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?

Join the Conversation

955 Comments

Leave a Reply to miss magpie Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

  1. There is a system of charges for non residents but emergency care is not covered by that neither is primary care, mental health, family planning (yes abortion gasp lol) and infectious diseases for obvious public health reasons. Only acute care caries charges for non UK residents.

  2. I’m healthy and have no chronic health conditions.Two experiences: In the U.S. My health insurance has always been paid for by my employers, although a monthly amount is also taken from my paycheck to help pay for it. I discovered exactly how much when I left my job–it cost me $800 a month to continue my insurance coverage which was, coincidentally, the same amount I was receiving in unemployment benefits. I was permitted to retain the insurance only for 18 months, after which, I was on my own. Do the math and see how much that coverage cost me.

    In the UK, my English family was in an automobile accident. Ambulance to the hospital, transfer to different hospital for one person, followed by plastic surgery; orthopedic surgery for another, plus two months in hospital. Because we were far from home, my sister and I were given a cottage to live in on the hospital grounds for a month. It wasn’t luxurious, but it was a godsend. Total cost of all the care received: 11 Pounds.

  3. You went to one of the top research hospitals in the UK, in no way representative of hospitals across the country.

    1. I had my first child at one of the top research hospitals in the UK, and it was a disaster. A great research hospital doesn’t necessarily have great patient care.

      1. To the moderator – could you please delete my last name? I wasn’t aware it would post when I registered. Thank you!

    2. Before my retirement, I was the consultant in administrative charge of a small A&E Dept among the ‘dreary steeples’ of Tyrone and Fermanagh.

      The Associate Specialist who did most of the work had had several years’ experience in ophthalmology, and passed this onto others. Of course, the Dept had a slit lamp.

      The care here would have been identical to that given at St Thomas’s — if anything, it would have been prompter.

      I refute utterly your suggestion that only teaching hospitals in the NHS are up to scratch.

      1. That’s Norn Ireland and is a hospital that caters for a handful of people. Most A&E departments that dont have massive funding because they are in strategic locations and are renowned teaching sites or ones out in the sticks that serve 10 people are representative.

        Go to a general hospital in London or in an average size town and you will have the experience most people have.

    3. (This is a reply to your reply; I can’t post it directly.)

      Yes, and no; it’s more complicated than that. And Norn Iron is a rather different place from England.

      Nevertheless; one major teaching hospital in Belfast was forced to close it’s A&E because it couldn’t get the staff.

      In my locality, the well-functioning A&E Dept was turned into a ‘Minor Injuries Unit’, with serious cases going elsewhere. I also worked at ‘elsewhere’, and was fully aware of the delays in the A&E there; I also had the experience of trying to manage patients in beds in the corridors in the Dept. Sometimes, the place was so full that it was physically hard to move.

      In the past, A&E Depts were called ‘Casualty’. This name came from ‘casual’ patients who walked in off the street; this system was greatly enlarged during WW2. At that time, if a GP saw a patient needing hospital admission, the patient was admitted directly to the ward. Later, rebranded A&E Depts became triage stations for all patients, whether admission was required or not — a sort of ’empire building’ if you like.

      And today’s problems relate to all of this; people find it hard to get GP appointments, and GPs are overworked with numbers of patients, so the patient betakes themself to an A&E dept. (And A&E means ‘accident’ and [major] ’emergency’.) A hospital is thus the ‘lender of last resort’.

      While it’s easy to describe the problems, it’s much harder to solve them. Far more medical and nursing staff are needed, even if this is called ‘shroud waving’, and that needs more money which the government in the UK is very unwilling to provide, despite what they say. Some, and I don’t think they are paranoid, see ‘death by a thousand cuts’ as the start of the slippery slope leading towards much fuller privatisation of the NHS than now exists. And the winners of this will be those with connections to private health care firms; The previous SoS, Mr Lansley is one such person. Jeremy *unt co-wrote a book a decade ago about privatising the NHS. (Yes, I did mean *unt, it’s not a typo.)

  4. I’m very happy that you had such a great experience here. It makes me proud of our universal healthcare system and how well it works. We as a society firmly believe in accessible healthcare for everybody, and for good reason.
    However, it is not at all reciprocal between here and the US. I would have to pay a small fortune for the equivalent service over there and even with expensive insurance I still have to co-pay.
    Your son was in essence treated at my expense. British citizens’ tax money. I think it only fair that you insist on paying for the service received.

  5. I twisted my ankle quite badly while visiting my son in Seattle earlier this year and needed to get it assessed and x-rays, etc. Fortunately I had purchased travel insurance before my trip. The exercise cost over $2,000 yet it would have cost nothing if it had happened in Australia, where I live. I love our socialised healthcare system here. Nobody goes bankrupt in Australia due to medical bills.

  6. I am English, and unfortunately I had a miscarriage while on holiday in America. They over- treated me and refused to let me miscarry naturally and insisted on me having a d and c amongst other things, all the while criticising the NHS. I was billed $5000 dollars for the privilege. Three years later, I had another a miscarriage in the uk. I phoned the early pregnancy unit at my hospital and explained what was happening and asked to be left to miscarry naturally. They respected my wishes and gave me follow up advice and what to look out for etc etc all free to me on the NHS. My first experience of this event was harrowing and traumatic and left me with PTSD (I’m pretty sure), however my second experience couldn’t have been more opposite. I love the NHS.

    1. I am very sorry for your loss. You may have been overtreated for two reasons. First, doctors and hospitals make more money when they give more treatment. More importantly, though, they’re afraid of being sued. So they overtreat to avoid being accused of negligence. I am appalled that they would not allow you to miscarry naturally. They were practicing “defensive medicine” to avoid being sued, rather than *caring* for you as a person. That’s a very sad part of our system.

  7. Our girl had a suspected broken wrist on Saturday night at 9.45. I called the no emergency helpline, spoke to a lovely lady who took all the details. Could be a long wait for a call back so she went and badgered her supervisor til she could speak to them. Best go to A&E. We got there twenty minutes later and she had called ahead so they already had the details, no need to go through it all again. Waited less than 30 mins for triage. Nurse was certain there was no break, er doc could confirm if there was tendon damage, likely to be a two hour wait (it was Saturday night after all!). We decided now that a break had probably been ruled out, we would go home and come back if anything changed. The thing that took longest was travelling there and back, And that was on a Saturday night!

  8. Should you need NHS treatment and you have not arranged insurance, you will be charged at 150% of the standard NHS rate, unless an exemption category applies to either you or the treatment. If you are coming for more than six months, you may need to pay the immigration health surcharge.

    Some services or treatments carried out in an NHS hospital are exempt from charges, so they are free to all. These include:

    accident and emergency services – not including emergency treatment if admitted to hospital
    family planning services – this does not include termination of pregnancy or infertility treatment
    treatment for most infectious diseases, including sexually transmitted infections (STIs)
    treatment required for a physical or mental condition caused by torture, female genital mutilation, domestic violence or sexual violence – this does not apply if you have come to England to seek this treatment

    http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/access-services-in-England.aspx

  9. All Children Under the age of 16 in the UK (regardless of resident status) are entitled to free NHS treatment.

    Children under 16, and young people aged 16, 17 and 18 in full-time education*

    You get free:

    NHS prescriptions

    NHS dental treatment for any course of treatment that starts before your 18th birthday or, if you are in full-time education, your 19th birthday

    NHS sight tests

    NHS wigs and fabric supports

    You also:

    Get help towards the cost of glasses or contact lenses
    May get help towards the cost of repair or replacement of glasses or contact lenses
    May get help with travel costs for NHS treatment.

    1. Well thats ok then Pity its not reciprocated, would Dr Gunter treat someone for free?

      Yes the NHS is a remarkable organisation but cannot treat the world for free. If the good Dr was able and willing to pay she should have or at very least made a donation.

      1. Absolutely agree and any other non National Health contributors. Makes me wild after worked for over 40yrs.

      2. It’s not so bad, the kid is only 11 years old. I have always worked and paid my share. Not quite 40 years, but I’m only 34. I don’t mind kiddies getting free treatment. Compared to what is cost in the U.S. It probably seemed like they got away with robbery. But I think not. If that day out at the hospital would have cost $1000 in the U.S it would only cost $300 here,due to how much more efficient we are. And the doctors and nurses would have been there anyway. So as long as nobody had to do overtime because of this one child. The actual cost was negligible. And the money Dr Gunter spent here in V.A.T alone probably more than covered it. So if we get a visitor from the U.S and he or she does not use our healthcare system (like in 95% cases) we are making a profit.

      3. It’s not treating the world for free. It’s treating the small number of people who have an accident.

        You want to let them die rather than treat them? The cost of the coroner, and the mortuary would outweigh a few minutes of a doctors time, the pence that an xray costs and some generic antibiotic cream. I dont think the total cost of that care would be more than £20 it’d cost them more than that to collect it.

      4. Tony: Tourists in the UK have paid landing fees, VAT on almost everything they buy, possibly an additional hotel tax, road fuel duty for the transport they use etc. They’ll pay an air passenger charge when they fly back. It ought to be enough to fund emergency treatment.

        I’m sure Dr Gunter is bright enough to have located St. Thomas’s charity, but here’s the URL anyway: Guy’s and St. Thomas’ Charity: Homepage https://www.gsttcharity.org.uk/ . I hope they take credit/debit cards or have a US bank account, because bank charges on dollar cheques in UK are murder!

  10. While a Student in England I was a victim of a horrific car accident. I was rushed to St. Bartholomew hospital (the oldest hospital in London, I believe) 5.3 minutes before the car I had been in blew up. At St. Bartholomews I received amazing care with a huge dose of love. I had a severe concussion, a total of 14 fractures in both legs, dislocated vertabrae, deep cuts and abrasions all over my body and face as well as partial scalping. They stiched me up, popped everything into place, plastered me up and were by my bedside 24/7 for a month. They helped me study for my A level exams, they talked with me about anything and everything, they helped me heal physically and mentally. The pain was excruciating, the fear of my future overwhelming. They healed me. All these years later, I am happy to report I’ve had a good life and have many more years to come. Not I, nor my international US insurance, was ever billed for ANYTHING ! Can you imagine the bill I’d still be paying off if it had been in the States?!?

  11. Not exactly similar but a sprained my ankle in new York state last May. €3000 (about $3600) was what my insurance was billed for 2 xrays and one tab of zofran plus 2 mins of the doc’s time. I’m a GP myself and thought that was abolutely scandalous.

    1. You’re so right, it’s absolutely scandalous, your insurance company being charged money which bears no relation to the service you got, and if we all have to pay insurance, we pay for it in the end. British friend of mine took child to doc in US for ear infection, didn’t object to doctor’s charge but just flatly refused to pay the £200 charge for the antibiotics which she knew cost around £5. She was an NHS nurse and was fully insured. She just refused to let them charge her insurers that money, and they did back down.
      Famously, BUPA refused to pay £200 for a tub of talc the hospital billed them for. It was a BUPA hospital.

  12. Just wondered if the US government are worried about unemployment from nationalised care? Years ago read an article (I’m an accountant, sorry) that said as much money was spent on the administration of the US health system as the entire NHS….
    Agree with others, hospitals should bill overseas visitors, but cost of chasing unpaid invoices and belief of medical staff in free service means they rarely are. Donations are welcome.

  13. I’m a Brit and very proud of our NHS. We all know it is creaking under pressure from increasing population and decreasing resource. I’ve also lived in the western USA for several years and experienced healthcare there. Both systems have advantages and disadvantages but I’d opt for a national system any time.

    I think I’d summarise the two systems thus: the US healthcare system is at its strongest when everybody’s sick; the UK healthcare system works best when everybody’s healthy.

  14. Myself and my son have had plenty trips to the ER nothin city and rural and I have never waited more than about 40mins to be seen. And to be fair, that was more minor injuries so nothing emergent.

    I am very proud to now work for NHS Scotland. All our goal ever is or has been; patient care.

    People like to denigrate my fellow colleagues but let me tell you, if you had to put up with half the nonsense they did; you wouldn’t last two minutes in the job.

    Is it perfect? No. Healthcare can never be perfected. It changes too quickly, too often.

    My colleagues don’t live to make you wait for hours in and A&E but people need to realise; you have been triaged for a reason. That reason is to determine whether, if something emergent comes in, you can wait without it impacting on your health. One of the biggest problems in A&Es is people attending with no emergent conditions, when they should attend a minor ailments centre or the GP.

    We have an outstanding service, whatever may be said, and we have patients not clients. People are not frightened to come to hospital or GP for fear of the bill. People can safely be treated and medicated without wondering how long it will take them to pay it off. People should no be slave to healthcare. Healthcare is a universal right. With a little taken off my wages every month I know that if I break my leg, am in a car accident, fall down the stairs; I can get and ambulance, be triaged, seen by a doctor, go through a battery of tests, be given medication, stay overnight in hospital and be discharged without ever seeing a bill. I can go home in the knowledge that I have nothing to worry about.

    I wish more countries would adopt this system. People shouldn’t be avoiding their health over money. People should die because they cannnot afford medication. It simply should never happen.

  15. I am very pleased you enjoyed our wonderful free NHS. We do pay for it via a tax called National Insurance around 15% both employers and employees pay on. I imagine at some point you will get a bill. They NHS are suppose to making non UK/EU citizens pay for our services. But whether you do actually receive the bill time will tell. Our NHS is struggling financially due to Government cutbacks and high wages of men in suits. All Brits are very proud of their NHS and we are desperately trying to protect it from being privatised.

    My sister has worked for the NHS for over 30 years.

    1. Actually the NHS is mostly funded by general taxation, National Insurance only pays a small part. Eligibility for NHS treatment has nothing to do with how much NI a patient has paid in, tho before the NHS, National Insurance DID cover free medical treatment to people who’d paid in – male workers mainly – women rarely paid enough in, and children weren’t covered at all. All hail the NHS. http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/how-nhs-funded

  16. You won’t get a bill, its covered in our taxes. Its perfectly acceptable for tourists to use in an emergency, as your situation was. The NHS is great, the management of it not so much. I feel thats why some doctors leave, better pay and working hours abroad.

  17. What frightens me is our government running a National system as their”rules” with Medicare and Medicaid make no sense most times and cause patients to not get adequate care – too much and too little – making docs do work arounds. PS – I’m a pediatrician in a small town, solo private practice, level 3 medical home with 55% Medicaid

  18. Had a similar experience in the UK when my then 6 year old son got a painful ear infection. Off to hospital – Emergency Setvices. He was looked at within 10 minutes, given a shot of antibiotic, given antibiotic tablets (10 day supply), treated with gentleness, kindness and professionalism. I’m and out in 35 minutes and when we offered up our insurance information to pay for the services and the medications, we were told there was no charge. Even though we were foreigners (Americans) in the UK – no charge. We could do the same here, our insurance and pharmaceutical industries just will not allow it… And they have spent hundreds of millions fighting universal care. Here in the USA it’s about big business and their profits – ALWAYS about the money. Always.

  19. @NHSmillions on twitter, many many users of the service telling their stories.
    I promote our NHS Scotland at any opportunity I have, it’s one of the many reasons why I voted YES in the referendum.
    I do know that in Scotland we take your details and generally send a bill on but I’m not sure how that is dealt with at the hospital at the time..

    Yes our NHS has some issues, but what major company throughout the world doesn’t. Cant please everyone, even when they pay buttons or even nothing (those unemployed) but I LOVE it. And do not want to lose it.

    As for moving to Australia, us Scots move for the weather, the job is a perk, living under Westminster rule isn’t all that great, especially when they are managing NHSEngland and Wales into privatisation.

  20. I am an American living in the UK for about two years now. A British friend of mine made the comment after I was complaining about someone jumping the queue (cutting in front of me in line) for carpal tunnel surgery (while we were all waiting in the hospital in our gowns 🙂 ) that we don’t pay in money for the NHS services, but we do pay in time. Everything takes aaaaaaaages to happen. I waited for eight months for this surgery when I’m the US I would have probably had it within two weeks of deciding it was needed. Everything just takes a lot longer. And it’s not free. We all pay for it with our taxes. It’s just free at the point of delivery.

    1. You could have had your carpal tunnel treatment more or less immediately if you were prepared to pay privately, but private medicine costs a lot more because of the inefficiencies involved in the extra admin and profit required by insurance companies and medical providers. You do have to wait a little longer for non-essential treatment because the NHS runs at full capacity (and then some) which makes it highly efficient financially if not quite so effective seen by the patient waiting for non-urgent treatment. I feel your impatience but I bet you weren’t even once tempted to nip back to the US to get your op done there.

  21. As a UK taxpayer I find it grossly incompetent that St Thomas failed to bill their American customer for the care they gave his son. I appreciate that they get paid anyhow so that explains why they can’t be bothered but there is no reason at all that they should pose as the International Health Service.

    1. Emergency treatment is free throughout the EU and Europe in general for everyone including visitors – can you imagine what the admin cost to the NHS would be if they had to break down notional costs of the treatment St Thomas’s gave this family? Much cheaper just to deal with it. Had the patient needed further treatment the family would have been liable for charges. Fast, cheap, efficient, effective.

  22. I am English and well used to the mostly-wonderful NHS (it has its problems as does any country’s healthcare) and also lived in the US for 17 years so have experienced the US system which is excellent (again, not without some problems) but you do have to pay.
    Anyway, my son was visiting from the US and within 24 hours of arriving had chest pains. We took him to the Accident and Emergency (A&E ot ER) in Worcester. The nurse said there was no way he was having heart problems because he was a fit 17 year old. They did a test and I have never seen such quick action once they diagnosed a potential heart attack (very quickly assessed).
    He was quickly wheeled into a trauma room and assessed as well as being given initial medication. The doctors decided they did not have the right facilities so he was to be transferred to Queen Elizabeth in Birmingham.
    I went with him in a white knuckle ride in an ambulance (I was in the front and am sure they never got my fingernail grip marks from the dashboard) to transfer him.
    He then spent three days in a Coronary Care Unit and was given the all clear – turns out it was an infection giving false heart attack symptoms.
    When my ex-wife (a nurse in the US) asked what the bill was, expecting a new mortgage to be required, was amazed when the doctor scoffed and said “his Dad is English so he is too, no bill”.
    Wonderful care from the doctors and nurses throughout the process and Andrew was treated wonderfully.
    Here is hoping we never get rid of it.
    Oh, and as for the US, I had great care when I had my knee repaired from a rugby injury at the Hospital for Special Surgery in Mew York but thankfully had 100% coverage or would probably still be paying for it.
    The NHS is not free (as some people misguidedly think) but it is, in my opinion, worth every penny of tax we pay!

  23. Last year my wife suffered a cardiac arrest in her sleep. Her shaking was so violent it woke both me and our 3y/o daughter (who had sneaked into our bed in the night) and I had to keep her alive as best I could with CPR while we waited for an ambulance. It arrived inside 5-10 minutes, but she was so far gone (prior to me waking and beginning CPR) that it took 4 shots of adrenalin and 3 defibs just to maintain a really faint pulse. All credit to the paramedics who transferred her to the ambulance and then spent half an hour working to get her breathing spontaneously again. It was only then that they took her up to the local hospital’s A+E where she was immediately intubated, ventilated and sedated to stabilise her condition in resus in order to receive a CT scan, an MRI scan, be diagnosed and then moved into the Critical Care Unit. Then she was hooked up to a vent and at least 6 computerised IVs and arterial lines and nasogastric tube were inserted. She went on to spend a month in coma under constant care of a team of registrars, nurses, CCU consultants and specialists from other teams – dieticians, neurologists, cardiologists, physiotherapists, radiologists, anaesthetists and the list goes on and on.

    Despite the professional consensus being that she was beyond recovery the whole team were reticent to withdraw care and allowed her to continue at her own pace with the result that she eventually defied expectations and regained consciousness. She suffered severe hypoxic damage to the parietal and occipital lobes in her brain and lost all vision, most movement and had her short term memory recall seriously affected. This, combined with a month in coma had left all her muscle mass atrophied so she as unable to even sit up unaided. She was transferred a short time later to cardiology to focus on that aspect of her care where she remained for a further month, during which she underwent a surgery to fit an implantable cardioverter defibrillator (ICV) to mitigate any future incidences. Once the cardio team were happy with her condition she transferred to a smaller hospital, closer to home, while she waited for a room in a specialist neurological rehabilitaion centre attached to another hospital. Even during this time her care and rehab continued with the Occupational Therapists (OT) and Physiotherapists beginning their work to teach her to sit up, stand, walk and feed herself again. After a short time here she moved to the rehab centre where she remained resident for 9 months with more intensive Physio and OT sessions. Throughout the whole journey she has been visited by other teams of specialists – dietary, speech/language therapists, opthamologists, cardio (following up) and remained under a consultant neurologist who specialised in rehabilitation. When she was discharged from hospital her care transferred to our local authority and the OT community team who continue to visit, set goals and work towards them. We have been provided with a wheelchair, DAB radio, bath seat, perching stool for use in front of the washbasin, had handrails fitted in the house and had the outside access to the house modified. She’s also attended outpatient clinics for opthamology, cardiology (check-ups on the ICV) and GP to review her meds. The local pharmacy delivers her prescriptions to our home and her condition (registered blind) means that even these don’t come with the usual small prescription charge.

    Total bill (at point of use) to date = zero. Of course, I have paid into the system through general taxation, but there’s absolutely no way that private health insurance would have covered all of the costs incurred throughout her treatment. Just sitting down and trying to count the number of people who have been directly involved in her care from the moment I dialled 999 to now boggles the mind. The NHS is an amazing service. It saved my wife’s, and mother of my daughter’s life. It continues to give her a life back and won’t stop until she’s gone as far as she possibly can in recovery. The only treatment not covered by the NHS (and it’s a shame, as it really works!) was HBOT which is run fairly locally by a charity and which we had to pay for personally. But I can’t begrudge this one additional treatment not being available on the NHS, because they have provided us with so much already.

    And for this reason I will always defend the NHS against its detractors and attackers. It’s a world class healthcare system that delivers much better value to the end user in terms of personal financial cost and relative quality of care than many private systems.

    1. In the US, a health crisis like almost certainly would have led to a “medical bankruptcy” for most families, which in turn sets folks on a path to financial ruin and homelessness. It’s truly dystopic. People live in fear of illness, hanging on to horrible jobs they hate because they can’t lose their insurance. Our labor is basically extorted through fear of dying without healthcare.

      And, there’s another side to our system in the US, that no one talks about, and that’s how difficult it is to heal in a healthcare economy of that’s marked by scarcity. If you don’t have the money to pay for services you *might* find treatment if you’re diligent and extremely lucky, but you’re treated like you don’t deserve treatment, which takes a huge toll psychologically on the patient. And even then, your treatment will likely be spotty — and people let you know that you’re there by their good graces. I know someone who died b/c his cancer medicine was cut off for a few months due to bickering with his insurer. His illness couldn’t accommodate the lapse in treatment.

      I didn’t have insurance until my mid-30s, and was accustomed to being treated as an outsider in the health care system. Then I contracted an infection in my spine which led to months spent in a hospital. Most of that time was spent without a diagnosis. I was told I “must have AIDS,” and suspected of malingering because they couldn’t find a source for the pain that creating intense spasms in my back (osteomyelitis at L1, L2 was the cause). Once I was diagnosed there was even a sense that I didn’t deserve treatment because this is a disease that usually only hits drug users, so they didn’t want to treat my pain. Despite it all, there wasn’t a day I woke up thinking “thank god I finally have insurance,” because without it I would have been kicked out of the system, the infection would have taken over, and I would have died. The whole process took from May until December, and during that time, once I was diagnosed, I needed constant IV antibiotics. Any break in that regimen would have killed me. I didn’t have the energy to feed myself and I couldn’t walk, so I surely didn’t have the ability to fight with administrators about how to get the medical care I needed.

      In Florida alone, six people die every day because they lack insurance. That’s 2,190 a year, in one state alone.

      1. Some very sobering words there, I hope us Brits take note and fight to preserve our wonderful NHS. As for Americans that are reading this, please don’t believe the propaganda you are fed and fight too for have a system that provides for everyone as a matter of human right.

  24. I’m an American born NHS Accident and Emergency doctor (ED Resident). Your experience at our hospitals is fantastic and one I find, happily, as standard. I would please ask you to make a donation to St Thomas Hospital. Overseas visitors are not entitled to free care in the NHS; we will always provide emergency care but our NHS is crumbling under the weight of finance and this is one way you could please show your gratitude.
    The doctor who treated you was entirely wrong about payment for overseas visitors, and it would benefit future patients such as yourself to have the NHS in place.
    Please make this financial payment-for-treatment-received to hospital in question.

    1. Hi Dr A,
      Whilst I understand the sentiment behind you asking for a donation, I wanted to let you know that it is you who is wrong, not the doctor who treated Victor.
      Rightly or wrongly, given the state of NHS finances, regardless of your country of origin ALL EMERGENCY CARE is free to everyone in the NHS. Only had Victor needed non emergent follow up care would there be a charge.
      Current guidance can be seen here https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations.

  25. I have a friend that is Canadian born (to US parents) grew up in the states, served as a medic in the US forces. Has travelled the world as a medic is married to a US woman nurse. Lives near the Canadian border, both at times cross o er to use the Canadian health service. Both will tell you it’s a mess and a socialist haven and the US is better off without it!!

    1. Parts of the Canadian system are a mess, but it works. And what we have is 4,000 times better than anything Americans have. If it’s such an overall mess. Why would anyone come across the border to avail themselves of our service? Would it be because we have world class doctors? Maybe the world class research and development? Would it be the cost, because the doctors who stay in Canada aren’t greedy, money grubbers afraid of getting sued every time they treat a patient. We have a great, if somewhat faulty system.

    2. If it’s such a mess and the US is better off without it (presumably meaning the US system is better) why do they go to the trouble of crossing the border to make use of it? Why not stay at home and make use of the superior service?

      is it by any chance because they cannot afford to do so?

  26. Having been an A &E nurse for 8 years and then moving to the US 13 years ago I have a slightly different persoectitive. The NHS is fabulous, in the US physicians are so concerned about malpractice suits they spend a lot of time and consequently money on extra tests (to cover all the bases). Additionally as a nurse in the south of England I earn less than a nursing assistant in the US. A newly graduated nurse where I work in the US earns >$30 an hour that is double that of a new nurse in the UK. Is it any wonder healthcare costs so much in the US?
    I hope the UK protects its national treasure it really is a gem!!

  27. So glad you had such a positive experience. Whilst on honeymoon in Florida some 23 years ago, my husband was taken ill with gastroenteritis. As it was only the second day, I thought he was taking the vow of “in sickness and health” to the extreme as his temp was really high and I did wonder if we would be going home together! I took him to the local doctors via a cab, both of us really worried. The first thing I was asked for was a credit card, before they asked his name or enquire as to the problem. 😟 I am so very grateful for our NHS.

  28. You won’t get a bill. It’s free at the point of delivery. For everyone. For now. 😊

  29. I am really pleased that you got excellent care from our NHS for free at that too!
    Unfortunately for us poor minions the story is quite different 99% of the time!
    2 year 4 month wait for a child mental health assessment for my now 9 year old, the same 9 year old is on a 22 week waiting list to see a neurologist after an MRI scan found multiple cysts on her brain(This is my child & I have to sit back & wait with pure worry over what is happening to her brain)
    3 accident & emergency visits over 3 weeks for my very sick 2 year old granddaughter after being told she was misbehaving resulted in an eventual diagnosis of diabetes insipidus.
    My then 19 year old daughter discharged from accident & emergency after displaying stroke like symptoms & vertigo because a CT scan showed nothing! Fast forward another week & she lost her memory, a full 9 weeks after initial symptoms diagnosed with a rare disease (Susac Syndrome) she’s 23 now & has brain damage & is disabled!
    Now I’m aware of others who have had positive experiences but the negative experiences far outweigh the good, I feel our NHS has a lack of care because the staff are so overworked, Great Britain is bursting at the seams & the NHS has took full force of this! In the meantime we are suffering from a lack of care & extremely long waiting lists..

    1. I’m really sorry that your experiences have been bad, but it’s not because GB is “bursting at the seams” – it’s because the NHS is critically underfunded. And THAT is a political choice by a government intent on strangling social healthcare to death.

      1. Totally agree. Scotland does not have the same levels of immigration as England, but its NHS has nany of the same problems, Child mental health is not only underfunded, but suffers from a lack of available qualified staff. In my area that has really been helped by the appoinment of a new child psychologist. She’s Polish.

  30. Great article good job she wasn’t visiting west Yorkshire it would have been a different experience. Especially Dewsbury .

  31. The NHS is a fabulous institution and should never be privatised. My only experience of emergency health care in the US was when I had a bad reaction to insect bites. Attended a PromptCare clinic and was seen very quickly but only after I’d paid the $200 upfront fee. I was prescribed a course of steroids which I was dreading finding out the cost of however this was only $7. But all in all a costly 20 minutes! That same summer (2010) my friends in the US were very interested in how the NHS worked but we’re largely not interested in paying for others care who “didn’t take care of themselves”. Thats not really the case with the NHS (though some may disagree!) and it didn’t matter to them that it would likely be way less expensive than their current insurance.

  32. The NHS is invaluable in GB and because we have a good system we have really cheap private hospital plans too. I belong to Benenden health £8.49 a month and the if a waiting list on the NHS is a bit long then Benenden will do it….they also give you £1,400 to cover any specialist (up to £5,000) for separate illnesses.
    Couple of years ago I had a lump in my mouth…they agreed to pay to have it removed at our local Nuffield in Woodindean.

    As they have to compete with the NHS it’s really cheap!
    I have had many dealings with the NHS too….and by having very low cost medicine it takes the strain off the NHS lists.

    1. Your really cheap “private” insurance is a mirage. It’s only possible to offer a product that cheap because of the way that privatised health care leverages NHS resources. If all health care in the UK went over to the American model you’d be out campaigning against the high price of health care.

  33. I know this post is a little old, but I only just found it.

    I’ve seen a small portion of the US anti-NHS stuff – what I’ve read online, and what has been reported here, so I can well believe an American coming here would be expecting mud huts and rusty re-used needles. They never mention the fact that the UK has a higher life expectancy than the US, or that (despite the cliche) people in the UK have better teeth than people in the US, statistically.

    But I have to say, as a Briton, I love the NHS. It’s one of the greatest things this country has ever done.

    I’m quite firmly in the category of people who simply couldn’t afford healthcare if it weren’t for the NHS. I couldn’t pay independently, and I don’t think I could afford the insurance. And I’m self employed, so no employee benefits.

    Over my lifetime, I’ve been treated for seizures I had as a kid (2 weeks in hospital each time, once nearly over Christmas, which the nurses managed to make feel like an adventure), for innumerable coughs, colds, etc, dental treatment, and I’m currently being treated for ptsd. Yes there are problems – there are waiting lists, and it can be tricky getting a GP appointment, but it’s still probably the best thing about the UK.

    I was brought up by my Nana, and she used to regularly tell me stories about pre-NHS life. Specifically about her mother, dying at 48, unable to afford any treatment other than pain relief – and that only because she washed the doctor’s shirts to pay his bills. There are plenty of people who’d be in that situation again here, if it weren’t for the NHS.

    To add to that, my mother-in-law had a stroke at the end of last year. the ambulance was there in minutes (and they live in the middle of nowhere). She was rushed to a specialist stroke care unit, then a few weeks later transferred to a specialist stroke rehabilitation unit. She’s at home now, and has been for some months, but she still gets regular treatment sessions, regular sessions of speech therapy, and regular physio. Her care has been outstanding at every stage. And it has all been NHS.

    Put it this way, I might very well be prepared to fight to the death to defend the NHS. And almost everyone I know feels the same.

  34. My daughter recently had a serious accident in Mexico. I’m from Britain but live in Canada which also has universal health care. The first thing I was asked as my daughter lay critically I’ll was for my credit card to pay a deposit for care and insurance. I remember watching Michael Moores “sicko” where he compared health care systems. I worked for the NHS and am so proud of it. I think if you have the means to pay for care then you should, but ultimately everyone should have a basic right to access health care.

    1. “if you have the means to pay for care then you should”, is a dangerous sentiment used in connection with the NHS. Government and business are keen to destroy it and intend to make those who have the means to pay do so. The fact is that everyone working in the UK already pays into the funding for NHS. There are multiple problems with the NHS in it’s current shape and a good deal of them are down to fragmentation and imposition of a totally synthetic Market process and associated levels of expensive non-medical tiers management.

      I know from my experience in international business that when you add a “value” chain to any service or commodity the cost goes up in proportion to the number of entities taking their margin.

      It strikes me as insane that anyone in the UK would think that moving to a model more like that found in the USA would deliver better service at lower (or par) cost.

      Government has managed to persuade some of the population that the NHS is broken and needs to be replaced, but starving it of cash in order to break it was probably the plan and Government should be called to account for not properly funding the service and for hampering it with needless layers bureaucrats.

      In the UK those who have the means are paying, but what they’re essentially getting is access to the same senior staff who sell their spare time to private Health Care entities like BUPA. The reality is that apart from having quicker access to diagnostics and nicer hotel services the standard of care is dependant on the standard of practitioners available to NHS users. Effectively BUPA and their ilk allow you to jump the NHS queue. In the event of any complications it’s not unknown for these folks to have to transfer patients to their nearest NHS facility for further treatment.

      1. The US system is broken. Face it, the whole world is broken. Almost anything you can think of someone in politics is claiming is broken.

        Looks to me like the NHS is better than the US system. At that it costs one hell of a lot less. In the US they agonize over what such a system would cost the government. What they need to look at is what it costs the country. One way or another it’s paid for, you just pay less.

      2. “Starving it of cash in order to break it” sounds exactly like the way government treats public education in America.

      3. This was in the context of a visitor using the NHS,what us wrong with asking for their insurance by the admin staff at the front desk nothing to do with medics who treat.

  35. Immediate and necessary is free through the NHS no matter what your nationality,you won’t be billed. We are ultra proud of our health service despite its many flaws g

  36. ‘Emergency’ care is free to all in the UK regardless of country of residence as is care for HİV and Tuberculosis. İf you needed follow up there might have been a charge but anything through a&e is free. İt is a fantastic system although not perfect and despite the government and media trying to destroy it the staff and service is mostly first class.

      1. You have to be have been legally resident here for 6 months before you are entitled to free treatment. If you need followup care after A&E you have to get it back home for pay for it here. On return from overseas my husband and I weren’t entitled to free care (except emergency care) even though we are British citizens born and raised here, and paying NI and income tax for many years. For that reason his company paid for our health insurance. We think that’s fair enough.

  37. Fabulous fabulously written Dr. Gunter . All these years later , did you ever get a bill ?!

      1. And there in lies the major problem , you should have paid ,it should free at point of use for Britons ,not for the rest of the world

      2. Tony, don’t embarrass yourself. I work for the NHS and providing this level of care for a little boy is nothing.

      3. Not embarrassed at all so did I, therein lies the fault thinking it all costs nothing everytime the NHS dies anything it costs money. The hospital administrators should follow up for oayment for treatment received or obtain the insurance details. This happens in most other countries , I would not go on holiday to Spain just relying on my EH11 card and neither would you.

      4. It would probably have cost the NHS as much to create the bill as the treatment cost. Remember, they don’t do it for patients as a matter of course.

  38. As an American who has lived in the UK for 14 years I love the NHS – I have had nothing but good treatment any time I have had surgery and the last time I was in I told them I wanted to be in control of all of the medications that I brought in with me so that my normal medicine regime was not disturbed and they were very accommodating and I just had to tell them what I took and at what time so it could be recorded xxx

  39. I was in Florida once and got infected from a spider. It costed me $350 to visit the hospital and find out that it was nothing. I had bought some travel insurance for the first time, as this was a trip to US and I knew there is no free emergency medical service. I tried to claim this money back and was asked to prove that this amount could not be covered by my primary insurance! I tried to explain that people don’t use private insurances in the UK because we have the NHS and don’t need private insurances. They were not prepared to accept this. In the end they asked me to write a detailed letter and certify in the American Consulate. I had to pay $50 for the certification.

  40. I took my mother who was visiting me from India. She needed to see GP and she was so relieved with her pain in 24 hours ,she is still blessing the doctor. It didn’t cost of anything.

    1. Foreigners are supposed to pay because they do not pay taxes into the British system but often do not get charged.

  41. Touch wood, I’ve never had to visit a hospital in the UK. But I did end up in an ER in Washington State, just outside of Seattle, about 11 years ago. Nothing at all to complain about regarding the facility or quality of care (I was in and out in about 40 mins), but that near-midnight panic attack cost me nearly US$800.

    Compare that to an ER visit I had in Taipei eight or so years ago for a broken rib. With no insurance, I paid a measly $1,200-some Taiwan dollars (about US$40), including X-rays and four days’ pain meds. After returning a few days later with my National Health Insurance card, I was refunded all of that save for NT$300 odd.

    I can’t speak for NHS, but after more than a decade in a country where affordable, high-quality health care is given to everyone, I have little desire to put my family through moving back to and living in the very broken United States.

  42. Just to point out that NO ONE pays for emergency treatment on the NHS, including foreign visitors. As much as the Tories would like to do it we’ve not yet descended to that inhumanity.

  43. I am Italian. Our national health system is certainly less glorious than NHS but I am proud of it. I appreciate many aspects of the American society but I simply cannot understand how one of the richest countries of the world can tolerate 50 million citizens without real coverage. I appreciated a lot efforts made by the Clinton and Obama. It gives hope to many poor people.

  44. Americans are constantly told that the NHS doesn’t work, the doctors aren’t paid enough, the service is bad, the treatments ineffective. It’s all propaganda and an outright lie.

    I’m part of a support group for people with a debilitating illness. The American users are all in serious financial problems due to the American system and yet they still insist they wouldn’t want an equivalent of the NHS . They told me it wouldn’t be fair to doctors to be paid so little – I told them they’re not, GPs tend to earn around £100k. They said that’s not enough when they have hundreds of thousands in student loads – I had to explain that, in the UK, they don’t.

    The thing is, as someone with a chronic illness, I’ve had serious issues with the NHS – it’s not the waiting, it’s the attitude of doctors I’ve had issues with. It took me 10 years to get diagnosed with a condition that affects 1 in 10 women and has pretty obvious symptoms. Then I found out that the average diagnosis time in the US is just as long. Turns out your care isn’t better just because you’re paying for it.

  45. $1000 for a little eye problem and a tube of antibiotic cream?! Holy sh*t! Never been happier to be British!

  46. Lots of people cwandering why so many in the US think the NHS is a bad thing – that’s easy, they’re told it is every day by those controlling govt and media who have large investments in the money-making machine that is US healthcare !!!! Which is exactly what the Tories want here too !!!

    1. Actually, I distrust the NHS because of my own experiences in the UK. When I was in hospital, things happened that would get an American hospital shut down. The staff blamed the abysmal care on lack of funding, but actually, the nurses I dealt with were uncaring and incompetent. That’s an attitude problem, not a money problem. I had such a bad experience that I moved back to the USA. When I told my doctor about my experience in the NHS hospital, she couldn’t believe care was so poor in a first-world country.

  47. I’m British living in US and I just broke my wrist. The ER and the operation would have been free at home, and completed by equally qualified people in the same timeframe. I’m terrified waiting for the bill!

  48. Reading the article I am not surprised at all that you had a fantastic care provided by NHS! I live in the UK and I work in a hospital. Yes people complain but not about the service just sometimes long waits which is probably max 5hrs for a free care but don’t people complain about everything? We are very very very greatful for the nhs and very proud. Our DRs are happy to their job and never heard them complaining about wages. After watching a documentary called “Sicko” I honestly couldn’t Even IMAGINE how horrible would be to live in America !! You have to pay An awful amount of money for treatments that your government should provide!!! You get ripped off left right and centre on insurance that still charges you a heck lot of money and you pay extra charges. I reallllly feel awful on people in America. And couldn’t be happier with the fantastic NHS that we have!

  49. Unfortunately, the likelihood is you will get a bill in the post after a few months. I THINK it is a standard charge of a few thousand pounds but I may be wrong.

    I only know this because the South African mother of one of my British consultants received a bill for the services she received while visiting her daughter. The bill came a few months after. Another friend who is a GP received bill for the care his Malaysian father received while again, visiting him here in the UK.

    Although, you may get lucky and not get a bill.

    All the best with you.

    MG

    1. This visit will not be charged as it is classed as an emergency visit, with no admission or follow up required.
      Emergency care in the uk is free.

    2. This is just uninformed nonsense. We’re a charge applied it would be of the order of £100 – £150 max. But as observed throughout thus thread very few units charge for minor A&E attendances.

    3. Completely untrue. As this blogger didn’t even have to leave her name or address she can’t be charged, and the nominal charge for this treatment would be in the 10s of £s, except that all emergency treatment is free. Had her child been admitted as an inpatient, she would have been liable to pay as did the South African and Malaysian patients, and not always them. NHS medics treat first and bill later – the fact that your colleagues were medics and likely insured probably made it worth the NHS pursue the claim. Really, they do not pursue uninsured patients, and they do not charge in emergencies, ever.

  50. I’m facinated by this post. We are from the US, currently living in Germany and my daughter is in school in the UK. We LOVE the German healthcare system which sounds similar to the NHS. My son has been diagnosed with Type 1 Diabetes (while we lived in the US). In the US, we had great health insurance. He was able to get his new pump the same calendar year he was diagnosed… this helped minimize our costs since we had maxed our out of pocket with his hospital stay. In Germany, virtually everything that is a prescription is free for children under 18. No problems with insulin, test strips, etc. The only thing we have been told he cannot have is a CGM. My daughter also ruptured her ACL and no problems or costs for doctor visits, MRI, surgery. The only cost we had was 10 euros per night for her hospital visit. I can’t imaging how much we would have spent in the US… even with ‘good’ insurance. The only thing I’m not sure about in the NHS is care for Type 1 diabetes. I just read a study that talked about life expectancy for diabetes in the UK is less than in other developed countries and I believe in the UK they have less access to pumps and other technology. I just don’t know for sure, but it is disturbing that life expectancy for Type 1 diabetics is shorter in the UK,

  51. My husband and I are 26 years old with a 3 year old daughter. AFTER taxes, we barely bring home 40k. “Obamacare” forces us to have insurance, says we fall under the poverty line, but make too much money for any government help. If we get private insurance (neither of our jobs offer insurance), it will cost over $800 per month to be on a plan that doesn’t have a rediculous deductible. We are better off paying the fine and crossing our fingers everyone stays healthy! I don’t care what anyone says, there is no such thing as free health care.

  52. We live in Australia and when on holiday in the Uk, my then 11 year old experienced chest pain. Having previously had open heart surgery I was anxious. Although she had been fully cleared years before, I was worried that air travel may have had an impact.
    We went to a hospital in London and were seen immediately, ecg was done as well as a thorough investigation. We were in and out within 90 minutes, there was a play area within the room we were treated in, which was fabulous for me 7 year old as I was there alone

  53. Even though I’m one of those people who still believes that the Supreme Court got it wrong on Obamacare, it should be obvious to everyone by now that Obamacare’s WORST feature is that it is the worst of both worlds. If you’re going to have a mostly-free-market health system as we used to have in this country, fine; you just need a reasonable “safety net” for those unable to afford it, and otherwise it works well. If you’re going to have a completely public health system like the NHS, fine; like the UK’s, it should work well once it shakes the bugs out. But the system we currently have means that most people are now paying 100% of the costs of their health care (because they never meet their ever-increasing deductibles), PLUS they pay an ever-increasing insurance premium.

    It seems to me that Obamacare was crafted to convince everyone that a fully-public health care system would be better than the status quo. Which, today, is obviously true.

  54. Had a slightly different experience. Got an infected toe with diabetes didn’t want to mess around . antibiotics are not OTC med in the UK. So had to see M D. However I was absolutely vehement I was going to pay. The hard part was finding out where to go. Fortunately the neighbor to the house we were sitting was a RN and got me a phone number for a private clinic. 50 GBP including the RX later I was out the door. I had a similar accident 6 months later. My out of pocket costs WITH health insurance were close to the same $ with co pays, lab costs( seriously?!?!) And deductibles. The UK is trying desperately to recoup foreign tourist medical costs but the NHS is fighting it. They don’t want the hassles.

  55. Try this:
    What is the National Insurance in the UK (pension contributions + Health Insurance) It is basically 28% of salary before tax. The total pension paid by the state in the UK comes to about 500 GBP per month. Say ratio of working time to retired time is something along the lines of 2.5:1. This means 200GBP of national insurance per month goes into pensions. If your cost to employer is 2500 GBP/month (still below avg for UK) you pay around 450 GBP in National Insurance per month. Well, this is clearly more than most insurance plans in the US.

    Waiting times for non-emergency care are not acceptable by most. Try getting a follow up on that eye.

    1. In the UK, National Insurance contributions are compulsory. For an employee, earning a “decent” or “average” salary or wage the contribution is 12%, for the employer 13.8%. The calculations are of immense complexity, the contributions do not rise in parallel with rises in income tax; the employer may have to pay extra for “benefits in kind” such as a company car. Different, though similar, rules apply for the self-employed.

      NI contributions, despite the name, are quite simply an addition to income tax, though the perception of a rate of basic income tax of 20% is very different from a rate of 32% which is the reality.

      NI contributions, at least in theory, fund pensions, sickness and incapacity benefits, unemployment benefits and others. Trying to calculate what part actually funds the NHS is next to impossible. The NHS, overall, costs each member of the scheme very much less than most other places in the western world, especially the US.

      1. Total bullshit. I’m aware of no mechanism that allows the computation of how much NHI contribution goes into pension provision an how much goes into health care. Add to this that NHI is levied on a percentage basis (which is capped) on employee and employer contributions. You make a great job of pretending to be fact based but Neale t to mention that you pulled numbers out of the air to support your specious opinion. Suspect you are some sort of republican anti socialised healthcare fascist stalking this rather old thread.

      2. Total bullshit. I’m aware of no mechanism that allows the computation of how much NHI contribution goes into pension provision an how much goes into health care. Add to this that NHI is levied on a percentage basis (which is capped) on employee and employer contributions. You make a great job of pretending to be fact based but Neale t to mention that you pulled numbers out of the air to support your specious opinion. Suspect you are some sort of republican anti socialised healthcare fascist stalking this rather old thread.

      3. Sorry – my comment refuting the tax burdens on individuals was intended for QWERTY, comments by KORHOMME are even more lucid and competent than mine and totally refute QWERTY’s assertion that the UK model of health provision costs more than the US.

    2. Total bullshit. I’m aware of no mechanism that allows the computation of how much NHI contribution goes into pension provision an how much goes into health care. Add to this that NHI is levied on a percentage basis (which is capped) on employee and employer contributions. You make a great job of pretending to be fact based but Neale t to mention that you pulled numbers out of the air to support your specious opinion. Suspect you are some sort of republican anti socialised healthcare fascist stalking this rather old thread.

    3. 1. As above, the NI contributions are taken from official sources.

      2. If NI was once a hypothecated tax, that hasn’t been the case for a long time. Even Gideon Osborne has considered combining NI and Income Tax. (The Road Fund Tax seems to have been the first such hypothecated tax to be incorporated into general government revenue; this was done by Winston Churchill, in the 1920s.)

      3. According to World Bank data, health service provision is 17.7% of US GDP; in the UK it is 9.6%

      see here:

      http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

    4. National Insurance is a tax on all working people which qualifies the payers for a low state pension and certain limited unemployment benefits and that is all, and most welfare payments to pensioners and unemployed are not paid out via the National Insurance scheme anyway National Insurance contributions have always had zero to do with access to the National Health Service which is free to every UK citizen whatever income tax or National insurance they have paid.

      It IS an unfair tax because it falls heaviest on poorest workers as there is an lowish upper ceiling after which no worker pays any more no matter how much they earn. So the really high percentages quoted here are for people on the minimum wage.
      High earners pay a tiny proportion of their income on National Insurance.
      Which has nothing whatsoever to do with NHS.

    5. Totally incorrect. National Insurance has nothing whatsoever to do with the National Health Service, and hasn’t since since the NHS came into being – before that National Insurance did pay for free health care for workers, which left out all children, most women and unemployed. Since the NHS came into being all UK residents get healthcare out of general taxation. Now Natiional Insurance pays only for the shrinking Old Age Pension which is so poor that people solely reliant on it have to have means tested benefits to make it liveable, and gives unemployed workers around £70 per week for 28 weeks. Point is that so called National Insurance is a high tax for low earners and gives little benefits. Thankfully, our NHS provision is not dependent on you NI contributions.

  56. Your experience is typical. We had to take an american friend’s boy to the local hospital after he fell off my daughter’s bike at our house. He was seen quickly, given a lot of time, had nothing wrong with him and was charged nothing.

    If you need emergency care, the NHS charges nothing and asks no questions. They are trying to crack down on health tourism, though. People are flying in and trying to get free surgery for existing conditions.

    My Turkish neighbours, who are long time residents in the UK and business owners, had their parents staying for six months. About two months into the visit the father had some sort of heart incident. He staid in hospital for 4 days and my neighbours were sent a bill for £2,000. So you can’t be sure your care will be free. However, I think most Americans would consider 4 days in hospital with heart monitoring and testing for £2,000 a real bargain.

    My husband is a high earner. His national insurance contributions are cheaper for us than paying for private insurance in the USA, PLUS his contributions cover other people who aren’t as fortunate. My children never go to school with classmates sent in with earaches, bronchitis, etc. That matters to us too.

  57. I interned for a month at St. Thomas’s when I was a pharmacy student. I was pregnant at the time and caught an awful cold on the flight over which lingered for quite some time and eventually I meandered down to get checked out and make sure it wasn’t anything more severe. Everyone has to go through A&E triage and then if it’s less severe they send you to the urgent care side. That was the case with me and I saw a doc (I think maybe an advanced-practice nurse actually) who said, yep, it’s a cold, you can take Tylenol, and that was pretty much it. I never saw a bill either. It was just a stupid cold and if I hadn’t been pregnant I probably wouldn’t have bothered, but my experience was pretty much the same as yours in that it was efficient and easy and I didn’t have to pay a thing.

    Now granted, I did see some things on the ward there that I found to be a little hair-raising, but on the other hand, I think there are probably still some more backwards US hospitals that do the same things.

  58. Very pleased, but not surprised, that you had an exellent experience with the NHS! We are hugely proud that the NHS matches the expertise and standards of anything world wide! I have used the services in the UK, US, Australia, throughtout Europe and elsewhere! All have been equally as good! It was only in the US that I have been required to pay! Enjoy the rest of your visit!

  59. I enjoyed reading your post and found it very accurate for how good the service can be. I am a UK resident and have a chronic condition that has seen me spend a years worth of my life in hospital out of the last 4 years of my life and the NHS does have serious issues, some of which are sadly due to the National part.

    There are the normal problems you’d expect like getting a grumpy head nurse and junior Dr’s is a recipe for disaster (this particular recipe left me in the critical care section of A&E for 4 hours and it wasn’t until the arrival of my sister a Dr herself that I was seen. At the time I was fevered tacky cardiac and dehydrated with a perforated colon). That’ll probably happen anywhere but is caused by poor management. Again an anywhere issue.

    The major issues all stem from how much the politicians muck the system around, talk about competitiveness whilst building monopolies and whilst we don’t get a bill personally the political atmosphere has meant hospitals care more about cost than caring. I don’t think the USA has it right (especially the poorly written laws for Obamacare) but if you were to introduce State health systems free from Washington control I’d be willing to bet you’d see something good. Ours needs to be county run with budgets handed out from the central on a population age/size basis. But that’s just me!

  60. I live in the UK and have always taken the NHS for granted. Recently I had a trip to the ER in New York. I had bad food poisoning and needed IV fluids. I was there for 6 hours, most of which was spent waiting for a doctor – the treatment I needed was fairly straight forward. There seemed to be more armed police than there were medical staff, however I cannot fault how good they were when I did see them. My bill came to $1600 which I had to pay there and then. I had a discussion with the doctor who said if she was going to get sick on holiday, England or France would be where she would want to be! I have to say I totally agree.
    I have never had to wait to get emergency treatment for my children, never have to worry if I can afford it, I just do the best for them.
    Sorry your little boy was in hospital but pleased you had a good experience of our fantastic national health system. It my be creaking a bit under strain, but it is something to be proud of.

  61. A lot of emphasis is placed on the bad practices of the NHS in the media. It’s sensationalised. Mainly because most media outlets are commercial entities that see investments into private healthcare another means to profit. So they demonize they NHS. Also recently American lobby groups have been found to fund fake pro NHS rights groups (http://vimeo.com/18907486). We also have common purpose losers (look them up) inside the NHS opening the backdoor for private companies to infest the NHS. When it comes down to it private healthcare will never equate to the best care because the guiding principle is profit with as little service as possible. A national health service only has one profit margin, to provide the best care they can. I know which one I would choose.

  62. I am an Anglicised American (32 years in the UK now) and I have NEVER had a bad experience with the NHS. Any problems people talk about tend to revolve around middle management issues, and never ever the care or treatment. In fact it seems that the more we try to mirror the US model the more problems rear their heads.

  63. It’s great to see that most of the comments here are pro-NHS. I have nothing but praise for the NHS, one of the wonders of the world. Of course there are abuses and of course, it fails at times but it’s still fantastic that there is UHC. Note that it is not ‘free’ as the current government is constantly implying; it is free at the ‘point of use’. If there are abuses then we must stop them, if there is waste let’s stop it – the solution is not to dismantle the NHS and sell it off, surely? It’s obvious that today, governments of whichever political colour, are hell bent on privatising the NHS – a clear indication that most politicians with power are owned by corporate capital. (Better informed people than I have already commented on how doctors and health care services are being strong armed into privatisation by the use of various devious tropes)

    I have lived in other parts of the world and if you have no money there you’re dead in the water; healthcare is for the well off alone. To lose the NHS as we know it would be deep folly.

    UHC makes sense even from a Capitalist perspective as a healthy population is a more productive one. Besides, its ethos is rooted in compassionate, humane Christian and Humanist traditions which are at the foundations of our society.

    My wife has Parkinsons and my son has Chron’s Disease, both of which are incurable conditions which have to be managed. Without the NHS I could not afford to pay for their care, excellent or not.

    Thank you Dr Gunter for highlighting your positive experience with our NHS.

  64. Iam an nhs nurse however in 2012 I visited Florida with my 2 children. During our visit my 18mth old with known asthma became poorly in trying to get a gp I was informed due to his age he had to see a paediatrician x I went to local hospital (which had valet parking !!) had a warm welcome on arrival dispite my son vomiting everywhere x we were taken to a side room with frosted glass that I could flip on and off, a 42inch TV, own bathroom and a seperate door to a different corridor x I was amazed ! Treatment was good he got nebulisers and steroids and was kept for 4hrs. During this time I had to find insurance numbers and fill in documents. After this we were taken out the other door where we could pay for treatment, total being $1,900 !! Of which we had to pay half of that before we left (credit card). Luckily I had insurance who reimbursed me when I got home, however it made me very grateful of our NHS. Although it has it’s faults and failings I know when I have been ill or my kids and your really worried you don’t have to have a penny in your pocket to receive treatment x this in the uk we sadly take for granted, and when we privatise it will be a very sad day x

  65. The NHS is amazing, I’ve used it a lot with one of my kids, relentless A&E admissions until we got diagnosed & under control and I’m eternally grateful that we didn’t have to pay a gargantuan bill for the excellent treatment we received, nor for the regular medicines required as all under 16s get free prescriptions. In fact, we visited the US during this period of poor health absolutely terrified that we may have to go to an ER and be billed a gargantuan sum, fortunately we got through without illness. The problems with the NHS come from woeful underinvestment and bureaucracy which are political and administrative issues. No-one here wants to lose the NHS, I want our taxes to be used more effectively to improve and preserve this service. A health service free at the point of need, what an awesome thing. I’m so pleased that your son got good treatment from the NHS whilst you were here, many thanks for sharing your thought and experiences on here.

  66. Thank you for kind words about our NHS. I’m a Registered Mental Health Nurse in Wales where our devolved government control healthcare. Whilst the overall picture isn’t as bright as the corner that you saw in London we still have a system that is free at the point of delivery. Yes it’s underfunded, yes it’s understaffed, yes we’re all stressed to the max, sometimes. But in the end we get paid to care for others and in some cases (mine included) that means we’re getting paid to do something we’d do for free. We have the best job in the world and sometimes we have to do that job in less than perfect conditions. It’s far from perfect but one of my training mentors told me that I’d learn to work with the system I inherit and she was right.

    The penultimate thing I want to say is this. I write fiction too and my perfect life would be split between nursing and writing. That’s what nursing means to me. Part of that is because I work for the NHS, I see what I do as public service. I wouldn’t feel the same if I was filling the coffers of a consortium.

    As I’d say to the medics I meet at work when they’ve done something I liked or that needed doing…Thanks Doc.

    1. Lovely post, Jay. We are all truly grateful for the wonderful service you and your colleagues give us and so sorry that we can’t seem to persuade our gov to provide proper funding. I don’t know any citizen who feels differently.

  67. Hi, nice article. Yes waits can sometimes. Es get long, but kids and frail are usually prioritised, and triage also gives impression of activity while waiting, most industries do it.

    But a wee bit of a wait is no big deal considering from splinter removal to heart transplant it only costs me 200 sterling a month, some pay more some less based on income.

    I have had 3 ops, 2 sinus and one knee probably about 18000 sterling, no Co pay or extras and it was carried out in a private hospital under contract to the NEW.

    Waitingood sometimes is annoying, but which of your readers would love a wee wait for reduced payments, no exclusions for pre existing.

    Also on the question of billing. ER treatment is usually not billed. Immediate and necessary is offered to everyone, and as a tax payer I have no issue with helping those in distress.

    However after stable and crises is over, any further standard treatment, repeat visits may be billed If the cost of chasing it isn’t more than the bill.

  68. While on holiday in the UK 2005, I suffered appendicitis; I was fortunate to be in London when the symptoms became acute enough for me to seek medical attention. I was taken by ambulance to St. Mary’s early on a Sunday morning, and underwent surgery that afternoon. I was the second non-citizen to arrive that morning for the same complaint, and there were fewer staff on the weekend. Perhaps as a result of that unremarkable delay, my appendix had ruptured, so (a) the less invasive laparascopic approach was no longer viable and (b) I would need to stay a week in hospital to receive antibiotics. As a US citizen, the NHS did not bother with my insurance info, but they did take a credit card. A flat fee was charged to my account for each night of my stay. The total cost for ambulance, ER care and tests, surgery, and post-op stay (6 nights) was around US$8500. Although the hospital facilities were not the most modern, I have no complaints about the quality of care that I received, and there’s no way I could have received a similar level of care in the US for anywhere close to that cost.

    This Republican has absolutely no issue with gov’t-provided universal health care.

    1. I no longer live in the mainland UK and fall outside of the NHS. In October 2012 I suffered a massive heart attack and was taken to the local hospital. There is no cardiology department to speak of and they are unable to offer angioplasty. I received a clot busting drug to open a severely blocked artery, “died” and was resuscitated. Overnight I was kept in the Intensive Care Unit and arrangements were made to charter a medical flight to the UK for treatment at a specialist hospital in Southampton. I arrived in Southampton in the evening and assessed by a Professor and a Consultant Cardiologist. My condition was now stable and now considered non-urgent so I was placed on the list for an angioplasty and stent procedure. The next morning at 10:30am I was being operated on and the stent was inserted with no problems. During the next 48hours I was seen by the Professor, the Senior Consultant and a Registrar. I also received visits from a rehabilitation nurse, a pharmacist, a specialist cardiac nurse who carried out and ultrasound of my heart as well as several 12 lead ECG’s. I was asked if a flight to take me back to the island where I live should be arrange, but I elected to stay a few days, together with my wife at her sisters on the south coast. We made our own arrangements to fly home after a weekend of recuperation. My bill for all of this treatment and flights? Zero, nada, nothing……. The island on which I live also operates an NHS type healthcare service, not quite as comprehensive as the NHS, but very close to it. On arriving home I continue to receive treatment and checkups for free. I have no medical insurance,why would I? It isn’t needed. There was no waiting, no drama, just some questions as to who I was, where I lived and what had happened. The quality of care I received was exceptional from the tea lady to the Professor of Cardiology. I did not have to pay for the flight to the UK and if my wife was able to have travelled with me she would also have done so for free. She did fly out a few hours after me as she is a carer she had to arrange cover for herself.

      This fear of the NHS is being fed by self interest and ignorance. The UK healthcare system may not be perfect, but I have not had to sell my house to pay for my treatment, nor am I crippled by the need for a loan to pay the bills.

      I should also point out that I also have a daughter that was born 15 weeks prematurely and she also received treatment both on island and in the Special Care Baby Unit at the Princess Anne Hospital in Southampton. Nearly 6 months in hospital, flights etc and no bill. She also received incredible care from highly trained and highly motivated health care professionals and is now a perfectly healthy 22 years of age.

      What would we have done without universal healthcare? Put her in a shoe box in the corner of the room to die or sell our home to cover the costs?

      If citizens of the USA believe we have to beg the local commissar for treatment and he/she then selects who and when we will be treated you are sadly mistaken. The medical professionals make the decisions on what treatments are required and they are generally unfettered by the cost.

      I for one am proud to live in the UK and where the vast majority of people are proud to have a National Health Service that is free to all at the point of use.

  69. I visited a doctor in Lake Tahoe recently with very painful gastritis/oesophagitis. I had to wait an hour to be seen by what I assume was the US equivalent of a healthcare assistant and then another hour to see a nurse practitioner. She examined me, wrote me a prescription and sent me on my way. The consultation cost $200 and the medication $70. I’m still waiting on my travel insurance company to cough up! The most it would have cost me back home was the standard prescription charge (£7.20 I believe, I have a prepayment card so not sure of exact amount currently).
    My experience in the USA only made me more grateful for the service the NHS provides to me and everybody. We will pretty much scrape anybody up off the road and treat them without worrying about how they can pay us! I’m not suggesting the care was in anyway substandard but the whole money thing completely threw me. It was pretty much one of the first things the receptionist asked me, how did I intend to pay?!
    Nothing is perfect and the NHS certainly has it’s flaws but I’m proud to work for them (I’m a cardiac radiographer) and proud that they will treat anyone whether they live on the streets or live in a mansion.

  70. Not meaning to highlight the role of optometrists (and being one) in the uk – but they would’ve been able to do all of this (minus the issuing of antibiotics – but you can buy some broad spectrum drops OTC) still at no charge.

    1. I would have gone to an optometrist but being a tourist I really had no idea how to find healthcare on a Sunday!I tweeted my issue and location and several helpful folks told me I was just across the bridge from St. Thomas, so there we went.

  71. Jen, we were on a Bahamian cruise out of Charleston, SC last week, when we had a spookily similar case – even down to the speck of dirt in my 4 year old daughter’s eye. We’d docked and gone walkabout in Nassau when Ruby got a piece of wood in her eye from the dust around a local guy who was carving in the market there. We were reliant on the onboard doc and had a very similar experience. For the record, I’m a British ex-pat, living in Canada. I’m very proud of the NHS.

  72. Whilst I am pleased that you had a good experience in an NHS hospital, being a Londoner means that I can tell you that your good experience was mainly down to the fact that you were seen at what is considered to be one of the best hospitals in the world. St Thomas’ is the leading hospital for research on many different diseases. In particular, Lupus.

    Should you have been seen at a different hospital, certainly one out of town, you probably would have had to wait hours. And it was lucky that it was something that was easy to diagnose. When doctors qualify, if they want to put a London hospital down as their first choice there is a whole different procedure for applying. It is very competitive and only the best student doctors get placed at these hospitals. Therefore, outlying hospitals get the doctors that didn’t make the grade for London. I can’t speak for other cities in the UK but it certainly means that of I’m taken ill in the home counties, I’m gonna drive into a London A&E to be treated.

    There are plenty of people that don’t know about this and are perfectly happy to go to their local hospital outside of London. Good luck to them. However, I have been misdiagnosed EVERY time I’ve been to one of these suburban hospitals. So even insisted that my baby was born in St Thomas’.

    Whilst I will defend the NHS because if it wasn’t for that, I my poor health would have cost me a fortune over the years and I’m pretty sure I would never have seen a pregnancy all the way through without St Thomas’ (I have APS). As my Pulmonary Embolus was put down to Plurisy at my local hospital outside of London. And my bloodshot eye, and body covered in bruises was put down to removing a contact lense i correctly rather than ITP, which was eventually diagnosed at, yes you guessed it, St Thomas’.

    Don’t even get my started on the GP referral system.

    So yes, the NHS is a wonderful thing but it depends where you go.

  73. I work for the NHS is the emergency department.
    And i quite frankly love it.
    Most doctors who leave so leave for better pay – but, hey – you not in a caring industry to make millions.
    We do have times where some minor injuries (who should have gone to a minor injuries unit) waiting for 3/4 hours in an ER but – hey, it gets busy, there are emergencies.
    Again, in love working for the NHS

  74. As a NHS worker (for almost 16 years now) I am so pleased and proud to read your post. The NHS is often criticised both here in the UK and from overseas so it is lovely to get some positive feedback. Despite it’s failings, which in my opinion is largely due to increasing financial pressures, lack of investment and interference from our present government, I still strongly believe in the original ethos of free cradle to grave health care for all. I could’ve have easily chosen a career which paid me more or moved into private healthcare but I, like most NHS workers, feel that we are providing an invaluable service which is one of the best healthcare systems in the world. It is a completely alien concept for us Brits to imagine a system by which decisions to provide the best clinical care are determined by our insurance or financial status. Unfortunately, some people from overseas do take advantage of our free system. I have personally seen patients travel to the UK for the sole purpose of receiving free treatment. However, we treat all people the same regardless of their nationality. I recognise that this was not the case in your experience and I’m so glad that you were able to access our services with no fuss during your vacation. I’m glad that you received the appropriate care so promptly and that the staff were so helpful. I hope you don’t get billed for your care! Thanks again for your positive feedback. It reinforces why I’m doing my job and makes me incredibly proud! Sarah (Physiotherapist from Huddersfield).

  75. My experience of the National Health Service: My mother, my sister and I were in a terrible car accident years ago while vacationing from our home in the US. We were picked up by ambulance and taken first for emergency treatment, then to a regular hospital. A plastic surgeon repaired my sister’s face wound; my mother had excellent orthopedic care for a broken hip and leg, and spent several weeks in traction. Since we were far from home, my sister and I were given a cottage to live in on the hospital grounds (complete with maid service and meals in the hospital cafeteria if we wanted them) so we could visit my mom twice a day. Total cost: $10 for the ambulance ride.

    What the hell is so scary??

  76. Well the nhs is socialist. It’s a beautiful example of the redistribution of wealth, and the best health system in the world . Maybe socialism isn’t that scary?

  77. I am a US citizen living in the UK for 17 years. My brother came over for our wedding and then went to London for a fee days. When we met him in London turns out he had food poisoning from a meal the previous night. My husband (English) took him to the hospital where he was admitted and kept in overnight as he was dehydrated. To this day no bill has been sent. That was in 1997.

  78. I can’t imagine that Dr. Gunter anticipated that she would initiate such a volume of divided opinion on the NHS simply by expressing her gratitude (I didn’t find it condescending at all). It seems to me, reading through all these comments, and myself being well informed with regard to the NHS, that the concept as developed by Nye Bevan on the three basic principles of:
    a. that it meet the needs of everyone
    b. that it be free at the point of delivery
    c. that it be based on clinical need, not ability to pay
    is still a strongly held belief in the UK. Of course this is threatened as our population increases through rising birth rates and immigration as well as an ageing population. The NHS is ostensibly funded through National Insurance contributions – though these days it cannot function purely on that tax. We have problems to solve in the NHS, and maybe the model needs to be rethought for the 21st century, perhaps co-pay and a more rapid rise of the private sector is on the horizon, but for the time being citizens of the UK, who are the primary beneficiaries of the NHS, enjoy free healthcare – and before attacking the system as broken we should look elsewhere at other models that are based primarily on the ability to pay. Dr Gunter – I am truly glad that you had a positive experience of the NHS, and hope that you will use your experience as a counter argument to those in the US that would use the NHS in a negative light to object to Obamacare.

    1. The problems we are having with the NHS now are not social in nature, but contractual and political.

      Yes, we have an ageing population (we don’t have rising birth rates – that’s WHY we have an ageing population – the demographic of the old becomes more dominant as the demographic of the young contracts).

      But the key hammer blows to the NHS are the billions we are wasting on PFI contracts, the administration of the internal market, and the “efficiency” savings it is supposed to make (despite being among the most efficient healthcare system of all the G7 nations, we spend 9.3% of GDP.. the US spends 15%).

      It is being perniciously underfunded in order that it will fail, to give the incumbent government an excuse to privatize it. It’s currently very very good value. Thinking that this will continue when the private sector gets it’s paws into the pie and carves out a slice for it’s profit margin is wishful thinking. They’ve already washed their hands of their obligation to provide healthcare (using the Health and Social Care Act 2012, which declares that the government no longer has this obligation), in order to make what they are doing legal.

      We need to vote them out, and make it very clear to the opposition that their stay in government is dependent on them reversing these changes and restoring the NHS into the hands of the people who bought and paid for it, not the people who bought and paid for their political campaigning.

      1. Dear drbarnowl,

        Thanks for your interesting reply to my comment. I am afraid we will have to agree to disagree on some points, on others I am in agreement with you.

        I think we have both grossly oversimplified the statistics around population growth, this is a blog after all not a scientific review. However for the purposes of clarity, in the last census the birth rate was recorded as being on the increase, the fact that the populations survival rate over the ages of 65, and 80 (the latter is used in several statistical analyses) is rising more rapidly than the birth rate is why we have an ageing population. There are of course a multitude of factors that complicate these analyses including net immigration figures – but that would take too long to discuss in detail here. The point is that the NHS is under strained at all points – that is why there is a shortage of midwives, health visitors and carers for the elderly. That is why there are attempts to keep care in the community – and the boundaries between the NHS and social care system are becoming ever more blurred. This latter point was a topic much discussed at The Kings Fund recently – a conversation that I was a party to.

        So to me, and many other commentators on the NHS, that all indicates that the challenges our system faces are a combination of social, political and financial (including contractual) – we agree in part there. Part of the issue must surely be the constant use of the NHS as a political football – the previous government must take some blame for the current state of affairs having allowed a growth in the managerial staff at the expense of front line staff. But to suggest that a new administration should reverse everything that the current one has done just continues the vicious circle. You will no doubt suggest that I am naive, but I still maintain that the NHS must be developed and managed independent of politicians – their constant tinkering leads us down one blind alley after another.

        On PFI I agree with you entirely – it was lauded to be the way forward. It has been a spectacular failure. I am certainly not advocating that healthcare in the UK heads down a two tier system of NHS and private – although that already exists for those that choose it, but we cannot simply put our heads in the sand a deny that we have a funding crisis. So then it IS back to politics, which party will raise income tax or NI contributions sufficiently to fund the NHS? Given the population dynamics that we both mentioned already is that even possible?

        Much to debate, and many complexities to this debate. I’d certainly enjoy further conversation with you on these topics. Maybe you will attend a Kings Fund meeting soon and contribute to the discussion of the issues?

  79. We are totally blessed to have the NHS here in the UK. For the service we receive I really cannot complain whatsoever. My young son has had eye and food allergy problems since birth and the NHS staff have been so efficient, helpful and clearly well trained that it has made our life so much easier. And we’ve never had to pay a single penny extra at all. Literally hours worth of service in return for paying our taxes. I can only hope that we can keep the NHS and that the same opportunities can be found in the US.

  80. I cannot realistically read the 700 plus comments so far but I am nurse in primary care / doctor’s surgery and I think the free NHS is great. However, my take on the situation in the UK as to why the free NHS is struggling and overloaded is multifactorial. Yes, also, many of the staff like myself do provide care on good will.

    I am a senior nurse working within limited facilities, and a “chosen” career I enjoy, but although I respect the utopia is to provide “what the patient wants”, the reality is there are no expansion of nurses to provide those demands and also I would have provide additional services at the reduction of my existing services.

    The NHS and population also has a much greater supply of expensive drugs to treat even more conditions that the patients expects to be treated, we also have had a huge influx in past couple of decades by people who have British passports bringing in families who have no inclination to speak English.

    If the above isn’t enough, we have a greater amount of alcohol and drug use where “the patient wants” to just attend “ER” after a good night!
    We also have a change in ethos of who perceives ER (our A&E) is for the most basic treatment such as headaches and cut fingers because we now operate in a society who demand instant treatment somewhere if they cannot get an appointment with their doctor same day.

    I have worked in a private hospital some years ago. The patients had great food choices and lovely curtains, BUT when I transferred to a run-down looking NHS hospital I realised the hospital with the curtains hanging on too few hooks and not so great food was where I trust my major heart surgery to be done should I ever need it.

  81. You were lucky with the short waiting time. In my experience that is not usual. I lived in London 20 years. When my dentist could not extract some teeth she arranged for me to go to hospital. I waited 3 years. The first wait was 6 months, then the appointment was cancelled and delayed a further 6 months. That kept happening. When I finally saw the dentist she told me that they used to have a system where forms were filled to confirm entitlement to treatment, but Blair’s govt abandoned the process and told them they had to treat everyone, no questions asked.
    When I contracted poly myalgia rheumatica the waiting time to see a consultant was 9 months. Fortunately I had some private insurance through work so I saw the consultant in a few weeks. He told me that if people with poly myalgia (a type of arthritic paralysis) are not seen quickly they can end up with permanent disability .

    1. The timeliness of NHS dental services have been a problem for a number of years. Successive governments have tried to push it towards the private sector in one way to do this is to allow waiting times to rise. This is a consequence of government policy and not the fault of the NHS.
      So far as your Giant Cell Arteritis goes.
      1. It is clear that you didn’t actually try to get an appointment, your account is simply hearsay. You have private health cover and you used it.
      2. I very much doubt that the routine waiting time to see a physician in your area is more than a few weeks. It is rare for waiting lists for medicine outpatients to be of any great length.
      3. GCA is a sight and life threatening condition if ignored. However if GCA is suspected then a GP would start steroids immediately and/or refer urgently to secondary care. We receive such referrals quite frequently and these patients are usually seen the same day.
      I – and I suspect most of the contributors to this thread – regard your contribution as nothing better than gratuitous sniping from someone who is in the privileged position of having private health cover.

      1. Regarding the dental problem, as a result of the arthritic complaint I suffered a dry mouth which accelerated tooth decay. My dentist was both NHS and private so it was not a matter of paying for the treatment. The dentist thought the likelihood of the teeth disintegrating was so great that they needed to be removed in hospital who were equipped for such an actuality.
        My poly myalgia presented unusually, mainly affecting my legs not shoulders and arms. My doctor, who was excellent, was quite miffed she had failed to identify the condition because of this. My GP herself informed me that the waiting time to see a consultant was around 9 months. Poly myalgia is not life threatening so has no priority.
        My medical insurance was through my employer, the Royal Mail. It is a Beneden scheme open to everyone employed by the Civil Service, which cost then about £2 a week and enabled me to see a consultant right away up to the cover of £1000. The consultant was very expensive and I had a bill for £300 on top. It was worth it as otherwise the Royal Mail would have laid me off sick as I was barely able to do my work.

      2. Waiting times in London are excessive. When I first started work with the Royal Mail, twenty years ago, our office cleaner was on a queue for heart by-pass surgery. He died of a heart attack before he was even scheduled for the operation. Perhaps you do not live in London or as a medical person you get fast tracked for treatment? I cannot believe any ordinary resident in London is unaware of the long waiting time to see a consultant for any medical condition.

  82. I think this post is lovely, and Jen’s comments and opinions of the NHS made me smile. I received medical attention for a mosquito bite that had got infected in France. The treatment was painful, I was very young and it took a number of nurses and my parents to hold me down. After several days it continued to get worse so the hospital told me to go home immediately and seek medical attention at home. We did. Straight away the Royal United Hospital in Bath (my local hospital) diagnosed the infection as Impetigo and treated it accordingly. The treatment I had received in France had aggravated the infection even more, and by this time it had spread right across my body and around my back. The infection quickly healed and I was left with no scarring at all! This was the worst case the RUH had ever seen. But I will be forever greatful for the NHS as I’ve been to A&European more times than I can count. The bad reputation is more on a personal level. I have myself been let down and angered by some things that have happened (or not happened) to me but that is down to the doctors and nurses and paramedics involved rather than the NHS itself.

  83. One reason that the US is scared of the NHS, is that those in power fear they will not be able to make any more money by parasitising sick people. But do not fear, when Cameron sells it all off like a cheap whore, you will be able to cream the British public for profit, just like you do in the USA.

  84. You won’t be getting a bill. Even if the trust (organisation in-charge) of St. Thomas has the facility to create and send you a bill, I doubt any of the staff are aware of it.

    The NHS can issue charges for certain things, such as getting a lift home in one when you’re too drunk a few too many times. Or for medical procedures which aren’t free. And essentially, it is meant to be free for the British taxpayer. However, for a number of reasons, one being responsibility to the hypicratic oath, the NHS cannot refuse anyone but diesn’t bother with the complications of who will pay.

  85. As a tax paying Brit I am more than happy to cover the cost of your emergency care whilst on holiday in the UK – that might sound odd to some: But imagine this, if I run over a cyclist in my car do I take them to hospital or do I check if they’ve got credit first because it might be a better life choice for them to lay bleeding on the side of the road to avoid years of debt…

    However. I do of course draw the line at non-ER services. For those please use your own tax dollars 😛

  86. I lived in the UK for 10 years and am hardly a fan out of the NHS. The author declares that the only break downs in care come from clerical or human errors, not systemic failures. In my experience it was the system itself to blame for the poor care we received. At the top of the list was the fact that children in the UK are only treated by pediatricians if they are admitted to the hospital. This can be incredibly dangerous if your children have special needs, which both my children do. Within six months of returning to the US from England, my daughter was diagnosed with cancer. The diagnosis came after her pediatrician ordered a serious of tests because she wasn’t meeting certain developmental milestones. No one was tracking her development in the UK. Similarly, within a year of our return my son was diagnosed with autism. He has received a rigorous course of physical, speech and occupational therapies — all covered by our insurance — and as a result of the doctors catching it when they did, he is expected to be very high functioning. For obvious reasons, I prefer the US system. Much lower down on the list of complaints were cost — we spent more on taxes for the NHS in one year than we spent for a year being self-insured in the US — waiting lists for care and incredibly long wait times for set appointments. I know not everyone has such a good experience with their health care in the US. I wish people would understand that the NHS is far from perfect.

  87. and to think that we get free medical care, free social care, free nursery from the age of 3, paid maternity leave, free college (well relatively free compared to the US), free culture (museums, concerts, etc.), media unbiased by commercial interests (and no commercials)…and the list goes on…AND UK taxes are only marginally higher than the US. In fact, if you live in a state like NY, by the time you pay Federal, State and City taxes, your tax bill will be even higher than in the UK.

    One has to wonder why the US thinks it can’t afford decent healthcare…

  88. I think you were lucky because it’s not at all unusual to wait many hours in A&E in the UK. Perhaps your child’s eye injury was assessed as critical, and you jumped the queue. However, from my experience, enjoying excellent and entirely free treatment is entirely normal at NHS hospitals.

    FWIW, London actually has several minor injury clinics, including one at Guy’s Hospital, just a short taxi ride from Parliament Square. These clinics resemble A&E depts but tend to have much smaller waiting times (an hour in and out is not unusual) because they don’t deal with major traumas.

  89. No system is ever perfect. I live in the UK but grew up in the USA and I’ve experienced USA, UK, German and Australian health services. I’ll take the UK any time, thanks! A few years back I had to deal with my mother’s health care in the USA and my father-in-law’s in the UK. My mother broke a hip at the age of 89. She was well cared for and due to her age there was little to pay for the emergency care, hospitalization and follow-up nursing care. The problem really hit when she decided to go to a ‘home’. She was diabetic, and for a while all was well, but then her sight deteriorated to the point where she could no longer read her meter, nor could she measure her insulin. Her carer checked her readings before allowing her to inject herself, until an inspector caught him at it. At that point the state (California) threatened to remove her from the home. From 8000 miles away I had to threaten lawyers to buy myself enough time to get to California and deal with it. I had to move her to a home that employed a nurse. But that meant that her insurance had to change, as it didn’t cover nursing ‘care’ for four injections per day. But if I changed the insurance, the new insurance didn’t cover many other things, including other medications. Gap insurance, I was told. But one package would cover some, but not other, medications. It nearly drove me insane trying to determine how to maximize the necessary coverage at a cost that my mother’s funds could actually cover (at which point I developed pneumonia but couldn’t get a doctor’s appointment because I wasn’t ‘registered’ with any provider, until my auntie sneaked me in to her provider, for which I was charged several 100$$ for the prescriptions, let alone an examination). With my father-in-law, nothing at all was required except for his GP to arrange a HOME VISIT from the gerontologist, who came out the next day and assessed him. Later when he went into a home when I could no longer manage his care, we paid for the home, but his medical care was entirely covered by the NHS. No forms. No questions. No problems. Yes, at times dealing with the NHS can require an assertive (and helpfully, an informed) attitude to the doctor and at times it can be frustrating. But I can’t imagine anything more like a nightmare than trying to navigate the US system, particularly if one has limited means.

    1. I should have added to this the fact that on a number of occasions when my mother required tests, the tests were carried out, but then we were told that the results were “lost” and the tests had to be repeated. In one case, we had one set of tests and three repeats before the results were not “lost”. This was all funded by Medicare. I can only assume that either someone was astonishingly badly organised or else Medicare was being diddled for extra cash to the benefit of the medical care provider. And my poor mother had to suffer a second (third, fourth) visit to the provider, have more blood extracted, yet I’d be willing to bet that the original test results were still around, the second, third, and fourth samples were simply thrown away and the paperwork submitted to Medicare for payment.

  90. I’m really pleased that this has been posted from an alien-to-the-NHS’ point of view. Our Conservative government are making cuts to the service and want to privatise our healthcare. There have been many petitions against this so it’s good to know that the same views are shared, and that people outside of the UK see the NHS as an example to learn from. Though I must be honest, even I was shocked when reading that a bill was requested! That simply does not happen, and thankfully for good reasons. Hands off our NHS Tories!

  91. I am from the UK and my boyfriend lives in the States. I have one experience of US healthcare which I tell everyone when any talk of them privatising the NHS comes up.

    I always buy health insurance when I travel abroad, and I was visiting my boyfriend in New York when I developed a bladder infection. I woke with a very painful bladder in the night and knew I must go to the hospital. We went to a local hospital that we were told was very good, and on arriving they did triage within about half an hour. I then had to wait. And wait I did. There weren’t too many people in the waiting room, but I must have waited for about four hours before they called me to a window so they could ask about my insurance. I told them I was from the UK and produced proof of the medical insurance I had purchased. I don’t know what would happen in this instance if you don’t have any insurance. I then waited for another hour or so before going into the ER. They gave me a urine test and I waited some more to see a doctor. I saw the doctor for five mins, he confirmed my bladder infection and that they’d get me a prescription and I’d be out of there in five mins time. I waited another hour before they came to see me with the prescription.

    The prescription wasn’t expensive at about $10, so I bought that quite easily. It was about a week or so later that the bills appeared. My trip to the ER cost $1300 and a seperate bill arrived for the doctor I’d seen for five mins. Those five mins cost me upwards of $300.

    Coming from a country where you don’t pay anything, the US healthcare system scares the hell out of me. I can’t fathom that in this day and age a country such as the US, does so little to look after it’s citizens fairly. I can’t imagine having coverage that only allows me to visit the doctor so many times a year, or that may not even cover me if I get really sick. The fact that such a high proportion of Americans loosing their homes and declaring bankruptcy is down to medical bills is shocking and appalling.

    And what is at the heart of this? Making money. A system that the UK government is currently trying to implement in order to line their pockets, with so many of Tory politicians having vested interests in private healthcare firms. They are starving our NHS of money in order to make it fail, so they can say that privatisation will save it.

    And what chance do the public have to do something about this? When the news do not even cover our marches and protests! When the government closes it’s ears and refuses to listen! We can only hope that the Tories get voted out next year and we can go back to making our country fair and just again, looking after our most weak and vulnerable.

  92. Bear in mind you were at St. Thomas’ if you’d jumped on the tube (or taxi) to Moorfields the opthamology would have been even more impressive. I rocked up at Moorfields at 9:30am with a detached retina. By 2:30 I was operated on and by 6:30 I was in the car on the way home.

  93. Two points. St Thomas’s Hospital has a major emergency department as it is one of the central London hospitals tasked with dealing with a disastrous event that might happen in central London. It’s also bang opposite the Westminster Village. If you ever want to go to an ER, this is the one you choose. You could arrive dead and they would revive you.

    Secondly, there is no charge for emergency treatment in the UK. Full stop. You could owe the UK government £10M in taxes and you still would receive free treatment.

    99% of NHS treatment is like what you experienced but the media never wants to talk about it. Headline “Boy receives prompt treatment for minor eye injury and leaves happy” doesn’t sell newspapers. They need to search out for the disasters to get everyone’s attention. If you have 60 million customers, you’re going to get some complaints. Combine the fact that you may be taking about a matter of life and death and people are going to be vociferous in their complaints. Sick people die. Whatever medical care they receive, they will probably still die. But in the UK, families will try to blame the NHS. They may also pursue legal action because they are aware that they might receive compensation.

  94. Yes the NHS has it’s problems, but on the whole delivers a good level of care. Unfortunately it hasn’t a clue about funding. Yes, as a non UK citizen you should have been given a Bill (unless of course you were from the EU or another country which has reciprocal arrangements with the UK). That is why the NHS has a chronic money shortage problem!

  95. Comparing 30 yrs in the UK and 20 years in the US – I have had stellar and abysmal care on both sides. That is between the individual doctors. In the US I have had refused and seen refused care based on ‘not the right medical coverage’. Including waiting 3 months for a doc appt due to misadministration, being told half way through $25K worth of treatment which we had battled 6 months to get approved that it now ‘wasn’t approved’, being made to walk out of a hospital with a fractured leg, and being turned away because of an outstanding 5 year old bill that the patient said they’d never received, despite the fact they said if the bill was resent to the correct address, they’d start making payments as finances permitted.
    In the US, if someone getting medical coverage through their employer gets a serious health issue, the primary aim is to keep working to keep the coverage, or to pay the exorbitant COBRA charges. In the UK, the primary aim is to get well.
    In both countries, police services, law courts, infrastructure, for example, are paid for by the population through income-based taxing and used as needed. As is health care in the UK… but not in the US.

    1. I’m going to answer that one for you. Unless she has a grandparent or more recent relative born in the UK, or you marry her first or she has a solid job offer, it’ll be a ‘no.’ Look at it externally…a foreigner with no British relatives, no job and health issues. It won’t happen. Especially if you met her on the internet. I suspect you did.

      1. I am indeed marrying her. We are in the process of sorting out her fiance visa as we speak, have already checked the financial support threshold (which I do meet) and will be acquiring accommodation as soon as we get a date set.
        Thank you for your concern anyway.

  96. in the UK if you do go private and there are complications then they can, and do, have you taken to an NHS hospital – nuff said. I’d rather have people who can do the job rather than carpets and a swanky menu

  97. Loren – how do you feel that the US system empowers ER docs to deal with drug seeking fakers better than NHS? Why do you think this problem is better here? With EMTALA if they succeed in tricking doctors they get their shot in the arm anyways and the hospital is left holding the bill. The broken insurance system in ERs is one of the major factors driving up prices for everyone else, and would be completely eliminated by a single-payer system.

    This little comment of yours seems to reveal a more powerful interest in denying care to those you deem unworthy than in enabling care for those who’d otherwise go lacking…

    1. It’s not that I think our system is any better at dealing with the drug seekers. I’m saying that since the nature of her son’s problem basically precluded either drug seeking or lazy behavior that they would be sure the issue was real.

      What I’m trying to say is that her experience isn’t a measure of how valid the complaints against UHC are as it’s about a perfect example of what they get right.

  98. The NHS does not charge for ER treatment, nor does it charge any EU National for any service, nor does it charge people who are legally resident here as students, etc. If also will provide long term treatment even for people who are not entitled when it comes to infectious diseases such as HIV or Hep B. It will charge for Non-EU nationals who come to the UK to be treated, and certainly would not provide some services that the NHS provides in general on an individual basis (such as organ transplant, plastic surgery, and so forth). It tries to charge when people fly into to London from places such as Nigeria or Ghana in order to have NHS treatment, but it treats first and asks questions later. It is notably unsuccessful in collecting such monies. It is not in the world view of medical staff in the NHS to think of asking for money.

    Emergency Rooms (called Accident and Emergency here [ A&E ] ) can have long wait times, especially on Friday and Saturday nights, but that is a universal situation I believe.

  99. As for the blog itself, thank you for taking the time to write a simple, clear, unambiguous description of what you experienced from NHS treatment. Apart from anything else, most blogs I come across as just about the negative things in life.

    Also there is a very worrying trend to demonise the NHS, drum it down and generally try and change the publics opinion against the NHS.

    For most people, thankfully the most they have to experience of the NHS is their GP or rather Doris on reception to make an appointment but all the times available are the most inconvenient to everyone (I believe there are support groups for those left traumatised, The Friends of Doris, not to be confused with the friends of Dorothy). But comparing that to the NHS as a whole is well, it’s like comparing a gnats fart to a hurricane. Even for the most flatulant of gnats and stone faced Doris.

    There is this mythical carrot being dangled that “if we used private heath insurance” it would be cheaper (laughs hysterically) and it would for those who suffer nothing more in life than a stubbed toe and a paper cut. But for everyone else…

    In truth we the Great British tax payer. We pay for it through central government NI, prescription charges and othe methods of funding which accounts have made up; part of the ‘free at the point of service’ evaluate someone quite wisly realised that being asked for you insurance details, bank details, credit rating when you are in casulty with a broken leg/arm or when your being informed that you have a lump is in itself traumatic and could cause other issues. Besides, have you ever asked someone who’s been given a pre op injection a question, you might just as well ask a “Tea Party” member if they still hang around with The Mad Hatter, you get the same blank expression, try it.

    It is questionable that I could afford the costs and if I went for private cover. My premiums would finance a few drinks for some of the lower end of the banking sectors annual Yule do. And then there’s the medication. Apparently one of the box of pill costs over £1,000, kind of puts that perscrption charge into perspective. But they keep alive, healthily, in active gainful employment quite a nice amount above national average and I pay all my taxes. So I can see why that carrot looks tasty for some. The trade off is I don’t have kids, either by genetics/choise/or corrupted by (insert preferred group to persecute) actually I was born gay, always knew I was gay), I pay in part for the education of other peoples children. And accept that and all the other wonderious things my taxes went on because that’s part of the social contract we are apart of, it’s all part of the wonderful thing called “society”, it was reported as being a myth by a former PM who’s picture hangs on the wall of our current PM. There, staring like a harpy of myth.

  100. The idea that the NHS is ‘only good for minor ailments’ is so profoundly arse-about-face as you can get.

    You can be a fully paid up BUPA member but the minute it looks like the procedure with be complex or expensive they will refer the patent to the NHS as it’s equipped to deal with ‘big boy and girls toys’. In the example I can give, the patent had a calapsed lung which was out of BUPA’s league.

    BTW, you do know that the Queen Elizabeth Hospital in Birmingham was where the injured or, as in far far too many cases seriously injured with multiple limbs in varying states on complete – the NHS too.

    Now if course it could be as simple shattered limbs, missing limbs, severe PTS and other body trauma might in your world and on your scale minor and a relatively trivial item to treat. But I can assure you that as a biker who has more than his share ‘incidents’ and come round thinking “I don’t think I’ll be home for tea….. Is at all”, with a surprisingly large number of now ex-services men and women, a few passed through the QE’s care, I can say with hand on heart and in a statement that would stand up in court that “the NHS ‘only good for minor ailments'” is the biggest lie I have ever heard and should be treated (see what I did there, it’s Monday morning…) with the contemp it deserves and ANYONE making such claims should substantiate those claims.

  101. I for one cannot thank the nhs enough for what they have done for me and my family, I was a premature baby (only by 2 weeks) and had jaundice when I was born (I know now its not very serious but 28 years ago it was a big deal), when I was 4 I fell over in a gravel car park and had a stone lodged in my knee, when I was 7 I fell over in the playground at my school and ended up with a massive gash in my other knee, when I was 8 I not only lost my gran to breast cancer but my mum’s uncle was diagnosed with terminal prostate cancer (he fought it for 15 years, had 3 heart attacks and yet died of old age), my grandpa had an angina attack not long after and had to undergo a triple heart bypass, my older sister suffers from ibs and astma, both my sisters have arthritis despite only being 24 and 30, I suffer with anxiety, hypothyroidism, dyspraxia (which my younger sister also has) and interstitial cystitis (a currently incurable bladder condition), I have also had surgery on my mouth, surgery on a broken toe and exploratory surgery and my dad has had surgery on varicose veins, all of which have been diagnosed and treated on the nhs, and I can be more grateful than a lot of other people as due to my hypothyroidism I qualify for a medical exemption certificate which means I don’t have to pay the nhs prescription charges for any of my medication (equating to 5 boxes every 4 weeks and 1 additional box every 24 weeks), this saves me approximately £40 every4 weeks, the only problem with the nhs is the way that the staff are treated

    1. So you don’t like the NHS because children are seen by paediatricians?! Do you realise what a paediatrician is?! The clue is in “paedia.”

      A child is not just seen by one type at all. They are initially seen by a paediatrician and will then be referred to a specialist.

      And the fact that they didn’t spot the cancer or autism…how many diagnoses were there? What did you initially go in for? For example, if I had cancer and a bad leg and when in for the bad leg once, I wouldn’t be blaming them if they didn’t notice the cancer. I understand your assumable heartache but it just seems like you’re looking for someone to blame during a bad situation.

  102. As a paediatrician and neonatologist working for the NHS in UK, thank you so much for this article. Bad stuff gets published and flung around all the time, it can be quite disheartening and depressing as a doctor, nurse and healthcare employee. I had heard junior doctors and nurses contemplating leaving the profession and had thought about it a few times myself, but then could not think of any other jobs that I would really love to do!
    It always surprises me when visitors ask to pay for treatment. All under 16s care eligible under NHS is free. At the same time, it annoys me when people ask about free housing and benefits before even asking about their child (unfortunately, that happens too often). I am baffled when people get surprised that I work all night without sleep, on holidays and weekends. Healthcare is 24 hours, who else is going to look after you? Emergencies is not restricted to 9-5. On the other hand, I had some parents complain when they saw me eating an orange and talking on the phone through the window when they were waiting to be seen. Never mind that I was actually making a surgical referral on the phone or eating my first bite the whole shift whilst listening to my junior doctor presenting a case and writing notes at the same time. Although I had parents who goes above and beyond – one guy took it upon himself to get pizza for all the staff members every night his kid was admitted (a good few weeks) and even came back for Christmas and New Year.
    I am
    lucky enough that I enjoy my work and find that working with children is fun and rewarding. They like to share their chocolates and candies! Yes you have to deal with the parents too, but even the annoying ones are at least doing it because of their children so I’d rather they care than not. Compared to my colleagues in the States, Oz, Finland, Singapore, Malaysia… we get paid very little but work longer hours. They seem to get long stretches of leave that is unheard of here in the UK. Surf before work and sail on the weekends? How do you find the time, and the energy? They have allowances! Flown business and first class to conferences. I’m sure this is a handful or maybe, I just have really lucky friends, but wow!
    So yes, NHS, like anything else, is a mix of good and bad – working on it or by using the system. I am glad your son had a good experience. We certainly aim to provide the best care possible and limit waiting time when we can. And if you’re a kid – no charge!!

    1. I need to add an addendum to my comment: I actually have no idea who to refer patients to when they ask where to pay, not that I get asked that a lot. I’ve also been in situations where we have ‘tried’ to bill patients (for longer term care with non-eligible NHS patients) but never got the money. Since every UK resident is paying National Insurance but not all use it, and those who have paid hefty insurance premiums, have used the NHS and is paying out, how do we make this more efficient? We seem to be always short of funds for equipment and staff, and the media have finally caught on how much money has been spent on those who is not eligible for the NHS.
      All that said, I do still think emergency care should be free for all. The last thing you should be thinking about when you’re truly ill is the medical bill. As a doctor, I would quite honestly feel a bit slimy handing out a bill. And no, I don’t include sniffles, flu, constipation and being intoxicated as emergencies.

  103. Dear UK cousins, You all seem very flustered by the American negative comments and suspicions and you are determined to prove to them that NHS is wonderful, which it is. It is like beating your head on a brick wall, here in Canada Americans come across the border in droves to the point where our universal healthcare system is being stressed to the point of breaking. They lie and finagle and we treat them because a large portion of these patients are children needing routine vaccines or they are unemployed or working poor who need basic care that costs thousands in the US and they will just get sicker if we don’t – no one is turned away and yes we too are notoriously bad at collecting for non-emergency care on non-residents.
    One of our doctors was invited to speak at a congressional investigation hearing into universal healthcare and unlike the doctors from Europe and Asia she was not caught off guard by the Senators rudeness or the paid propaganda lackey on the panel and schooled them. Some of the Senators were sincere but over-run by the ignorant and loud.
    It is not about the greater good in America it is every man for themselves. They do not believe if you have a healthy well educated population you have a better country and society. I can not count the number of times I have heard an American say ‘Why should I pay for someone else?’ but those people are healthy and can afford their insurance at the moment and have no idea how close they are to one little illness bankrupting them.
    I can not even imagine paying thousands of dollars over and above the cost of insurance for the birth of my son and I know I got better care than the average birth stay in a standard US hospital where they have infant mortality rates as high or higher than most third world countries.
    Be proud that your healthcare system is one of the best in the world and a system to be aspired to, ours could learn from you but our shear size causes other issues. Be glad that you were not unfortunate enough to be born in the USA. But most of all stop trying to figure out our neighbours to the south, we gave up long ago. Any day now they will be claiming the sky is not blue only because the rest of the world says it is.

  104. Dear a Europeans,

    Please don’t be offended. Mericans don’t travel much. We have low expectations that are regularly exceeded. Pleasant surprise bursts out merican style. Sorry about the disruption. But take heart. Doesn’t take long to realize everything our political party fed us was a pack of lies. Yes, we are annoying but we can be taught.

  105. I have used the NHS countless times and also had to use the American medical system as well. I have been diagnoised with two degenerative illnesses that are currebtly being managed by the NHS as they are not curable but the care I have had us second to none. My local GP is fantastic and I have been hospitalised four times in the last four years for my illnesses and been really well looked after. When I was hospitalised the second time I was taken for an ultrasound and there was a man brought down after me who was a lot sicker than I was and was asked if I would mind him going before me – asked not told or forced or moved back because of a relationship between the doctors and I didn’t mind at all it wasn’t like Iwas going anywhere. My sister has broken her coller bonevtwice and each time it has taken less than 5 hours to get her sorted and home again and one of those trips was at 3am in the morning. Both my parents have had major surgery and I have been treated for broken bones and concussions more times than I can count. The NHS is a brilliant system but nothing is perfect, you’ll get bad days and sometimes long waits – 6 hours at 1am when your friend falls of his skateboard and breaks his teeth and loses half his chin being a long one but then they had seven students brought in with severe to lethal levels of alcohol poisoning that night. We have walk in centres that don’t need an apointment for when you can’t see your gp and its urgent, night emergency services so that you don’t need to go to the hospital but can go to a gp with a minor problem even at night and a helpline that gives you advice on symptoms and when you need to go to the hospital instead of turning up and waiting for hours. It took the American system four hours to tell my sister she had tonsilitus whilst we were on holiday and cost my parents $1200 whereas it took my doctor five minutes to tell me I had it and £8.05 for the penicillin, well less than that as I have three month prescription fee of £29 that I pay to cover the cost of treatment drugs and inhalers on the NHS.

  106. Similar experience for us when my husband had to go to an ER in Newcastle UK. No charge or later bill. Also true in New Zealand, when he had to go to a clinic to have a hand wound checked out. No charge.

  107. First off it’s great that Victor got treated and recovered quickly. Hope it didn’t spoil your vacation too much.

    Between my wife and I (and if you add in some friends and family the ‘N’ gets a little larger) we’ve experienced health care (emergency and scheduled) both sides of the Atlantic. The quality of treatment depends on the provider and the people one gets to see, not so much on the system. Far more often than not – thankfully – they’re excellent, both sides. No one takes up the responsibility for doing this stuff without a latent sense of empathy and care, I think, and for that we’re (the ‘lay’ consumers) very grateful.

    But healthcare costs. A lot. The more the medics can do (drugs get better, procedures more complex) and the sicker we all get (longer life – more conditions) we’re going to be facing up the ramp wherever we are. When it comes down to it we’re human, we love those who mean something to us and we want the best for them. At the time we worry about the costs later.

    One time, for me, the NHS refused to carry out a procedure that would make my life far more comfortable. This was probably because I was uncomfortable, not life threatened. I’d had the ‘run around’ for years. I made the decision to investigate the private option and paid cash to see (one of) the best in the field. That surgeon changed my life and his fee was worth every penny. And…. yes…. I haggled. And the very decent private healthcare provider knocked a little off the bill. Please be aware that there’s a lot of people in the UK (usually via an employment ‘perk’) who pay (on top of their taxes) for private healthcare. Some pay out of their own pocket, usually in desperation. It isn’t always better (same Doc in both private and NHS locations)……..sometimes it’s worse (My wife is a Medic and she was shocked by the filth in one private facility we visited my father in one time. It was no surprise he suffered with a post-op infection).

    I think (although I’m not able to do the ‘Math(s)’ right now) US citizens tend to pay less tax than we do in Britain. Our cultures are also slightly different in terms of our acceptance or rejection of ‘commercialism’ (Dr Gunter alludes to this in the comment about the ‘kit’ I think – there’d be many in the NHS horrified that manufacturers provided equipment by way of marketing. My wife was told when she worked in the NHS that she could not attend training funded entirely by an expectant drug Co.) The kit in the US hospitals certainly looks impressive and if newer means better in many other fields (I don’t really want my old DOS pc back thanks, but it still works okay) it may offer more accuracy or deeper analysis. If that saves a life or improves a treatment it was worth having.

    Maybe our experiences, thankfully good with both systems, are down to luck. The media likes shock tales of incompetence and economic starvation because it sells media. A state-run system has faults like a private system, and, tragically, there’ll be N<30 tales where stuff has gone wrong. I could write a story about how surprisingly good our experiences have been when in the US (our Brit friends were shocked that we weren't shown the credit card reader before my wife boarded the ambulance in the US).

    What was interesting though was that our insurers haggled when paying the US hospital bill. We paid the deuctable and were reimbursed straight away. But our insurers took their time and only paid up about 60% of the amount they were invoiced for. Now that's interesting. What is the actual 'cost' of treatment in the US ? And if it's opportunistic profiteering when people are at their most vulnerable then it poses some serious moral questions. I'd have thought that for the US system to work effectively the providers and insurers should all be non-profit organisations and it surprises me that they're often not.

  108. As one of the UK’s rural family doctors who has recently been squeezed out of the system by the big boys (corporate NHS trusts and corporate pharmacy employing cheap labour) I worry that this story is simply promoting the perception of the NHS it’s bosses and health ministers wish for us Brits to believe in while it is being dismantled.

    Come on! This was a simple corneal abrasion/foreign body requiring little more that a drop of local anaesthetic (with, perhaps fluroscein stain to exclude an alternative cause) judicious use of a cotton bud with an otoscope acting as an illuminated magnifying glass to aid in detecting and removing that piece of grit – failing which a full examination of the eye with a cobalt slit lamp ophthalmoscope and/ or referral to the eye clinic located 50 miles away in the centre of town might have be appropriate.

    This is TRIAGE and is what GPs have traditionally done.

    Not quite as simple as a splinter of wood in the skin but it was hardly a life-threatening or sight-threatening emergency.

    There is no such thing as a free lunch and someone must pay. In this case it is the Clinical Commissioning Group or taxpayer who, one way or another, will pay for this case of over-investigation all at specialist rates; It was provided at a centralised institution although it was something that could so easily have been done locally, rapidly, safely and cheaply in good old fashioned British General Practice.

    Oh I forgot, we have not had a GP service in the UK for about 10 years.

    At least the American system is openly capitalist, it is not bankrupt and is not politically driven in claiming to provide all things to all men.

    As a system the NHS is morally and financially bankrupt. It cannot and it will not last but fear what is to replace it.

    How long, I wonder, before we are invited to purchase shares in NHSco?

  109. I’ve never been able to understand how anyone could truly trust the opinion of a doctor that is going to bill you. I’d always be thinking: a nice new shiny car comes out and I’d have to have three more unnecessary x-rays.

  110. As well as being a surgeon I have a role in NHS information systems.
    Non residents are not entitled to free care.
    http://www.nhs.uk/chq/Pages/1086.aspx
    Further detail at

    Click to access ovs_visitors_guidance_oct13a.pdf


    …..however in practice
    1. The priority of all the staff is to look after the patient. Anyone presenting will have their personal details taken including normal place of residence (but not a credit card). This includes A&E (ER).
    2. NHS hospitals are encouraged to chase up the billing of non-residents. Most of these are people from countries with whom we have reciprocal agreements and it is their government that pays all or most of the cost (e.g. The European Union member countries). Many hospitals have been lax about this (it is a long story, but the hospital gets paid by the local health commissioner whether or not they submit this information so not motivated, this is about to change) but there is a drive on to improve.
    3. The more expensive the episode the more likely the hospital is to chase it up – e.g. If it is serious enough to get admitted.
    4. Nevertheless many patients, especially those that have intentionally come to the UK knowing of their condition, or those who get ill but know the system, give false details and many invoices are returned “not at this address”.
    5. The overhead of administering charging systems for a small minority of patients from non-reciprocal countries is high. So the return in financial terms that would be obtained by chasing up each ER attendance is low. So it doesn’t happen most of the time.

    “$20 Harald” seems to be a proponent of the three shell trick with his GDP calculations. The facts of the matter are, as pointed out by others,
    US spends twice the proportion of GDP on health care as we do, from a higher per capita GDP. This is real, a spend is a spend. It matters not whether it is directly from someone’s pocket, via insurance or taxation. It is the proportion of national income devoted to this end.
    The result is poor (commonwealth fund report).
    http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
    The US spends a higher proportion of GDP on FEDERAL funded healthcare (Medicare, Medicaid, Veterans, public health) than the UK does for the whole NHS.

    Harald can include me on the list of whom he owes $20. But I suspect that I have as much chance of seeing that as the money from the west African seen in clinic last week……..

  111. I am a huge fan of the NHS and have never had a problem. My son broke his arm a couple of years back and we were seen, xrayed, diagnosed, casted and out of the hospital about 90 minutes after arriving. A friend went recently with her daughter with a similar injury, they were in and out in an hour.

  112. The things that frightens Americans about an NHS style health service is the idea of a socialist system and the idea of paying for someone else’s bill.
    Both concepts that are polar opposites of the American norm.

  113. I was in England this summer and sprained my ankle. For me I would have had to pay on the spot, not sure how much, plus 50 pounds for X-rays, but I had health insurance through my study abroad program. Also, I was a student in England and all us international students had physicals done and given a card with the name of a doctor we could see. I don’t recall if this was free or part of the cost in my tuition.

  114. I took a friend to the ER at a hospital in Scotland. He was seen immediately, got excellent care, and was told not to worry about paying because it would be more trouble than it’s worth to figure out the bill. I lived in the UK for 11 years and never had a problem with the health service.

  115. If you never got your bill, you could find out how much it cost. All NHS charges are published online through the Department of Health (using a ‘tariff’ based system for most treatments) on an Excel spreadsheet. As I see it, putting NHS services out to tender is a flawed approach. Contracting skills are lacking and the monitoring of a service, regardless of how it is commissioned, is only as good as your contract monitoring skills. There’s a really good infographic comparing administrative costs of worldwide healthcare systems. The UK’s is most efficient because, unlike the US, the proportion of money spent on administering the system is low. That’s not to say the NHS can’t make further efficiencies, and it would be interesting to see how the UK and US public health indicators compare, especially when looking at different social groups.

  116. I have read all of these posts and the stupidity contained within startles me. Your care is not free, far from it. Your taxes are sky high. From where do you think the gov’t is getting the money to pay for medical care for its citizens. I have never paid the outrageous rates for a root canal as was posted here. What planet are you living on? I will take the excellent care we receive here, the very latest and best equipment available for every condition known to medicine, highly trained doctors. If care is so bad how come doctors from other nations come here to complete their training. We do not have old antiquated diagnostic tools as was described used for the child who had a cinder in his eye. I have never been in an ER or medical office where the slit lamp could be described as “old”. Because the very latest equipment is available perhaps that is the reason for medicine to be so expensive. I’ll take our system and our doctors any day. You can have yours. I forgot to mention I am an American and grateful to have the system and superb care I have received through the years.

    1. As I’m a physician I’ve got a pretty go idea of what is older equipment. The point is US hospitals (private ones) frequently get new equipment as a marketing tool. People think brand new equipment = good care, or many do. However, in most cases older equipment works just fine and there is no point in wasting the money just because there is a newer model. The comment was a way of pointing that out.

      1. My son is a physician. I know what it takes to put a son through college and medical school. We paid all the bills as we didn’t want him to graduate with a huge loan to repay. I worked in hospitals for years as a medical/surgical sec’y and administrator of a large clinic. Nothing is free, not here and not in the UK. Replacing older equipment with new when advances are available that results in a better and more accurate diagnosis is certainly wise. As a physician you should understand that. And of course there is so much new equipment today not even imagined years ago. A good and modern hospital should have these available. This equipment costs millions of dollars. Someone has to pay the bill. I am grateful for the large hospital where I live and the ever expanding radiology dept. ,walking through there is an eye opener and I can’t even begin to imagine the total cost of it all. I have always heard complaints by the Brits about their outrageous taxes. If they didn’t pay in taxes they would get the bill when medical services are rendered. Insurance pays just a portion and patient pays the rest. It is that simple.I would rather pay for services received by me and not have a sky high tax bill all year that pays for others. We do pay a high price for welfare in this country.

    2. Doris Johnson and many other Americans have commented on the high tax rates paid by Brits to fund (amongst other things) our NHS.

      Whilst I would be happy to pay more in taxes for the security and societal benefit of the NHS, I was curious to see just how much more UK citizens are being taxed than US citizens (remembering that they then need to stump up for health insurance with their non-taxable income).

      The following article calculated how much a high earner on a salary of $400,000 (£240,000) in 2013, with a mortgage of $1.2m (£750,000), would have left after all income tax rates and social security contributions.

      They assume this person is married with two children, one of them aged under six.

      United States – 60.45% (based on New York state tax)
      United Kingdom -57.28% so only 3.17% worse off and no health insurance to pay.

      For a single person on average salary with no children, in the USA marginal tax rate is 22.7%, UK 24.9%, higher yes, but only slightly higher.

      It did seem to improve significantly for married couples with two children with USA only 10.4%, UK exactly the same as unmarried at 24.9%.

      http://m.bbc.co.uk/news/magazine-26327114

      Now I am probably oversimplifying but what strikes me is that in general both the very well off and many of the averagely waged in the UK do not pay extortionate taxation compared to Americans.

      It’s obviously true that medical care has to be paid for one way or another. The benefit of paying through taxation is that it is fair to all (noone dies because they’re poor and uninsured) and it’s less scary for those who can afford it. How many middle class Americans are terrified that if they lost their job with employer-based health insurance, and couldn’t afford insurance, they would be in a mess if they or their families got sick? You know the answer.

      Furthermore, as I previously commented, our healthcare system has been shown to be more efficient than the US one http://www.theguardian.com/society/2014/jun/17/nhs-health
      The insurance-based system engenders waste and high prices for exactly the same care.

      Finally, it’s a small point, but as far as I know, a working slit lamp that is a few years old can visualise the anterior chamber as well as a new one. When it needs replacing, it will be replaced.

  117. If you thin the NHS is such a good thing it’ll disappoint you to learn it has already effectively been privatised in England. The secretary of state for health has formally abdicated responsibility to provide healthcare for all. All NHS services in England must be put out to tender. And now there is talk of introducing a fee to visit a GP.

    Since I live in Scotland which has it’s own separate NHS (there’s no such thing as a UK wide NHS). I don’t have to deal with these changes yet. But our devolved governance can’t protect us forever since our budget is still ultimately set by Westminster.

    But thank you for your positive appraisal of the NHS. It’s nice to read something positive when all we get in our news is the negative.

    September 18th can’t come soon enough 😉

  118. The UK NHS is a far better,more equitable and indeed cost efficient way of delivering Healthcare to it’s citizens.c

  119. When I woke up with a high fever in a small town in Scotland we decided a professional opinion was justified. The biggest problem we encountered at the NHS clinic was the order of month and day in my birthdate. After a short consultation the doc and I agreed that a short course of antibiotic was reasonable. Back at the desk I was informed that my visit was “emergent” so there was no charge. And at the “Chemist” I found that prescriptions are free for anyone over 60.

  120. How nice to see a positive write up of the NHS. Having worked for it for 25y I have to admit it has its failings, usually related to chronic (i.e. long term for the non-medical) care. We do have waiting lists for routine operations which has been used by the anti-Obama-care endlessly and in an inappropriate way. However, acute (i.e. of rapid onset and rapid need) care we do pretty well. Thank you.

  121. As another transplanted American (12 years now!) I have had mostly good experiences with the NHS. There have been long A&E waits, there have been trips round the houses to get out of hours care. But my antenatal care and the birth of both my children in a lovely modern midwife led birthing unit, as well as follow up care (including a breast feeding advisor) was excellent and all free.

    More importantly, we will never go back to the US (which we were planning on) because my son was diagnosed with severe haemophilia shortly after birth (no family history). He spent a month in NICU, has had two operations, numerous tests, several stays on the wards and all of this has cost us nothing. More than that, I just worked out the rough cost of his every other day life saving medication – about £218,000 a year. (And it used to be much more – at one point it was several thousands of pounds a day). That’s not including the ancillaries, check ups, and excellent care he receives from a top children’s hospital. Total cost to us? Nothing. Yes, good insurance in the US would cover some of that, but not all, and we would have to fight for it. He may have dual citizenship, but we’re not moving back while we’re responsible for his care.

  122. As one of the UK’s rural family doctors who has recently been squeezed out of the system by the big boys (NHS corporate trusts and corporate pharmacy) I worry that this is simply promoting the perception of the NHS it’s bosses and health ministers wish for us Brits to believe in.

    Come on! This was a simple corneal abrasion/foreign body requiring little more that a drop of local anaesthetic, (with, perhaps fluoroscein stain to exclude an alternative cause) judicious use of a cotton bud with an otoscope acting as an illuminated magnifying glass to aid in detecting and removing that piece of grit – failing which a full examination of the eye with a cobalt sllit lamp ophthalmoscope and/ or referral to the eye clinic located 50 miles away in the centre of town might be appropriate.

    This is TRIAGE

    Not quite as simple as a splinter of wood in the skin but it was hardly a life-threatening or sight threatening emergency.

    There is no such thing as a free lunch and someone must pay. In this case it is the Clinical Commissioning Group who, one way or another, will pay for this case of over-investigation all at specialist rates and yet another example of the increasing trend for the British taxpayer to pay specialist fees at a centralised institution for something that could so easily have been done locally, rapidly, safely and cheaply in good old fashioned British General Practice.

    Oh I forgot, we have not had a GP service in the UK for about 10 years.

    At least the American system is openly capitalist and is not bankrupt in trying to provide all things to all men.

    It cannot and it will not last!

  123. I’ll tell you what frightens Americans (and conservatives): distribution of resources based purely on need, not ability to earn or pay, and the social and intellectual freedom it would give to everyone.

  124. Well we ae bloody idiots allowing foreigners (by which I mean temporary visitors and non-residents) to obtain NHS treatments for free. We Brits and permenant residents get issued with a card with our NHS number on it to prove our entitlement to services but no one bothers to check them and I can’t understand why not. We are throwing money away and giving away services for free that we would have to pay for if the roles were reversed. I mean I wouldn’t mind if it was a reciprocal arrangemnt between nations but it isn’t.

    I don’t think the NHS can afford.this. I have lived in South Africa an ld America and I always had to show my medical insurance card to get treatment and I got billed for the stuff that wasn’t covered and it was pricey.

    Your story highlights the disparity. It’s not your fault though. It is our government’s fault. You offered to pay. We were stupid not to bill you. We contribute to the cost if healthcare through National Insurance contributions and taxes. In other countries without state funded healthcare you contribute toward healthcare through insurance premiums. It is unfair to hard working Brits that visitors/foreingers pay nothing for the care they receive here. That’s nothing personal to you. I’m glad your son’s eye was fixed but seriously we need to sort this kinda thing out or the NHS will be unsustainable.

  125. We (two American ex-pats living in Germany) were spending a few days with friends in London when our daughter took a spill down their half-flight of concrete stairs. She didn’t pass out, didn’t vomit, didn’t show any classic signs of anything serious, but the bump that swelled up on her head was huge and ugly so we followed the flow-chart on the NHS site and ended up with “you’d better call the emergency number”. About 15 min. later an ambulance showed up, examined her, took us off to the hospital (all the while carefully — but clearly seeking to rule out child abuse/neglect — questioning us as to why we had a half-flight of concrete stairs, a toddler, and no baby gate: We explained we were visiting). By then it was clear we weren’t urgent — the lump was still there but she was running around happily. We waited maybe half an hour before being seen, and when we were seen the dr. ended up calling for a second opinion, since the goose-egg was right at the 5cm cut-off point above which they mandate a head scan. However, it was just small enough, she was showing and had shown no signs of internal trauma, and our flight back to Germany was that evening, so they sent us on our merry way.

    We were never asked for our address, so even if they wanted to send us a bill, they wouldn’t be able to.

  126. Canadian ex-pat optometrist here working in the education system in the US. Randomly came across this blog! Just a little comment on the “slit-lamp wasn’t brand new” comment: Not sure if you could actually tell that it wasn’t new, but this is a Haag-Streit slit-lamp, arguably the highest quality of slit-lamps out there and they are still designed to look that way (if judged based on appearance). The model shown isn’t the top of the line model but they all have the same quality of optics; this model simply just has less features. It still is very possible that it wasn’t ‘new’, but Haag-Streit slit-lamps definitely have a reputation of being products that will literally last an entire lifetime, so even if it wasn’t new, they’re using top of the line quality instruments. Another plus to your visit in my opinion! (I just realized this sounds almost like I’m marketing Haag-Streit. No affiliation! Just used plenty of different kinds over time and done lots of literature searching!)

  127. Hi, I’m Brazilian and lived in London for 2 years. You won’t get a bill from NHS. The whole British heatlh care is based in free care for everyone. Brazil has the same system. However, in England it works because the government money for it actually gets to where it’s suposed to, whereas in Brazil the government steals for themselves (corruption).

  128. I am interested to know among all the posters who love “free” health care, where they think the money to provide it comes from? If you pay tax, it comes from you so it’s not free. If you don’t pay tax? Well it comes from the people who do pay tax.

  129. I am Canadian, but I had the same experience when my daughter was stung by a hornet on a beach in Wales. She quickly developed a reaction to the sting (for the first time ever). We rushed her to the local “cottage” hospital where she was treated. I offered my out of country medical insurance information, but was politely told it wasn’t necessary. We have never received a bill for the treatment. I always purchase out of country medical insurance, just in case…. And most certainly NEVER cross the border into the US without it.

  130. Anecdotal story to be sure. Glad you had a good experience, but like anything else, not every such experience is a positive one. I lived in the UK for 6 months back in 2000 and asked the locals how the health care system worked, in case I needed to use it during my stay. I’ll never forget what I was told: Let’s say you need heart surgery. It might take 6 months to get on the surgeon’s schedule, but you’ll be dead before then. But not to fear: they’ll be happy to “fit you in” next week… as long as you bypass the nationalized health care system and pay out of pocket. So now you had the worst of both worlds: higher taxes to pay for a health care system run by bureaucrats, plus you’re also paying for the service you need because you prefer not to die while waiting for your turn in the operating room. I think I’ll take the American private system, warts and all, thank you very much.

    1. George, that’s not the reality – serious stuff gets picked up very quickly. I had a cause to get a heart scan last year and the whole thing was done within a couple of weeks on the NHS. And, in any case, compare like for like: in the UK you can chose to pay for full medical cover and bypass the system altogether – I do this (though elected to get my heart scan done on the NHS because it avoided me paying an insurance excess and was as quick) and pay, for fully comprehensive, top-level of cover just under GBP70/USD100 per month (me, male, late 30s, non-smoker). AFAIK, this is about a third or less of the typical price in the US from what friends living over there have told me. So, yes, in theory, I’m paying double (once in my taxes, once in my insurance premium); in practice, I’m getting equivalent healthcare cover for far far less. The main reason for this is the cost control that the NHS’s presence effects on the marketplace.

    2. George, did you actually use the NHS at all? It seems that your big mistake was to ask the Brits what it was like, without understanding what we Brits are like! We moan and talk things down all the time, NHS – awful, until you actually need to use it then it is brilliant. Olympics – they are going to be awful, we will mess it up etc. and what were they like? Brilliant and generally acknowledged as the best ever. We talk things down in the same way that other nationalities big things up. NHS – it is OK and coming from a Brit, that is high praise indeed.

    3. But you didn’t actually use the system? People in the UK like to moan about the NHS, but generally speaking, if it is an urgent surgery, it will be done promptly. Judging a system on people having a moan is hardly a scientific method. I’m sure the taxes I pay to cover the NHS are less than I would be paying in insurance premiums and copays to cover ridiculously inflated and opaque medical costs in the US ($500 for a Tylenol?). My mother had a double lung transplant in the US, so I know how much that care can cost (and she was lucky to have good, US govt backed insurance)

  131. Healthcare in Britain is quite surreal. It’s also a little bit varied – I’ve had both long and short waits (at the same hospital, but on different occasions). You won’t get billed. I, and my fellow countrymen, have already paid for the treatment through our national insurance tax contributions. You’re welcome to it – I have to pay the tax whether it gets used or not. I hope you enjoy the rest of your visit.

  132. I was born in the UK and lived there all of my life up until I was 21 (I’m now 22) before moving to the States. I just want to say how much I enjoyed your article on the NHS. Many people are so quick to critisise the NHS because of long waits and care that may be below the standard that they expected but your article goes to show that the NHS does get it right sometimes. As someone who was born on the NHS and grew up with the NHS, they have been there when I broke my arm, when I had extreme pain in my neck and when I had suspected meningitis and not to mention countless visits to my primary care doctor and all of this without having to pay a single penny (including transport to and from the hospital). I found your article enlightening and thank you for posting it. I’m glad your son is doing better!

  133. You ask why Americans are so scared of the notion of an NHS. As a Brit who used to work in public health and hence had to know a lot about public policy, I suspect that you don’t need to look much further than the vested interests that make a lot of money out of the US not having an NHS.
    No system is perfect but the big advantage of the NHS is that is is roughly the same all over the country and we don’t waste money on collecting payments because taking it out of tax is much more efficient.
    If you want to look deeper the US seems to have no idea what social solidarity is, (though in parts of our right wing political parties I think there are folk who think it is a Polish trades union). From what we read in the peppers the US sometimes seems to be a place, not a country. They may all worship the same flag but they don’t seem to pull together. It seems like a place where selfish people congregate in order to shoot each other. The strange thing is that almost all the Americans I have met seem to be decent folk, but they seem to be powerless to make the country a better place because democracy appears to have been taken over by big money.

    1. I am an American – everything you have said is accurate. Almost everything is a monopoly – our news stations are only owned by three different companies (so good luck getting unbiased coverage, and good luck helping people get along when what they’re getting is definitely biased and/or somewhat misinformed), and in almost every town in the US there’s only one option for internet (and the rates are ludicrous for what you get). The high initial cost of installing internet keeps any other business from trying (except Google, who is starting to give free internet at 5kbps upload – which sounds bad, until you realize my internet company charges $50 a month for even that). So when things are this bad with regular companies, you can imagine how terrible it is with politics. They did a few studies on it, and the USA is essentially an oligarchy now.

  134. Dr Jen Gunter should be thankful “The Committee For UnAmerican Activities” is not still around or she would be disbarred (and probably hung, drawn, and quartered). I can imagine the scene, Dr Jen sitting before such a committee – “Have you ever received socialist health care, or know anyone who has received such care”?

    I have no on the ground knowledge or experience of the USA, just perceptions. I perceive American citizens to be among the most brain washed people on this planet. Things have got so bad in your country that the word “socialism” is considered a curse word, not even worthy of discussion.

  135. I’m off to the USA in December this year an having read all the comments, I’ll be double-checking my insurance details and taking all the necessary paperwork with me – just in case.

  136. Thank you for the article which I read today in the Independent. I had cancer treatment last year in three Scottish NHS hospitals and every member of staff I met performed above or well above average, whether they were doctors, radiographers, nurses or the parking attendents in the cancer patients’ dedicated car park at the Western General in Edinburgh.

  137. I’m a medical student at St Thomas’ hospital. To put you all straight, you wont get a bill. Healthcare in the UK is offered free at the point of delivery to everyone who walks through the door. We are very proud of that, and you are more than welcome. 🙂

  138. I’m a Canadian living in the UK. I took a nasty fall and went to the A&E with my passport in hand thinking I’d have to fill in a long list of forms and have a long wait. I waited for no more than 30 minutes, gave nearly no personal information (could have remained anonymous had I wanted), got very good care, and when I needed a follow up operation this was paid for through the NHS. I had a similar injury in Canada years ago and I sat in the ER for 8 hours and had to pay for the surgery I needed. I’m still very pleased with the Canadian healthcare system, but compared to the NHS, no contest.

  139. I had a serious flare-up of iritis while in the UK years ago and went to Moorfields several times. I had to pay 5£ towards my medication- that’s it. Now I live in France and also have excellent health care. I pay about 800€ a year for supplementary comprehensive insurance which covers about everything, except cosmetic dental surgery like crowns and implants which is quite pricey.

  140. I had an ultrasound in a Florida hospital once on holiday whilst pregnant. I was worried I’d lost my baby, so when in for my ultrasound the lady whispered to me “I’m not supposed to say anything but she or he is fine” and turned the monitor to me so I could see.
    Then i waited for three hours in a room, but before telling me my results of the ultrasound they started to question me about payment. I am so grateful to the lady during the ultrasound because i can’t imagine how I’d have reacted at the attitude of “give us your money first then I’ll tell you if your baby is alive” if I’d have not already known.
    Two months later i received a bill for $3800 which had been paid for by my insurance. I will never ever knock the nhs again, i had a horrible experience they also left a woman in the middle of reception wheel chair bound throwing up into a bucket on her own because they claimed there was no where to put her, maybe because they leave people in them for hours at a time to make the ridiculous payment seem more fair 😦

  141. I had strep throat in New Zealand and it cost $425 for a 3 minute visit. My deductible on travel insurance is $450. I’m not arguing that this cost was unfair, however it is important to recognize that care is not free for non residents in national health systems.

    Also, the NHS has a “4 hour rule” which means patients must be out of the ED within 4 hours. This is great for patient wait time, but means a fair number are admitted to overnight or one-day type units when perhaps they could have been discharged from the ED in say 4.5 hours….

    If the UK is like NZ you make be covered under an accidents system where all accidental injuries (which includes suicide attempts, being drunk, overdoses, bee stings, and car wrecks) are paid for by the government (and in turn by an accident tax that all working people pay in the country). In that case, you will not be billed.

    But imagine if the “accidents” listed above were all paid for by US tax payers….

  142. I’m glad your son is ok and you was happy with the service. But I must admit it has hit a nerve that tourists don’t pay yet English tax payers like me do. This just proves that the governments claim of making people pay for health care if they do not live in Britain is absolute b*****ks.
    There is constant debates about who is to blame for the NHS losing so much money. Why people get crappy care because hospitals don’t have money for new equipment, not enough nurses, life saving drugs are constantly denied because of the cost, etc. The elderly, smokers, obese and drinkers get blamed all the time. The government talks of making such people pay. Even though they are already paying. Yet it’s very clear who is really at fault here. Health tourists and hospitals themselves.
    While reading this apart of me thinks it’s nice that you had a good experience while visiting. And another part of me is really p***ed off that non Brits get it for free. I’d just like to add in your case the hospital was to blame as you did offer to pay. And thank you for that. Many don’t.

    1. I think you’re way off the mark here. You can’t possibly describe this scenario as ‘health tourism’ when a child gets something stuck in their eye – it’s just an incident that occurred and I for one am delighted, and deeply proud , that when a visitor to our country has a health complaint they are treated with the best possible care available.

      I would hope that for a more serious complaint that would involve an overnight stay for example that yes the insurance claim would need to be processed but I would imagine by the time you’ve added all the extra bureaucracy that would be needed if we started charging every visitor for every minor complaint then the net gain in monetary terms would be negligible.

      There is certainly room for the NHS to tighten its belt – for example I was given a pair of crutches recently to use, with no suggestion at all that I ought to return them when I was better – however in this instance I would far rather continue, where possible, continuing to prioritise the eyesight of the boy as opposed to harassing his father for money.

  143. I have used A&E a few times over the last few years and I work in the NHS. When people go to A&E appropriately they will get great services eg cuts, abbrations, broken bones etc and I have rarely waited more than 30min before receiving treatment and frequently much less time than that. Its when people turn up with gallstone pain or nonspecific long term problems and think they will get a diagnosis that’s where the dissatisfaction starts. I spend hours of my week explaining to patients how to pick the right services to get a satisfactory service (they are in pain so it won’t be fun) to treat their problem. I think there needs to be quite a bit of education on the appropriateness of where/how to find treatment (often the GP or out of hours GP service is better for their conditon) and that I find is the bit that goes wrong. Our GP service has always been private (yes I know you probably didn’t expect that!) And its this provision that can be poor. They doctors have always been paid on a per item basis so there is little incentive on prevention not cure. GP’s the claim back from the CCG (used to be PCT) the money for your treatment. Some GP practices can be brilliant (like mine) and really engage with their patients and offer excellent care but others just seem to feel entitled to receive NHS payment and provide poor service.

    Anyway, I’m glad your son had prompt and excellent treatment. Nothing ruins a holiday like unexpected injury (and, of course in america, a huge medical bill).

  144. I used to work for the St Thomas hospital overseas visitors unit. By and large treatment inside the A&E Department is free (there are a few exceptions) regardless of whether you are a tourist or a resident. For all other areas of the hospital to qualify for free care you must be 1. Entitled to live in the UK, and 2. Actually living in the UK. There is a modestly complex policy document issued by the Department of Health to cover corner cases.

    The unit uses a variety of methods to identify possibly chargeable patients, and then follows this up in each case with a personal interview and examination of identity documents. In some areas of the hospital we require all patients to provide identity documents and proof of residence at their appointment. This is focused on clinical specialties with a high rate of previously identified chargeable patients.

    Non-payers are reported to the Home Office. No medical details are transferred, just the persons identifying details and the amount they owe. Such people are refused re-entry to the UK until the debt is cleared.

  145. The tariff that NHS Hospitals can claim for an A&E attendance is not classified but is buried deeply in the Department of Health website. I also don’t know what the charges for overseas visitors are, but they are probably the same as the internal NHS Tariff, the tariff is designed to encourage quick, effective treatment, whilst discouraging the use of unnecessary diagnostic processes. i.e. you don’t do a CT for an eye injury. For the kind of visit described the Hospital trust would get considerably less than £200. Probably about £130.

  146. Thank you for this great account. I also had great treatment for a scratched cornea in Washington DC once. The big difficulty for me wasn’t waiting, or the principle of paying for treatment in the US (I am British). It was handling the paperwork when I couldn’t see, and knowing that I wouldn’t be able to see unless I somehow managed to complete the paperwork.

  147. As a UK resident (although originally from NZ) I have very mixed feelings about the NHS. My family has had occasion to use A&E three times in the past 10 years, twice for an asthma attack and once for post-operative haemorrhaging. The emergency care was superb in all three cases.

    However day-to-day care is very poor. Over stretched GPs haven’t the time to see you properly and don’t really know you. Coming from NZ this shocked me. We pay to see the GP in NZ and this seems to ensure much better continuity of care and a far more personal approach. My maternity experience at the Radcliffe in Oxford 12 years ago still gives me the horrors – it was quite one of the worst experiences of my life (not, fortunately the emergency c-section, but the extremely poor aftercare and the filth on the maternity wards, which was like some third world country). In years following the birth of my child I have had two last- minute cancellations for operations, causing major disruption, and a failure to diagnose post-natal depression.

    When the NHS works well, as it does with emergencies, it is a wonderful institution staffed by incredible people undertaking really challenging work. Sadly, more people experience the frustration and indignity of a day-to-day service that is stretched to its extreme and cannot function to fully support patients in the way that they need.

  148. I’m a paeds nurse. Don’t think the NHS charges for kids emergency care. The NHS is most maligned but tbh we are good. Glad he’s ok and you all enjoyed your British holiday x

    1. I have experienced the NHS over more than 50 years – as hospital in-patient, hospital out-patient, parent of infant patients, and with our spectacular GP surgery. They have treated visiting family members, friends from overseas etc. without ever considering payment.

      It makes me cross when our NHS is so often maligned – we are incredibly fortunate in the UK that Aneurin Bevan was so determined to provide healthcare at the point of need for all UK citizens, regardless of ability to pay. That this continues so many decades later, and with a much higher aging population, is remarkable, and a tribute to the determination of the professionals and managers who work so hard to make it so.

  149. Our friend from the USA visited us in England, this past summer, on the second day here, she fractured her ankle that required surgery, she needed screws and a metal plate. She had a few visits to the clinic for a dressing change. They did bill her and it cost $4100.00 . The care was excellent and she was very happy with the excellent care.

  150. You won’t receive a bill. We don’t even have a system to bill you which is part of why our system is more cost effective- there’s no medical billing admin cost. If you feel you would like to pay feel free to donate to one of the organisations trying to save our NHS from current government’s attempt to privatise it, or to a US organisation trying to provide medical help to the poor, or directly to me who discovered the night before my emergency surgery that my travel insurance had quietly expired. I hope to never deal with medical bills again which is one reason I doubt I will ever live in my American motherland and will fight loudly for the NHS. X

  151. I was a college student traveling around Europe and developed an ear ache. I was in London at the time. I actually thought it was a toothache. I went to a hospital that actually had a dental clinic. I was amazed at that first of all. They evaluated me and said it was not my teeth. They sent me to the regular emergency department. I did not wait long before seeing a doctor who diagnosed me with an ear infection. When I was discharged they asked me if I was working and I stated I was a student from Florida. They then filled my prescription right there and never asked me for any money. I was amazed.

  152. It is so varied — I was treated in one hospital in London where I honestly feared for my life on one ward, and on another received the very highest standards of care. The NHS has grown to such a behemoth it is virtually unmanageable in term of consistency — except it’s capacity to produce hordes of managerial cadres who strip resource from frontline work. Like most Brits I love the NHS and fear for its future.

    1. I feel the same about the Australian Medicare system, I am SO worried what the current gov is going to do to it in the name of saving a few dollars up front :/

  153. I too had an experience just like this when I was in the UK years ago. I developed shingles while on vacation and the sores were around my eye. The A&E doctor quickly got me over to Moorefield’s Eye Hospital (an elite institution) and I was given an extensive inspection to make sure the virus had not attached to the nerves in my eye.
    That was 2006, maybe their accounts receivable department is extremely slow, but I have never received a bill, and I got exceptional and focused (please mind the pun) care. I have been an advocate for their system ever since.

  154. I am Australian and we have Medicare here which is similar to NHS. A couple of years ago I travelled to San Francisco for a vacation. I became I’ll with a sore throat on the flight to the US. By the time we arrived at our hotel I had deteriorated further with a full blown strep virus. It was so bad my throat had almost closed with swelling. I had to go straight to bed while my husband went to a pharmacy to get me something.

    The virus got worse overnight with vomiting. The hotel did not have a Dr so we had to go to a hospital 10 blocks away. The emergency room was empty and I was seen within 10 minutes. I was diagnosed with Strep throat and given a Vicodin and shot of penicillin. I was then taken ro accounts and given a bill for some $1500 I was in shock, especially since I had to pay before leaving and they wouldn’t wait for my insurance to pay. I eventually got reimbursed but it put a dent in the vacation budget.

    1. Vicodin? Seriously? For a sore throat? Strep even!!! I’ve had strep throat a few ties and Tylenol is the choice pain killer…not a narcotic. However, things may be a bit different here in Canada when it comes to prescribing narcotics; they don’t hand them out that easily I guess. I’ve never even had them after leaving a hosp after having surgery. And for this I’m glad.

  155. While visiting in London once, my daughter developed a respiratory infection. We were scheduled to come home in the next couple of days, but she was so phlegmy she kept throwing up from the cough. I knew a flight would be horrible without medication. We went to a clinic and were seen in very good time. We were charged £50 but that included the visit and the medication. When we got home we submitted the receipt to our HMO and were reimburesed. I am originally from the UK and most of my family still lives there. From their experiences problems arise when you need a minor surgical procedure. My cousin had gallstones and had to wait 6 weeks to get in and have her gallbladder removed. My dad was diagnosed with gallstones about 35 years ago and by the time they sent him a referral for the surgery they were no longer bothering him so he never had the surgery. They can still be seen on recent ultrasounds. I had a gallbladder attack here in the USA and was in and out with surgery the same day. I don’t think our system is perfect, but neither is the NHS.

    1. Hi, I just wanted to mention that there is a reason for the long referral time for certain procedures, and gallstone removal is one of these.

      If you scanned the general public, you would fine lots of people with stones who have never experienced any symptoms. When patients do have symptoms, some episodes can and do resolve within the waiting period. This is because stones can pass spontaneously, or move and stop causing symptoms, depending on the size of stone, location, etc… There is always a risk even with minor surgery and if the stones have settled and aren’t causing any symptoms, there is really no medical reason to remove them. I think this is a key difference between the US and UK systems – I suspect that in the states the procedure would usually be performed anyway.

      Other types of referral with different waiting lists can be made if surgery is more urgent, usually based on the severity of the episode, general health of the patient or any suspicion of associated infection.

      The NHS has good and bad, but sometimes the things that seem to be frustrating actually have reasonable explanations.

  156. As a tourist in the United Kingdom using our A and E services for an emergency is free, (apart from prescriptions but most people get away with that as the cost is smaller than trying to cover it). As a foreigner coming over to use our medical facilities it is not hence the out rage at people trying to come over use the A and E for things prior to there trip just for free care.

  157. Because I have lived in UK since just 8 years now it’s difficult for me to judge NHS in one way or another. But from my current experience, and being a father of one (4 years old boy) born in UK I can say that I should be on stress therapy so far. Perhaps it’s my bad luck or just lots of bad days, but definitely can say that I’m not happy with NHS medical service at all. I’m not having bad feelings to people working there, just to level of their knowledge and simple understanding.

    I’m from Poland (and have rough idea how people in US imagine my homeland) but the truth is that having a conversation about NHS with my close friend, paediatric in Krakow (Poland) I gave her so much thrill she had no felt since watching Psycho under duvet when she was 12.

    I’m happy for your son being all right and you had found proper and free medical support. I can understand that in comparison to US paid service you fell amazed, and that’s great! But from my perspective I would expect from medical stuff at NHS rather proper level of knowledge and recognition instead of prescribing paracetamol for ALL symptoms and calling depression all states out of “normal”, don’t mentioning my child hospital thrill stories.

    OK, at the end of the day I must admit, that I find people working in NHS supportive, friendly, and the fact its all free gives me a huge relief. More, I used to work for NHS (admin dept) for few years and got to know system a bit. And my conclusion is: level of knowledge and experience from Polish doctors merged with NHS finance and natural-born-british-friendly-attitude would won the Best Medical Service of The World Prize in no time.

    1. That’s my thought too. I wouldn’t expect you to receive a bill. Your son needed emergency care at a time he was our guest, and nobody, especially a child, should have to worry about whether they can afford emergency care.

      Look at this way, if he’d been laid up for a few days he wouldn’t be able to contribute to the British economy through the purchase of toys, fish and chips and London tat souvenirs 🙂

      If you really feel you’d like to give something back for the care you received then the hospital you went to has a charity attached. They fund programmes that can’t always attract pharmaceutical support, and equipment (to replace things like that old lamp, it might work, but a new one might work even better…)

      You can donate here: http://www.togetherwecan.org.uk

      I hope you have a lovely holiday, and no more mishaps!

      1. Yes, but unfortunately this is not the law. The British government does not provide hospitality to visitors for any kind of medical treatment. If voters wanted to be hospitable, I guess we could start campaigning. As it is the British government has recently said it is getting tougher on not charging non-residents (which by the way includes UK citizens who live overseas) for NHS use. The real issue is that because billing is not really part of NHS culture, no-one knows about it and many people slip through the net. The real issue will not be that the treatment is free for visitors, but when billed, I am sure the bill will be less than US treatment. A single-oayer insurance scheme (which is in effect what one part of the NHS deal is – everyone pays into a common pot) holds down the costs by having a monopoly on payments A single payer system in the US would do the same (even if the medical industry itself was not nationalized). This is the real misdirection of the US debate. Single payer insurance does not mean nationalization of healthcare facilities. It just means a universal pot of money. Given the US already asks people to put money into common pots (and more or less without any real choice, since your employer decides), I think that single payer (perhaps administered at state level) should be politically possible.

  158. As a human being I’m very glad to hear that Victor was ok and that you received top notch care at a great NHS hospital. However as a taxpayer and ex-NHS service manager I’m disappointed that no one in the hospital made any attempt to refer you to the overseas visitors unit which exists to ensure that your insurance company covers the cost of your treatment (for which I’m sure you pay pretty hefty premiums). While emergency care should never (and will never) be refused to someone who needs it, NHS Trusts are supposed to at least attempt to recover the costs of treating non-residents. However, this fact is usually known only by those of us who’ve had to manage a hospital department budget and there are zero incentives for staff (clinical or administrative) to pass on this information as they don’t want to be seen as uncaring by patients. It would be interesting to know whether the overseas visitors unit ever gets in touch. At the end of the day, if they don’t, it’s only your insurance company who stands to gain at the expense of the NHS.

    1. I too work for the NHS, and am furious when people say that the NHS is a free service… people need to understand that EVERYONE in Britain pays for the NHS every month via their payslip (it’s called National Insurance) -regardless if they use the service or not. This is not the first time I’ve heard of people using our NHS whilst they are on holiday and being told they don’t have to pay. They should… we have to if we go abroad… in fact in Spain you have to pay cash BEFORE they will even look at you. Stories like this one only encourage the “hip operation holiday” we have heard of so often. I’m not saying visitors should not use the service at all, everyone should be able to receive healthcare when needed, but at least pay something towards it. People who have paid into the system all their lifes are now being told they cannot receive certain drugs or operations as the NHS cannot afford it…. I’m glad your son is ok, but you have also contributed to somebody else being refused treatment and not receiving care they need. I love and am very proud our NHS and don’t want to see it privatised, the hospitals need to ensure they take the insurance details of any visitors (especially as in this case they were willing to pay!)

    2. Although I understand your desire to have generated a bit of revenue from this episode, we weren’t given a time or day of the visit and perhaps the overseas visitors unit was shut. As a tax payer I’m not in the least bit dismayed that no costs were recovered. All staff were working anyway and the cost to the NHS was little more than the cost of a tube of antibiotic ointment, local anaesthetic drop and cotton bud. Even in today’s cash strapped NHS I do not begrudge this £2 or so to a visitor who will have injected many orders of magnitude more into the local economy

    3. Immediate and necessary emergency treatment is free to all in the UK regardless of where they come from. You are only charged for any on-going treatment once the emergency has been dealt with. In the case of Victor there would be no charge unless he required follow-up.

    4. Totally agree. We hear a lot about the medical tourists who dodge paying for healthcare while in the UK, but what about visitors who end up using the NHS and are more than happy to pay but are never allowed to. It’s easier for staff on the ground to tell patients not to worry about it. Had a similar situation after a GP appointment while on an extended holiday in the UK. I tried to pay, explaining I had insurance etc, but there was no way to do it. The receptionist just waved me out. As you say, insurance companies are benefitting at the cost of the NHS, and the taxpayers who fund it

    5. Frankly, we should treat visitors the way the author was treated. getting rid of the bureaucratic overhead that you appear to have represented would save us all money.

  159. I have been to Hospital Emergency in the US twice on both sides of the country. Each instance was a minor laceration but I was shocked that I was charged between 600 and 1200 dollArs each time.
    My wife and I moved back to the UK partially to avoid the fear of having your work linked to health care.
    I love America but the Health care system is run as a business and that is just wrong. I also think it’s sad that American doctors try to ignore the cost vs care issue as it is a reality for injured or sick people who need help but don ‘t have thousands of dollars or insurance.

  160. HI Jen

    I’m a Brit who has been living in the US (California – not sure if that really counts as the US !) for 3 1/2 years. We’re heading back to the UK at the end of this year, and the lack of a functioning health-care system in the US is one of the main reasons. Whilst we’ve experienced good medical care in the US, it’s been at a price – over $10,000 for a complicated root canal and crown for me, and over $6500 for a D&C following a period of HMB for my wife. The real kick-in-the-teeth was when my wife was lying in bed at home bleeding, to get a phone call from the hospital the DAY BEFORE the D&C telling us that the insurance wouldn’t pay and would we like to pay on installments or cancel the procedure ! This is no way to treat a fellow human being.

    Talking of which, whilst there are many aspects of public life that need a kick up the behind (useless postal service, inefficient banking system, lack of broadband, no public transport worth talking of, dire television, pathteically awful radio, gasbah and aloof politicians, rampant gun violence, etc, etc), it is the basic provision of health care that really sets the USA out as a second, not first world country. What is most surprising is that many more Americans claim to be religious; the basic tenant of which is to “do unto others as you would wish other yourself.” In other words, look after each other. But they don’t – they winge and carp about paying taxes, about “bad socialism” whilst sitting down and watching disgusting sights on TV such as the annual free treatment for the poor people of Oakland – this is the annaul bazaar where American citizens that can’t afford health care rely on charity handouts by doctors and you see people queue for hours to get simple things such as a filling done. REALLY ? Is THIS how you treat people in America ? And to make matters worse, instead of the TV news chastising your politicians for allowing that kind of third-world spectacle to take place, the reports impine over how “wonderful” it is that these “poor people” can be treated. Where is your national sense of shame ?????

    I find it most bizarre that in a country that is far more irreligious than the US, we pride ourselves in national public services; of making sure that all, prince or pauper, are treated as we would wish ourselves to be treated. And I say that as a Socialist Atheist ! Ask any of my right-wing bible-bashing nutter neighbours here in the US what THEY think about that…..

    I could go on for hours about how having insurance ties sick people to a job, the lack of paid sick days so that really quite ill people come into work, or the endless paperwork (I am still trying to prove to a debt collection agency that I have paid an $85 bill to visit a doctor 3 years ago) or the way that my son’s Scout troop “require” an annual medical (cost $250) before he is allowed to join in any games (and thereby precludes those in your society that cannot afford that kind of outlay). But I won’t.

    So, I am glad that you found the kind of social care that is at the root of a civilised government to be so worthwhile. Across Europe, I think you’ll find similar levels of care.are a base expectation. Please tell your fellow Americans to demand that same for your society. I think you’ll find it turns you into a less cold, more cohesive society as well as simply treats people humanley.

    1. I am a Brit who due to own stupidity, ( a rock climber!) and just existing have had to attend outpatients (ER) in Switzerland, Sweden, Spain and Germany. All the same as described in the article. We have E111 (or whatever its called now) to reimburse cross border work, but I have never had to use.
      I have had one experience in California (I am old not accident prone) and whilst good, it was not swift and costs covered by my company. Again as an N of 1, the comparison was poor

    2. Jen Hi,
      I am pleased that you can appreciate the value of the NHS and the fact that it was there for you when you needed it. From the UK perspective, however, things are a little more complex.

      It is a sad fact but precisely because the NHS has been labelled a free service is why in many people’s eyes it has diminished in value. Amongst the NHS’s fearsist critics are often those who receive the most out of it and because they don’t value them, patients are wasteful of NHS resources and staff steal supplies to sell on ebay, yes that happens. The governments answer to all this is to allow more and more private companies to supply services to the NHS so every thing from cleaning contracts to leasing of a whole hospital is supplied on a commercial basis, that is for profit. This we are told will be more efficient, even though evidence of this is hard to find.

      But the NHS is not free it is paid for by the UK taxpayer and as the government spends more and more money on other things, the NHS budget is being cut. It is some what ironic that while your President strives to achieve affordable healthcare for all we are in danger of loosing ours.

    3. Wow this proves all I have been fighting for my and this Nations pride and Joy NHS What alot of stupid Leaders
      the USA Has and we seem to be getting the same type . I despair . People get clever and fight for HEALTH CARE FOR THE WORLD>

    4. Yes, I am a UK citizen and would not swop having to find work in the USA that paid ‘benefits’ for anything. I think that to be ill and to fear the cost of your treatment might threaten your home and family must be awful. As someone who was healthy person all my life I was staggered when a lump in my throat turned out to be thyroid cancer. I had amazing, immediate clinical and surgical care at my local hospital, complete with a few stays in a brand new, state of the art, lead lined ensuite room when I had radioactive iodine treatments. I will have expensive blood tests and an appointment with a Head and Neck specialist consultant every six months for the rest of my life. No bill!

      The professionalism of the nursing,radiologists and nuclear medicine staff was and is so high. The equipment, level of skills, research and ongoing training made me proud to be a part of this great NHS scheme. As the person above said, you could be penniless and still get what I received. The National Health Service is the greatest asset of our country and everyone paying in under their National Insurance contributions means we are all insured. Peace of mind – it is precious let’s make sure the private insurance companies don’t asset strip it!

    5. At the risk of writing the longest reply to-date…. Some clarifications..

      1) The $6500 for the D&C was the co-pay – the actual billed amount was more like $12,000. The argument was that the clinic was not an “in-network” provider so was subject to a higher co-pay on our insurance plan (for Brits, co-pay is the same as a car insurance policy excess – the amount you have to pay before insurance coughs up). We’re not poor – but $6500 is more than we pay for 3 flights back home each year and a half-decent hotel to boot.

      2) A frient needs reconstructive leg surgery. She needs both knees replacing. Even with insurance, she could only afford to get one done a year due to the co-pay (which was HUGE !). So, last year she had her right knee replaced thinking she’d have her left knee replaced in 2015. However, the strain on her left ankle became so great due to the dodgy knee that now she needs her left ankle rebuilt ! So, the crass medical “system” has caused more suffering and more waste and expense. But that’s fine because more doctors, surgeons, insurance companies, etc, have made money out of her. Bonkers.

      3) Side effects of this corrupt system are everywhere. People are much more scared to speak up and criticse at work – the times I hear “but if I loose my job, who will pay for my medical expenses ?!” Or the price and availability of basic OTC medicines – much more expensive and much more controlled than in the UK (e.g. paracetomol OTC here for 12, about $5-7. UK, £0.39 at Boots at Heathrow last week). Far fewer OTC because the drug companies WANT you to go to see a doctor (e.g. Zovirax cold-sore medicine not available OTC) because they can control what drugs are sold…. On a roughly monthly basis, we have company-wide emails with people asking advice of how to get help for payment of medical bills – the answer is usually setup a conference call between HR, the insurance company and the doctor/debt agency !

      4) No one complains. I’m told that “America is the greatest/most democratic/fairest/ country in the world” despite the fact that most of them have never experienced any other country and simply believe what they are told without question. When I ask why they don’t complain, the answer is usually the same – “what can I do – it is what it is !” Most democratic ? I think not…..

      The NHS is not perfect – GP access is a real problem and its part-private/part-public nature as a hang-over from nationalisation is an issue that needs to be dealt with (personal preference would be to fully nationalise the GP service, but we also need to fix the supply of GPs through better education). However, when I hear UK politicians extolling the virtues of “privatisation” a-la US of A, I really quake and wonder which other EU country would take me as a citizen….

  161. Thank you for the wonderful feedback for our NHs here in the UK. As a nurse in the nhs, it has been always a puzzle to me why some British people complain about the nHS when other countries are far worse than our services– or much more expensive. Regarding being billed ; you will not be billed as emergency services in the Nhs are Free to all people who are in need of immediate care, irregardless of race or nationality. If you required an admission to a ward or facility; then that would be the time the nhs will send you a bill or will get the insurance from you.;-) so dont worry about it. Btw: just for info – registrar is equivalent to a fellow intge US.;-)

  162. I am glad your experience of the NHS was so positive. I work for the NHS in a different part of the country. I am glad you were not forced to part with money in order to get treatment, but you should at some point receive a bill. Clearly you were not planning to be there, however many many do. The UK has a high number of health tourists, people who visit to take advantage of our healthcare provisions. In part it is the inability to recover this money – patients do not always give correct details or respond to payment requests once home – that puts the NHS in such a precarious position moving forward. I can not always get the treatment I require from my area, despite my GP stating it would be best practice. I have also correctly diagnosed myself after 13 years of looking for answers (recently confirmed by the NHS). Through my taxes I pay for my healthcare through the NHS and feel everyone should contribute through proving they pay tax or by payment before they go home. If everyone tried to pay and was enabled to pay at the point of contact the overall experience would have been even better with top rate equipment etc.

  163. One of my good friends from Knoxville, TN, once said to me on a visit to the US – “The healthcare companies over here are raping the citizens of the USA, they have congress in their pocket, and even though I don’t support Obama and his policies, I can see that he wants to break the stranglehold these obscene organisations hold over our people. Whether it’s the healthcare insurers, or the pharma companies, they are all hand in pocket driving up the costs to the people of this country. Your NHS scares our politicians because their backers are scared. All we hear are stories of corruption and waste, never about the free care for all of the people of your country. Healthcare costs will kill the USA, “Obamacare” won’t work either, it’s impossible because all of those working against it” Now that comes from a real flag waving USA patriot, a GoP voter, someone who has seen the issues that is killing America. And while America remains corrupt in the pockets of the political funding corporations, you’ll never see what we see here in the UK. FREE medicare at the point of delivery. Yes, we pay for it in our taxes (via National Insurance), but it’s a LOT less per capita than the medicare insurance my dear friends in the USA have to pay. My 91 yr old mother has just been admitted to hospital with a broken thigh bone (femur), and by now (10pm) she should have had her operation to pin the bone. There will be no bill. No insurance claim. Just healthcare, immediate, and caring.

  164. Dr Gunter, you will not be charged for your sons care, because under the NHS charter, everybody is entitled to free EMERGENCY care, if accessed through “Accident and Emergency” (ER) or Walk in Clinics. No matter what your nationality, if you’re in need of care (ie gun Shot wound, appendicitis we won’t wait until you’ve made a phone call while you’re in a coma, or make your ambulance go another 20 miles to a charity hospital so that you can die on the way to there! We treat and care about people, not about your wallet! I have worked in the NHS for nearly 30 years, it’s brilliant. Welcome to the UK, I hope your vacation gets better, and take comfort that if NEEDED you will be taken care of!

  165. i have a fair amount of experience of the US system ( children plus a holiday home in US= doctors!) i have visited urgent care several times in the US and found it to be efficient, if pricey. however, if a hospital visit is required it would probably be best to get on a flight home! their charges are geared to overcharging insurance providers and the noughts just keep being added. my private health care provider paid up but i am sure my hike in the following year”s premium directly related to the claim.
    you query the anti-NHS american media which was in full flight around the obamacare debate- simply political, in my view. you can find horror anecdotal tales in ANY health care system, so they only had to be exploited.
    i think the UK should have urgent care outlets in malls and residential areas- but for the anti- brigade this is a mythological slippery slope.
    i appreciated reading your post.

  166. I love our NHS, glad your boy got the care he needed. All I can say is I’m glad that I pay for the NHS and our welfare state. It’s far from perfect but brings a peace of mind knowing that my mother is well taken care and should my daughter need health care it’s there from her. The welfare state is flawed but precious and needs protection, thank you for praising it.

  167. The difficulties lie in the notion that some working people end up paying for those who aren’t at work as described to me by my friends in the USA.
    in the UK we are having a wide ranging debate prompted by the current financial climate, about the affordability of a universal free to user service.

  168. Hi
    I was visiting the UK Wales to be specific last summer, when my appendix decided to give in the day before my trip home. So off to A&E we went, where I was seen promptly and subsequently admitted for emergency surgery. This was at the royal Gwent hospital, where I received excellent care, there was some waiting involved but that is too be expected. Long story short I have nothing but good things to say about the care I received. Now once I was admitted, the service was no longer free so I did receive a Bill in the mail however it was for around 2500$, this included the surgeon, the surgery, an overnight stay as well as the drugs for pain etc. This would run into the tens of thousands here I believe. So I’m misty certainly not complaining.
    The nhs may not be perfect but it’s a damn sight better than going broke trying to pay your medical expenses.

  169. The UK has public (National Health Service, aka NHS) and private (aetna, etc) health care. What the NHS does very, very efficiently is mop up the low-end cases: seeing a GP for a sick note or some antibiotics, pre-natal oversight, etc.

    But it’s a private health care system introduced /over/ a nationalized system. So be careful when considering trying to map the same notion back onto the US system.

    The PUBLIC healthcare service has multiple impacts on the quality, efficiency and cost of the private care systems.

    1. The trivial stuff that clogs up American systems – the sick note, request for antibiotics, the flu check, referrals, etc – the stuff you *could* go get from Minute Clinic etc, is provided – without needing to bring your wallet – by a doctor with a vested interest in bringing you into their long term care and providing a solid, olde-school “family” experience that will have you sign up with their practice.

    2. This makes Brits far more pro-active about trivial preemptive care than their American counter parts, and it leads to their being less heavily medicated (in the UK, that thing behind your mirror is where you keep your tooth brush and pain killers and band aids while in the US it’s just outright called “the medicine cabinet”; in the UK, the equivalent of WalMart is largely a book store with a cosmetics aisle, a row or two of pain killers, bandages, and herbal stuff plus a pharmacy counter, compared to Walgreens or CVS where you have an AISLE of antacids, an AISLE of anti-allergens, etc…)

    3. This raises the bar for the point at which most Brits interact with their private medical providers; this makes those providers more available, more focused, more attentive.

    4. As a result Brits spend far less time with their medical providers (of both kinds) and both systems are able to run more efficiently, more cost effectively and more successfully. Americans expect it to mean that you’ll save a little on your private but spend more in your taxation for the public. It’s actually, over all, much cheaper – the private insurance is lower, the actual expenses when you use your private care are lower, and the service is MUCH less impersonal.

    The US health system, by contrast, is mired in ridiculous green-tape. That’s my term for what starts out as red-tape (practices required to keep a hospital from getting sued) with the primary directive to make money (green as in the color of money).

    My first experience with American medicine, after 7 years in the US, was a gallbladder failure. Whole story below.

    At various points in the whole process and post-op, various medical people asked me “do you want a blah-blah-blah-ology”? Then and during a couple of subsequent ER visits, the pause while I tried to decipher the latin/greek words to figure out what I was being asked was often interpreted in a way perverse and confusing to me until I realized what was going on.

    For example, one doctor asked me if I wanted a colonoscopy. I didn’t immediately know what that mean’t, and my first translation connected colon and biopsy, which sounded excessive for the situation. Again, they’d recently given me morphine so I was operating on thrusters I didn’t know I had.

    By the time I’d registered that it was where they just take a look, he’d already concluded that I was formulating a “no”. By the time I was ready to clear that up he was making other suggestions and I was following along.

    I just wasn’t used to a doctor *asking* me if I wanted things rather than advising me. I wasn’t sure if my British accent was making people think I would automatically know every medical term and product name or what.

    My first assumption was that he thought I was being prudish about having someone go near my backside.

    But in hindsight, I realize that it was about costs. American’s expect to get fleeced and the dialog with the doctor/surgeon is actually a bartering negotiation that would make an Arabian flea-market vendor cringe. “For a life time of debt, we can do this curiously expensive procedure that will completely resolve all the issues and symptoms, or we can save $100 and possibly cost you a leg and put you on expensive medication for the rest of your life”.

    In the UK, the first discussion is purely and solely about health, health care, individual comfort and preferences and THEN come the requirements and costs.

    *** My first US emergency room experience…

    The very, very first thing any American medical professional asked me was “Rate your pain on a scale of 1-10”, in a slightly annoyed “why are you here” tone. The second was “Do you have insurance” and the third was “sign here”.

    I was in a lot of pain, disoriented, and across the hall a patient who appeared to be bleeding out was being defibd. I suspected that was a lot more painful, so I said 6. Wrong answer. I was given forms to sign (which I couldn’t actually see) while I was tormented with phrases like “please just sign it so we can treat you” when I showed difficulty comprehending the questions which appeared to be interpreted as “got a stupid one here”. I started to feel bad for so terribly inconveniencing these ER doctors with my silly tummy ache.

    The next part is a bit of a blur, someone decided on antibiotics, and it was indicated that it would be soon because it seemed urgent. An hour later, nothing had happened and a nurse complained at me that I should be sleeping. I asked where the antibiotics were and she told me “oh, I’m sure someone will bring them, go to sleep”. I explained I was in more pain than I’d ever felt before and she frowned at me. “Do you want or some morphine?”

    I’m not a doctor, I didn’t know the terms, and morphine is a drug. So I said “no”. “Ok” she said, and connected the morphine drip and started it dripping. “No morphine” I blurted. “Oh, did you want the ?” she asked, starting to leave the room as she did. “No” I said. “OK” she said as she disappeared out of the room.

    The next nurse showed some alarm about the no-show of the antibiotics, especially when I described the pain. She scolded me for giving the wrong answer on the pain scale, was very annoyed, turned my morphine off and went in search of antibiotics and someone to do a sonagram.

    The guy with the scanner arrived shortly before the antibiotics. He indicated that I was interrupting his lunch break, and that if I wasn’t in a hurry he could come back in about an hour. In hindsight, my rating my pain as a “6” rather than a 10 made everyone think I was a time waster. Fortunately he noticed my temperature, told me I should be drinking cold water (which hadn’t been offered me), and took the scan. Shortly afterwards the first person showing any actual interest/concern arrived, told me off for taking so long to make them aware that I had a serious problem going on and that my gallbladder was blocked, infected and on the verge of rupturing.

    “Do you want surgery?” What the HELL kind of question is that to ask someone doped up on morphine in agonizing pain. You’re a doctor. Why aren’t you telling me the best course of action and making sure I understand the terms and trademarks coming out of your mouth?

    In the small hours of the morning, a half hour after the nurse had again responded to my answering “no” to the question “more morphine?” by giving my more morphine, the surgeon arrived and gave me a vague outline of what he would be doing.

    “We can send you home with some antibiotics to clear the infection, and then in a few months it’ll get infected again and you’ll die, or we can remove your gall bladder” he told me.

    Honestly, I was flying. I’ve never done recreational drugs, rarely drink, didn’t smoke, morphine hit me like a truck with a cow catcher and a magic clown and a lot of helium balloons. I thought it would be really cool to see what my gall bladder looked like. “remove” didn’t mean to me, then and there, what he thought it mean’t. I *think* I just imagined they’d tip out the stones and put it back.

    “Can I see it?” I asked.

    “Erh, we usually dispose of biological waste safely to avoid risk of contamination” he replied.

    I thought this was bizarre. I was in hospital because, after 37 years, it had finally made me sick, so how was it going to “contaminate” me just to look at it?

    “I don’t want to touch it, just see it before you put it back” I said. I don’t think he caught that last.

    “I’ll see what we can do” he smiled.

    “OK, that sounds awesome” I beamed and shook his hand.

    And so the next morning I was rolled into surgery. Apparently they didn’t know how to catheter an uncircumcised male, because I subsequently got a bladder infection. Nobody warned me that this guy used staples, so I woke up with a rather piss-poor staple job holding together my incisions. And most importantly, they hadn’t put my gallbladder back. There was a tube with a bulb sticking out of my side, when I rolled over to look at it, it made a horrible slurping sound and send weird, painful sensations all around my abdomen – I’d been sleeping on that side and, as I discovered over the next few hours, it would drain nasty stuff out and then squirt it back in when I accidentally rolled onto that side. Eventually a nurse arrived and scolded me for not emptying it myself.

    I protested, “Nobody told me I had to empty it”.

    “It wasn’t obvious to you that stuff is nasty and needed disposing of?”

    “I have no idea how to ‘dispose’ of it and it didn’t seem like a good idea to go pulling things out of this hole in my side.”

    She turned up my morphine and left reassuring me she’d be back in a half hour to empty it again.

  170. nteresting and glowing review of our NHS and worthy of note to the NHS that they don’t appear to be set up to take advantage of non UK citizens who have medical insurance and take it out for exactly the sort of case highlighted. Sure this is the thin edge of the wedge when it comes to how the NHS is run and managed and how they fail the committed surgeons, doctors, nurses, consultants and all the other staff who simply know the work they do is more than just a job but a role they feel compelled to do. Nice read, thank you.

  171. Thank you Dr Gunter for your comments. I have worked in the NHS for 30 odd years and feel very proud to have done so! I feel that it is an institution to be proud of despite all its problems and i am glad you found it so too. I wish more people would sing its praises.
    A lot of people would not get the appropriate treatment if they had to pay for it or access it thro’ insurance so lets have more votes for the NHS free at the point of access!

  172. The irony is, if you start billing foreign nationals’ insurance, the cost will go up. We would have to hire a whole administration and billing centre for each hospital; the existing management structure could not fit it in, and that additional cost would have to be bourne by those who are being charged for the service. Accounting would be a nightmare – nurses and doctors would have to be required to list treatments, scans, medications, investigations, sundries and bed allocation for billing purposes – which takes their time away from their critical work – getting the patient back out the door!

    Pay it forward… give the equivalent to a UK charity or children’s organisation.

    I wouldn’t swap the NHS for anything. I agree with some of the comments that it’s sometimes a bit of a random goose-chase (if you have a complicated condition and don’t get referrals to the correct consultants first time), but the two streams of treatment for acute and ‘regular’ treatment is worthy of its history. And it’s kind of like an insurance, we all pay tax for it, and get pretty much all the treatment we need to keep the workforce healthy and gainfully employed and mobile. It could be streamlined, like any huge organisation, but the working bits far outweigh the broken bits.

  173. This is a really great post… Mainly for the reason that, especially In my part of the country, (North East England) hospitals and the NHS sometimes get a bad rap, and it’s not fair because the doctors and nurses work their arses off… I’m not a doctor nor a nurse but I’ve spent a lit of time in the bloody places I feel I could be lol… Awesome! Xx

  174. I am 60 years old. Most of my experience with the UK National Health Service throughout my life has been dire. Both my parents were misdiagnosed when they had cancer and died as a result. I was misdiagnosed with another condition and nearly died as a result. GP receptionists treat me with contempt and refuse to let me use my rightfully gained title of Dr (in case “Doctor” in the surgery might get upset?). Nurses refuse to listen to my story and jump to unfounded conclusions. Asian doctors are the worst of all. Rude, intolerant, ignorant and totally lacking in compassion. I can only get an Asian GP where I live. Result: for the last 5 years I have avoided going to the GP and have bought my medication online.

  175. Thank you for making such a positive post. I have recently moved from the UK to the US and am saddened by the overwhelming negative attitude to the NHS over here, mainly from middle class people who can afford health insurance. My heart goes out to those who can’t. When in the UK I was a podiatrist in the NHS and was proud of the service we provided and the commitment of all of my staff, from the receptionists who did their best to fit everyone in when they needed to be seen to my foot care assistants who worked with us and my fellow Podiatrists.
    In addition I have been in and out of hospital since I was 6 weeks old with long term illnesses that made me nervous about coming to the US. My godmother offered to pay for me to go privately on many occasions but I could not have had better care than I had from the NHS, from my GP, in the ER, on admission or in theatre. It was that care and dedication that steered me to my future career.
    I have only been in the US a few months, the care I have received has been excellent but I don’t enjoy receiving the bill!

  176. I look at the American Healthcare system with much sadness (I am a Brit). From what I saw of the propaganda against “Obamacare” in the reporting of it in the UK a lot was made about “socialised medicine” (not a term we use over her) being evil, and yet some of the richest people in the US are the CEOs of Medical Insurance companies. It’s hardly rocket science to understand why.

    My wife went to see her GP about a prolapse in April, was referred to see a specialist in June – wherein a 8cm tumour was also discovered in the same locality – and had the 5-hour operation last week (beginning of August) at the Worcester NHS hospital. She stayed in hospital for 4 nights, had a room to herself, and had excellent treatment throughout. All the staff (except 2 agency nurses on one particular night shift) were courteous, friendly, and informative about what to expect. Cleaning of the ward was notably diligent throughout (UK hospitals had a bad time a few years ago with superbugs). Overall the entire process was rapid (4 months from diagnosis to surgery), totally successful and there is no bill at the end because medical treatment is free in the UK. My only cost was car parking. NB Her medication is free as well because she is over 65.

    Big business really seems to have many markets sewn up in the US. I gather broadband can cost over $100/month, over here we can get it for a quarter of that price (inc line rental). “Socialist medicine” is evil?? How does anybody – at all – believe that hogwash to be true?

  177. I moved to England three years ago to come to university. During the 2nd week I got hit by a car. (They drive on the wrong side of the road). I woke up in the hospital 4 hours later, they had already given me a head scan to check for any serious damage (there was none) and then they stitched up my ear, gave me a meal and offered me the bed for the night. I refused to stay in the hospital overnight so they gave me a phone to call someone to pick me up. Everyone i met was incredibly nice and caring. I have not one bad word to say about the hospital. Would have been a great experience if it had not started with being hit by a car.

  178. Our daughter had Acute Lymphblasic Leukeamia (ALL) at the age of 2. She received her first dose of chemo within hours of initial diagnosis. I always say, the NHS is the best if your life is on the line, if not, get in line. It certainly puts things in perspective.

  179. I had a moped wreck in Thailand and was sent to the ER for scrapes on my left knee and foot and a big abrasion on my right lateral ankle. Because of the ankle swelling and poor ROM, the doctor ordered an x ray. It was negative but still taken. I also had more than a weeks worth of daily visits to the ER nurses for bandage changes. Having worked in healthcare and of course, using it in the States, I was cringing at what the cost would be without insurance. At no point did they collect information except my name and dob. Only payment after. My total charges for all of my care were less than 100 dollars. For a Thai, they thought it was outrageous. As an American, I felt guilty getting such a steal.

  180. Neoliberal propaganda is what frightens them. It also frightens me. I love the NHS it got me into the world safely inspite of me being an awkward #er arriving feet first, with the chord around my neck. At the time it was only five years old, but l fear l will out live it. If l do it will only be for as long as l am not ill. I blame Thatcher and Regan.

  181. Neoliberal propaganda is what frightens them. It also fightens me! But l love the NHS, it bought me into the world, through a complicated birth, when it was only five years old itself, but l fear l might out live it. lf l do, l guess it will only be for as long as l remain healthy.

  182. Hi Dr Gunter, it’s great that your son was well treated by the NHS.Yes, as a Brit I believe it is something to be proud of but it is not without problems. I live in Wales where our Welsh government has responsibility for NHS spending, one of their “brilliant” ideas has been free prescription drugs for all. Recently I damaged my shoulder and received two prescriptions – one for a codeine based pain killer that is not available “over the counter” the other was for about 250 Ibuprofen tablets as an anti-inflammatory. Ibuprofen is easily and cheaply available at a local discount store and I couldn’t help wondering if my prescription was the best use of NHS money. We also have an acute shortage of NHS dentists and the private option is every bit as money grabbing as the US counterpart.

    1. You forget one thing, in the UK you are restricted to a maximum of 3 packets of Paracetamol or Ibuprofen tablets over the counter. For any amount over an above it must be by prescription. So it was the best use of NHS money and saved you having to return to a pharmacy many times over a few days to obtain the same quantity of tablets. It’s the same in Scotland, free prescriptions

  183. There is a national target in the UK for people being seen within four hours in the emergency department. This has its advantages but there are times where the public can abuse this (I say this as a Brit). You often see people clogging up what is essentially the Appendages Falling Off department when they have no visible injuries because they can’t get a GP’s appointment or don’t want to sit in minor injuries. At times this is what extends waiting times.

    I hear from an ex-NHS employee that anyone, regardless of nationality, is entitled to free care for the first twenty-four hours. As such, you probably won’t be billed. 🙂 I’m very glad you had this experience because it is a shame America is so petrified at the thought of free medical care. To add to your survey of people, I wouldn’t trade the NHS for anything. I think it helps the public psyche to feel taken care of in a crisis.

  184. I had to go to A&E in St Thomas’ before and had this idea that I’d have a long wait. It’s a central london hospital and my problem was only minor. But I only waited just over an hour. My longest wait in NHS A&E has been 3 hours. Huge difference to the care it used to get in Ireland, where my average wait was around 10-12 hours and we only have 1 A&E department per 2 counties (with exception of the cities), to top it all I had to pay for my health care! Even when considered a emergency, I spent half a day in a chair in the waiting room semi-conscious attached to a drip the triage nurse had put in. When I finally got admitted I was actually given the wrong antibiotic (making me worse) instead of better, meaning a longer stay in hospital. My bill was just over €2500! Very thankful for NHS, have access to it has actually improved my life for me, and the prescription fee has been a huge help to me too.

  185. Sadly this is not the same everywhere in the UK. Some areas are severely underfunded, understaffed, and crowded. My fiance, a UK citizen, suffered a severe crushing blow to his hand one day. He had a very long wait to see any doctor, and was eventually sent home to wait surgery, because they hadn’t someone there to do it. The wait was a considerable amount of days. The surgery was complex and required the removal of bone from the hip to reconstruct the hand, pins, and a cast. He was left with a loss of movement in his hand and hardly any therapy to restore it. His hip has also caused him troubles in later years. I know that had he been to a better hospital I don’t think this would of been the case — but many UK citizens have no choice in the matter simply because of where they live. When I visited several years ago he needed some dental work, so we went to a dentist. There was a long wait for an appointment (if he had been here he could of been to see my personal dentist immediately). The building was shabby, old, and didn’t appear cleanly. The staff were caring sure enough, and I cannot fault them for that. But the tools used were very out of date. Since he did not wait the cheaper fillings offered, he paid out of pocket. I noticed then that a lot of dentists were leaving the NHS in the area (as well as doctors), apparently because of governmental overreach and lack of funding. They feel going into private practice gives them more freedom and money. This has limited choices and caused more problems. I can also tell you a story of a newborn with known severe medical issues that needed immediate NICU and should of been moved to a hospital in London that could of provided life-saving surgery (however risky)… but the doctors at the understaffed hospital had no intention of doing that as they felt no point. There was no C-section, and the mother had to endure hard labour and see her child suffer afterwards with no treatment. The child died a day after it was born without any attempt to save it’s tiny life. Look, as an American that has experienced her fair share of madness and stupidity with our medical system I cannot fault the NHS. For the most part it works great. If you live in more wealthy areas, chances are you will get the best of all care you could ever desire. But it is not the same everywhere. If those standards were across the board, I’d have no complaint at all.

  186. Watch out for TTIP – American firms will be able to sue the NHS for “uncompetitive practices” if it’s passed unamemded.

  187. A few commenters have suggested that they should have charged you and that they were in error in failing to do so. As I understand it, this is incorrect. Had you visited a GP, had your son been admitted, or had you undergone any non-emergency care, then you would have been charged (or at least should have been). However, this was an emergency room visit, and your son wasn’t admitted. According to NHS rules such treatment is free even for overseas visitors. And I’m proud that this is the case.

    (More information here: http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx)

  188. Dear dr Gunter,
    You were just lucky! You wouldn’t be talking like this if the dear NHS had killed your full term and perfect daughter during your labour day. I believe every one prefers to pay instead than having a daughter killed. Thanks Stepping Hill hospital in Stockport uk. I have even got their admission of fault on tape!

    1. And PRIVATE hospitals never loose babies!!! I remember some years back where a private maternity hospital in London managed to kill the baby AND the mother despite the best efforts of the NHS emergency service to save her after she bled out. This was a big story in the newspapers and TV news. In an emergency you’re MUCH better off with the NHS.

  189. I’m an America who lived in London and I have only good things to say about NHS. It’s not just the UK, though. Oddly enough, I had the same experience of a bit of dirt blowing into my eye in Rome. I went down to the local eye hospital, conveniently located down the block, waiting a few moments, was moved towards the front of the line because I was slightly uncomfortable, received great care and there was no bill. We need this so desperately in the US! I have been singing the praises of “socialized medicine” ever since. Last February I had the flu with a high fever so I went to an urgent care center in my neighborhood, was seen by the doctor for about 10 minutes, was told I had a fever (you don’t say!) and was given some Tylenol and went home. I waited about an hour and a half to be seen while in a lot of discomfort and trying to corral my toddler. The bill was $1400! And that was THROUGH insurance (!) because I have an outrageous deductible. I asked what the cost would be out-of-pocket and it was $450. This is also outrageous and that $450 doesn’t even count towards my annual deductible. I feel forced to forgo health care because I’m worried about the bill. Meanwhile, my family pays close to $400 per month in health insurance premiums. This is shameful.

  190. And the real kicker : this marvellous health care system costs a little over half per capita than what the US system spends (and gets better outcomes).

    The US does not fear the real face of public healthcare. They fear the boogeyman that has been raised in it’s place by those who want to continue to profit from it.

    The US wastes so many resources on their system. Vast number of clerical staff who operate both ends of the tug-of-war rope that is insurance billing. Systemic over-investigation of patients because of the lawsuit culture that all that money encourages.

    Hiring doctors to work for insurance companies and deny payment on policies. It is the US that has the _real_ death panels, staffed by doctors like the repentant Linda Peeno.

    I am glad to live in the UK and cannot personally imagine entering into a contract with any entity that would profit from my death (rather than saving my life).

    Unsurprisingly our NHS is under attack from the big corporations who make profits from healthcare, lobbying their stooges in our government to give it into their hands. The wedge is being driven in deeper every year. I hope we can manage to pull it back out again.

  191. My father had a mild heart attack in the US. He had a full body CT scan which uncovered a much more serious kidney issue that saved his life. The NHS wouldn’t have carried out the scan. The bill , including helicopter transfers etc was £50k which was eventually covered by his travel insurance after months of correspondence. Initially, there were never any questions asked about how he would pay but he was asked for his credit card on discharge . He now has one kidney and his life so we are all very thankful for the care he received in the States and we wonder if he would still be alive today had he had the heart attack at home ! So there’s good and bad in both systems!!

  192. I was in the US in 2006, upstate NY, I got some kind of bite or cut on my elbow which got infected, redness, heat….I was flying home in 4 days but I knew in the back of my mind that if I didn’t get this fixed it could become very nasty. I inquired about the nearest public hospital, got a taxi and off I went. It was small hospital, as far as I could tell there were 4 people working in the department, an AP clarke, a triage nurse, a doctor and another nurse assisting. The first person I spoke to was the AP clarke who made sure I could pay, took my credit card. The time then from triage to doctor was quick, everyone was very kind and polite, the doctor gave me some antibiotics and a warning that if it spread I must come back immediately to be put on a drip. The whole thing took less than 2 hours,I was billed $600. The antibiotics cleared up my elbow but the bill nearly have me heart failure!!!!

  193. I hear that emergency treatment is excellent on the NHS, and despite having lived in the UK for the past 20 years, I’m lucky that I’ve never had to experience it. I’ve experienced maternity care. Apart from the initial booking and the 12 week scan getting delayed so much that it was too late for it due to a bureaucratic mistake (that the GP wasn’t “allowed” to put right), everything was great.
    HOWEVER, when I started getting worried about my 18 month old toddler’s health and visited my GP, he suggested I should see a pediatrician as he didn’t know the answer to my concerns. He said he’d schedule an appointment. A month later, I got a letter from the NHS to let me know that they’ve scheduled an appointment for 2 months later. 3 months to see a pediatrician??? I don’t think there’s another country in the world, where one has to wait 3 months to see a pediatrician. Very disappointing.
    We’re a healthy family and hardly ever use NHS resources, and the one time that we need to see someone, we have to wait 3 months. I wonder how long I will have to wait if she needs any treatment following her appointment. Shall wait and see.
    My overall opinion is that the NHS doesn’t work, and we desperately need some drastic changes to the system.

  194. I was interested to learn recently that the cost to taxpayers for the American healthcare system is actually HIGHER than in comparable tax-funded systems.

  195. Having been born with a congenital hip defect, and the subsequent concurrent de-rotation femoral osteotomies I’ve had (yes a mouthful) I’m incredibly grateful for our NHS and cannot praise the men and women that have looked after me and tried to get me walking again. I’d dread to think what it would’ve costed, had I been born elsewhere and its lovely to read such a positive account of what on the whole, is a pretty amazing system. thank you.

  196. Glad your little boy is ok 🙂 this was an unplanned incident its not like you came over specifically to get treatment on the nhs. My sister in law was in vegas and caught her leg on a fence or wall or something. She got taken to the ER and they had to put her out to stitch the wound as it was really deep. She just got a bill for £ 17000!! Now theres a huge problem with her insurance paying it because the hospital were supposed to get her to check with them that they would pay up first. Booooo to the USA!

  197. I’m English, and an absolute supporter of our NHS – it may have a bad reputation internationally, but I am convinced that this is of our own Governments doing, in order to push for privatisation. I went to A&E two weeks ago with a sore throat, and feeling very strange. This was on a Friday when I would expect to be waiting for hours. The triage nurse saw me within 10 minutes and said I had a normal temp and blood pressure, and I fully expected them to send me away to try and see my GP. They didn’t, and after seeing a very sympathetic A&E consultant 20 minutes later, who wasn’t sure but suspected something, and then an ENT consultant within 20 minutes, I was diagnosed with acute supraglotittis and admitted. Everyone I came into contact with through A&E and my week long stay in hospital was wonderful. It may not get it right for everyone all of the time, but I am so thankful for our NHS.

  198. Hi. Great to hear that you were impressed and I (a British/Canadian used to healthcare) want to share a story of the USA with you.

    Went to LA (Culver City) to visit a friend and arrived with a cough which slowly got worse. Eventually I knew i needed to see a doctor and as I had health insurance and a clean credit card made my way to the hospital fearing the worse.

    I entered the ER and asked to see a doctor saying I was from the UK and had insurance. They took my details and within about 15 minutes was brought in to a room with beds to wait for a doctor. When she arrived she did the usual checks and then listened to my breathing. Diagnosed it was bronchitis and prescribed a dose of antibiotics. The hospital provided me with a very detailed printout of my condition and instructions.

    Then they discharged me. I went to give them my details which they took written on a piece of paper and that was it. Never heard anything after that.

    I have been told that hospitals can provide ‘free’ care in the US but it is up to them on how it is done.

  199. You got lucky.
    When it works it works great but for every story like yours there is a slough of tales of endless waits and underfunding and harried incompetence. I’d rather be in a US hospital any day.

  200. Our NHS is amazing. I am sorry you had to use it but glad you got to see it at its best. Sadly our current government are eroding it but I have never understood why every civilised country doesn’t have something similar. It appals me that people in a civilised modern country have to bugger themselves to get medical care.

  201. So pleased you had a positive experience in our “free at the point of care” NHS. I am Staff Nurse on a surgical ward in the NHS and couldn’t be more proud of the service we give to everyone, regardless of your sociological status. I cannot imagine suffering the pain of Cholecystitis or Appendicitis, or not getting my bowel symptoms investigated for fear of whether I could afford to pay or not. Our system has flaws, like any other, and sometimes mistakes are made, like any other company, but when you consider the millions of people every year who are treated, the percentage of errors is small. If you have to wait a long time in the A&E it is more than likely because the staff are busy saving someone’s life, or because of the sheer volume of “customers”. We should be proud of our system and ensure that we don’t lose it.

  202. The NHS isn’t perfect, far from it, but its free at the point of need. That was the very principle it was founded on, and why it works so well. Everybody is equal, whether you’re rich or poor, British or foreign, you pay tax or you don’t. Some say this is why the NHS is supposedly falling apart. I work for the NHS and while times are tough, I wouldn’t say its falling apart. I’m glad that your child who was suffering was treated for free. For that reason I am happy to pay my tax. It saddens me that in the states the poorest of the poor don’t get the service they deserve. It confuses me why so many in America are so afraid of a nationalise healthcare system. What is the worst that could happen??

  203. Our 2 children are only here because of the NHS. One was born at 32 weeks and spent 3 weeks in SCBU. The second was born at 27 weeks and spent 10 weeks in SCBU. The care whilst they were in SCBU was amazing and the follow up for the next year was also faultless. Had we had to pay for all this, our second daughter certainly wouldn’t be alive today.

  204. You will not receive a bill. My nephew from Holland broke his leg in Scotland and was also not charged. The systems don’t exist for it asit is suh a small proportion of NHS spend (contrary to uproar about medical tourism). As a UK tax payer, thank you for offering though!
    In my experience, the minute a child is involved there is a very short waiting time – not the same can be said for adults.

  205. I received first class care when I fell ill in the US but received the most ridiculously high bills from lots of different departments for months after. Luckily my travel insurance covered it. When I was discharged I received a prescription for Vikadin and my cab driver told me that each tablet on their own I could sell for about $20 as so many people try to self medicate as they can’t afford medical bills or insurance. This made me sad as although in the UK you can go on a waiting list you will get seen for free, and, if the condition is serious they get you seen PDQ. My partner is walking proof having received life saving surgery to remove a tumour which they originally thought was inoperable due to it’s proximity to vital organs. Five years on, he’s fighting fit! I am so proud of our NHS.

  206. Interesting statistic is that although the US government foots the bill only for medicaid and medicare patients (and even then not 100% of the bill), the cost per capita is twice that of the NHS. I’ll say that again – the US government pays twice per capita to treat a subset of the population than the British Government does to treat the whole population.

  207. I’ve often wondered as to why America, and certainly Republicans are so against a national healthcare system, and the only logical explanation I can come up with is this –

    The Republicans (arguably) are a corporation-controlled party. Their interests of decentralized government, minimal taxation and minimal regulation are borne out from the lobbyists (for corporations) whose primary interests are profits. A nationalized health system, in as much the government guarantees health insurance for all of its populace as standard, is an affront to profit making. By ensuring corporations control the health insurance it keeps their employees in a state of fear. They’re afraid to leave or rather lose their job in case they or their family get sick whilst unemployed and they have a massive medical bill waiting for them at the end of it. This fear ensures that employees take the fewest holidays – Americans get on average 14 days off a year (compared to the British 28) but only take about 10 of them (compared to the British 28). It ensures they work longer hours – it’s becoming standard across America in most industries to work upwards of 12-hour days (compared to the Western European standard of 36 hours a week). Why? Because as long as the corporations have carte blanche to fire employees who aren’t pulling their weight and control over their access to affordable medical care, the employee will accept whatever demand is made of them. It ensures maximum profits for minimum costs.

    This is the only explanation I can find as to why a first world country will protect it’s populace with a military, a police force and fire department but won’t protect it’s state of health. It’s entirely about money.

  208. Hi, just read your story about our NHS and I’m glad your child was seen promptly and came out ok.

    Free at the point of delivery, no questions asked if we can’t give comfort to a child irrespective of nationality, I would want to give up the whole game and emmigrate. It really is our finest creation, it’s a pity that there’s back door privatisation going on just now but that’s a discussion for another day

    And visit Edinburgh next time (if you never made it up). We would love to see you!

  209. Dr Gunter, thankyou so much for your article. It was so encouraging to read. The NHS has literally saved my family’s lives more times than i can now count. A few years ago my dad underwent a routine scan to identify a slipped disc in his back. They found one kidney full of cancer. Only TWO DAYS later, he was in surgery and it was removed. Fast forward 8 years and my dad’s cancer came back, as it sometimes sadly does. He has been in intensive care 3 times, for weeks at a time sometimes, receiving round the clock one-on-one treatment as they battled to save his life. My brother and sister in law visited from the states. She just couldn’t believe that he was receiving all of this – for FREE. In the States, we would have had to have made some awful decisions and likely turned off his machines a long time ago as it would have cost more than our house. Over the course of his treatment there were times when things messed up. Sometimes there were long and frustrating waits. But when he finally did die, in an NHS hospital bed, he was treated with the utmost care and dignity right up until the end.

    Both he and I have paid taxes all of our lives, and so contributed his fair share to the NHS. But his entire life’s earnings were probably not enough to cover the cost of the intensive treatment that he actually received in the end. There are some winners and some losers when we all contribute to a big pot in terms of what we receive from it. If I never have to use the NHS myself again I will count myself blessed indeed (which of course will never happen!), and will remain delighted that I can contribute to something that means others will ALWAYS receive the care that they deserve – because their value is not in how much money they earn and what they can afford, but because they are intrinsically valuable as a person.

    1. Forgot to add my latest experience which was due to an infection from a wisdom tooth extraction. It was out of the main clinic’s hours (9pm) so had to go to the A & dept. The trip took until 1.30am but in that time I was triaged, blood tests done and processed for septacemia, saw a registrar, transferred to the oral surgeon who sent me for an X – ray at midnight, put on an IV antibiotic drip, handed two types of antibiotics and two types of strong painkillers, extraction site dressed, and sent home. I waited no longer than 20 minutes at any one point and received top notch care. And walked out paying nothing. Why are people frightened of it?

  210. My last (and longest) trip to the hospital happened 5 weeks ago. I was fortunate to go through triage on the delivery ward rather than triage in the ER (Accident and Emergency or A&E for short). I think it depends where your hospital is to how fast you are seen along with what the issue is. We’re in a town called Bedford about an hour both of London by train and it always seems like there is a long wait so if we can we often go to the drop in clinic in the first instance as you can be seen and home within an hour on a good day. (In fact on Sunday we’d been seen, been home and got to the pharmacy at the local supermarket within that hour).

  211. As an American citizen who lives in Australia (with a medicare system similar to the NHS) I am constantly bewildered by the US healthcare system. Bureaucratic organisations can always become bloated and suffer inefficiency – but isn’t that just an argument for better management rather than giving up?

  212. You really shouldn’t get a bill for your son’s treatment – you’ve already paid your share!

    It’s not obvious to a visitor, but there’s 20% VAT (a kind of sales tax) added to the cost of most things and included in the advertised price.

    While you were here you must have spent a small fortune on hotel rooms, restaurant meals, hot takeaway food, visitor attraction tickets and souvenirs. The VAT from that went straight to HM Treasury, which pays for the NHS.

    So, you’ve already contributed to the cost of the NHS, you shouldn’t have to pay twice 🙂

  213. Thank you for sharing your story. I’m an American who is currently visiting the UK and has visited many times. A friend of mine recently had her first child and everything was covered under the NHS and she recieved excellent care. I can’t even begin to imagine the medical bills she would face had she been in America.

    It truly boggles my mind that Americans are afraid of universial healthcare. If anyone in the UK ever went into bankruptcy because of a medical bill, it would be a huge scandal in the local media. Unfortunately, the current Tory government is trying their very best to bring in an American-style system because certain vested interests are looking to profit off of those who are sick or injured. That’s why it’s so important to ensure that the NHS doesn ‘t go away. It may not be perfect, but no Brit I know of would ever want to trade it away.

  214. I am so pleased that you found our NHS so efficient.

    My husband and I were on holiday in the USA when he was taken ill. Our trip to A & E was quite a shock, in the fact that a credit card was asked for first before he received treatment. The bill was for $900 dollars, of which he had 3 bags of saline which were charged at $150 a time.

    I have also lived in Nigeria, where cash is needed to be handed over before they will touch you.

    I just thank god that I live in the UK where we have such an amazing NHS.

  215. In Arkansas fairly recently. Infected horsefly bite on knee. ER triage, long wait, X-rays, hospitalist, long negotiation (he wanted to admit me for a week, I was on a visit and hadn’t planned for that). Result? including the 1/3 discount for immediate cash settlement, US$ 2000, then later, separate bill from hospitalist, also including 1/3 discount for immediate settlement, US$ 400. No complaints whatsoever about care, from triage to billing. Good job they accept Mastercharge!

  216. I love our NHS and want to keep it unprivatised. And when in the US as a student years ago I had an allergic rreaction to mosquito bites and was treated by an A&E department who also said we’ll send a bill and never did. And years later I did something to my back, fainted, asked to be put out of my misery and the local health centre x-rayed me, gave advice and an injection and follow-up care and I never got a bill for that either.

  217. I’m glad your son received treatment. There should (legally speaking) be no charge. While it is charming that NHS doctors don’t know their own billing regulations, the other side of the coin is that, when someone is undergoing a procedure for which they will in fact be in charged, they are almost never informed in advance- a violation of basic due process. Of course, the effort and time needed to find out whether or not somebody is chargeable before operating could be a hindrance to medical treatment- but that just means we shouldn’t be charging anyone!

    I also object to charges for maternity treatment. When a British Citizen is born, his/her parents should (morally speaking) not be billed! But they generally are if the mother was eligible for billing before the birth. (There are some technical legal arguments why a mother who has just given birth to a British Citizen child isn’t liable for medical treatment, although the NHS generally ignores them).

  218. I have nothing but praise for the NHS in S Bucks. I can see a GP without delay and have never had issues waiting for surgery (& have had numerous repeat surgery for a recurrent problem which may not have been funded by private insurance). Am currently awaiting knee surgery which will be funded by NHS at the local private hospital on a date agreed mutually with the consultant. Prior to this I gave had great support from the NHS physios. I had superb ante natal care with a very complicated twin pregnancy. There’s no way we could afford the premiums being mentioned by US residents. Where the NHS works, it works brilliantly and I for one am immensely grateful.

  219. I’m a Canadian living in the UK. So far I’ve had two A&E experiences, both for myself. The first was a couple months after we got here. I wasn’t registered yet. I managed to dislocate my shoulder. It was a busy night just before Christmas. It might have been the fact that my shoulder was obviously dislocated through my winter jacket, but I was headed to X-ray less than 10 minutes after walking in. The only long wait was for X-rays after my shoulder was reset because a number of victims from a wreck came in. I’d been treated already and wasn’t in pain anymore, so it didn’t bother me. The whole experience was 2.5 hours. The second was a few months ago. I sliced my thumb open while preparing dinner. Again a fairly busy evening in the emergency department. My friend (who took me) was parked less than half an hour before we were headed home, fully treated. No bill from either trip.

  220. As a taxpaying Brit I’m glad you had a good experience of our NHS :). It’s always staggered me the attitude in the USA where lives seem to have a price and if you can’t pay you’re out of luck. Where are the actual “Dementor-staffed death panels” I wonder?

    If it weren’t for the NHS most of my family (including myself) would have died years ago. This year a family member had a serious problem and was in hospital for a week. Out of interest I looked up how much it would have cost in America ($70,000 for the treatment alone it turned out), however of course it was free for us (aside from the £2 coffee we bought to cheer her up a bit)!

    Definitely already got years of tax contributions’ worth out of it. Long may it continue!

  221. One or two observations.
    We do pay for the NHS through income tax and national insurance, if we are earning. If you don’t earn you don’t pay.
    I and several of my friends are still walking the Earth and not bankrupt owing to the NHS.

  222. I wonder if the travel insurance company execs in the states are laughing away to themselves swimming in the profits of insurance sold to cover medical expenses during trips to the UK!

  223. I think the NHS is one of the best things out country has ever done. The beauty is that you are assessed based on your condition not how able you are to pay. This annoys some wealthier members of society who are spoilt with service in other areas of their life and also businesses who could make a lot of money if our health system was privatised. From the outside it would appear that the fear in the US is stoked by the two groups above – who are well served by the current health system and see no reason for change

  224. I was doing some cleaning in the bathroom late at night (go figure) when the bleach cleanser suddenly splashed into my unprotected, un visored, and totally undeserving right eye, and I freaked out to my fullest extent forthwith. I rinsed my eye immediately as I was instructed to do on the bottle, for about 15 minutes, and then drove my non-insured self to the local emergency room, fearing impending blindness in that eye. I spent several hours there at UCSD med center, was given a litmus test to determine the pH of my tears, and then sent to another room for a lengthy saline flush. The bill was ultimately around $1500. I consider myself very lucky, and eternally grateful for the prompt (yes, several hours is prompt) and very kind service that I received there. I highly recommend UCSD medical center, but I know from past experience (broken bones, overnight hospitalization, etc) that the medical system here in the US is scary and a big problem for the uninsured such as myself.

  225. What a great story! As an American who has lived in the UK for the past 35 years, I have watched the American healthcare debates in recent years with horror. The NHS is brilliant! I am alive today only because of the swift, fantastic and top-quality care I have had, after contracting a severe and rare bacterial infection last year. And all of my treatment was free. It doesn’t take a lot out of my salary in taxes, and I would happily pay higher taxes to keep the NHS. Indeed, most European counties have excellent healthcare systems. It is so sad that the US doesn’t. Thank you for spreading the word!

  226. An excellent post.

    I can’t comment about “what frightens americans about the NHS” at least not from direct experience. As a Brit who has travelled and worked in the US, and who stays very much in touch with US politics I will offer this. Lobby groups frighten Americans about the NHS. The lobbyists realise that socialised medicine could very well drive down the billing levels and introduce more transparency into the system. In short, our model of health care in the US has the potential to seriously damage the earnings capacity of everyone in the sector. Turkey’s don’t vote for christmas. These days they hire lobbyists to get christmas banned, or to have some other fowl determined as the bird for the season. I don’t contend that all americans vote along the lines the parties propose (and the lobbyists promote) but I’m sure enough lobbying spend influences enough voters to secure the required outcome.

    I think you had a very good experience. Some A&E/casualty departments can resemble your antechamber to hell visions, but in reality the experience of being processed and treated is no more annoying or protracted than catching a long haul flight.

    Possibly the biggest threat the NHS faces is that earnings (and billing) potentials elsewhere in the world have a direct, negative effect on recruitment and retention of talent (at all levels) and your politicians, pundits and lobbyists have sold our trough swilling cabals a vision of how much better your system is versus ours. Successive UK Governments (usually of the GOP flavour) are slowly but surely nudging the NHS into a more American mode of operation. As a cynic I am certain that some of the motive for this can be found in the opportunities for billing that currently only exist in the UK private sector.

  227. As a UK resident I have used the NHS numerous times, from A&E for injuries (mostly of my own doing through sports) through to surgery for reflux disease. I think during 40 years I have had 2 bad experiences, one with a grumpy GP when I was a teenager and one with a grumpy nurse as an adult. The reason those 2 stand out is because they were so different to all of my other experiences, I can still recall the nurse leading me in for a general anaesthetic making me giggle all of the way to OR, almost every contact with NHS staff has been excellent.

    We are proud of the NHS in the UK, we are proud because it is good, bloody good. We pay for it through our taxes and yes, that goes toward paying for treatment for people who never pay a penny, often because they don’t have any money, we are proud of that too. The care I have had during my life has been superb and a number of friends and family have gone through the system and been treated with dignity and care by the professionals involved, some of them wouldn’t be here today without the NHS.

    There are some issues, Britain is a small Island with a lot of people on it so some hospitals struggle with resources and management, some drugs can’t be accessed, some procedures aren’t available, but we still have the option of insurance or we can still pay privately for those if we wish to bypass waiting lists.

    Who would have thought we have more freedom and choice than the land of the free?

  228. Your blog is great and I was hoping you could kindly visit my blog and read my first post as I’m new to blogging?

  229. I’ve had several experiences with the NHS, both ongoing care for long term conditions and emergency care because I’m a bit accident prone and also my cartilage hates me.

    On two occasions I was very, very seriously ill and at those times I had a doc with me within minutes of arrival. Ambulance care, once experienced as a passenger and once as a patient, is without fail excellent and the paramedics were both friendly and chatty (I’m very chatty myself) and reassuring.

    On the other hand, I’ve has to wait for a long time to see a doc for injuries (first time my now husband took me to a&e he was very confused as to why I made him stop at McDonald’s on the way!), but I am young and generally healhy, and wasn’t leaking bodily fluids all over, and I know there are people in a much worse state than me being treated, so I understand the wait and don’t really mind. You also get to see some interesting people in the waiting room, so there’s live entertainment as well 😉

    All in all, I will figh to my dying breath to keep the NHS. It’s a national institution of which we can be truly proud.

  230. I would love to comment, but I’m afraid that it would end up being pages long, and have really had only 1 good experience, as all have been here in the US, and I live here. But I can tell you, the best ER care came from a hospital not in my own state, but in TN, after visiting 2, in state where I live! It was Blount Memorial, Maryville, TN. The Dr. was Dr. Steven R. Mynatt, and my care was phenomenal! Timely, and most humbly caring, and Competent! So KUDOS to them! 😍

  231. We are Americans. My husband became very ill uptown disembarking the plane @ LHR, was evaluated by EMS (Medics) and transported by ambulance to a NHS hospital (closest to LHR). He was evaluated by Registrar and appropriate testing done in logical sequence as related to his symptoms and evaluation by Drs. (I am a RN, so fairly familiar with expectations and hierarchy of care) He was admitted to hospital for 3 days, seen by 2 different kinds of specialists (Cardiac and Pulmonary) medical and pharmacological treatment, further testing, and discharge plan of care developed by medical staff. Discharge medications also provided.

    We had “travel insurance” plus personal health insurance. I insisted they take all of our insurance info and that care would be coverage, but could also offer credit card payment. They assured me there would be no cost to us because ” it was an emergency, and it is the HUMANE thing to do”. While I agreed with that…I assured them it would be much different in the USA. UK citizen would indeed be billed, even for emergent care. I did ask them to please bill us, as we do not expect citizens of the UK to pay for our medical care….it is not fair. And no country can afford that kind of generosity.

    My husband recovered and we were able to return home after following medical plan of care. We have traveled internationally since that time. It has been over 2 years ago. We did not ever receive a bill.

    1. As a UK taxpayer, can I just say that you are very welcome to my share of the bill. I object to many things my taxes pay for, but providing treatment to visitors in need is not one of them. I hope you and your husband continue to enjoy good health.

  232. Glad that your boy is okay and that you had a wonderful NHS experience.
    I was an occupational therapist in the NHS and moved to WA, USA for a two year contract in skilled nursing facility 8 months ago. Working and living in the US made me appreciate and love the NHS even more – same good quality care minus the stress of financial means. I feel sorry for patients that have to go home because of their benefits being exhausted. A manager once told me that at least 50% of bankruptcies in America is due to medical bills – not sure how much truth there is to that info given to me.
    We all fear that the govt will go ahead with the privatisation of the NHS.

  233. Point of pedantry (sorry): A registrar is more senior than a resident, they are at least 5 years, often 7-10 years post graduation, and typically members or fellow of a specialist college (i.e. MRCP etc). Most registrars would be equivalent to a fellow or even a junior attending in some specialities. Credit where credit is due and all that.
    Thanks – UK trained Doc living in the US.

  234. I’m an American, too, Dr. Gunter, and I never received a bill for the time I visited the ER in a London hospital, and my visit even included X-Rays!! I did have to pay about $5 for a supply of antibiotics they gave me, but that was it.

  235. Glad you appreciated the nhs (even though it is slightly ageing in places). As a tourist you only have to pay if you’re admitted… They did try and implement tourists paying something/obtaining money back from their own country if a tourist attended a&e about 10 years ago but, this wasn’t something that could really be implemented as we don’t have to carry round ID with us and nhs doctors/nurses couldn’t ethically turn patients away who couldn’t pay.

  236. My husband did have the same problem in U.S and yes after bills came in from each department it was over £1,000 I also think we should charge foreign tourists as we have to pay for healthcare in their countries and as stated by the gentleman he did have insurance anyway. If we charged all these people the NHS would be even better.

  237. It will never leave me, the panic in the voice of my New York friend, who awakened in a london hospital after a 5 day coma brought on by infecting swine flu. He was choking back tears and freaking out as we spoke: “I can’t afford this. I’m ruined”.

    Once the nurse reassured him that he was free to walk out the door, and that everyone was pleased to see him make a full recovery, he immediately applied for UK citizenship.

    True story. God bless the NHS.

    1. This ladies health concern drove her out of the USA:
      http://www.city-data.com/forum/35996438-post2278.html

      “I lived on the North Shore of Long Island. I owned the house free and clear, and, aside from my late husband’s medical expenses, was debt free. I drove an old car, bought my clothes and my children’s clothes at the charity shops, and always ate at home. No Christmas, not even for the kids, other then a turkey dinner, and whatever I could find in the thrift shops.

      No up-to-date equipment, except the computer, and DSL (which I knew would be my way out).

      I knew that something as simple as an attack of appendicitis, or a broken arm if a kid fell off a skateboard would mean I’d have to sell the house to pay the bills, after which we’d move into an apartment little by little using up what money was left from the sale until we had nothing.

      All this as a result of my having been injured which resulted in a ‘pre-existing condition’ at the age of TEN.

      The rest of the world isn’t as fortunate as Europe… not even the US.”

  238. I have had a similar case in the US.

    About 5 years ago, my son got something in his eye while riding home on the bus from school. I tried to flush the speck out at home but was not successful. I waited until 3:30 pm to get his sister from her school, then drove to Urgent Care. We were seen in less than half an hour. They found the speck in his eye, but were reluctant to remove it because he was anxious and very squirmy, so they referred us to a pediatric ophthalmologist. (If he had been calmer they would have been willing to try.) They gave us a list of nearby doctors (at 4:35 pm), so I started calling from the parking lot and found one that was willing to stay open. I drove him over and he was seen immediately by the waiting staff. The pediatric ophthalmologist was very reassuring and gently talked my son through the procedure. He removed a tiny, metal spot from my son’s cornea. He said that if we’d waited a day to get it removed, it could have rusted and created a ring of rust on the cornea that would need to be scrubbed out. Ick! The visit was pretty quick, though, and we were out of there shortly after 5 pm.

    We ended up paying two co-pays, one at Urgent Care and one at the Ophthalmologist’s office. I can’t remember if we had $10 or $15 co-pays at the time. We also paid $5 for generic prescriptions (eyedrops). Our statements from our insurance company said that they had paid between $100-$200 to both the Urgent Care clinic and Ophthalmologist. I don’t think I still have those statements around. I remember thinking that those were both quite reasonable costs, give the services provided. We were lucky that it was during business hours because I would think that ER would have billed a lot more for the same services. We are also lucky to have pretty good insurance coverage through my husband’s employer.

    So I’m pretty sure that between our co-pays and what insurance paid, it was under $400. If my son had been less squirrelly, then it would have been half that because we would only have been seen at the Urgent Care.

  239. I’ve had kidney stone experiences in UK, Australia and USA – UK and Australia it was free healthcare and prompt support. USA wanted my travel insurance before they’d even see me, they did exactly the same tests as Australia and UK but the bill to my insurance company was around 8000 dollars. If I hadn’t had the insurance I swear I would have gone bankrupt!

  240. Great story. Glad your son was well looked after by our NHS A&E.

    I’ve had the pleasure of partaking in some clinical electives in the States when I was in Medical school. My university also had alot of American students, and this was around the time when Obama was trying to pass his signiture health care act.

    I remember the first time I went to doctors out-patient clinic, I couldn’t believe that the first thing the receptionist asked for was proof of payment (insurance card). I really wanted to ask the doctors I rotated with about this, but decided I didn’t want to upset anyone. I remember thinking that even though all patients in America know they have to pay, I have yet to see a hospital or doctors clinic that has a price list of some sort. You may find it funny, but I’m actually shocked to why they don’t have such a thing.

    Anyways, the main point I wanted to make was as follows. I had a really good chance to observe the debates about Obama care and gain perspective from US natives and US TV. I’ve also lived in the UK all my life and so I have had first hand experience of the NHS system. The thing I’ve noticed is that in both countries, politicians use their health care and any talks about changing /upgrading /updating the system for there own political gains. Neither countries politicians are brave enough to seriously stand up and seek change, because they know there’s an “army” of politicians that know how to scare the general public to the point where that individuals career comes to a stand still. We hear “horror stories” about the US system here in our news all the time, and I’ve heard almost the exact opposite about the UK system from US news companies.

    Neither country has the perfect system. The UK is the “flag ship” social health care system of the world, a system which every other nations social health care is compared to. The US has the “flag ship” private health care system, to which other private health care systems are judged upon.

    With our rapidly growing aging population and obesity crises, great changes need to be put in place with both our nations health care systems. Obama care, in my opinion didn’t go far enough. The NHS, in my opinion needs substantial investment and needs to create an environment where medical professionals can develop entrepreneurialism at the local level, to help care for the needs of the local population.

    Basically, we need to learn from each other, and have the opportunity to introduce change for the better. In my opinion, a close to perfect (I use the term perfect in a very very loose manner) health care system is somewhere in the middle of both of ours (US and UK).

    If only policy makers spent more time engaging and educating the electorate, instead of fueling fear.

    Last point to add. As a recent medical graduate, one important lesson I’ve learnt is that every patient presents differently, every treatment plan must be patient focused, and there’s ALWAYS advances in medicine that bring about new treatments. So medicine is dynamic and always changing. One would think this is what national medical health care systems should also do, too bad it doesn’t really y happen.

  241. i am here as a uni student and recently injured my ankle whilst in sweden. when i got back to sheffield (about an hour or so southeast of manchester), i went to the er to have my ankle x-rayed to be sure it wasn’t cracked or anything. considering it was an x-ray and not a checkup because i was ill, i figured it would cost me regardless of being a uni student. i did sit for a good bit (like maybe 45 minutes or an hour or so), but once i was seen it went quickly and smoothly. they were professional, knowledgeable, and explained it simply enough that anyone could understand. when i was done (like 15 minutes or so after i was seen), they just sent me on my way. that was a week and a half ago. i still haven’t seen a bill. one may come, but nothing was ever said to me. that whole visit in the states would probably have cost me well into the $1000s. i dread going back to america where i can’t afford even basic health care that i can get here without a worry not to mention free.

  242. I am a brit, recently moved to the US. Let me tell you, the process of getting health insurance is both confusing and long winded. Not to mention expensive. Still, I had to do it so I endured the paperwork and confusion. Now I have insurance, which I pay a pretty penny for each month, and I have to see a doctor for a physical. Again more confusion trying to find a local GP in my network and close to my home/work (I’d prefer not to travel too far since I can’t get my driving license without the previously mentioned physical…). After contacting several doctors the best option I found is a 20min drive out of my way, in another state, and there is a 2 week wait. I’m not so sure this system is better than the NHS in any way at all.

  243. I’m a young(ish) woman who has always found sex painful but presumed that was just the way it had to be! I went to a local GUM clinic after a while, fed up with how much it affected my life and my relationships, and received the best treatment possible. I had a very kind (and funny) specialist listen to my problem, empathise then diagnose. I was then given free treatment by a nurse who gave me more information, before being told to make another appointment for a month’s time as a check up.

    When I talked about it later, I realised how lucky we are to have free treatment! It means that we, as a nation, can go for stuff that we worry is a bit silly, or a bit of a waste of time. Looking back, I can see how ridiculous I’d been to categorise this life-affecting problem as “making a fuss” – but everyone does it. People easily underplay problems or are discouraged by embarrassment. I am still young and I wouldn’t have had money to pay! I would have been put off if I had to rely on my parent’s, especially not knowing how much it was/if insurance would cover it… To put it bluntly, if money had been involved, the problem wouldn’t now be solved.

    And, as a final note, because this was diagnosed young (again, an age when money is limited), the problem is less serious; I have had less emotional and mental damage in reaction to this stressful condition and it will probably be easier to treat. And I will (hopefully) now have more years of a satisfying love life! I’m not religious but god bless the NHS!

  244. Thanks for this. I hear horror stories about nationalized insurance, but I firmly believe we need it here in the U.S. The health care insurance system here is completely broken. Between my employer and I, we pay approx. 5K a year for my health insurance, yet I had to pay $3500 out of pocket for an hour-and-a-half hernia operation last year. People don’t generally have that much money just lying around. I would much rather pay up front in taxes, and be able to just go in and get the service I need without worrying about whether something is covered or not, or if I’m ever going to be able to retire.
    Thank you especially for “it is really impossible to tell as billing practices are so bizarre and opaque.” If I have already paid my co-pay at the clinic, I get statements from insurance companies but none from the clinic for office visits. And the insurance company, the same one which negotiates a surgery down from $18,000 to about $12,000, unquestioningly pays a general practitioner MD $250 for a 5-minute consultation. Hospitals and clinics, which complain about barely “staying afloat”, take forever to bill us. On the 4th of July, I had to go to the ER to have stitches in my foot, (since no clinics were open, of course). 6 weeks later I still have gotten nothing about that–no bills, no insurance statements. Perhaps my 9-year old daughter will get a bill for this sometime in 2050 or so, after I’m long gone.

  245. The amount the hospital would get paid for a UK resident for that care is roughly $120-$140. Hospitals are meant to Bill overseas visitors after the event where cost of recovery is proportionate to what is likely to be recoverable.

  246. What Americans fear about the NHS is that it’s not a highly profitable organisation. Medicine in the states is entirely an economic affair. You’re prescribed drugs more frequently because you’re seen as a paying customer. If you can’t afford treatment -you die. There is no logic in this to us. Someone’s ability to live shouldn’t depend on their salary

  247. Glad to hear you had a good experience in NHS.

    Yes! dr Gunter! as a foreign visitor you should pay. The details of your insurance or yourself should have been passed to finance department where you will get a bill later on but unfortunately not that many doctors/those work on the front line either not knows or not care much about it. It is partly ignorance! and we should charge especially in these times when NHS is struggling!.

    Of course! we do treat first then ask for payment in emergency! I love the way NHS work. It is unique system of health provision but has its flaw too!

  248. I have nothing but good to say about the principles of the NHS, how it has worked for me in practise and the qulity and calibre of their staff.
    To add a new point I want to also point out that in the UK it is not just the NHS that is free but emergency rescue. I’ve just got back from holiday in Devon and watched someone be airlifted by helicopter from a beach – a massive operation involving the RAF helicopter, coastguard, RNLI lifeguards and paramedics. This is free to any who need it.
    Later in the holiday I had to call an ambulance for a young lad who collapsed by the road. I was so thankful to have a qualified paramedic closely followed by a fully equipped ambulance arrive to help take him to hospital at no charge .
    In the States the charges for any type of emergency transport can be prohibitive – http://www.nbcnews.com/id/34419018/ns/health-health_care/t/air-ambulances-leave-some-sky-high-bills/#.U-01WihdUYM

  249. Thank you for your blog post, Dr Gunter. I’m glad we (speaking propriatorily as an NHS doctor) gave you and your son good care.

    ‘It makes you wonder exactly what frightens Americans about the NHS?’
    Two words: Fox News

    You may well know that the Washington DC based Commonwealth Fund recently found the NHS to be the world’s best healthcare system, whilst sadly being critical of the US system, ranking it bottom of the 11 countries assessed.
    http://www.theguardian.com/society/2014/jun/17/nhs-health
    This is of course a reflection on the system rather than the doctors, who are amongst some of the best in the world.

  250. Well just watch the 2012 Olympics opening ceremony from London and our tribute to the NHS. It is loved.
    Could you please tell this story to our idiot prime minister and his selfish government – they seem to think the NHS needs privatising. Fools.
    Hope you enjoyed your trip to the UK, come back any time!

  251. You will most likely not be billed for anything, all urgent care is free, almost all peadreatric care is als free. And for the things that do incur charges for non residents the NHS is woeful at actually collecting payment. Paying for anything is so against the culture of the system that it simply dosent occur to the staff that you might actually be billable.

    You were lucky with the timing. And also peadreatric a&e usually has much shorter waits than adult a&e, still the longest time I have had to wait was a couple of hours and that was on a busy Friday night and I was on the bottom of the urgency pile (xray for what turned out to be a badly bruised elbow)

    When I have needed more urgent treatment (pneumothorax) the wait was minimal, I was triaged, xrayed and admitted within about an hour.
    The only really awful thing about the inpatient experience is the tasteless food!

    1. To bill visitors from abroad would take a large admin’ office setup complete with new nationwide networked software, etc. It is cheaper just to treat people and be courteous to visitors.

  252. That’s such a nice story. Here’s mine (as a UK resident):

    Born in the UK. I left home 30yrs ago and have never bothered registering with a GP and have only once gone to a hospital in relation to my own body. Here’s my three tales of my experiences with the NHS:
    (i) Years ago I broke some ribs. After 9 days of pain I eventually felt I should visit my local hospital. It took about 45 mins to be assessed by triage and was made to feel like an idiot with a dismissive “we gave up binding broken ribs years ago… just take it easy”. I wish I hadn’t wasted my time, or theirs.
    (ii) My son was born with a kidney problem. We knew he’s have to be operated on eventually but it felt as if there was no urgency, nor was thre any quality information about the condition shared. On one appointment, just before his op, (at the same St Thomas’ hospital as the main article), we arrived to find that the specialist had ‘gone sick 3 days ago’, but no one had bothered telling us. The same went for several other parents, some who’d traveled overnight from Northern England. After a 9hr wait, (whilst I wandered the corridors, repeatedly looking through the partially closed blinds of one consultant’s room who was on eBay and Facebook every time I looked in!), we were advised that a (seemingly very junior) doctor had been found to talk to us. He was really nice and full of empathy for our plight and embarrassed at how we’d been treated (we’ve all worked for crap organisations… so I didn’t blame him at all!). He knew no more than I did about the kidney physiology that I’d picked up doing ‘O’ level Biology at grammar school 20yrs before. What an utter waste of everyone’s time… presumably due to the non-medical jobsworths who infect the NHS’s administrative processes. It wasn’t the doctor’s fault, he did his best. However, after this example of bureaucratic incompetence my son was operated on by one of the UK’s top specialists in pediatric kidney surgery. All went well and he’s now 6 and doing perfectly… (& my eternal thanks to the wonderful Ronald McDonald House that put me up for two nights… put your pennies in the donation boxes at your local McD’s… it really is great what they do!!).
    (iii) Tonight I heard a noise outside. On looking out the window I see that two two-man ambulances have attended (now for over an hour) my elderly neighbour who lives next-door-but-one. I have no idea what is wrong but (being a nosey sod) I have seen the silhouettes of them working on him through the ambulance blinds.

    Having read this article two days ago what are my thoughts?
    (i) Sometimes I couldn’t see the point off the NHS. I paid my taxes but was ambivalent to its future
    (ii) I’ve argued with friends who work for them saying it’s all an inefficient and dysfunctional, and ‘highly emotive’ example of British ‘tradition’ and nothing more.
    However…
    (iii) Having sat for an hour in the dark, watching to see if I could see any drama unfolding from two-doors down, I pondered the NHS… and I put everything in balance. I realised that the NHS has indeed touched my life many times…My sister was sectioned and had years of great psychiatric treatment. She has also been a ‘max insulin dose’ diabetic for 20yrs… My other sister has just come out of chemo for breast cancer and is doing well… My mum has had her gall bladder removed (pre-keyhole, when it was a major surgery), and had half her thyroid removed due to cancer… and been bought back from death after an RTA… Whilst my dad has had prostate cancer treatment and last year fell from a ladder and spent weeks in hospital…

    So… Looking out of the window at the evident care being given to my fellow resident (who I have never spoken to) I would have paid my taxes twice over… and then when I consider that also my closest family members (i.e. my two parents, my two sisters and my son) are all alive due to the NHS’s ‘value for money’ service that they received through mine, and theirs, and others’, tax deductions…, I am sooo glad we haven’t been ripped off by one or more insurance companies. Just think how much more that would have cost?

    One day I’ll register with a GP (aka ‘family doctor’) and when I do I’ll look back on the previous decades when I’ve personally not made use of the NHS and not begrudge what I’ve paid through my taxes at all!

  253. I’m glad your son is okay. You may have come across this quotation before; it’s as true today as when it was first spoken.

    “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.” Aneurin Bevan (Minister for Health 1945 to 1951 and “father” of the NHS, 1897–1960)

  254. Would it really hurt to charge? Particularly foreign residents/Holiday Makers… They have insurance cover and it would help to get even better care for the local population.

    As a country we have a huge national debt and this just makes it bigger and bigger – All we are doing is forcing our children to pay our debts….

    Just a thought.

    1. That’s an issue that is blamed for some of the high cost of medical insurance in the USA: emergency care must be provided free of charge to all who need it, and so those who can’t/won’t pay find themselves forced to go to the ER for care. Getting coverage from unfamiliar insurance companies is often challenging for payment departments that aren’t used to it.

      The current version of universal care in the USA attempts to deal with that issue, but has to deal with the same complaints the NHS does: those who don’t need the care (now!) don’t want to pay for those who do – and they demonize the needy by portraying them as leeches.

      1. I read somewhere that the reason private billing in the states is so high is that hospitals are used to billing insurance companies who then haggle, so the original bill is pitched high in the expectation that maybe half that will be paid, but private individuals aren’t brought up to haggle so end up paying over.

        The us system sounds utterly terrifying though, I certainly couldn’t afford to be self employed if I lived there

      2. Opusanglicanum: (Sorry I can’t reply to your comment directly, there’s a depth limit on comments.)

        It’s not that we are used to haggling. Rather, the ER generally sees three types of patients: The insured (which get the rate the insurance company negotiated with the hospital), those who can’t pay (in which case the hospital will see little) and those where someone else is going to end up paying the bill (usually accident cases.)

        The insurance rate is generally a reasonable rate for the service provided. The problem is the hospital needs to not bleed on the other two categories–and thus marks up the third to cover the losses on the second.

        It’s an ugly system that really needs to be changed. The fact that I oppose full UHC systems doesn’t mean I think ours is peachy. I think the right answer is somewhere between the two.

      3. That’s fine except “free of charge” is a deception. If you go into the ER with no medical insurance they will charge you. If you are unable to pay you will be sent to a collections agency. My 15-minute visit cost me $800 which the hospital (the public one!) said that I must pay or they would send the bill to collections. If you can afford to have your credit ruined sure it’s free but there is a price to be paid.

    2. The NHS is by far not a large strain on our national debt, global studies rate it the best system in the world, any I would think that any alternative, which would inevitably be market based, would offer less value for money. See the privatised railways and energy markets for how marketisation of natural monopolies have failed to reduce consumer costs!

      1. I totally agree. Aside from the fact that no-one should have to suffer without medical care because they can’t afford it, the practical benefits of the NHS far outweigh the costs. It should be looked upon as an investment in the well-being of the nation.

        Free medical care encourages people to seek treatment early, meaning that their conditions are often far more easily and cheaply treated than if they’d waited (in the hopes it would ‘just go away’) until things had become more serious. Early treatment also means people tend to have fewer sick-days off work, so they’re more productive, which can’t be a bad thing. 🙂

      2. I would think at 13-15% of UK yearly outgoings is a significant spend. Given that a new hospital costs in the order of £200M or more some contributions from visitors won’t hurt…

        http://bit.ly/Z2qAcY

        Or should be be the Worlds Doctor for free?

      3. Tony, you should also consider the large amount of money that foreign visitors spend while over here. Think of free emergency care as a kind of sweetener helping tourists choose to visit Britain with the confidence that they’ll be looked after if something bad happens. Charging fees would require a very significant new layer of bureaucracy and I’m sure I’ve seen studies suggesting the bureaucracy would cost more than the fees would bring in.

      4. I haven’t checked the numbers lately, but my old go-to on the cost of single-payer and socialized health care systems was the fact that the nation with the highest per-capita government spending on health care was, wait for it, the US. That was direct spending, (e.g. Medicare, Medicaid, and the VA), it didn’t include employee health insurance where the employer just happened to be a government.

    3. It probably would not hurt to charge, but only if it never got in the way of treatment – which would mean it was to some extent voluntary. A simple process where people could register their insurance whilst waiting would seem sensible. However, it would make almost no difference to the funding of the NHS, the amounts would be small and the cost of collecting it would take most of the money collected – but it might make people feel better about it.

      1. As a Brit now living in Germany, my legally required health insurance covers me for treatment in the UK. So the NHS can simply recharge the costs to the German healthcare system should I ever require treatment while visiting. The same goes for Australian citizens and also many (if not all) citizens living in European or Commonwealth countries.

        The problem with non-payment only occurs when somebody who has no form of health insurance turns up. And personally, I’m really ok with them receiving free treatment should they require it. I’m ok that part of the money I pay, will also cover somebody who is poor and who is unable to pay anything. After all, we like to think that we live in a civilised society in the west…so it’s only right that we should strive to live up to those ideals, which to me, includes universal healthcare regardless of where you come from or how much that you earn.

      1. I recently had to assist with a non-EU or Commonwealth crew member landed from a UK based ship heading to the Far East to work. He had appendicitis and needed an appendectomy immediately with the ship departing that day. All went well and the process was very swift and efficient and he is now back home recovering. The local hospital did invoice me for his treatment and the invoice has been passed to the ship owners for them or their insurance company to pay. The invoice did arrive (although this did seemt o be the least effeicient part of the process as it took over a month to arrive) and they have been or will be paid by my accounts department. The system does work!

    4. I think the point of universal medicine is not paying. I am an economist so I feel sometimes the urge to advocate for paying. However, putting the cost benefit analysis aside, the philosophy is what makes it great. What gives humanity to the medical profession. Economists and other professionals have to work now on finding ways to make it sustainable.

      I have experience the medical system in the U.S. and the U.K. and though both are great I feel less vulnerable here in the UK. The service and the care have been truly outstanding and I have learned to use just what I need (less overmedication which is great!). Sometimes I feel frustrated, specially with my kids because I want them to be seen my a paediatrician everytime they have a cold but I’ve learned to trust both my instincts and my doctor. I’ve only dealt with minor illnesses though so I cannot comment on major things (which is a complain I often hear about the UK system).

    5. I think the point of universal medicine is not paying. I am an economist so I feel sometimes the urge to advocate for paying. However, putting the cost benefit analysis aside, the philosophy is what makes it great. What gives humanity to the medical profession. Economists and other professionals have to work now on finding ways to make it sustainable.

      I have experience the medical system in the U.S. and the U.K. and though both are great I feel less vulnerable here in the UK. The service and the care have been truly outstanding and I have learned to use just what I need (less overmedication which is great!). Sometimes I feel frustrated, specially with my kids because I want them to be seen my a paediatrician everytime they have a cold but I’ve learned to trust both my instincts and my doctor. I’ve only dealt with minor illnesses though so I cannot comment on major things (which is a complain I often hear about the UK system).

    6. Thing is, for most trusts the cost of the occasional foreign patient is far less than the cost of having an additional administrative department solely to deal with all that.

    7. I fell and smashed my wrist when I was in the UK visiting my dad. It was a really bad fracture that needed surgery when I got back to the US. Had excellent care in the NHS hospital and they were prepared to do the surgery there but since I was returning to CA a few days later, they put me in a cast and the surgery and PT were done here. I was billed eventually – the total cost was less than $2,000 for the ER, an overnight stay and pre-surgery tests – I can’t imagine what the cost would have been had it happened here. The UK specialist also sent me back with my x-rays and a letter for the hand surgeon here. My insurance company picked up most of the tab. So, it’s not that foreign patients don’t get charged – they don’t have to pay on the spot but, in my experience, the bill does arrive later and I was glad to be billed for such excellent care. Thank you, NHS, for taking care of me at such a reasonable cost.

    8. I thought this would be asked, and no doubt many are thinking the same. But as soon as you bring the cash tills, metaphorical or otherwise, into the hospital the sooner we’ll all be paying. There will be huge overhead on collecting what will be a tiny percentage of total NHS income. The US spends a stupid amount on its charging systems. What we as a nation collect in return is goodwill from tourists.

    9. Actually it may hurt in this setting. Currently for short stays/visits to the GP (family Dr) collection and administrative costs would cancel out any profit from charging. This gives you an idea of the size an bureaucracy in the NHS (3rd largest employer in the world – over 1 million staff).

      However if the care is chronic then non EU patients do get billed.

      On a slightly different note, one has to remember that healthcare systems are products of the society and in my opinion can not really be copied from one culture to another.

  255. It’s good to see all the ‘Hurray for the NHS’ comments on here. I’m an NHS GP and it’s been getting tougher to do my job every year- we are stretched so tightly that we’re at risk of falling apart at times. I’m fairly laid back about a lot of things but the NHS is one that I’ll fight for. It’s an old, bulky machine that could do with fine-tuning but it saves the day every day for so many people.

    1. Thanks, you are the people who can save the NHS from the inside, thanks again

  256. As a Brit, the accepted opinion (correct or not) about the NHS is that if it’s A&E, maternity or a life-threatening illness, it’s good. Free screening is also good. If you have back problems, or need a knee replacement, that’s not so good. You’re in pain, but because it’s not dangerous, it’s lower priority and the wait can be long. This is where claims about a ‘two tier’ system come in, as wealthy people can ‘go private’ at that point, whereas others have to wait. As a mum of two young children, I’ve had many occasions to be glad of the NHS. I’m self employed, so if I was in the US I wouldn’t get employer-based insurance, and might struggle to meet costs myself. If I had a full-time job, I wouldn’t see my kids as much. So the ramifications are potentially bigger than just half an hour in A&E. Maybe.

    1. I owe my continued relatively good health to the NHS. I had lost my job when my university shut our course down and to cut a long story short I ended up needing a double by pass op. The op was a success (99.7% of them are apparently). If I had relied on an insurance based scheme I wouldn’t have been covered, and would presumably have slowly sunk into further cardiac ill health followed by – well I have an idea! I don’t understand the political objection to an NHS style system, and neither can anyone else I know. The land of the free in this case seems to mean the land of the free to die earlier than you need if your luck is out. What a shame.

    2. I think that the main issue with the NHS is media attention on it. I agree with Emily that people’s accepted opinion is that A&E is good and that back problems or knee replacements are not up to scratch, but when I had my back surgery on the NHS 6 years ago, I had fantastic treatment. Two days after my partial disc removal I was walking 5 miles a day, a week later I was walking 15 miles a day. When I talked with the physiotherapist, he told me that the prognosis for my type of operation was not good, as people did not follow the recommended regime once they had had the operation. Having also lived in America and attended the doctors’ surgery and the hospital there, the only difference I have noticed in both Emergency medicine and routine medical treatment is that there was a credit card booth when exiting the building. I had insurance, but a trip to the GP for ‘strep-throat’ still cost me $80 for a 3 minute consultation and a prescription.

      I think the only difference for a point-of-use payment health service and the experience of accessing the NHS is that you don’t have to worry about whether you will be able to afford it. No one in the UK has to worry about attending the doctor for financial reasons, ie. whether they will be bankrupted for attending. In the US, in addition to the illness angst, many millions of people have the additional worry of the cost.

    3. I have seen the insides of four hospitals, with the same kidney condition.

      Hospital 1
      Hospital 1 was an improvised maternity unit in a converted office building in a remote town on the Brazilian/Argentine border. Serving the local Indian population the charity volunteers diagnosed my condition, and patched me up sufficiently to get me on a flight back to London, clutching a report in Spanish and after three days in a coma. Their care was supreme and they saved my life.
      Points 10/10

      Hospital 2
      Back in London my NHS doctor sent me to a local hospital for investigation. I endured more pain than I thought possible and found, among much else, that my consultant had ordered painkillers to be withheld. She was, apparently, Arabic, and I have an obviously Jewish name. I walked out.
      Points -5/10

      Hospital 3
      The first operation went wrong, with the result that a second was required, also incomplete. While recovering I was threatened by another patient, when I woke up during the night to find him standing over me, with his walking stick raised over my head. I called out. He disappeared. Nobody came. I couldn’t stay. I could hear nurses arguing about shifts a few steps away. Covered in tubes, from my back, bladder, wrist and nose and carrying/dragging various bottles and containers, urine, oxygen, drip, et al, I made my way to the nurses and asked for another bed, of which there were plenty. They refused. I asked to see someone in charge. After refusing to return to my bed they eventually made a call and twenty minutes later someone who had evidently just woken up appeared, rubbing her eyes, and demanded that I get back into bed or she would call the police. I told her to go ahead. I got another bed and my assailant was moved away. I returned to my GP and insisted he find me another hospital.
      Points 0/10

      Hospital 4
      Hospital 4 turns out to be the leading hospital on kidney surgery, worldwide. Also it is nearer than Hospital 2, and only a few minutes further away than Hospital 3. Why did my GP send me to Hospitals 2 and 3 when the leading kidney hospital, worldwide, is on my doorstep? They have partially corrected the surgery from Hospital 3, including removing a surgical clip from my kidney, left behind by the previous surgeon. It has been painless, efficient and quick. Suddenly everything went right. What’s the problem?
      Points 10/10

      Hospitals 2, 3 and 4 are all NHS.

      1. If you had a kidney condition such as acute or chronic kidney failure, it is likely the reason the ‘Arabic’ doctor refused to prescribe you pain relief is because NSAIDS are nephrotoxic (v bad for kidneys) so perhaps it was nothing to do with your heritage at all. After all, it doesn’t sound as through you ever fond out why this occurred. It’s easy to jump to conclusions when you’re unwell and in pain and everything just seems awful.

  257. Same sort of results here. I am a US citizen, and lived in Sydney, Australia, for 5 years. The systems aren’t identical, but my Australian medical insurance (for me and my wife) was under AU$300 per month for premium coverage. We never had any serious problems, but my wife had a number of tests and procedures for various issues; the actual charges for any procedure were always under $100, even when general anesthesia was used. In addition, you were always given a copy of your test results and the doctor took the time to explain them.

    My US insurance, the least expensive, high-deductible, plan runs over US$900 a month, and has increased over 10% for each of the last five years. That fact alone was almost enough for us to want to emigrate – the only reason we didn’t was that the US is our home.

  258. So nice to hear some appreciation for our NHS. I am a NHS Health professional who had a pretty standard upbringing, yet I know I would of died with out the nhs, as the help they gave me would of been far too much for my parents to afford when I was a baby. Crazy to think, I wouldn’t be here living a normal life with out it.
    NHS is completely free, no bill will be sent. I’m glad your little one is ok too.

  259. Hi,I work within the NHS ,in many departments including A&E,and as far as I am aware,emergency treatment in the first instance is free to all.It would only be billed if your son had needed and inpatient stay.I for one am very glad your experience of our wonderful instition was a good one,I too have had to visit the A&E department of St Thomas,not for mysef but for a grown up child ,they were very thourough,although not so quick due to the fact my daughter had been involded in anRTC

  260. The NHS provides free emergency care to any one accessing it, weather national or visitor, further care if necessary would be billed as would elective care. To those who are upset by having to pay NI even though they pay for or are provided with private health insurance remember that private hospitals do not as far as I am aware provide emergency care and if you should need to to be rescued via ambulance you would receive NHS care via A&E. The welfare state is about providing for all even is you have reduced means, however I do agree that it was never intended to provide for so many who are unable to contribute and some sort of balance needs to be found again.

  261. Glad your boy is ok and you had a great experience in an NHS hospital.

    No bill will be sent as the care was for urgent/critical care to save life or limb. If you rocked up for an elective treatment, that’s a different story and there’s an overseas tariff for that.

  262. We spent 6 months in the States whilst my wife held a visiting professorship at a university in Texas. We had, we thought, excellent healthcare coverage through Blue Cross. Whilst we were there, a minor injury that my son (aged 3.5) had sustained to his hand just before we left turned out to be trigger thumb. I travelled with him to the Scottish Rite Hospital for Children in Dallas and they recommended surgery. My doctorate is in English literature, not medicine, so I don’t argue with medical professionals and the case they made was persuasive, so we agreed.

    Surgery was a success. Everyone at Scottish Rite was lovely and helpful and kind and patient with us. I don’t have anything but praise for the American medical professionals we met. However, even with healthcare coverage under Blue Cross we were left owing $2500 at the end of the experience. No one explained this likelihood before we agreed to surgery – I guess it is so engrained in US culture that you have to pay, that no one raised it with us, and then I think we were naive about healthcare coverage works in the USA: because it was unfamiliar and also because we were so used to receiving medical attention without having to worry about paying for it in our own country. We were lucky that we’re both in employment and could weather the financial hit, although it was a nasty surprise.*

    By way of contrast, when my son was 4 weeks old, he developed an inguinal hernia. A specialist saw us within three hours of me noticing the bulge on his tummy and contacting the health service; he was operated on within 24 hrs and completely cured. (Obviously, the unfortunate side effect of this was that being healthy and vigorous, he ran around a lot and fell on his thumb 3 years later.)

    Conclusion: those of y’all in the USA (6 months in Texas did something to my vocabulary) who fight against the idea of universal healthcare provision, free at the point of access are nuts. We, in the UK must fight every attempt to diminish and run down the NHS – it is a truly great institution. It isn’t perfect, but I don’t grudge a penny of the taxes I pay to help keep it going.

    * The truth of it is that, since the Scottish Rite Hospital is a charity, the charge was means-assessed. It’s still unclear to me whether a family who were less well-off, might have been deterred from agreeing to the surgery because of the costs or whether the hospital would have waived the charge in their case. It is pretty clear to me that everyone in the UK ought to be grateful that they don’t have to worry about this on a regular basis.

  263. I got sick in the US once. It cost me $200 dollars for a five minute consultation and two prescriptions. The next month, an American friend got off a plane here and came down with malaria. Five days intensive care, no charge. He kept deliriously offering them his ID, they weren’t interested. His boss emailed me in a panic worried that I’d had to remortgage my house to ensure he got treated. That’s an anecdote, not evidence; but the evidence backs it up. the NHS is one the best and most efficient systems in the world. Far better than the US. The Tory govt and the Murdoch press (same thing) are busy slagging it off so that they can sell it off to their rich mates and make packet. Private heatlh care companies are among the largest funders of the Tory party. Wonder why.

  264. I love this article. It makes me beam with pride.

    I am a paramedic and I work in a city that welcomes a lot of visitors from across the pond. Whenever I treat somebody from the US, I am always puzzled by their attitude of, “I must pay you some money.” I would even say some get visibly worried over the subject. I even have a bit of a spiel prepared, to explain that payment, in situations were emergency care is required is certainly not a condition of that care being delivered. Patients, with whom I have spoken to after their ordeal always praise the NHS.

    Yes, we have our problems, but a system that guarantees healthcare from uterus to grave can be no bad thing. A system that is the most efficient in the world at delivering that care can be no bad thing. Just look at percentage of GDP spent on healthcare. The UK has one of the lowest figures in the developed world. The US. The highest.

  265. Hi, it’s fascinating reading about your experience. Although I don’t still hold record of the bill, but my sister had a similar emergency hiccup in her trip to Orlando US, with a different – very different, experience at the US ER.
    My sister visited me in New York where I was doing my masters. She went with her friends to Orlando. They called me one day in the evening telling me she’s not feeling well and exhausted, dizzy, felt nausea, and headache. I suspected a flu or sun stroke.. Told her to take some aspirin.. But she and her friends insisted to go to a hospital. I had lived in the US for a year and knew what she will be facing.. Hours and hours of wait.. And a big fat check. Exactly.
    They made her wait for over 5 hours until she was checked and diagnosed with dehydration! They hydrated her at the ER and voila she got slowly better and better. Given she was not a US resident nor was insured.. She paid around $900+ in CASH! And had to cut her Orlando trip short! Sigh!

  266. Thank you for taking the time to tell others around the world of your experience in the UK. I am proud to work for the NHS, and can’t imagine why any other system could be thought to be superior.

  267. Hang on, a doctor from the States didn’t have the life experience or inteligence to realise the NHS was free? And because it’s free, we can’t moan about it? What a shit bit of propaganda comrade.

    1. Obviously you are one of the few here to troll. Of course I know how the NHS is funded, but I didn’t realize that a non-citizen wouldn’t have to pay. I really had to spell that out for you?

  268. I have just beaten breast cancer. I had 6 sessions of chemo, more medications than I care to count, a PICC line inserted and line care weekly, a total of 9 MRI scans, 3 CT scans a bone scan, two trips to A&E, two admissions for dehydration, a mastectomy with overnight stay, 5 follow up appointments. All on the NHS. My treatment was not only superb but successful too. I was told that if I went private the cost of beating cancer would have gone above £30,000. I never paid a penny. No one can really fault the NHS. To the original post, you will not be billed, it’s just not what we do. I’m just glad you’re telling the world how amazing it is

  269. You should have been charged! The N H S is owed millions of pounds when the money for treating visitors has not been pusued. The workers of Britain pay for the NHS via the National Health stamp. If the workers have to pay you should too.

  270. It saddens me that the only comments so far are fairly negative. We have the best health system in the world. The only thing that threatens it is privatisation.

  271. That poor people will get care for free. That is what frightens people. That the poor people they hope will just go away and die, wont be able to pay to live healthily. And tnen yay no more welfare either! It’s a win win.

    I have issues with our healthcare system in Canada, but the thought of having to weigh an er visit with yoru mortgage payment? f that

  272. We love the NHS. My family and I have received so much brilliant care for a range of complicated conditions. I dread to think how much it would have cost us if we lived in the US. We’ll always be grateful.

  273. What frightens Americans about the NHS is the right wing biased media who’s friends run the private health care companies…

  274. I never understand the fear of national health schemes that since US residents suffer. The NHS is fantastic – not perfect, but as you’ve pointed out, nor is private care.
    Some people complain that they have to pay tax and “don’t use the NHS that much”. I haven’t used it an awful lot myself. But I will be forever grateful for the treatment my mother received when she developed pneumonia. She was admitted, diagnosed and treatment was started so quickly – it’s no understatement to say the efficiency of the NHS saved her life. For that reason I am more than happy to pay taxes for the privilege of having my mother still around.

  275. There is no such thing as a free ride.

    Have you considered how much the Brits pay in taxes to be able to afford this “free healthcare”? I will bet you $20.00 that in the end, it’s more expensive than in the US.

    I live in France myself and pay a fortune in taxes. Our “free healthcare” here means I pay 50% of every medical bill next to around 51% income tax.

    And in my experience: the more the state runs health care, the lower the quality of it. So I do concur with Bootsanlibraries’ comment above: it’s not free and it’s quality is poor.

      1. The British live longer because the obesity epidemic is nowhere near as high, guns are banned (for the most part), fewer people own cars and Americans work more hours.

    1. Harald – Jen’s post has generated an amazing amount of response so earlier comments often get lost to new readers. I hope she is willing to report my earlier comment (below) because it answers som eof your points:

      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 won’t claim the $20 and to be fair you’re talking about taxes whereas the last figure in my short list above is percentage of total GDP spent on health. But you can see a picture emerging about resources spent on health and outcomes.

      1. Thanks Roger and Jen!

        But health expenditure as % of GDP doesn’t really mean very much. Let me try to explain. In the 80’s, people were all over Ronald Reagan for his “Reagonomics”. Those against would argue he let the US go into much higher debt than ever before. Those in favor would argue he raised the GDP enormously (actually, national debt in the US in terms of percentage of the GDP went down, but the total debt went up enormously in absolute numbers).

        So in terms of a % of GDP, we are not really weighing health care expenditure, as one would need to weigh local circumstances; country A isn’t the same as country B. It’d be much more interesting to see how “John Does'” monthly income looks. So suppose John in country A has 1,000 income and 500 of that is taxes, or Jane in country B has 1,000 equivalent income and 100 of that is taxes, actually makes a big difference. Say that John doesn’t pay additionally for health care, but Jane pays a hefty sum of 300 (so 30% of the equivalent income). Who’s better off now?

        Like I said: there’s no such thing as a free ride. In the “socialist model” (which the NHS is; it was even created by a Labour government after WWII), the cost to the individual receiving care might look small or non-existant, but the cost to society as a whole is probably (due to a number of factors) larger. There are no real incentives, for example, in state driven health care systems. So you have waiting lists, friction costs (inefficiency, and so on). Look at Cuba: it has an excellent health care system and nobody pays anything (not directly, that is), but would you like to go live there?

        Mind you; I am not saying the doctors, nurses and everybody around them aren’t trying their utmost to treat and heal patients! That is the individual quality of every single person working in health care and I am in no doubt all of them are working their behinds off to give their patients the best possible care they can offer!

        But for the patient it’s all (too) easy: you need care, you get it. And you don’t even SEE the bill. But that doesn’t mean that money isn’t paid, doesn’t get wasted or doesn’t “evaporate”.

        When I mentioned France in my earlier post, I was (but I don’t think it was obvious) referring to Michael Moore’s “Sicko”, in which he suggests medical care in France is free. It isn’t. Next to being taxed to death (my accountant is in dire need of more loopholes to recover some of my money), healthcare in France is not “free”; the 26 euros to see my GP is refunded with 13 euros (so 50%); I wear glasses; the EUR 350.– they cost me, got me a (I kid you not) EUR 5.00 refund.

        I’ll post my bank details next and look forward to receiving your $20.00 🙂