal health care system

    2. ‘Non-British citizens’ who are nevertheless legally settled in the UK, have the same entitlement to NHS care that citizens do. Non-*residents* are required to pay for non-emergency care. However, as this was the A&E, and the staff there were evidently satisfied that this was a valid emergency (as opposed to something for which they should have waited to see a GP), there’s no charge. And frankly, even if she were to chase people until someone finally figured out how to send her some kind of bill, the administrative costs would most likely outweigh the cost of the treatment itself.

    3. As far as I know emergency treatment not requiring inpatient treatment is free for even non citizens. That is, fracture arm requiring cast in ED is free but fracture finger requiring k wire is to be paid.

    4. This is incorrect. As a doctor in the NHS, here are the rules.

      The following are entitled to FREE services:

      1. All Emergency care is free for ALL in the NHS (citizens, foreigners, visitors… anybody!)

      2. All NHS services are free for all UK residents (UK citizens & non-UK citizens with residency or students visas)

      Who pays for services in the NHS:

      1. Visitors (visit/tourist visa holders) who seek or are redirected to non-urgent care/consultation

      2. BRITISH CITIZENS who live abroad (those that live less than 90 days/ year in the UK are considered non residents – they dont pay tax but are not eligible for free NHS healthcare either!)

      For further info: http://www.nhs.uk/chq/Pages/1086.aspx?CategoryID=68&SubCategoryID=162

    5. A&E treatment is free to all, including foreign nationals. They are only charged if they are admitted or receiving elective treatment.

    6. Those who are ‘ordinarily’ non resident – i.e. visitors etc are exempt from NHS charges in the following circumstances:
      *Accident and emergency services, whether provided at a hospital accident and emergency department (but not emergency treatment given elsewhere in the hospital);
      • services at a walk-in centre or minor injury unit in respect of services similar to those at an accident and emergency department of a hospital;
      • family planning services;
      • treatment of certain communicable diseases, where treatment is necessary to protect the public health (a list of such diseases is provided in the guidance);
      • treatment for a sexually transmitted disease at an STD clinic or on referral from one10;
      • compulsory psychiatric services (e.g. treatment given to people detained under the Mental Health Act 1983 or other legislation).

      As such no need for any payment from our American doctor author or any other visitor for that matter using ’emergency’ services.
      Continuing non emergency care would be different.

  72. I work in the nhs and my partner is currently an inpatient at the same hospital. The care myself and my colleges give to our patients is exactly the same level as my partner is receiving. I am always the first to pick up on poor standards but there have been none, I am utterly sure he is in the safest place possible and knowing that his tests, weeks as an inpatient and ultimately surgery and long term follow up will not cost us a penny is a no brainer. We don’t earn the wages that I could in private practice but I wouldn’t swap jobs or my husbands place of care for anything.

  73. For those saying Americans are worried about a lack of choice if they accept some kind of NHS style system, I simply don’t get it. As several people in this thread have already said, PRIVATE CARE IS ALSO AVAILABLE! You are not ‘forced’ to go NHS if you can afford otherwise. A lot of UK employers provide some form of health insurance for their employees as part of their benefit package and you can choose to go private if you wish. I have health insurance through my employer but wouldn’t go private unless there was going to be a long wait for a life-threatening condition.

    There are issues with the NHS – care can be variable depending on where you are in the country and what’s wrong with you and sometimes you have to be a bit bolshy to navigate the sometimes arcane structures of the system! But I assume that can be the case whoever’s paying the bills.

    I’ve had 2 childhood operations on the NHS as well as physio after a fall which worked brilliantly and innumerable GP visits over the years, including preventative care offered to all women such as cervical screening etc… I think in a system where the taxpayer is footing the bill, treatments and tests have to prove themselves to be effective before they are made available on the NHS – I actually think this is a good thing most of the time, I like to know that a treatment has been proven to be safe and effective before I’m offered it! I can understand that this may make people feel that they’re not always getting the most cutting edge treatment available, but again, you can access alternative treatments privately if you can afford it.

    IMy mother in law was very ill for many years with emphysema and breast cancer – her care was sometimes better than others, but through a mixture of house visits from our doctor and community nurses, hospitalisation, some time in hospice care and a radiotherapy, she ended up having another 6 years with us than was initially expected. The idea that that time might have been dependent on how much we could afford is abhorrent to me.

    1. I think one interesting thing to mention on this is that even people with insurance and the ability to go private use the NHS. Not only for their GP. For example, my mum had cancer and through my dad’s job we have medical insurance but actually my mum’s treatment was a combination of private and NHS for the reason that actually she would be handled more quickly under the NHS for some procedures.

    2. Ah – the old ‘private option’ in the UK argument.

      This is only partially true – private companies do not operate ambulances and emergency services. If you’re in an accident, it’s the NHS that will attend the scene, treat you in A&E/ICU, save your life and bear the biggest expense before handing you over to the private wards and consultants.

      As with US insurance companies, try looking at what insurance is available if you have long term/complex health issues – eg. post kidney transplants, etc. I have friends who would have been uninsurable in the US (until ObamaCare came in) and have been quoted a kidney for UK private care who would be dead if not for the NHS.

      I come from a medical family – my mother was a nurse from the age of 15 until she retired as a Matron last year at the age of 65, both my sisters are nurses, and most of the women on my mothers side have been nurses going back generations. It pains me to see the NHS being slowly dismantled by successive Conservative governments, and the last Labour one didn’t help much by bringing in PFI. I just hope the next one remembers why the NHS was created and addresses some of the problems that 30+ years of underfunding and neglect have caused.

    3. If you had a life threatening condition, then there wouldn’t be a long wait! The long waits in the NHS are real, but never for life threatening things.

  74. I for one have the NHS to thank for the amazing care my dad received for over 20 years he was diagnosed at 50 with Hypertrophic cardio mynopathy. He was given the best care and more than 1 hi tech pacemaker fitted through that period which gave him 20 years off prolonged life he would never have had without. He was able ee his grandchildren grow up. I dread to think the outcome if he had to pay. My dad was working class and low paid joiner and would never have been able to afford similar care in US. Unfortunately in UK the NHS is being broken up bit by and being privatised its nice to see people praise it. Let’s hope we keep it

    1. This is happening here in Australia as well. We have great public health care that is underfunded by successive governments and our current conservative government wants privatisation of almost everything :(.
      As a nurse who has worked in and and been a patient in both private and public sectors, I know I am in the majority of health workers when I say- if you are sick go public. The private sector is for nicer food and prettier decor; nice but unnecessary when you are really ill.
      The old worry, “Oh you can’t choose your doctor in the public sector” is a furphy to me, most referrals are to specialists your GP knows, so who is doing the choosing for you?
      There are more cheques and balances in the public sector too, no hospital wants a public enquiry into it’s standard of care, whereas damages can be paid quietly in the private sector and no-one needs to know (shh).

  75. What do Americans fear about NHS type healthcare systems? The idea that their tax dollars will be used to fund the health care of someone else and that someone who is jobless might get the same standard of healthcare as them?

    1. and why shouldn’t they? Why should someone be refused healthcare if they are sick just because they are unemployed. When did humans stop caring about their own kind? Surely the fortunate should help the less fortunate. There are people who work very hard, but loose their jobs in the recession, or have a family member suddenly become very sick who needs looking after. There maybe a small number of people who are too lazy to work, but it’s a very small number. Let’s not change the nhs for the majority because of the minority.

      If you are sick, you are cared for. That has to be a fundamental right for all, not let in the gutter to suffer.

      1. I couldn’t agree with you more. I am a firm believer in the NHS and the ideal of social health care for all. Paid for by the fortunate and available to all on the basis of clinical need rather than ability to pay. My point was that this goes against the prevailing mentality in the USA (of course by no means all Americans think this way but it may well be a majority opinion). The American mentality is that you work hard, earn money and use your money to look after you and your family. The idea that the government can come along and take a significant proportion of your earnings and decide to re-distribute it to the less fortunate in society is a “left-wing liberal European socialist / communist” idea which doesn’t sit well with a significant proportion of the American public. Centre right politicians in the UK would be considered very left of centre in the USA.

    2. This never ceases to amaze me, if you pay private medical insurance and don’t receive care, your insurance premium is divided between profit and healthcare costs for someone else. You are literally paying for someone elses healthcare. Both socialised and private medicine work on the same principle, lots of people pay a small amount into a kitty and a small number of people make big withdrawls. The only difference is that with private medicine there is a layer of profit on top which drives up costs, socialised medicine is all healthcare costs.

  76. It’s much the same in Canada (“free” health care, and it’s fine), except non-residents should expect a moderately hefty bill.

    1. I spent my first evening in Canada in hospital (after spraining my ankle, but a ‘walk-in’ doctor (equivalent of a UK GP) thought it might be DVT from the plane. After coming home, I got a bill for several thousand dollars – fortunately entirely covered by my insurance.

    2. Though from what I’ve heard, much of Canada really does have a waiting times problem. This isn’t a problem with universal health care (in Japan, you don’t even need an appointment to see a specialist, you can walk in), but with Canada, which has fewer doctors per capita than even the US.

      Likewise any problems with the NHS might be fixable if they spent more; the UK is rather cheapskate when it comes to health care, spending maybe 8% of GDP vs 11% for similar countries (or 16% for the US…)

      1. The US pay 17.9% GDP and the UK pay 9.4% (http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS), but what do the US citizens get for their 17.9%, seen as everyone needs insurance to access medical care?

        The UK citizens get free healthcare, for all. We have a higher life expectancy while spending half as much. More efficient, more ethical and more effective. Great deal really.

  77. As a Brit who has lived abroad for years I do not get the whinging about the nhs. Free health care! And whilst it might not be perfect it is better than any other system I have experienced (and paid for).

    1. As I understand it, as a Brit abroad, you aren’t paying income taxes on your ‘foreign’ income to pay for the ‘Free health care’. Is that correct? As a US citizen you would be required to pay income taxes on all your worldwide income.

  78. Please don’t be fooled by one positive experience of a small (yes, seriously St Thomas’s covers a relatively small area) NHS hospital A&E department. My repeated and regular interactions with our local A&E dept terrify me. My daughter has brittle asthma and frequent pneumonias requiring hospital admission as well as several other medical problems. Whilst her consultant led care is all at St Thomas’s (and is EXCELLENT) in an emergency I have to take her to our much more local (much larger) teaching hospital, and the terrifyingly slow and slap-dash triage procedures, the under-staffing of paeds A&E HDU, and the patchy nature of the doctors we see give me ongoing nightmares. That said they have repeatedly kept her alive over the past few months, and my thankfulness to God and to the staff, for that, cannot be measured. I would say that a large part of why these interactions have had successful outcomes has been to do with my persistence as a parent, my refusal to sit quietly in the waiting room while my daughter quietly gasps for breath. If I had the choice of getting my NHS taxes and NI contributions back and getting my daughter seen privately I would do so, but the truth is there is NO emergency private paediatric medical care available in the UK. So in practise our hands are tied, and we do not have “the best of both worlds” as one of your previous commenters stated.
    Please don’t misunderstand me, I am very thankful for the NHS, but please don’t make the mistake of judging it as a whole based on one trip to one very unique and special hospital.

    1. Chances are your taxes and NI contributions, even if returned would make a very small dent in the high cost of your daughters repeated care. I am sure with your daughters life in your hands you would be willing to pay the £1000’s each admission would cost plus the true real cost of her prescription medications but there are many that would simply not be able to afford such bills. My nephew in the US has respiratory problems and they are left crippled each month by the cost of medication that would be free to us. They have good insurance but it doesn’t cover everything and who can deny their children the meds they need to keep them healthy.

    2. If you got all your NI contributions back do you really think you could afford all the treatment your daughter received on the NHS in the US with it?
      What would happen if you or the rest of your family got sick at the same time?

    3. Well feel free to read my comment: as someone who spent years of his life in life/death situations from 8-28.

      First of all there is nothing wrong with being adamant about the care you, or someone you care about, is going to receive. Obviously it must be informed rather than reactionary but, oddly, in the UK (and any long term hospital user will see it) there is an all too often deification of medical staff where patients simply defer to them even in the face of common sense. You wouldn’t act like that in a shop, with a utilities provider, and you certainly shouldn’t for healthcare either. You must always be ready to ask why, how, and when, and question any contradictions or mistakes – this will hold true whatever the arena and especially medical care. If you don’t like how a professional performs a treatment you know well: speak up! And equally though, don’t be ashamed of doing so or believe that because you know your loved ones condition better than most anyone that those who don’t know it as well as you are inept. I mean they may well be, but equally you have the experience and the right to make sure whatever treatment it is, is then undertook properly. I don’t think that points to an intrinsic failing on the part of staff, but have, to counterbalance, also experienced genuinely inept, egotistical fools where I feel that either I, my mother, or my girlfriend, have had to firmly steer the ship of my ill-health back in to calmer waters. These individuals though, and even at worse, these wards, aren’t the result of public ownership but simply are poor healthcare professionals, and poor managers, and they would be whoever paid their wages.

      While I wouldn’t ever doubt that my mother’s, and later my own, persistence, and occasional aggressive pursuit of the correct treatments paid off the link between this being extrapolated to represent the idea that there is better care in private than public is, frankly, bizarre. Firstly I want to establish this: the UK there is no true private care. The doctors and nurses your daughter would see have all been trained and funded by the NHS, they will also likely be the same doctors your daughter sees at the hospital (especially if consultants, as my mother found out when she broke her back), your daughter may be admitted to a private bed on a public ward in a public hospital. Equally you might find that, due to a lack of government funding in NHS hospitals, as is shamefully happening more and more now, your daughter may even be referred for treatment at private hospitals with the NHS footing the inflated bill. As a result I can see nothing directly that privatised healthcare would solve for you that changing to any other NHS hospital wouldn’t accomplish just as easily.

      Of course the above instances of private healthcare come as no surprise though as private care in this country piggybacks off the funding from the public sector: whether it is staff that the NHS have paid to get through University, then paid for all of their initial hospital work, then give them schedules that allow them to run private clinics in the morning turning up late to afternoon NHS clinics; or BUPA, and Healthcare at Home, who provide training and supplies for those at home and are frequently inefficient and poorly regulated but are paid from NHS budgets.

      I speak from vast experience. Healthcare at Home were due to train up a fellow opposite me in the hospital bay for home TPN, years ago when I recommenced TPN myself. Due to my arriving later than him and recent budget changes BUPA were assigned for my home training. BUPA kept me clogging a hospital bed (as the NHS don’t provide training in house now – as they did when I was 15) for three weeks. Not so bad. The fellow opposite had waited months, I discovered, three/four months! Now Healthcare at Home, I believe, are floated, you can buy stocks in them, they are the very definition of a private health provider. And rather than outlay a little extra money for staff they kept the poor man in hospital and cost the NHS thousands of pounds while denying the bed to those that may need it. Healthcare at Home have also repeatedly missed delivery dates for my £12,000 per year drug, delivered them when I have rung them to tell them I can’t take it (due to infections, etc), leading to wasted stock of an expensive drug. Then the little things like not sending me a sharps bin for months until, eventually, I had to contact my team to get one sent to me.

      Then there’s BUPA: who run many a private hospital. To restate: I am reliant on TPN now to live, two days without it and I must be hospitalised (I am allowed one day per week off – any more and severe dehydration/body reacts to the loss of its 2.5 litres per day of vitamins/minerals/fats/trace elements etc). Just two weeks ago my Monday delivery arrived, all my ancillary stocks (sterile dressing kits, sterile gloves, surgical scrub, etc) but absolutely no food. None. I was very unwell, had been sick multiple times and morphine had slowed me, but I rang BUPA and spoke to them. ‘A terrible mistake’, though one they couldn’t actually explain why it had happened, ‘are you in tomorrow?’. Well I wasn’t, I was at hospital, so I agreed to have the night off (BUPA don’t provide an extra, fall back, bag of emergency feed to patients anymore for situations such as these, as they are supposed too) to deliver on Wednesday. Wednesday comes and, approaching 5:30, and beginning to feel worse for wear, I rang them just to be certain. Just as well really; they had another unspecified mishap that meant the feed still hadn’t been sent out, spotted due to my due diligence. As a result they had to send it out via 24 hour courier with it arriving after midnight – no doubt charging the NHS for the two abortive attempts and the third, extremely, expensive option. There are other problems: changing the feed bags to ones wildly unsuitable for TPN and the sterility required (after I complained, and my team complained, about their unsuitability I received months later a letter telling me that these bags were ideal, sorry); not sending items out, sending incorrect quantities, only sending three bags of food not six . . .

      The above did have a point, however unscientific because, unlike the NHS, I do think that these are systemic issues with private healthcare; the idea is to charge more to make more – whether they’re charging the NHS, charging your insurer, or charging you, their aim is to make a profit. What this might mean in residential care, for example, might be the current state of affairs in the bigger chains investigated by Panorama, or even in a smaller privately run, exclusive, expensive care homes terrible examples of cost-cutting (personal experience), and unbelievably, extremely low staffing.

      So cost-cutting for profit often will lead to shoddy practices across the board due to lower staff numbers, poorly paid staff members, and focussing on savings rather than quality service. It is sad to say that over the past few years I do think you can identify that trend developing in the NHS due to budget cuts and staffing cuts but it is only in its infancy and can be reversed if it becomes endemic.

      Of course though, as I said, the issues of the sort you mention facing, and which I have too, will never be fixed by just going private. If they were America would be outpacing the entirety of the Western World with its life-expectancies, its treatments, its infection rates etc – but it isn’t. And, even if it were, they pay nearly double for that level of care – they also have insurance companies that, as one poster mentioned earlier in relation to his work in litigation, investigate people to avoid paying their medical bills; and hospital bills that often seem inflated, and often are, as a result of the insurance system.

      If the other hospital is that bad then contact their PALS team (they may have another name for it – but it is basically a team who’ll investigate such issues) and gain some positive action from your negative experiences. It might lead to new pathways being introduced that help others. Or if you’ve already done that, keep doing it, go to your MP, contact the managing director of the trust, and really rattle the cages. You can do all of these things and they often produce worthwhile results.

      What wouldn’t produce those results, however, would be to turn your hospital into a ‘private hospital’ – certainly no more than a change of management in general, anyway. You’d still have the same issues, the same staff, and (unless they shook up management in A&E) the same sloppy work. Except those staff would all be paid more, the building would get a lick of paint, but to balance that out cost saving measures would be found elsewhere, and you’d probably pay more than your NI contributions to boot – though considering your daughters condition is a chronic one, it is doubtful you’d get the requisite cover at all.

      All you’ve mentioned is not to judge by a small picture of the NHS, by my experience of over 10 (15 if you include visiting other folks) hospitals yours is equally small! All you describe (though I don’t use all in any sense as a pejorative) is simply the sort of differences one could expect from place to place whatever the system, certainly not one you could ascribe to the NHS across the board (though admittedly one would hope a large system like the NHS would be better placed to iron it out). And, crucially perhaps whatever you think of them, they’ve kept your daughter here and with you. That is the best thing and long may that be the case.

      1. I was employed by health care at home. I when I realised the management structure was work the employees hard, treat them badly and bully any that stand up for themselves or others.
        They are only interested in making money the customer is very low down on the list. And the employees even lower down than that.
        They are all that should be worried about when (sadly not if) this government privatises the NHS.

      2. I was employed by health care at home. I left when I realised the management structure was work the employees hard, treat them badly and bully any that stand up for themselves or others.
        They are only interested in making money the customer is very low down on the list. And the employees even lower down than that.
        They are all that should be worried about when (sadly not if) this government privatises the NHS.

    4. So we have one ‘good’ experience and one ‘bad’ one; and two only makes this anecdotal rather than statistically accurate, and therefore inconclusive!

      Perhaps to you, mamma, we should say “please don’t make the mistake of judging it as a whole based on your, one bad experience”.

      1. Perhaps you should re-read my comment, and note that it refers to multiple interactions, admissions, and negative experiences, not just one. And then perhaps you should re-read my original comment in the broadly positive vein in which it was intended. I am thankful for the NHS, I am thankful that my daughter (who has been ill from birth to the present day – almost age 6) is still alive, and I am thankful for lovely NHS doctors who continue to investigate what is wrong with her. But I resent my lack of choice (and please don’t insult me by quoting the “choose and book” service to me), and I regret the many terrifying experiences we have had in emergency situations at our local large teaching hospital. Again I say, let’s encourage this author not to assume that because she has had one positive experience (and I am delighted for her) that the NHS is broadly a good and efficient service with its patients well cared for in both emergency and routine situations. Because to make such an assumption would be farcical.

    5. People can bash the NHS all you like but at the end of the day you yourself typed, “That said they have repeatedly kept her alive over the past few months, and my thankfulness to God and to the staff, for that, cannot be measured.” After all, isn’t that what it’s all about?

    6. There is no emergency private paediatric medical care available in the UK for a very simple reason – not because of an overbearing Stalinist government but because there is no profit in it. You can have your baby delivered privately in a room with pretty wallpaper. But if there is any serious health problem with mother or baby, an NHS ambulance has to be summoned to take them for free treatment on the NHS which provides it. I would be interested to hear what sort of premiums – and out of pocket payments – are required in the USA for a child with brittle asthma and frequent pneumonias. And how many visits to A&E all your NHS taxes and NI contributions would pay for before you are rendered bankrupt (as I believe many Americans are by medical expenses). Of course that ignores the fact that, so far, there have been no NHS taxes and NI contributions made on her behalf. As in, you have not paid any more in to the system for your daughter than I have. And, believe me, I am happy to have helped pay for her treatment even if I have not got “my money’s worth” for myself. I wish your daughter well and am glad that her care at St Thomas’s is all you could ask.

      1. I really think only the negative stories make it over the pond. I can’t answer regarding asthma treatments but I am a mother of two children who need ongoing care here in the US — one has cancer, the other autism — and I can easily say their treatment hasn’t come close to bankrupting us. Just as you pay into a national health insurance scheme, we pay into a private scheme, which has covered the majority of our costs. The government here pays for treatment for the poorest. My children receive the same level of care as children on our publicly-funded scheme and the parents of these children are often reimbursed transportation costs and provided interpreters free of charge. Our problem here is that the safety net is nowhere big enough.
        As for the original post, I think it was more than fair. She is speaking from her own experience and highlighting a segment of the system which is lacking and not deriding system as a whole, which she rigorously defends.

      2. Re taxes and contributions on behalf of the child: Here in the US I have to pay a separate full payment for my child from 1 month of age. It is over $5,000 a year for one person before any copays etc for doctor’s visits or tests or drugs. And it isn’t even top-of-the-line insurance.

  79. On the one hand I want to say this is a really interesting post. On the other, I’m just astounded that anyone, particularly a doctor, would so uncritically harbour these kinds of misconceptions. I’ve visited several ERs in the US on my travels and haven’t yet had an experience that I would say genuinely beats the experiences I’ve had with the NHS. Different hospitals have different priorities, but otherwise they’re much of a muchness. I’ve been in many a drab hospital in North America, is the decor really worth a mention? You got good care from well trained medics, how and why is that a surprise? And if you’re really worried, you can pay to go private.

    1. The decor is mentioned because the majority of large US hospitals and outpatient centres pay an exorbitant amount to continually refurbish their interiors. Many drawing a likeness to banks or executive offices. I lived in the US for eighteen years and after returning to the UK and using a hospital for the first time, it was a marked difference in appearance, but it’s simply because the NHS focuses on what is important, whereas the US is all about maintaining an image even if unnecessary to the function.

    2. Paying to go private does not in any sense offer a better healthcare experience. And if your situation deteriorates you’d be shipped out to the NHS anyway.

  80. I was denied care by 6 US doctors, who not only did not know what exactly was wrong with me, but also did not want to further deal with me because I did not have insurance. I am able to pay for care, I was just told that I am uninsurable because of existing condition. So, I made the decision to seek care in a 3rd world country. They were quick to schedule me for consultation and every quicker to schedule me for surgery. It really only took a phone call. Once in Costa Rica, my Dr did a scope exam, located tumors that needed to be removed. 2 days later, I had surgery, where my Dr found colon cancer. a 7lb tumor on my colon. US Drs were unable to locate the reason why I could not poop. Hmm…? I paid $10 for my CR trip, that included 2 round trip tickets, healing house for 1 month, DR and Hospital bills, + additional bills for CAT scan, colonoscopy and Xrays for the new diagnoses. Once back on US soil, I gave me US drs the Costa Rica diagnoses. US Drs operated on me 4 times in 1 year to the tune of $500k. I will be paying that off for the rest of my life I suspect.

  81. I love the NHS. I am a generally healthy adult but when I needed to check out a heart irregularity it was done, blood tests taken, consultants check up, no charge. It does get abused by the drunks at A&E on a Saturday night, by the endless hypochondriacs, and by the private healthcare ramp. What we need is a serious debate on quality of life care in old age.

  82. I’m glad that your experience of the NHS here in the UK changed your perceptions. Yes, a lot of our hospitals may look a bit ‘drab’ because they often occupy buildings that were built early 1900, some are concrete monsters from the 1960s etc. Unfortunately a downside to the nhs is their sever lack of funding which often looks like some hospitals are a bit neglected however this does not mean care is compromised as you found 🙂 Some hospitals recently are being rebuilt to be more modern like and what we would define as more ‘American’. An example would be Southmead hospital in Bristol if you want to have a look. Originally consisted on lots of buildings on a big site that was hard to get around, now opening last year it is a brand new glass building with carefully laid out wards.

    As for cost, that has been a contentious issue here in the UK about who should/shouldn’t have to pay for treatment. If you are from within the EU and have an insurance card it should be covered however outside of this there is normally a charge. There have been recent findings though of hospitals either not billing ot failing to chase up payments from visitors to the UK which is causing some arguments between government and the NHS about how best to get this money back. It does seem we are the only country in Europe with a very lax policy on health insurance for visitors.

    As a citizen of the UK I am very grateful to have the NHS. I have spent a lot of my life in and out of hospital. I’ve had 5 surgeries so far and countless hospital visits. I know that long waits are expected, I just get on with it. I accept at the end of the day if you need help then you have to wait. There is nothing you can do. That said, when I have been unsatisfied with a hospital visit I have chosen to have a private consultation for a 2nd opinion. I would not be alive today if I had to live in an American style system because I really wouldn’t be able to afford the amount of hospital visits and surgeries I have.

    Im glad that we have the choice here of both private and NHS. You don’t have to pick one or the other. I’m glad that your son is ok and you enjoyed your time.

  83. St Thomas’ is an amazing hospital…went to their minor injuries unit recently and was impressed with how quickly I was seen…that’s not standard NHS fare. It was also the hospital that saved my sweetheart’s life after his heart attack, so will always be grateful to all those who work there. We Brits can be quick to moan and generally hate to gush, but having a system like the NHS here makes me very glad, and proud of my country.

  84. I have a feeling that we have the US to thank for the emergent ‘litigation culture’ that has meant that our doctors and nurses (NHS) now spend a ridiculous amount of their time filling in forms and documenting everything rather than actually caring for their patients. Simple procedures like cannulation and toileting now require a form to be filled in stating explicitly that the ‘operator’ washed their hands and followed other policy stipulations. There is definitely a new fear factor amongst staff that they will be sued.

    Other ‘initiatives’ such as the newly proposed naming and shaming of GP’s who have low cancer diagnosis rates further adds fuel to this fire and will soon remove any joy or desire to practice medicine, especially when young, intelligent people realise they can have higher job satisfaction and get payed plenty more in other areas of work.

  85. St Thomas is local to my workplace and sadly my asthma has led me to make at least annual visits. I’ve only ever experienced fast expert care and I am more grateful than I can ever express that I never ever receive a bill. The only complaint I’ve ever had about St Thomas A&E is that the lavatories are not as clean as I’d like… and that’s pretty petty considering that on one occasion they probably saved my life.

    Of course it is only free at point of use, I do pay for the NHS through my National Insurance but I don’t begrudge it. It’s an amazing deal especially when you consider that my Symbicort, monteleukast and all my other drugs only cost my £104 a year using the NHS prepayment scheme. I know I will never die or be non compliant because I can’t pay. Nor will I ever go bankrupt because of my medical bills.

  86. As a someone who has lived in the UK for 48 years, I think the NHS is great. Not perfect, but great.

    Many years ago I had an in-growing while visiting US. I went to see a podiatrist, who sorted it out. But the lasting memory is that he spent more time looking at my insurance paperwork than he did my foot.

    I think the NHS is one of the best things the UK produced. We need to fight hard to stop the politicians from privatising it.

  87. “It makes you wonder exactly what frightens Americans about the NHS?”

    Answer: ideology, propaganda and disinformation that goes back to Ronald Reagan and the AMA in the 1950s (as seen in Michael Moore’s Sicko). Tea Party types are so pig-headed that they’d rather be ripped off by private HMOs and insurance companies than admit that America has got it wrong for the past 80 years.

  88. I lived in the UK for 10 years. I am not at all a fan of the NHS and I am hardly alone. I’m glad that the author had a good experience and little wait times but during my care I was routinely made to wait for 2 to 3 hours — for a set appointment. And while she hasn’t received a bill, the NHS is far from free for the people who live there. What my husband and I paid in tax to the NHS in one year was nearly double our medical costs for a year being self-insured in the US. The bottom line is ever present and we often had to fight for our doctor to take our concerns seriously. My son and I were both hospitalized for conditions that could have been treated with a prescription but doctors are often constrained in terms of the numbers of prescriptions they write. Also, resource allocation varies depending on who runs your local NHS trust. Often the latest cancer protocols available in the States aren’t in the UK, because the government adopts a wait-and-see approach. A year after we moved to the US (my husband is British), our daughter was diagnosed with cancer. We are about 99.9 % sure this diagnosis would not have been made in the UK, because the tests her pediatrician ordered (our children weren’t treated by prediatricians in the UK, unless they were in the hospital) had to do with the fact that her development was delayed. No one was tracking her development in the UK. Similarly, within 3 months of returning to the US, my son was diagnosed with autism and began a rigorous course of treatment with speech, physical and occupational therapies. Because the doctors here caught it when he was young, and he received the care he needed, he is now very high functioning I’m always glad to hear that people had a good experience with the NHS, mostly because I hate to hear of anyone having a bad experience with medical treatment, but it concerns me when they decide this means the UK system has no problems of its own.

  89. All emergency care is free in the UK, no matter what you nationality. It’s only if you get admitted or need follow up out-patient care that you get charged. The NHS is wonderful, people forget that sometimes!!

  90. I’m an American who moved to Scotland for college and have continued to live here for 7 years. I have Crouzon syndrome, had my final surgery the summer before 12th grade, and still needed 1-2 follow up appointments by the time I got to the UK.

    So, once I was there, I contacted my university’s health service (which I understand was basically just an NHS office set on our campus) and they had set me up with an appointment with a craniofacial specialist an hour away by train only 3 weeks later. This specialist knew exactly what to look at for the follow-up to the final surgery for a very rare condition, was cheerful, helpful and competent. At the end I had the exact same experience – where’s my pile of paperwork to take away? How much do I owe you? Here’s the card for my mom’s insurance. They laughed (kindly).

    Since then I’ve had birth control and STD checks, I’ve had a trip to the emergency room for (mild) blunt force trauma a on Saturday night, my Scottish husband has had an emergency appendectomy, I’ve had mental health medication, I’ve called ambulances for acquaintances, I’ve had a wisdom tooth out, routine updates for my glasses prescription, I’ve had antibiotics. How much have I been charged? Nada. It comes out of my taxes. And I am VERY happy to pay those taxes, because all of the care I’ve received and seen others received has been supremely competent, delivered with a reasonable wait (even the Saturday night ER trip, in the middle of a city!), and immensely friendly. It’s a huge contrast to the USA, where my dad died of cancer when I was 16 and my mom was still fighting the insurance battles when I was in college.

    Relatedly: huge shout out to every branch of the Edinburgh emergency services. It’s unfortunate that I’ve had dealings with all of them while I’ve been here, but every single time I have been impressed with their professionalism, respect, and response times. Police, fire department, medical crews, they’re all brilliant.

  91. I was travelling in Europe for the better portion of a month with my wife who is British. We ended the trip with a week long visit to see the sister-in-law in Birmingham. I seemingly caught something in my travels and fell ridiculously ill while there. After a few days of misery in bed, I noticed a sudden rash…it was concerning. The sister-in-law told me to call the NHS hotline and see about getting checked out. I resolved myself that they simply weren’t going to let me on the flight back home in this condition, so I prepared myself to pay whatever I needed to, and to whomever.

    I called them. I told them that I’m a US citizen travelling abroad, and seem to have fallen quite ill. She had me describe my symptoms, assessed the situation, and ultimately said she was going to consult with another doctor and she’d call me back in about 10 minutes. Sure enough, 10 minutes later she called me back. She told me that she had already booked me an appointment at the local hospital, gave me directions to the place, the approximate location of the emergency room (because apparently it was around the back of the building), and it wasn’t going to cost me anything. I had her repeat that last one, and even ask if she was SURE that was correct. She assured me it was.

    I followed her instructions, and when I arrived I was told I was expected. I waited the exact amount of time it took me to fill out all of my forms (which wasn’t long) before they took me back to see me. They assessed the situation, diagnosed me, and gave me my prescription to be picked up at a local pharmacy down the road.

    Total time spent from NHS call to back at home with meds: 45 minutes.
    Total amount spent on emergency room trip: $11.00 USD (for the meds, which was 7 pounds 50…roughly $11)

    They were amazing, and it changed my entire perspective of socialized medicine.

  92. I think one of the best things about out system is our out of hour care. Monday to Friday 9to 6 family doctors treat crohnic problems and minor illness transphering straight to a ward/clinc if they need a specialist immediately the rest of the time we have an out of hours GP system that cares for those patients so they don’t clog up A&E. I have Crohn’s with strictures and when I double up in agony with partial obstructions I don’t go to an ER and get treated like a drug seeker I get treated by a general practice doctor who can see what meds I’m on and assess me. A few injections later I’m told if I don’t feel better within a time frame to phone back and they will admit me to a general medical/surgical ward for treatment. Usually I’m fine after anti emetic anti spasmodic and a pain killer the few times when I had a full blown obstruction I was given meds and admitted. I speak to a few people with my issue in the US and the last thing they want to do is go to the ER they report being treated like a drug seeker and try to cope without help rather than go in. The nhs have their faults but how can an ER work if people with crohnic illness only have that option they know it’s not an emergency but have zero other option. I get people are worried about NHS style medicine creating malingerers I think it would be a good way to keep malingerers out of the ER if they have a real crohnic illness they won’t be in the ER. My wait time to see a GI is a bit long at times but If I was truly desprate I could see a private one I don’t because I trust my GP and know if they think I’m struggling they will phone and get me seen at the emergency clinic or arrange for me to go to the ward. I live in Scotland so don’t have to worry about the cost of my drugs another thing I find my friends in America struggle with even when the have a partner that works they work as well in order to pay for drugs yet they are often not fit but have no option they can’t afford to be sick
    I’m glad I don’t have Crohn’s in the US it is possibly not as bad as I fear (like your feelings about our AE) but our quality of life would be worse. Here I have backup from community nurses and out of hour doctors and although it can suck being ill I’m never left in horrible pain if it can be helped. It’s been about 7years since I last had to go near A&E despite acute issues many times. When my kids have needed glued it’s always been quick and easy. If we had the amount of tax going into our NHS as America does going into it’s healthcare system imagine how much better we could do

  93. great article, thanks for sharing. You are right the NHS does work well. We like to make public comment on the things that need to improve. Old folk care is terrible in this country and it is all private now. I think it is very interesting to compare the US and UK systems. You don’t get too many articles coming out of the US praising their system, all the good they achieve is undermined by the horrendous tariffs the insurance companies charge (and offer no insurance that you will get treated!). While the NHS isn’t perfect , it is kind of perfect – we all get cared for, and in ways no other humans in history have had access to (for free at point of entry no less) – the greatest tragedy coming out of US medical “industry” is the corruption in the FDA who are funded 80% by big pharma. I am looking into this right now and it is shocking what is going on between the FDA and big pharma, the profit motive has no place in the hypocrite oath, and doctors, after all can only prescribe certain drugs that the FDA approves, etc etc , money makes the world go around…the wrong way.

  94. Dr Gunter.

    My tax paid for your son’s eyecare. I’m very happy it did, and I really hope you enjoyed the rest of your holiday.

    It is a great sadness to me that so many Brits have swallowed the line that taxes are bad; everyone should pay their way, etc, etc. Well to me, it is the mark of a civilised nation that we look after each other, and we provide civilised A&E to those that need it whilst on our shores.

    Sure, I’d be glad if they sorted out you paying, but more important is that your boy can see, hasn’t sustained long lasting damage and he saw the expert he needed, right?

    I am very happy that a tiny sliver of my taxes that I pay helped to sort that out.

    Please make it your business to counteract the insane nonsense I hear talked by American conservative commentators about the NHS. It’s the product of a nation on the journey toward civilisation, and I hope you guys can join us one day, before ours is ripped apart by the pressures of the present govt.

    Tax, and what it pays for, is not bad or wrong. It is good. And we should celebrate it.

  95. You won’t get a bill. The NHS operates a free point of care for ALL policy. Had you received treatment beyond A&E, there would eventually be a bill in the post…if the overseas patients team got their act together.
    Very pleased to read of your good experience with our overburdened, inefficient but somehow adequetely effective National Health Service.

  96. As a UK tax payer I do not mind that you did not have to pay for your treatment within the NHS. I doubt you will ever see a bill ever unless you chase one. Over 90% of UK citizens are in favour of the NHS and would never scrap it. It is without a doubt one of our best accomplishments. It is a part of our culture that the idea of billing people for healthcare is sickening to us and that’s why I don’t mind that you where not charged for the services you received. I would say to you however that if you feel you would like to give something back then why not give to one of the hospitals charity’s? A small donation. All hospitals have them to help raise funds for new wards, equipment or research and a small a donation as just £5 would be very welcome and gratefully received.

  97. Let’s not forget that Brits also have the option of purchasing supplementary private health insurance. Still, the point is that you won’t be turned away for not being able to pay your bill. You would be crippled by debt in the US for many of the same procedures. I much prefer the NHS universal payer system. It makes more sense to me. I’ve been in the US for 17 years and I still cringe when the health bills roll in 😦

  98. I’m not 100% certain of this, but I believe that emergency care is free for everyone and that charges only apply for overseas patients for tertiary/non-emergency care.

  99. I used St Thomases about ten years ago for an urgent appendectomy. I was seen inside half an hour, had the op that very night and had my own room to recover in. There was no bill to pay. One of the very best hospitals in my opinion and the nurses there are fantastic.

  100. Details of your visit will be sent to the overseas department of the trust. They will then bill you for the care you received, if your bill is not paid in full you will be unable to return to the uk. That’s how the system is meant to work. That is one of the best things about the uk that your healthcare is free at point if contact.

  101. You won’t get a bill. I was a tourist visiting the UK and went to the local doctor (not even the ER) for antibiotics for a kidney infection. Free and free.

    Now I live in the UK. I had sinus surgery, including a CT scan and an overnight in the hospital for free. In Northern Ireland our prescriptions are free. I get physio for a bad shoulder for, yep, free. I pay my National Insurance out of my paycheck, but it is a pittance compared to US health insurance.

    OK, so the NHS has financial issues, and maybe ‘free’ isn’t the way to go for everything… but after living in the US with nothing but a small ER insurance policy, I love the NHS.

  102. As a Brit who moved from the UK to the US six months ago, I can say that I’ve never felt so grateful for the NHS.

    We have insurance cover in the US through my husbands job…but nevertheless we have had such a shock with the medical bills. We pay a monthly premium (a few hundred dollars) and then on top of this we have to pay the first $4k , per year, as a family excess, before the insurance ‘kicks in’. Then, even when it does kick-in, you have to pay 10% of all treatments. You might think 10% isn’t bad….but the prices of treatments are ridiculous.

    The US private system charges are even MORE than the UK private system..eventhough clearly they must have more spending power (i.e get better prices on equipment and drugs etc as they are buying in larger quantities).

    Let me give you an example of a recent personal experience. I recently had an MRI scan, if I had one at an NHS hospital this would have been free, at a UK private hospital this would have been £228-£532 which is $380 – $888, (dependant on size of area) …..in the US I was charged $3455!!

    The pricing is also not transparent , so you have no idea what anything will really costs…without finding out the ‘code’ for your treatment and then making lots of phone calls to and from the insurance company (just what you want to be doing when you’re sick!). It leaves you scared to go to the doctor/hospital and asking the question ‘am I really sick, is it really that bad’, trying to convince yourself that you don’t really need the medical care, because you’re basically so scared of the cost. This is coming from someone who actually has insurance, imagine how those with jobs that don’t come with healthcare must feel. Oh and did I mention that on top of those insurance premiums & excesses we’re paying, the company is also contributing!! So as you can see, this is BIG business for the insurance companies and healthcare providers. They are making serious money and therefore have serious political power.

    Let me give you another example on pricing. I recently was prescribed some nasal spray to help with allergies, in the UK a prescription charge is £8.05 (about $13.45). The UK caps prescription charges for a year, so patients never pay more than £104 in a year (about $173.55) for all of their prescriptions. I went to the US pharmacy and was told my insurance didnt cover the particular brand of nasal-spray I had been prescribed and so I would have to pay cash. Do you know how much they were asking? $195 for a tiny bottle of nasal spray.

    I recently needed some physio and was once again startled at the price. I was told that if I paid cash, then it would be cheaper. So I was then left with this conundrum of should I pay cash…or should I try and get to the threshold of my $4k insurance incase there are any other medical needs in the next few months!

    Lets also look at the cost of an eye test. In Britian, you can get an eye test from an optometrist on the high-street for £10-£25 (about $16.50-42), quite often its actually free if you buy a pair of glasses. In the US, the eye-centre charged the insurance company $245 for my eye test.

    I’m sorry to say but my personal opinion is that the US system feels uncomfortably corrupt.

    The UK has great quality healthcare…and free! We are paying the same tax in the US as we were in the UK. But in the UK you are getting so much more bang for your buck..you’re getting free healthcare and more than that, you are getting the peace of mind that no matter what happens to you in life, if you lose a job and fall on hard times, or perhaps one of your loved ones becomes sick….you will all still be looked after.

  103. My family moved to the UK for 2 years (my wife is British, I am not), and we had nothing but fantastic experiences with the NHS. We lived in Cornwall and London, and had no issues in either location.

    1) First time I needed the doctor I was asked if I had an NHS number. I said no. They gave me a form to signup. I saw the doctor even without a number. There was no charge even though I’m a US citizen.

    2) Our 9 month old had breathing problems…we showed up at the local doctor’s office, were seen within 30 minutes, and both care and prescriptions were free.

    3) We used the emergency room three times (all three times at night), twice for the boys, once when I broke a rib and couldn’t stand it anymore at 3AM. Zero wait all three times. My guess for the zero wait is that because they have access to doctors during the day, that the emergency room is primarily used for (gasp) true emergencies.

    4) I’d had a carcinoma removed in the US before I left. First doctor I saw (the one we saw for my son’s asthma problem) asked me about it, and immediately signed me up for an every 3 month review.

    5) Under 21 years old, prescriptions are free. Over 21, prescriptions are 6 pounds regardless of the drug (I think it was 6 pounds at the time).

  104. I also had a fantastic experience with the NHS as an American in England. My visit was to a London ER (St. Mary’s) on a busy Friday night; the wait was short and the care was great. I’m still envious of their system.

  105. My husband fell ill working in Oman and as expats we had to use private hospital as the public health service is for nationals only except in emergency. Even though it was one of the better private hospitals we could tell right away the nursing staff were not expert and the ICU was a joke. This hospital misdiagnosed his condition and almost killied him. Only after a cardiac arrest at work could we finally get him to the public hospital. This was the equivalent of our better NHS hospitals, medical expertise of the highest order, no frills accomodation and very basic food, and very busy. After extensive, exhaustive tests they pretty quickly diagnosed the true problem.

    We were entirely confident of their care, but more urgent surgeries would mean a delay for him so we elected to use our insurance to get a mitral valve repair and double bypass in Germany. The surgery worked well, but he failed to wean off ventilation which was serious.

    Thankfully we managed to get him into The Royal Brompton in London which is expert at weaning patients off ventilation. As a UK citizen he would have been entitled to free care but BUPA insurance paid for it which pleased us as it would fund further free NHS care to others/save the taxpayer money (at no extra cost to us).

    The Brompton is a superb hospital from the consultants, juniors, nurses, physios down to pastoral care for the relatives. All patients and families got exactly the same treatment no matter whether NHS locals or foreign private patients (who do pay here)

    For any serious healthcare the only choice is a specialist NHS hospital whether as private patient or NHS. There are wonderful doctors in the private sector but the ones with the best reputations work and are trained by the NHS.
    The fact the same highest standard of care is given to each and every patient makes me proud to be British and proud, and grateful of the NHS.

  106. The NHS isn’t free. As a UK citizen I pay for it through my taxes and am happy to do so. Incidentally, I am a higher rate tax payer and see this as fair. What frightens Americans about the NHS – I suspect the notion that they might pay for someone other than themselves – exacerbated by the GOP, and those, other than medical staff, who make money out of the US system. I am proud of what we have and would fight to keep it.

  107. Great story (apart from the dirt in the eye bit!). I live in the UK and have had two live donor kidney transplants on the NHS. The 2nd from my American cousin, whose travel expenses and loss of earnings were reimbursed by the NHS. I regard the service I’ve received from the NHS as being utterly superb. I can’t think of a better, more efficient way for it to be provided, than to be provided as required to anyone with the misfortune to need it. Why create layers of costly insurance & billing mechanisms for something that nobody is ever going to choose to have if they can avoid it? Sure there’s always room for improvement, especially in the more ‘difficult’ areas mentioned above, but if anyone here in the UK has a serious condition/injury that can be helped by medical intervention, the NHS usually does whatever’s needed. I’m a dual US-UK citizen, and earn a modest and unpredictable living as a freelance jazz musician. I know I could never afford to do that if I lived in the USA.

  108. I think you were very lucky with waiting times, especially in recent times with all of the budgetary cut backs the NHS and London ambulance service are experiencing. I am a serving police officer in a Central London borough so I spend a fair portion of my working life in hospitals with injured victims of crime/suspects of crime and also people with mental health problems and I see first hand how A&E departments struggle with the high demand placed upon them. Having said that, none of the above is a fault of the NHS or LAS, it’s a problem caused by the govt arising from chronic underfunding, closure of NHS facilities to save money and penny pinch.
    The NHS is an absolutely fantastic service and one I’m proud of. My wife is from Long Island NY but has been living here for over three years. On a recent trip back to NY, she unfortunately suffered from Kidney stones and was in agony. She attended Jamaica hosp ER and was triaged almost immediately but after triage the wait was a few hours to be seen by the hospital doctor which would not be much less of a wait than here in the UK, she spent a total of 8 hours in the hospital, was given some strong pain killers, had a few scans and observed until the stones passed. The resulting bill for this was over $3,500 (which was sent to our address in the uk a month or so later) The service and care provided was no different, more efficient or better than what she would have received in the UK. The facilities and equipment at Jamaica hospital were no better than the hospitals in Central London either.
    My wife is currently pregnant and after suffering a miscarriage before this pregnancy and is now receiving fantastic care from the NHS which would cost an absolute fortune in the US. My wife and I both contribute more than our fair share of National insurance and tax and are both grateful we are able to use the fantastic services of the NHS.

  109. I am posting a newspaper column I had in The Denver Post after being hospitalized a little more than two years ago in Northern Ireland…which is, of course, part of the UK and part of the NHS….

    When I’m sick, I want the world’s best health care as much as anybody. But I wasn’t real optimistic that I’d get it a couple of weeks ago when, on my way to shoot a television documentary, I suffered a significant amount of internal bleeding aboard an overnight flight. Collapsing twice after we landed from massive blood loss, evidently I almost died.

    That’s why I’m ecstatic to report that my fears of inferior care were ill-founded. In fact I’m ecstatic to be around to report anything at all. But I am, and here’s one of the reasons why: an expensive and innovative (Israeli-designed) tool I had to swallow called the PillCam. 36 hours after launching on a fantastic voyage through the length and depths of my digestive system, collecting almost 60,000 diagnostic images inside me to pinpoint the source of my bleeding, the PillCam successfully completed its mission.

    The thing is, this 21st Century marvel wasn’t at the internationally-famous Mayo Clinic, or the vaunted Cedars-Sinai in Los Angeles, or the top-rated New York Presbyterian. No, it was at the big, battle-tested, National Health Service trauma center in Belfast, Northern Ireland called Royal Victoria Hospital, which I knew from covering the warfare in Northern Ireland in the 70s and 80s for ABC News.

    Frankly, that’s why I had felt so low about what I faced. The Royal Vic was for victims of external bombings, not internal bleeding. What’s worse, I was being thrust into the hands of the cash-strapped budget-dependent National Health Service, and I would be hospitalized in the long-war-torn city of Belfast. I’ll admit, I was scared.

    It wasn’t a perfect experience. I felt lost in the chaos of the emergency room. I had bloodlines spring leaks where they were inserted in my arms. I heard fellow patients around me screaming all night. And while recovering, I was presented with a couple of plates of food I wouldn’t pay for at a restaurant. But you know what? It’s a hospital. As a veteran of a few other life-threatening traumas, I’ve suffered the same at institutions in the U.S.

    More important, just as I have in American hospitals, I had the high-tech procedures I needed when I needed them. Two angiograms, two endoscopies, CT scans, x-rays, a colonoscopy, and that tiny alien capsule that traveled through me, the PillCam. Some argue that in a universal healthcare system (which critics would call a euphemism for “socialized medicine”), you’ll only get urgent care if you have urgent needs. Well, about ten years ago when my back collapsed and I was reduced to crawling around my house with screaming pain until I could have some vertebrae fused, I’d say the need was pretty urgent. But it took a week-and-a-half to get me into surgery. That was in suburban Denver.

    The bottom line is, maybe it’s socialized medicine but the doctors and nurses and procedures and protocols were first rate; they saved my life. I have pre-existing conditions, which disqualify me for most insurance at home. Here? Except for personal medical histories to help treat me, no one even asked. In fact, the bureaucracy is so minimal and the priorities so different, no one ever even asked to see an ID card to prove who I am, let alone a credit card to prove my ability to pay!

    And the cost? The “emergency” parts— the ambulance, the ER, the transfusions— came with no charge. The rest? Since I only went to Belfast to shoot a television news segment and don’t pay taxes and thus am not insured, I’ll pay alright, but since the model for hospital revenue isn’t based on market-driven, sometimes price-gouging profit centers, I won’t pay through the nose. If you think it’s no different in the U.S., you’re not paying attention. Market-driven healthcare systems certainly provide the best… but a big downside is cost.

    And here’s the biggest difference between the two healthcare systems: the one in the U.K. is open for everybody. Residents don’t have to assess and agonize over the cost because they don’t have insurance. If they need medical care at any level, they just go. As I did. And get fixed. As I am.

    And guess what: anyone who doesn’t like their universal healthcare system and wants something more can have it, through private insurance, if they’re willing and able to pay for it. Just like us. Socialized medicine? It’s not perfect, but then, neither is ours. This system saved my life. That’s good enough for me.

  110. The bill never comes cos they usually send it directly to the travel insurance company. Sometimes countries have reciprocal systems, like UK, NZ citizens have free access to Medicare in Australia. But you are right, health care should cost money, some people abuse this provision of such fantastic ‘freebies’ (eg why pay to go to a family doctor in the suburbs for your sore throat when you can get it seen to for free at the local hospital emergency department). and you wonder why our health system is going broke.

  111. Thanks for reminding us what would happen if we trade the NHS for the ‘pay-as-you-go’ american version.

    And so many UK politicians want to get rid of it!!

  112. Maybe I am too cynical, but the fear is that a national healthcare system would not fit in well with big business corporate health care, I have seen reports, maybe it is just speculation, that unnecessary tests are carried out because they can be charged for!?

    I have no idea what this may have cost, however my friend fell and required 10 stitches in his hand/wrist while in the US and that cost almost $3000 according to the insurance payment.

    My parents emigrated to the US back in the 90’s and in the 2000’s my father became terminally ill, and due to the level of his insurance (from his employer), in the final stages of his illness he was refused morphine because the insurance did not cover it, here I feel it would have been administered.
    Maybe the difference is, Care before money Vs Money before care. Yes cynical me!

    The NHS, while it may have its faults, for the most part is very good to excellent, nothing is perfect, however I have only had good experiences and I’m glad you have too.

    1. Patients Not Profits is the slogan of the National Health Action Party, which is dedicated to defending the NHS from this government’s privatisation agenda for the benefit of its wealth heathcare company backers – many of them based in the US. Check them out here http://nhap.org/about/#

  113. I had a similar thing happen. I got a piece of sawdust in my eye shortly before going on vacation. My eye hurt, but off we went. We were in Jackson, Wyoming on a Sunday when I had finally had enough. We went to the ER at the regional hospital. They couldn’t find any foreign bodies, but my cornea was scratched and my eye was irritated. I didn’t have insurance so the hospital billed me directly. It was about $310, which was hard to scrape up in my collegiate poverty, but not terrible in retrospect. The hospital pharmacy wasn’t open, so I had to go to a grocery store in town to fill the prescription for antibiotic eye ointment. It was $90 for a small tube, but they figured out a way to knock it down to $25 (can you say “insurance markup?). Looks like an NHS win.

    On the other hand, I had a friend visiting from the UK. She was experiencing shortness of breath and found any exertion faster than a leisurely walk difficult. It turned out that she had a tear in her heart. She had travel insurance, but they wanted her to get back to the UK so the “N” could foot the bill. The insurance company even forged the doctor’s signature saying that she was safe to travel. Well the doctor wasn’t going to stand for that and my friend had her surgery a few days later. She had to stay a few weeks longer than planned so she could heal, but she recovered fully and is back to normal activity. The kicker? In the UK she would have been on a two-year waiting list to get that surgery. In my world that’s criminal. Two years to repair a hole in the heart? It seems that in the UK when there’s a hole in your heart it’s not life-threatening. That looks like an NHS fail.

    1. I’m a uk doctor and have recently worked in a cardiology centre in Northern england. I don’t know what world you live in but a”tear in the heart” would be life-threatening and require immediate surgery. If, as more likely, your friend had a problem with one of her valves which was making her breathless, the average wait for valvular surgery is in the order of weeks. Even that can be sped up if a patients condition is deteriorating. Best of all, they don’t have to pay for it beyond their normal taxes!

    2. I’m pleased your friend received the treatment she needed for her heart but such a sweeping criticism of treatment for heart conditions by the NHS is just wrong. My daughter’s treatment through the NHS for a heart condition which has included open heart surgery has been and continues to be excellent and I can not criticise the NHS at all.

    3. If you can prove that the insurance company forged the signature, they should be charged with the offence of forgery. It’s only when insurance companies are held criminally liable for their ‘mistakes’ that they will stop.

    4. A hole in the heart is not life threatening, as it depends on where it is. As an example my brother was born with a significant one and was never operated on yet went on to represent the Irish National team for basketball. So please, those with a life threatening heart conditions are NOT on a 2 year waiting list! No GP would put up with it and it would soon hit the national press. I suggest the information you have does not sugest an NHS fail in any way

    5. You will never get a bill. A&E treatment is free to all.
      http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx
      This page explains when visitors will be charged and what conditions remain exempt.

      A&E and hospital care and waits vary throughout the UK. It depends on attractiveness to hospital/area for Consultants. For example, i lived in a very rural area and the hospital i worked at repeatedly advertised for a consultant and had no applicants. Eventually they advertised abroad and got an amazing consultant who desperately wanted to work and live in the UK and didn’t care where, just wanted a foot in the door.

      That said treatment is mainly universal and if you need good care outside your local area and your GP or Consultant believe best treatment is available elsewhere they can refer you. I currently travel 3 hours for treatment, the travel is expensive, it’s inconvenient, but it’s worth it and at least i never have to worry about finding the money to pay for the treatment. I could also reclaim some of my travel costs (due to personal circumstance) but i don’t as once the appointment is done, i just turn it into a day out and enjoy the local area.

  114. This is an excellent piece and it is so interesting reading your experience of the NHS. Disturbingly, however, the NHS, which was founded on the principles of universal healthcare for all, is under a great deal of threat at the moment, and is being rapidly and silently broken down and privatised- it will quickly become like a US-style health service if we don’t do everything we can to fight for it. Please find out more by looking at this trailer https://www.startjoin.com/NHS_SellOff, and this page will help explain the situation more http://weownit.org.uk/evidence/nhs This article from The Guardian explains it in more detail. http://www.theguardian.com/healthcare-network/2014/aug/06/privatisation-ripping-nhs-from-our-hands, Please spread the word, write to your MPs, share any information you can find and help us fight for our much-loved universal healthcare service.

  115. Great post! I was born and raised in southern California and now am residing in Buenos Aires. Here we have public healthcare and the state hospitals are excellent, not the most esthetic but definitely have the best doctors. You can also choose to pay for a private health insurance but this is more of a perk since it’s not necessary at all.

    Btw, there is also free college education which happens to be one of the best in all of the western hemisphere. All of this is very impressive.

  116. The NHS is an absolutely incredible system. I have comprehensive health cover with my job which allows me to have any procedure carried out privately but would only ever use it for the quick appointment. For anything major, the NHS is by far the best way to go. A friend of mine was diagnosed with a large brain tumour in January and, after much consultation with friends that are doctors, realised that the NHS was by far and away the best option, again even when he was covered by private health insurance.

    The bottom line is – if you are seriously ill the NHS is there for you with the best of the best. We are very lucky in the UK, I’ve seen private healthcare systems in the US and Australia and it is depressing.

    1. You don’t understand how someone could support the concept of national health care but because they live in another country not understand the nuances if how it deals with non citizens?

  117. Tigger: The answer is indeed that patients requiring long-term care are more or less left on their own in the US. Medicare (the US government health care program for those over 65) covers only 100 days of nursing home care; for at-home nursing, it covers only 28 hours of care per week. Health insurance purchased privately or subsidized by employers is unlikely to cover even that much long-term nursing care.

    Medicaid (the US government health care program for the very poor) is essentially your only option. However, you cannot get Medicaid unless you are down to your last couple of thousand dollars in the world. So you have to financially ruin yourself, if you had savings that you had worked all your life for (even if you have a spouse who doesn’t need long-term care but does need the savings: under certain circumstances the spouse can keep half the savings, up to a maximum of about $100,000, but not under most circumstances). And even then, many doctors and other providers do not accept Medicaid patients.

    So yeah. You’re on your own for long-term care in the US. I’m currently dealing with a family member who needs 24 hour care but is at best going to get about 14 hour care, because after the hours Medicare covers, we have to patch together family members to come and nurse, working around their own full-time paying jobs. I just hope I die quickly when my time comes, that’s all I can say.

    1. “you cannot get Medicaid unless you are down to your last couple of thousand dollars in the world.”

      I think that’s changed with Obamacare; now it’s just based on income, not assets.

      Offer void in states that have refused Medicaid expansion with the backing of the Supreme Court.

  118. I’m on holiday in America and had to visit their equivalent of A&E due to experiencing an allergic reaction to bug bite. The care was immediate and tge medicine worked but I’ve had to pay out $500 and have been told to accept another bill. I’m insured so will get some back and of course am very pleased to be well again. It does make you appreciate the NHS of course, but why is it that British hospitals are incapable of collecting the money they are legitimately owed for treating foreign citizens? NHS medical staff should be collecting it on behalf of all British tax payers and NHS managers should ensure systems are in place to enable them to do so.

    1. A few more words. Veterand Hospitals. Run badly. There is no reason why they should be. If the US Government would like some lessons, consult the NHS.

  119. In 2009 we visited the US and were staying in the Grand Canyon when my partner fell Ill, he had a fever, the shakes and generally very poorly indeed. I spoke to the hotel staff and was told it would cost is $2000 just for an ambulance to transport us to the hospital. My parents instead drove us to the hospital, it was a mega 60 miles away and took us 90 minutes to get there. After a 30 minute wait he was seen by a doctor and was told he had flu. He was given one single tablet to take there and then and told to rest, no follow up tablets no other directions of care. When it came to paying (which I knew would be the case) I had expected maybe $200 for the visit and a further $100 for the tablet. When we received the bill of $1600 I was absolutely flabbergasted! I was barely a few days Into my holiday and I didn’t $1600! I had to make an agreement to pay $600 there and then and they would send a bill to my home address for the remainder. I did receive the bill almost a year later, but my insurance refused to cover it so I was out of pocket again. What’s the point if even my travel insurance won’t cover a hospital visit?

  120. Sadly some of our politicians are so wedded to “the market” that they are working to dismantle the NHS so that their friends can profit.

  121. I don’t think Americans are frightened of OUR NHS, I think they are frightened of AN NHS. An American service and the perceived cost. A proper national service doesn’t make money, it’s not meant to. Ah….there’s your problem…..

  122. I work in the NHS and A&E visits are free to overseas visitors however if follow up visits or referral were needed then payment would be required. Glad you had a positive experience of our NHS.

  123. The UK government spends less on healthcare via the NHS, per person, than the US and it free at the point of delivery for all essential care. Compared to the USA where the Government has been spending more and still having its citizen’s fleeced by them having to pay in the hospital or through insurance. The NHS may not be perfect, and I have had some run in’s with doctors with a lack of knowledge or GP surgeries with a “send them to ER no matter what to save their budgets” attitude, but generally it is a great service we all benefit from and something we should all be happy to pay tax for.

  124. I’m pleased to hear you had a positive experience of Socialism from our NHS. Also glad to hear Victor wasn’t sentenced to death by one of our ‘Socialist Death Panels’ 🙂

  125. You won’t get a bill. The nhs isn’t really set up for a finance based provision. It’s unnerving but that’s the way it is. Bear in mind that if other countries ‘like’ it the nhs is becoming unsustainable as populations age etc.

  126. A British friend of mine cut her arm whilst on holiday in Florida. She needed stitches and went to the ER. The nurse wouldn’t attend to her until her travel insurance went through. I love the NHS. As a US citizen living in the UK, I was hesitant at first, like you, but I was so wrong. The NHS is indispensable.

  127. You won’t be charged. It’s free. If they gave you a prescription, that’d cost you to be filled.
    Unless you go to a doctor in Wales, then that’s free as well.
    Also all free here in Denmark. I work in the Danish health service and whilst I wouldn’t recommend being ill with the kind of thing our department treats, you’re welcome to get free treatment here next time your family has something, large or small, in their eye.

  128. As an American who has lived in Europe for the past 18 years, the health care provided to me and my family in the countries where we lived, Spain, England and The Netherlands, has always been to notch. Especially in the U.K.

  129. The great thing about having a system like the NHS is that if you don’t want it or don’t trust it you can STILL have private insurance. It’s not a case of one or the other.

  130. I usually find that after I have visited my Nhs hospital, which i help to fund by paying tax, that as my health conditions are relatively minor and I am thankful for that, that is a great idea to give a donation to a hospital charity. My favourite is the great ormond street hospital which helps children. You could always make a donation to them and help children with major health issues

    1. excellent idea for anyone visiting the NHS, Great Ormond Street is a what its says on the tin Great!

  131. I live in the UK. UK hospitals prioritise patients in A&E depending on what’s wrong with them. In my experience, eye problems are usually seen to quickly because of the risk a serious condition could damage your eyesight. Sometimes you do have to wait several hours to be seen if you don’t have anything serious wrong or you aren’t in a lot of pain.

    It’s not a perfect system by any means and is in need of changes, but I think it’s incredibly important to have free health care so that even the most vulnerable in our society can be treated. There are some wonderful doctors working in the NHS and I’ve had more good experiences than bad.

    If you have the money and want private health care you can have it, so like one commenter said, we’ve really got the best of both worlds here.

  132. Victor’s treatment was so minimal that if emergency care wasn’t free for all, I’d question the point of even posting you the bill. The only way to make it worthwhile to bill you would be to inflate the costs of treatment. Some antibiotic ointment, a drop of dye and a cotton bud – everything else was there anyway, including the doctors. They all got experience, and the wear and tear to a few hospital chairs, pen lights and one slit lamp was negligible. I see no room for profiteering except by lying about costs. The NHS does not exist to make money, despite what this government would like to believe. But then, they are also privitising the parole service, because apparently that ought to be making money too. They already privitised the national forensic service because apparently crime *should* be paying *someone*.

    The NHS is not perfect, but it is an ideal the entire world should strive for – healthcare as a right, not a privilege only for those who can afford it.

  133. “If anyone has had similar care in the US and received a bill please do post in the comments.” I’m a Brit and I have had occasion to use medical services while visiting the USA. There has never been a bill because among the first 3 questions asked was whether I had a credit card. May have been receptionists made nervous by the ‘foreign’ accent.

  134. I can answer your last question Doc , the republican party is who frightened Americans about the NHS . So I suppose I answered the question you didn’t ask but it is the reason , they started a misinformation campaign in earnest when Hillary Clinton was trying for some kind of nhs. Lot of lobby money in medicine and if you do get billed it will be roughly half the cost of the same care in the US which is befuddling ( or maybe courtesy of the functional but not shiny slit lamp ). My husband ( also American) over the past year has had bone marrow aspiration, numerous blood tests, genetic testing, brain surgery to remove the walnut sized tumour found to have destroyed his pituitary gland, numerous consults with one of the best neuro surgeons in the UK and is in receipt of hormone replacement and regular checkups which will last his lifetime. Being over 60 he and I no longer pay the minimal fee for prescriptions. His verdict on all the care he has had in 2 hospitals ‘ if the NHS had feet I would kneel down and kiss them’ . He is doing great and back at work, glad your son is also better . I am glad Pres Obama passed the ACA it takes such a weight off people who have enough to worry about when they are sick and once folk get used to that feeling they will never want to go back as a retired nurse my sympathies naturally lean toward patients .

  135. Hi, your care is free. Emergency care in the uk is free to all visitors. If your son had needed an operation and was admitted then your insurance would have covered the costs.

  136. I am not surprised by the treatment your Son recieved, unfortunately the reputation for long waiting times and poor services is often misleading as the majority of experiences, like your own, are positive. I recently had a cesarean and the treatment I received was excellent as were the staff who despite clearly being overworked were thoroughly professional and could not have provided better care. I am British and I am very passionate about our NHS, the main problems is that is underfunded and successive (particularly Tory) governments continue to find ways of making cut backs. In my opinion it should always adhere to the founding principle that it be free to the point of delivery and fear the proposed privatisation of particular aspects. I would be happy to pay greater National Insurance contributions to ensure the continued quality of the NHS and would like to return to the days when dental, eye and doctors prescriptions were also free. I also do not understand the American mentality towards our NHS, it seems to me that Americans have no comprehension of it as it’s purpose is not to achieve profit but to provide all citizens regardless of class or financial means health care, how can this be a bad thing? Perhaps this would explain why there is a such a gap ( and growing) between rich and poor Americans.

  137. The NHS is an outstanding institution. I lived in London for 16 years and was constantly in awe of how brilliant it was but none of my English counterparts agreed. It was constantly berated by the media and just about everyone. I am now living back in Ireland which isn’t nearly as expensive (or litigious) as the US but with 3 young children I can’t help thinking about how great the NHS is and how much I miss it

  138. As an American in Scotland, my longest ER/A&E wait times were in the USA not here. I waited over 5 hours at George Washington University Hospital where I had to pay on top of my insurance. I’ve never waited anything like that in the UK and when my son, who is four, has been involved we are always triaged immediately here. The NHS isn’t perfect but it works!

  139. I work in the NHS and it is lovely to hear positive remarks regarding the service, in the UK it is very under appreciated at times and people do not realise how much it costs to run, and if they was to just cancel the appointment instead of not turning up the money from that alone which can be saved. All services at the moment are going through reviews and trying to save money.
    I am grateful to live in a country that provides free healthcare for everyone and know we in the UK would miss it if it was to go.

  140. About 30 years ago I required similar treatment for a mudball fight that landed me in the emergency room with mud and bits of glass caked in my eye. I recall having to wait several excruciating hours to be seen, and then my parents had to take me to another hospital entirely because no one at the first one was prepared to do anything to help. This is in a major American city, mind you. And the bill for irrigating, swabbing, bandaging, and medicating my eye was something like $1500. It would be a substantial amount more these days. And that was WITH insurance.

    Honestly, as an American, I fear the day when I will require major hospitilization. Can anyone go through that without going completely bankrupt?

  141. I couldn’t be prouder of the NHS. For various reasons, I’ve had to visit my local hospital more times in the last 5 years than the whole rest of my life prior. On each and every occasion, my treatment and care was outstanding.
    One time, when I came out of surgery for an eye operation that came under a “quality of life” bracket (so not strictly necessary), the nurses who cared for me were amazing, explaining everything so clearly and simply. When I was under, the Iraqi anaesthetist kept me alive, and tubed me when I started to struggle with the breathing thing on my own. The surgeon did a neat and perfect job.
    When I broke my elbow, all the consultants I saw, plus the physio department were amazing.

    The UK may not be perfect, and God knows, there are many things I don’t like. But damnit, we do healthcare like champs.

    All my procedures would have cost me thousands of pounds. I got them for free. GO NHS!

  142. My daughter lives in New Zealand, and is going to an “Best of British” party. She asked advice on what to go dressed as. I suggested a white coat with the NHS logo, a stethoscope, and a sash saying “Free Healthcare”.
    And I strongly suggest that everybody should contact their MP and let them know in no uncertain terms that the selling off of the NHS is not a welcome move that voters will ultimately rejoice over. We won’t. Our parents/grandparents generation were around when the NHS began, and we’re proud of owning our health service, a service that supports patients, not “investors”. We pay for it, it isn’t free, we already pay for it!
    Ask private health insurance companies for a price to provide the same care as available on the NHS, including aftercare etc., to see how cheap the NHS is. Then increase our National Insurance contributions to fund the NHS better. Oh, but we can’t do that can we, because National Insurance is a progressive payment and the more you earn, the more you pay. So poor folks won’t pay as much as the owners of everything, and we can’t have that can we? Unfortunately, the Labour Party started the selling of the NHS.
    I’ll have to stop now because there’s a danger of this posting changing from a pride of the NHS post to a rant as I go from proud to angry.

  143. I’d just like to make a couple of points.

    Firstly, our NHS isn’t really ‘free’. We all pay for it through our taxes, which are considerably higher than in the US.

    Secondly, I lost my partner 3 months ago to cancer, at the age of 37. Her first diagnosis was 3 years ago, and I’ve had quite a lot of experience of the NHS since then, across 4 different hospitals. She had operations, chemotherapy, radiotherapy, blood tests, blood transfusions, multiple other treatments, and in the end, palliative care. I can honestly say that, apart from one instance in one hospital, the care she received was absolutely first class.

    Thirdly, and in direct contrast to the above, I have a friend who lives in the US, who has just last week been diagnosed with cancer in one of his kidneys. He’s in his early fifties and has always been healthy. He can count on one hand the number of times he’s ever seen a doctor, and until two weeks ago had never even had a blood test. He doesn’t have health insurance. Now, instead of concentrating on getting treatment and getting better, he’s worrying about where he’s going to find the $250,000 (or possibly even more) required to pay for his treatment. His cancer is curable right now. If he can’t find the money from somewhere, or doesn’t find it quickly enough, it will kill him.

    How can this be right in a supposedly ‘civilised’ country?

    1. I am glad your partner received good care. I am sorry to hear about your friend in the US.

      What kind of insurance does your friend in the US have? In 2014, all uninsured Americans were mandated by the Affordable Care Act to acquire health insurance. Those making below 138% of the federal poverty level were to enroll in Medicaid, and the rest were to purchase health insurance from the state and federal health insurance exchanges. Those making between 138%-400% of the FPL would receive subsidies for insurance purchased on the exchange.

      I was wondering why your American friend does not have the insurance he needs right now. Is he earning below 138% FPL but living in one of the states that refused to expand Medicaid? Is he insured with (inadequate) insurance from his employer and therefore exempt from the mandate to purchase regulated insurance from the ACA exchanges? Or, did he not know about the Open Enrollment period for the ACA exchanges earlier this year?

      I wish your friend the best, no matter his situation.

    2. The taxes thing is a complicated point at times, because of state taxes, though yes, US taxes are lower. However you still need to buy Health insurance – I wonder how much of a difference there exists then!

      Here is the kicker – the FEDERAL spend on healthcare, per head, is almost as much as the government in the UK spends. Then on average the same again is spent per person.

  144. I have experience of getting the equivalent of an urgent GP appointment in the US in 1993 in Orange County south of LA for a chest infection. I was given a course of antibiotics and 20 minutes on a ventolin inhaler, but no personal inhalers. Not withstanding that I had full cover via my employer’s (a US company) travel insurance I was charged IRO $325 on the spot and the insurance was charged IRO further $385. I was seen almost instantly by a nurse and doctor who appeared to have no other patients.
    A comparable visit at the time in the UK might have required a wait of a day and possibly a small charge of IRO £2 or so per item I.e. £6 if antibiotics and two inhalers had been prescribed.
    Having a similar need last winter I was seen the same day as I called the surgery received antibiotics and charged £7.50 per item. Now it would be free as I’m over 60. People on low income, children and with chronic long term illness such as cancer are also not charged. I can think of no reason why certain of our UK politicians think that adopting a US model of health care would bring improvements.

  145. I’ve worked in the ED at St Thomas’, and we do get a lot of visitors, so your presentation is normal for us. The funding issue was clarified a while ago, and at that point we were told that treatment was free in the ED but as soon as the patient was admitted (to a ward or to the clinical decision unit, the ED ward) they were charged for treatment. So you may recieve a bill for the opthalmology treatment but probably not as outpatient unscheduled eye treatment is considered an extension of the ED.
    With regard to ophthalmology management in the ED, it very much depends on the speciality of the ED resident (general paediatrics or emergency medicine) and whether there is an eye ED on site. As a senior ED resident I am happy to see eye problems but at St Thomas’ and my current hospital there’s a really good eye hospital/department so they usually see all opthalmology patients, which is good for the patients.

  146. The nhs is not free, we pay national insurance every month for it. It is free at the point of contact and you a guaranteed care until you are better or dead. The American system scares the pants off me as someone with an on going condition. I hear stories of people going bankrupt for their bills and I think it is outrageous. Health care is a basic necessity, it should be available to all.

  147. Reblogged this on Crohn's and Cupcakes and commented:
    As an American, I have never experienced any other healthcare system. This post certainly makes me want to move to England. Healthcare shouldn’t be insurance based or driven. It shouldn’t be about whether or not a person has the ability to pay in order to render fantastic care. Healthcare should be about seeing to your needs and reason for being in an emergency room or doctors office.

  148. In the 12 years I lived in London, I had four children, 1 gall bladder removal and many a trip to the A&E and not once was I charged. Two years ago, we travelled through Central America and stopped by Disneyworld. My youngest suffered an accident which required 12 stitches. A&E were superb, about as equal to the service I would get in the UK but I was charged over $2,000 (US) for it and that was after they took a 60% discount for paying up front. Fast forward two weeks and we were in Costa Rica. It cost us $10 (US) to get the stitches out. And even then, they were reluctant to take money off us. I will never complain about the NHS.

  149. You won’t ever get a bill. We have a reciprocal agreement with the USA in which all emergency treatment is provided free of charge.

  150. I was on holiday in florida and was vomiting and nobody would see me until our insurance confirmed that they would pay. I wasn’t even given a bowl to vomit into. It cost 98 dollars for three tablets to stop the vomiting on top of the bill the insurance company received. I love my NHS

  151. I’ve only ever received medical treatment in the UK, but I have nothing but respect and admiration for the NHS. I am so pleased that your experience matches up to the level of care I consider to be “standard”. People here who are saying that we pay more tax- We certainly do- but that excuses us the “health insurance bill” and mine would be incredible.
    I suffered a collapsed lung as a child and owe my life to the brilliant and fast acting doctors and emergency care staff at the JR in Oxford. Since then any related issues, caused by damage to my lungs, massive scars on my chest,seizures caused by oxygen damage, Damage to my heart and eyes have been brilliant, and as a result my life expectancy is “normal” and I am able to do all the same things as my peers.
    This would not have been the case if I had been forced to wait for care, because my parents could not afford to pay for it.
    I can say with certainty that my parents would not have been able to foot that bill if they had to pay for it, and I have since been unable to get health insurance to travel to America, So I can’t imagine what the cost of my insurance would be if I lived there!
    Perhaps I would be uninsurable?
    We are lucky that emergency care here is brilliant. Sometimes the NHS can be hit and miss when things are not life threatening, but I’ve certainly never waited more than 2 weeks for a referral for a non urgent issue.
    I for once have got out of the NHS what I have paid in in tax- but I am sure that given the option, we would rather pay that tax “just in case” and hope we never need it!

  152. As someone who has had hiv/aids for 30 years and been unable to work through much of that time, I can unequivocally say (from direct advocacy experience in the US) that if I lived in the USA or, living as I do in Britain, were it not for the NHS I would be dead.

  153. Excellent blog. We visited the USA a few years ago and had to go to an emergency room for treatment for a broken wrist. Had pretty much the same experience – excellent care and not much interest in offers of payment at the time (though our details were taken and we received and paid a bill for around $1,000 afterwards). Very different experience at a consultant’s office the next day – the receptionist wanted to see our credit card before we went any further. This was in southern California and the wait was quite long (4 hrs) mainly because it was so busy – lots of mexican families bringing children in with coughs, colds etc. Presumably people who had no health insurance? One of the things that fascinates me is that when I ask my cousins and other friends in the US a question like ‘where do you work?’, the answer 9 times out of 10 includes the phrase ‘and they have a great health insurance scheme’. So yes, in England we value the NHS greatly. Having said that, sometimes this masks complacency and inefficiency in the system which needs to be rooted out as the NHS faces ever greater demands from patients. Glad you had a good experience!

  154. What frightens Americans about the NHS? Good question.

    It could be that the US political lexicon is so tainted by hatred of anything remotely “socialist/collective” that it cannot and will not accept evidence, anecdotal or otherwise, to the contrary.

    It might be that Congress is bought and paid for by lobbyists and the Insurance companies who run the rule over healthcare in the US have the deepest pockets.

    Or it could be that the USA believes itself when it tells everyone that the USA is the best country in the world so therefore it must follow that everything that exists in the USA is also the best in the world.

    Obamacare is a far from perfect system and certainly won’t match up to the NHS but within the limitations of the political landscape of the USA it was probably the best you could hope for. But don’t be too hard on yourself or your country. Here in the UK it took WW2 (where British civilians were in the firing line and the nation became a far more collective institution than in the USA because of this) to establish the political will to create the NHS.

    Sadly the current political landscape in the UK (on the right certainly) is aimed at the NHS’ demise. So take your experience of socialised medicine with you and remember that it can and does work. For it might not be around much longer. In over a decade working in A&E (ER) I’ve treated a number of US citizens, only one of whom was a health tourist. In all but that one case (he phoned the Ambulance from the airport for a longstanding complaint that required an operation he couldn’t afford in the US) the US citizen was surprised by the friendly efficiency of the NHS and stunned that no one would take their money.

    It might be this lack of a profit motive that most disturbs the US establishment. Vivre la NHS, long live healthcare for the patient, not the profit.

  155. Great post, and I’m in total agreement. We lived in the UK for 18 months, during which time I was an outpatient at a hospital in East London. After being there for about 12 hours (for surgery and recovery) the only thing I left with was a single piece of paper that explained my diagnosis and how they had treated it. No bill, no paperwork. Being from the US, I was astounded and will never understand why a similar system is impossible to implement (or even comprehend) in the US. The NHS is simply fantastic.

  156. So pleased you were happy with the care you received. We get so used to having the NHS run down it’s refreshing to hear.
    I too was surprised the A&E registrar asked ophthalmology to see you. I suspect this was less to do with prematurity and ROP and more to do with you being a dr. More specifically an american dr. The stereotype of the awkward american patient (in no way am I suggesting anything about you) demanding specialists and threatening to sue everybody in sight is sadly widespread, a lot of the time very unfairly. So widespread is it that my med school finals OSCE exam featured an american threatening to sue if he didn’t get an MRI for something a CT was more appropriate for.
    Sorry for the stereotype and thankyou for your kind thoughts on the NHS.

  157. The only time the NHS sucks is when you have to stay in hospital for more than a day or two, but that’s because there’s absolutely nothing to do in there.

    Also, when going on an American-run cruise (which was fantastic), I had something wrong with my ears, in which they didn’t pop when our plane descended. After a day or two, I went to the on-board doctor and was charged £125 for him to say “you have to wait for it to get better”. Wasn’t exactly amused…

  158. I really liked your article. I’ve been working for the NHS for almost 2 years and i’m very very proud of it. I’ve also been admitted in the same hospital and can say that the treatment is awesome. Thanks for sharing!!

  159. Everyone knows what happens when you can’t afford medical bills. You start making methamphetamine and all he’ll breaks loose.

  160. you won’t get a bill. It’s amazing. Any child in the UK is covered 100%, no questions asked. It’s astounding. I’m an American living in the UK and I still cannot get over this. I always have awkward moments in the pharmacy getting prescriptions with my daughter where I stand there awkwardly, expecting them to give me a total to pay.

  161. Welcome to the UK and i read from your blog you have also found what ‘they’ call our glorious NHS, yes it is amazing, untill you are damaged in some way via the NHS that a british person has put their trust in for many many years, the damage of course is then covered up via one of their letters direct from the NHS this must be what ‘they’ mean by glorious, super amazing when i’m a single mum of my children it comes to something when my children ask questions now they are older of which i’m only to happy to answer them not sure about your dilema, lets hope you are not in for a shock 🙂

  162. Just for clarification. You will never receive a bill. ALL emergency care is free on the nhs regardless of nationality

  163. This article echoes my experience with the NHS on a vacation there. I injured my hand, which required cleaning up and a tetanus shot. Like the OP, I was apprehensive about navigating a foreign medical system and how the financial cost would impact us (young couple, limited funds to travel on), but the clinic we went to saw me quickly, patched me up, and sent me off without a bill.

    I realize that it wasn’t “free” — the British taxpayers were funding it (and I can see the modern Fox News headlines: “Foreigners sponge off taxpayers – free medical care for tourists”) — but it was deeply reassuring to know that if something bad happened the only thing I needed to worry about at that moment was my health, not my financial worth statement.

  164. I am curious that Americans think the NHS has “death panels” to consider who gets treatment or who dies. I imagine the concept of a social welfare service is that one gets treatment regardless of its affordability. On the other hand, if an American cannot afford treatment, isn’t he turned away? Or will the hospital provide treatment gratis? Isn’t being turned away because of, say, a lack of insurance in itself conceptually similar to a death panel?

  165. Just to point out that a “full hospice unit ” does not come under the the NHS. Hospices are partly funded by the Department of Health and from donations from the local populace. Good to hear a good NHS story, shame that they couldn’t get their act together about payment, but shows that care not profit comes first.

  166. as an NHS practitioner i can tell you that this is an amazing institution and it does not surprise me to hear your story that when you needed us we were there, and not driven by money. this is how a humane society SHOULD work – devoid of corporate greed and capitalism where the main structure is funded directly by everyone who is deemed able to afford it, at source.
    however, the NHS is dying. it is dying due to the direct impact of greedy and corrupt politicians – none more so than this latest government we have …..another couple of years and we will be taking our last breaths in favour of the american model.
    why are we failing and dying?……..reduced funding, budget restraints and dodgy contracts to outsourced companies we are forced to ‘work’ with on everything from CAT scanning to paperclips, closure of frontline teams who are only missed by other frontline practitioners and not the general public, higher caseloads too high to safely manage,a mass of unnecessary paperwork, audits and targets that prevent us doing what we came to do – help people!
    another couple of years and you will hear on the news our politicians tell you : the NHS is no longer fit for purpose and needs to be contracted out”….and it will be because we have been murdered by slow poison which we are forced to drink everyday.
    im glad though, you saw us whilst we were great.

    NHS: RIP xx

  167. In all honesty, they font mess about when it comes to kids or foreigners. Its the long term care of the NHS that is scary. Thank goodness you were at st.Paul’s and not the Royal in Leicester.

  168. For the last two years I’ve had kidney failure. I have dialysis three times each week and am very short of energy. If I had to pay for it, dialysis would cost £300 per time, in addition I get regular tests to keep me as healthy as possible, and Doctors and dieticians on call.
    On top of the above is a conscientious nursing staff worth their weight in gold.
    I hope the NHS gets over the coalition as they might a passing pestilence and puts them firmly behind them.

  169. To be honest, I think that the scariest thing about introducing a system equivalent to the NHS (as opposed to the insurance type scheme in Canada) in the US is the influence that the far right might have over healthcare – imagine the Hobby Lobby principles or Texan abortion laws being institutionalised…

    The second scariest thing would be that (if I’m reading SBM correctly), there’s an alarming trend in the US towards recognising the practice of various types of quackery and snake oil – which I would neither want to pay for with my tax money nor be subjected to in a state-run facility under the guise of medical care.

    1. Hey Laura, the sheer number of comments has overwhelmed me and I can only get to approving them every few hours! I’m trying to keep up, but I do read each one for trolling etc so sometimes it takes a few hours or so.

      1. i might have misunderstood your post, but british people living abroad, have to pay for their care when sick in the UK. it is a well known fact. I live in France, thus, not eligible for health care in UK. So who is fooling who?

      2. Already compulsory for expats working in Saudi Arabia and the Emirates, medical insurance is becoming a must-have in one more important country. No, not some other popular working expat location. Somewhere a little closer to home: the UK.

        Yes, it’s true, sensible expats are taking out medical insurance to cover not only their working destination, but also the UK.

        Why is this? Well, in the last two years it has become ever more likely that the expat who returns to the UK will find that NHS trusts will refuse to offer him free treatment. That is because he may be treated as a non-resident, and non-residents of the UK are not now eligible for free NHS treatment. Of course, emergency cases will be treated, but non-residents will probably find a large bill for any treatment beyond patching up in the Accident & Emergency room.

      3. All quite probably true, but for an honest discussion of the situation for British Ex-Pats should you not have mentioned the substantial amounts of income you save by avoiding taxation as an ex-pat. My point is that you seem to believe that your nationality entitles you to the same level of access to the NHS as someone who has not decided to abandon the UK in order to maximise their earnings potential. There is very little equivalence between your ex-pat situation and the praise offered here by a visitor who’s child was treated in A&E.

      4. right, so you’re complaining about being billed for non-emergency treatment…the blog is praising the free emergency treatment…Guess what, if you went to the USA you’d be billed for both!

      5. I am not complaining!! I am merely saying that the health system (NHS) is unclear at the moment with its many cut-backs.. Imho, for someone to go blogging on it, will raise questions that cannot be clearly answered which leads to further confusion. I have read two on line British papers reports on the NHS and ex-pats. both reports were unclear and quite frankly alarming for UK citizens living in Europe.

        BTW, we have lived the USA. My husband is American, and yes, it certainly is a expensive system. Although in many ways, far, far better than whats offered in the UK. (I speak though of 1970’s/1980 – I am sure it has changed.) We paid in fully into the British System, while we lived in UK. thanks.

        I am passing this blog post on to Anglo Info. in France. I think they will be interested in reading the post and the comments. 🙂

      6. Although the system is complex and insufficient information is provided, it isn’t completely opaque. All NHS treatment (except prescriptions) is free for those who 1) Live in the UK and 2) Have a right to do so. Those who fail condition 1 have to pay for some “secondary services”. These do not include emergency treatment (as Dr Gunter discovered) and they don’t include GP services either. Payment is after treatment not before.

        Because British ex-patriates fail condition 1 by definition, they have to pay for those services. Simple.
        Where it gets complicated is condition 2, because for some reason the question of who has a right to live in the UK has become almost a degree subject in its own right. It can take months or even years for the courts to work it out. Also, some people who arguably fail condition 2 still get free treatment- e.g. asylum seekers.

      7. Slight complication to add to Philip’s note. American readers may not know but health is devolved to our Scottish Government who decided a few years ago that all prescriptions should be free to all users (paid through general taxation of course). I don’t agree personally with that as it subsidises people well able to pay. But that’s the system there.

      8. It’s even more complicated than Roger and Philip suggest: the NHS is slightly different in England, Wales, Scotland and N Ireland, though the general principles are the same.

        All treatment was free initially, in 1948, when it was thought that with such wonderful health care, the costs of the system would actually fall. It was soon apparent that this was a naive idea. Charges have been introduced for prescriptions, and for dentistry. Eye tests are free, but the NHS no longer gives out free spectacles. Some ‘Trusts’ charge for patient parking; some even charge their staff for parking, even when these people need a car to get between various bases. (Staff can also charge for ‘Category 2’ services—the provision of insurance reports, or chest x-rays for immigration, for example. ‘Category 1’ services is the delivery of care, for which staff cannot levy a charge.) Hospital staff are employees; general practitioners are, technically, self-employed and under contract to the NHS; they can charge for some services such as completion of a passport application (though many of them refuse to do this now).

      9. And if you want a medical report for some other purpose (say, it is relevant for litigation), the doctor will charge upwards of £60. £60 is a very reasonable rate for a medical report though, I don’t know what a USA doctor would charge but I’m thinking a bit more than that.

      10. Eye tests in England are only free in certain conditions. Between the ages of 40 and 60 I had free tests because I had a close family member (my mother) who had glaucoma. After 60 or if one is on benefits eye tests are free. Prescriptions are also free to anyone over 60 or those with certain conditions. My husband is epileptic and got all his prescriptions free, even though he explained to his GP that he felt that only his phenytoin should be free and that he was more than willing to pay for anything else (he was told the paperwork to pay for some and not other prescriptions was too much trouble and it was easier for everything to be given to him free). Children are entitled to free eye tests up to the age of 17 (19 if in full time education). Likewise, children are entitled to free dentistry up to 17 (or 19 if in full time education), though the ‘free’ does not include visits to the dental hygienist. It even includes orthodontics where it is determined that a child may be harmed (even emotionally) by problem teeth. Pregnant women and those on certain benefits (e.g. income support) are also entitled to free dentistry. However, what is included in the ‘free’ package is limited to basic treatments (amalgam fillings for instance, not gold inlays!).

      11. As we are all off on one, can I suggest that there are differences in European and American ideas of people in need of help.

        Another straw in the wind. My son went as a child to Denmark as part of a school trip. Benefits of being the son of a teacher, you get to go too.

        Fell off a landing stage for a boat and hurt his head.

        Taken to hospital, triaged and given the full bhuna. Brain scan, the lot. Wife, as was, was terrified that there would be some enormous charge. Charge was there none. Because she is conscientious, she wrote to the hospital in Denmark and asked if they had made a mistake? They told her to forget about it.

        Treating people – as in need of help rather as a means to profit – is something I deeply care about. I hope we retain that openess to others after our independence. Your earlier correspondent mentioned the rules in England, these are political choices. Off the top of my head, Scotland has univeral free prescriptions, eye tests and basic dentistry.

        Aspiration to a better service is ill served by accountants and their ilk.

      12. E.D that is different. If you needed A and E in whilst back in the U.K you would only be expected to pay for any prescriptions required and not for the X-rays scans etc as you would in the States. If you were to fall sick and needed time in Hospital whilst visiting the UK it would be covered via your travel insurance. If you were sick before you got here from France you would be deemed to be traveling for the specific services and not covered by the insurance and not eligible for free health care.

      13. Thank you, we know. Still, your post is really misleading to many who are not British, who think that everything is rosy over there in UK. It is not. I should not have to pay from France , being France is part of the EU. The rules are ever changing, so none of us are in the clear. Post such as yours, are misleading and confusing. And free care – I am a British citizen and thus have paid in for Health ins. (NHS) from income earned. It is not free..

        yvonne

      14. When a person is taken into a hospital for treatment it is in the hope of being cured, restored to health.
        One never expects to die there … not really … as hospitals are there to heal the sick, to comfort and reassure the injured, to sooth the distraught, whether the patient is a child or somebody in the winter of their years; whether they are rich or poor, regardless of their race, or colour, their nationality or their religious beliefs, their sexual gender and preferences, or whether they are Punk-Goth or a criminal.
        In order to facilitate this a patient should be treated with respect, kindness, a warm smile, a few comforting words even; treated with dignity, whether their condition is terminal with no cure in sight or a serious fracture or a simple myocardial infarct or in the least … self-induced alcohol poisoning.
        It is beyond belief that in this day and age people are treated with less care and consideration than a murderer, paedophile, rapist or thief, languishing in prison.
        How sad that old people, pensioners, who have worked hard all the lives, having contributed honestly and diligently to society, must bear the brunt of callous and frustrated, over-worked and under-qualified doctors and nurses working in unhygienic conditions.
        That is the case in Britain as the NHS is run-down, poorly staffed with too many people waiting on the hospital doorsteps for treatment they may never receive, or an operation from which they may never fully recover.

        The following incident however, occurred not in Britain, but in Germany, where I was left in a side room after a suspected heart attack for six hours (there is more). I was so angry I wrote a letter to my medical insurance firm, the resulting letter is too long to print here, so I wrote a short story and posted it on Twitter, facebook and uploaded the book on amazon.

      15. Your comments about the NHS are quite astounding. People treated with less care than a murderer or paedophile? Callous and under-qualified doctors and nurses? (I cannot disagree with the overworked conditions, and hygiene could do with improvement although perhaps unhygienic is stretching it a bit). The NHS needs to be better-resourced, but the exaggerations you post are unfounded and amount to scaremongering.

      16. Well said! I have also just looked after my 91 year old mother for the last two years in my home. In her final stages of Parkinson’s Disease, her last few weeks at home she had continual health care – 3 x two carers seven days a week, The GP called to the house, The Parkinson Specialist Nurse was kept informed and the District Nurse came every other day. Mum passed away calm and without pain as a driver was used in her last two hours. The District Nurse and Rapid Response returned on the Saturday afternoon to verify death and wash and dress her. Kindness, care and treated with respect.

      17. Just to clarify, E.D: is it your position that anyone living in the EU should not have to pay for NHS healthcare? Or that British citizens living in the EU should not have to pay for NHS healthcare (but others living in the EU should have to do so?)

      18. If you are resident abroad (e.g. paying taxes there and not in the UK) then you will be charged as for anyone else from that country. Thus is equitable, otherwise a UK citizen could live in a low tax area with little in the way of state healthcare, pay no UK taxes and then will I’ll dump the cost onto the NHS / UK taxpayer.
        Patients from France (or any other EU country) should obtain an EHIC card before visiting the UK and bring it with them. Thus entities the patient to emergency treatment which will be billed to the country of origin.
        Non emergency treatment is only possible if the country of origin has agreed to pay. For instance Newcastle provides specialist paediatric immunology and cardio surgery to Irish patients.

      19. Dear Dr. Gunter. That is my experience too. However, if you are in a position to pay something for your free treatment, why not make a private donation to the hospital for your son’s treatment, with a note of thanks. I am very sure that the staff will put it to good use.

      20. I have been in the unfortunate position to use health services both in the US and England,having been taken ill while on holiday in the US. I was taken to ER in an ambulance, while I had no complaints about the care which was not noticeably different to that I received with the same presenting symptoms in England however the billing process was utterly bewildering. The total came to a little over $14,000, (my own Dr was staggered by the bill given what care I had been given) however what was truly bizarre was the fact that I was billed separately for Ambulance, Hospital Admission, a scan and the Doctor’s time.

        Fortunately I was covered by travel insurance and passed the bills to the insurer to settle which after a bit of haggling they did at $8,000. I understand the free market principle that US healthcare is organised on but the notion that the patient is a free agent in an economic sense is fanciful in the extreme. At the point of admission I have no means to challenge the care given for instance was the scan (price $1,200) strictly necessary? At the best of times I lack even a rudimentary knowledge of medical practice to make a judgement, right there I was in a lot of pain a long way from home and I just want the pain to stop. So whatever treatment the medical practitioner prescribed I would have gone along with.

        The discomfort of the event was compounded by the fact that the Healthcare industry tried to exploit my vulnerability by predatory pricing. Had I not had insurance I would have picked up a bill for $14,000 which given the subsequent settlement of $8,000 is either grossly incompetent or grossly inflated. My advice to travellers to the US do not leave home without adequate insurance you are as likely to be robbed by someone with stethoscope as a gun.

      21. I must admit I am terrified by the US medical system and I have never been. I was in tennerife paragliding when I droped out of the sky and dammaged my back. I was able to radio my condition and somone called for an ambulance to meet me while I crawled to the road. When I got there the ambulance had left. A paser by drove me to the hospital while I knelt in the passanger footwell. On arriving at hospital I was rushed into A&E where an English speeking administrator asked me for my insurance details. Waiting half an hour she returned, unable to confirm my insurance, she explained that I would have to be transported to the mercy hospital some 2 hours drive away and I would have to pay for the ambulance, unless I could stump up with 3000 euros for my initial investigation. I passed over my credit card which returned 3 minutes later with a consultant. From there on the treatment was excellent. CT scan revealed crushed lumbar vertebre with loose bone fragments, admin returned to say insurance was ok’d and my credit card would be refunded. I was informed, because there had been no one at the scene to charge the ambulance had not waited. I am fully recovered and do competent yoga. I dread to think If I had no insurance, if I had lost or not carried the paper work or not been able to produce it or my credit card.
        I think this cost my insurance in the region of £35,000 including my air ambulance back to a UK NHS Hospital. Where the care was excellent but they could not CT as they had no CT scanner they X-rayed instead.

  170. However – the coalition government has passed new health care regulations which have already seriously altered the basic principles of our NHS. e.g. “Areas which are no longer required by law to be free of charge are: maternity and children’s services, illness prevention, ambulance services, mental health services, dental and sexual health services. Local authorities must decide whether they can afford to provide these services.

    CCG’s can now decide which services are free and which must be paid for and no privatised service delivers more than the NHS for less without also excluding the poor and sick.” ref. 999CallForTheNHS . They have organised the People’s March for the NHS leaving Jarrow on 16thAugust and arriving in London 6th September. Support them if you care to keep our free at the point of need National Health Service.

  171. Universal health care is very good, and something I as an American aspire to for my country.

    However, as an expatriot living in London, I will avoid the NHS at all costs (I now purchase supplemental insurance that allows me to use private doctors). The care I have received through the NHS has been on three occasions negligently poor; the second time dangerously so. As far as I can tell, this has been due as much to cost-saving measures as to doctors’ errors.

    While some medical care is much much better than no medical care, cut-cost medical care remains a liability in the UK.

    1. What a shame. I’m an ex-pat also and have had to have a hysterectomy on the NHS. It was wonderful. The care up to the op, the op and recovery were smooth and as enjoyable as it could have been. I would never consider going outside it.

    2. The NHS is worst for wealthy middle classes, who might be able to afford better care if they hadn’t had the NHS take up so much of their taxes. This is a small group though. The rich don’t care about paying twice to go private (it’s much cheaper than ripoff US prices) and those of average to low wealth much prefer the NHS.

      This is what I don’t understand about the anti-NHS stance. Sure, you’ve been brainwashed against it your whole live but it’s been shown that the US system is grossly inefficient compared to every other system in the world. As I said, our private hospitals are much much cheaper than yours. Why would you put up with that?

      I also have encountered horrendous NHS negligence. Mostly I think it’s bad luck but it’s also partly my higher expectations as a health professional. I don’t buy into the religious idea that the NHS can’t be improved, though I’d like to take the tinkering out the hands of ideological politicians.

      Great article, Dr Gunter, and I’m glad our NHS did itself proud for you and your son.

      1. The NHS isn’t funded though Vat we pay a separate income tax called national insurance contribution which is exactly that it’s a insurance policy against I’ll health, unemployment and retirement.

        If you want to get into figure we pay much less for our healthcare than than the average US person.

        That’s not to say the NHS is prefect in fact I would say it’s far from it and it needs to improve which is was before the torys and their paymasters

    3. What you have to remember is the NHS is not Free. Well not free to everyone. The middle classes and people who are employed pay massive amounts of there salary to the NHS, but get the same service as people who pay nothing. National Insurance was the original tax setup when the NHS was setup. Originally it was a set price stamp for everyone. Margaret Thatcher changed this from the fixed price stamp to National insurance that is linked to earnings. So today if you are employed an pay tax as an employee your monthly National insurance will be around £500 per month if you earn around £50k per year. If you are a person who earns less than £10K per year your will pay a few pounds per month. So the more you earn the more you pay, but the service you get is the same. If you earn 50K per year and your company provides you a private medical policy with your package you pay tax on it. So example you get a private medical policy worth £3k per year. On a £50k salary this is added to your earnings so you now earn £53k and then pay 50%of that 3k in Tax back to the government every month.
      So in effect its a double kick in the teeth. If you have a private policy you still have to pay your monthly national insurance contributions, but your use of the NHS service is greatly reduced as you will always use your private health care over the NHS.

      Current rules below. Not a FREE SERVICE AT ALL.

      If you’re employed

      If you’re employed you pay Class 1 National Insurance contributions. The rates are:
      •if you earn more than £153 a week and up to £805 a week, you pay 12% of the amount you earn between £153 and £805
      •if you earn more than £805 a week, you also pay 2% of all your earnings over £805
      If you’re self-employed

      If you’re self-employed you pay Class 2 and Class 4 National Insurance contributions. The rates are:
      •Class 2 National Insurance contributions are paid at a flat rate of £2.75 a week
      •Class 4 National Insurance contributions are paid as a percentage of your annual taxable profits – 9% on profits between £7,956 and £41,865, and a further 2% on profits over that amount.

      1. the founding principle was free at the point delivery – funding via general taxation to avoid discrimination based on ability to pay – in my eyes a virtuous principle and worth defending at all costs (esp as the current and previous New Labour govt both undermined it with a creeping privatisation agenda).

      2. Yep John you are correct. It’s a service where those who are best equipped to pay pay more than those who can’t afford it in order to ensure that everyone in the country benefits from the same minimum standard of health care.
        I know that will sound grossly unfair to some of the people reading this but to others, for example Christians, who believe that they should be their ‘brother’s keeper’, it will make perfect sense. For everyone who fumes at the injustice of all of those poor wealthy people having their hard-earned cash taken from them and thrown away on keeping poor people alive and healthy there will be others who think that a system that tries to ensure that no-one in a wealthy Western nation in the 21st century should have to worry about whether they can afford a visit to the doctor or hospital actually sounds quite civilised.
        (And I am one of those who probably could afford a fairly decent level of private health care if only I wasn’t being robbed of all those hundreds of pounds of National Insurance each month!)

  172. British born and bred – I’ve used the NHS (who hasn’t) and also have private health insurance, so have used private hospitals in the UK. I’d choose the NHS every time over the private hospitals. [Don’t muck around with our NHS Cameron]

  173. Many years ago I was a radiographer at St. Thomas’ Hospital. I’m glad to hear that it’s still as good as it was back when I worked the emergency room.

    And I’m delighted that Victor’s OK!

  174. I grew up in the UK and moved back to the USA in 2001. I have a problem with my jaw, it dislocates if I yawn to a certain spot. I have been to the ER in Milton Keynes 4 times with this issue, once twice in one night. Being taken to a specialist the second time that night as my muscles spasmed. (Taken in an ambulance to another town) where I was fixed then taken home in the same ambulance. No bill or charges of any kind. I have been to the ER here in the US twice for this issue, once having to go to another hospital cause they couldn’t do it. (My friend had to drive me at 2am as I had been given meds that made me dopey) I was fixed at the second ER. I was billed from both hospitals. Over $800 for the first, which left me with my jaw still dislocated and over $1000 from the second which fixed me. I had and still have no insurance, so that was cash price. I miss the absolute security of the NHS. I love the NHS and people here have no idea what they are missing.

    1. We do Klea, believe me! There’s a march ending in London on 6 Sep, and lots of campaigning going on all over the place. Comments like yours are great for for this too – more evidence, and fresh ways of looking at the issues.

      1. Ah, got the wrong end of the stick here – thought you were saying WE didn’t know what we were missing – other points still stand!

  175. One word: TAXES. Have you looked into the tax rate there? That’s how they pay for all that. 15%+ tax on everything. Double than in the US. We lived there long enough to feel the cost of living burn a hole in our pockets. People have a hard enough time here in the US, always complaining about lowering taxes. Could you imagine if we tried to double it?

    1. I’d rather pay double tax than have to save up the same, if not more money just in case I have to go to the hospital! I see numbers in these comments like $8000 for a simple problem!? People in the US worry about tax and then pay thousands each year to the hospital. Having lived in three countries where the tax is always circa 15-20% on goods and circa 25% of income (including state health insurance in 1 country)- I still feel better knowing that if i go to the hospital I won’t have to fork out several months’ wages….

    2. Not taxes.

      You encountered VAT. That’s that 15%+ tax on everything. It’s something that occurs across the whole of the European Union. Member states must charge at least 15% VAT. But you’ll no doubt be familiar with sales tax in the US. It varies depending on the state, but is mostly between 7% and 10%. VAT amounts to 18% of UK tax income and sales tax averages 23.5%. So which is higher?

      The USA spends more than twice as much of its GDP per head on healthcare than the UK. So you wouldn’t have to double taxes to have a free healthcare system. Heck, it might even lower taxes.
      http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

    3. The BBC worked out the amount of money which is taken from out tax towards paying for the nhs….. It’s worked out as a percentage so the less you earn then your contribution is less, earn more pay more…. Based on a salary of £25,500 the amount of tax that goes to the nhs is approx £1090….. But that would also cover my family if I was the only taxed person in the house.

      How much would the average American on the average salary have to pay for medical cover for two adults and three children…..is it £1090.

      1. That’s an interesting point, Paul – but to be fair there is no way you could support a family of 5 on that salary without extensive additional benefits from the government, so it’s probably not the best comparison.

        As an American living in the UK, I think (based on no actual figures) that in terms of standard GP visits, we’re paying more monthly (via tax) in the UK than someone would in the US. However, once you elevate that to special care, then you’re in a completely new game and the NHS system really comes into its own.

      2. Emily…without having a direct comparison between the UK and US welfare systems and what Tax is or isn’t taken this is probably the only way to make a comparison…how much we pay as a percentage of income compared to how much the average American on average pay would have to contribute to health insurance.

        Part of the point was that regardless how much we pay in Tax be it zero, £1090 or more we all benefit within the household from free access to the system.

      3. Very interesting. I’m a single, 43-year old woman with no chronic health problems other than occasional lower back pain that is alleviated with good physiotherapy and pilates. My monthly health insurance premium in California under the Affordable Care Act is $400, and there are significant deductibles and co-pays. Prior to ‘Obamacare’, I was told that I simply couldn’t get insurance as a self-employed individual. My lower back pain made me “uninsurable”. That’s bad enough. For my sister and her family, they’ve estimated the cost of their current (largely employer-sponsored) health insurance for her, her husband and their 2 children at about $5000 per month if they had to pay for it themselves. INSANE. When will Americans wake up? The republicans have f*&%#d with the minds of most of the country, people who just don’t take the time to really examine the issues, and we all suffer as a result.

  176. I had bad stommack pains and went to A&E. After various tests, I found that it was a overian cyst. 1 week later, I was in hospital having a hysterectomy. Dread to think what the treatment would have cost in USA

  177. We had a very different experience in the US.

    My son also had severe eye irritation, and my first response was to turn the sink faucet upside down (on a hose) to let him fully irrigate his eye to wash out whatever was the offending particle.

    It was a Saturday, and my first attempt at getting him help was to call the ophthalmology practice we had used for years. They returned my call about an hour after I first spoke with the answering service. The ophthalmologist was not near the clinic at the time, and made it clear that it would be a considerable wait and recommended we go to an urgent care clinic.

    I next called the local urgent care clinic, reporting the issue and inquiring about their hours. I took my son into the clinic, where we registered, and waited, and waited (about 1 1/2 hours) … before a nurse came out to the waiting room to inform us that the urgent care clinic would not see a patient with an eye problem.

    Off to ER – we waited over 4 1/2 hours with no feedback.

    Finally, I called my wife, a veterinarian (she’d been working all day – now at the end of her shift). I took my son to her at the vet clinic…slit lamp inspection, scratched cornea, Rx for “my dog” … problem finally solved.

    It took a veterinarian (after 8 hours of waiting for a human doc) to solve the problem.

  178. I have experienced the very best the NHS has to offer, and the very worst. The worst is far outweighing the good. Sure, they saved my life 23 years ago at Dryburn hospital in Durham, but now that hospital is a teaching one, and I’m terrified to even look at it on the way past.

    It’s not the NHS, it’s the bloody idiots working for the NHS that cause the problem. Prime e