National Health Insurance

“Write about the National Health Service” was the request. OK, I thought – I’m a child of the NHS, having been born 5 years after it’s inception in 1948; it’s something I know well from experience of many parts of it’s operation as a patient and as a relative of patients. “For American readers” was the stinger in the tail; I don’t know how the US health care system works in practice, my family having had the good fortune never to be ill in the States.

But then it occurred to me that the US system is based on insurance, and I have had invitations to pay for health insurance dropping through my letterbox, in newspapers and on TV ever since I started paying any attention to these media. I’ve never felt inclined to take up any of these offers, except when going on holiday to somewhere else, and the “why” of that should give some insight.

The NHS was a socialist concept brought in by the Labour Party, part of the larger “welfare state” concept which was originally a child of the Liberal Party. The welfare state aims to eliminate want (i.e. poverty), disease, ignorance, squalor and idleness (i.e. unemployment); it’s basic funding was by a system of compulsory insurance payments (“National Insurance”) payable by those who earn proportionate to their earnings, but topped up from general taxation to provide for those who didn’t have enough national insurance contributions. The NHS could have worked on the same principle, but has been funded from start from general taxation, with the objective of providing “health care for all free at the point of need”.

I should comment at this point that although the labels “socialist” and “liberal” appear here, there has been no mainstream political party here since it’s inception which has openly proposed abolishing either the NHS or the Welfare State; conventional wisdom is that it would be political suicide to do so, and even proposing limiting spending on either is politically dangerous, though Conservative and even Labour governments have done so. Neither “socialist” nor “liberal” has the same kind of negative impact which it seems to in the States.

Now, what exactly would I get for my money if I bought some health insurance? Frankly, not much I’m concerned with. Single hospital room if I’m hospitalised, better food, smaller hospital, better decorations – all of those are pretty inessential from my point of view. No, the main thing which might attract me is not having to wait as long for an operation or other significant treatment; the NHS does have waiting lists, and sometimes it can take a while, first to be seen by an appropriate consultant and then to get whatever treatment is prescribed (unless it’s drugs only). That said, they’ve been making strenuous attempts to reduce waiting lists, and there seems to have been a fair amount of success there. The private sector can cut those times very significantly, for some operations or treatments. Not all – some of the more complex or advanced surgeries aren’t yet available in the private sector, who seem to like to stick to well-practised procedures which are clear money-spinners. Granted, some even more complex or advanced surgeries aren’t yet commonly available from the NHS either; however the chances of needing one of these are minute.

However, it’s only a matter of “jumping the queue”, and you jump the queue anyhow in the NHS if your condition is life-threatening, so I can live with that unless something very cheap is available – and health insurance isn’t “very cheap”.

The one exception which I’ve experienced is mental health issues. I have had issues there, and have paid for private treatment rather than wait perhaps years rather than months, not being remotely an “acute” case, as the budgets for mental health tend to be more cash-limited than most. This, it turns out, would have been facilitated by most available health insurance, up to a rather modest limit. Even so, with 20/20 hindsight I might actually have made a profit, assuming that the underwriters had approved the treatment. That’s a big assumption, as we’ll go on to see.

Where I have always thought health insurance valuable is as part of a travel insurance package. Even in Europe (where there’s socialised health-care everywhere I might go, with reciprocal arrangements), things like emergency flights home are useful to have cover for, and there are sometimes unexpected limitations of cover. Better to be safe. Outside Europe – well, that’s a dangerous place! Either it’s really expensive, or the provision isn’t nearly as good unless you pay through the nose. Cover is essential.

There, though, I have a horror story. No, two horror stories, both involving trips to Canada, one for my wife, one for my daughter on different occasions. Both times we had cover for medical expenses as part of the travel insurance. On both occasions, to cut a long story short, the insurers found a reason to wriggle out of paying, and we were left with bills paid but unrecoverable, and in my wife’s case that was a lot of money. In the case of my wife, the excuse was a “pre-existing condition”, despite the fact that the condition wasn’t diagnosed until it got looked at in Canada, and that my wife had gone to the trouble of getting clearance from her doctor here that the problem she had experienced had ostensibly been cured and had notified the insurers of this (it wasn’t a condition which could sensibly have been diagnosed at the earlier stage, either). This was compounded by us agreeing to the treatment on a verbal assurance from the insurers which they then withdrew after the event. My daughter’s claim just died in a welter of paperwork, with extra queries at every stage, and we eventually gave up, as it wasn’t actually a colossal bill.

So, would I now take out health insurance? Not on your life, except for travel – I can have no confidence that an insurer would actually pay out for anything really significant, and have every confidence that they’d make my life a misery trying to avoid payment by any means possible. Add to that the fact that such insurances are usually not open-ended; there’s a limit to what they’ll pay out, and once you get to that point you can be left without treatment, sometimes in the middle of a course. Would I support our government changing the system to an insurance-based one rather than one funded out of general taxation? Absolutely not, for exactly the same reason.

Indeed, I am not at all certain that I want to travel anywhere outside Europe, particularly as I get older and, presumably, more likely to have some medical emergency. I don’t feel I can trust the insurers. I’m left marvelling that the States doesn’t have a system like ours, and that Americans don’t overwhelmingly want to establish one.