Across Continents

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Beyond reach

December 22nd, 2011

P1070535

It was the chap with the billboard who’d got me thinking. Stood on the roadside, come rain, hail, or in this instance, snow. Of course, I might be wrong. He might have health insurance. But quite possibly not.

There’s an awful lot I do like about the US culture. A Constitution that clearly enshrines the rights of the individual and, just as importantly, a legal system that enforces them. Politeness. And quite a bit more. I can even put up with the guns and an overly punitive penal system. I’ve even forgiven them for the Declaration of Independence.

Where I do struggle though is with health care. If you accept the first duty of a Nation State is to protect its citizens, this is the US’ Achilles Heal. It may be home to some of the most sophisticated medical facilities in the world, but that’s little comfort if you can’t afford to access them. The free market model works only if it offers genuine choice, universal provision, competition keeping costs in check. This is patently not the case. Even if you can afford the premiums, the exclusions can render the policy almost worthless.

The UK’s own National Health Service is far from perfect. Postcode lotteries for certain treatments. Waiting lists. And it’s not free, simply no charges are levied at the point of delivery. But there is universal access based on clinical need rather than ability to pay. And I suspect diagnosis of terminal illnesses in Accident & Emergency is a rarity. Not the case in the equivalent US Emergency Room.

And that’s the terrible thing. Patients being offered little more than palliative care when the treatments they really need, even for life-threatening conditions, are withheld from them simply because of their lack of ability to pay. Knowing you’re going to die when the help you need is just down the corridor. Hardly the hallmark of a sophisticated society.

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