I Feel Like a Healthcare Criminal

My appointment is at 3:15PM on a Wednesday. The sky has already started to darken as the inevitable pull of the seasons brings us closer and closer to winter, yet the trees seem to have taken little notice. They are as green as they ever seem to get in Colorado summer, with that little tinge of what could be fall or drought depending on what you choose to see.

It’s sunny, but London’s hyperspeed clouds are still lolling by overhead. I put on my green sweater, check that I have my keys, and step out onto the streets. I immediately regret my choice of sweater. It’s a sieve. But I’ve already slammed the door behind me to shut it tightly and I just cannot be arsed to go back in and get a more suitable coat. I’m already just barely on time anyway.

Down the street, across the junction, and into the medical centre. It’s a nondescript white building which must have at some point been a private house, with a tiny parking lot and a block-letter sign outside. Up the walkway, pausing for a second to consider the mass colonies of germs on the door handle followed by the decision that I can’t avoid them without appearing to be some sort of weirdo to those inside, and a sigh as I grab the brass and turn. It’s warm inside.

There is a tiny boy of about four with his mother, playing games and pulling faces. He makes no hesitation in pulling one at me. I pull one back and make silly noises without missing a beat. It’s an interesting way to be greeted in a doctor’s office. I wait. The receptionists are in dull pink uniform scrubs, and one appears to have merged her ear into the telephone. A small queue forms around me, with as many languages as there are patients. The boy and his mom are speaking what may be Swahili, behind me is a Japanese couple, behind them a middle eastern grandmother, mother, and baby. I realise that I’m now late for the appointment.

“Right then, how can I help you?”

The other receptionist is back, and I tell her that I am here for a new patient registration appointment at 3:15. She looks at the clock, a bit displeased, and then says, “Take a seat over there, please.” I do.

Five minutes later they call my name from the hallway. The nurse practitioner is efficient, but seems tired. Is there any history of high blood pressure in your family, my love? Do you smoke, my love? Alcohol, my love? What type of birth control do you use, my love? Did you ever have a smear test, my dear? She is shocked when I tell her that in order to access birth control in the US, I had to have a pap smear every year since my teens. In the NHS, I wouldn’t have started until this year.

“That’s just too early! Why do they do that?”

“I think they want to make it as difficult as possible to access birth control in the US.”

She asks if it would be possible to give a urine sample, and gives me an impossibly small vial to pee in. I manage. No sugar. No protein. We’re finished, my love! See you later!

I walk out the hallway, into the waiting room. I hesitate, then walk out the door.

They didn’t ask me for an insurance card. They didn’t ask for my social security number. They didn’t need payment upfront, or even ask me for payment at all.

They didn’t force me to call my parents as a grown woman and ask them in the reception room what our policy number is, and why I don’t seem to be appearing on it. They didn’t say that I am 26 now, and therefore cannot use a family policy.

They didn’t ask about my employer. They didn’t care that I don’t have a job at the moment. They didn’t charge my credit card $170 for a consultation. I didn’t have to worry about how to afford my groceries this week because of the extra cost.

They didn’t give me an itemised bill showing $50 for a urine test. They didn’t pressure me to book a follow-up appointment, or give me a quote for several hundred dollars for whatever is up next. They didn’t push branded medications on me, while writing their notes with a Big Pharma pen.

I just walk out, and no one stops me.

I feel like a healthcare criminal walking out of my first ever free appointment, stealing urine tests and blood pressure readings. But nothing is exploding, the fabric of society is not degrading, and no one is threatening grandmothers with death panels. The sun is shining and the clouds are loping by, just as they were before. For the first time in my life, I know what socialised medicine feels like.

I don’t know how I ever got by without it.

Long live the NHS! Long may it stay socialised.

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London, Transitional Nature

7 Comments

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  1. Well, of course. This is the way civilized countries operate. I’ve had similar experiences with the national health systems of Germany, Austria, and Canada, as well as the UK (where i lived for three years). The US “system” would be beyond madness even if it produced acceptable results. But it doesn’t, of course. Obamacare will be an improvement, but nowhere near what is needed.

    • I’m not sure the ACA is in fact an improvement. Really, it’s allowed the GOP and others to play to their bases with the bogeyman of ‘socialised medicine’ while simultaneously giving huge power to the insurance companies in the name of ‘the free market.’

      It will fail, and when it does people will point and say, “See? See? We tried socialised medicine and it didn’t work!” when in fact the ACA sets up a system that is nothing like the NHS. It will provide a strawman for the GOP and others, and we’ll be worse off than we even were before.

      Highly disappointed with it.

      • I share your disappointment, and although I’m pessimistic about ACA, maybe I’m not pessimistic enough. It seems to me that two key mistakes were (1) not decoupling health insurance from employment (a relic from World War II wage and price controls), and (2) not getting the insurance companies out of the picture altogether. The answer clearly was Medicare for everyone, starting at birth, financed by cutting our bloated military and “intelligence” budgets in half and extirpating the NSA root and branch.

  2. When I lived in England, I had to show my NHS card. If you are just visiting, the provider cannot bill the NHS for your service. There is something missing in this story.

    • No, there are several things missing in your assumptions.

      I am not ‘just visiting.’ I am a full-time international student, under a Tier 4 visa, which allows access to the NHS (but not to public funds like benefit). Under current UK law, students are allowed free access to the NHS (they may change this in coming weeks and ask for a 200GBP one-time payment, but that is not currently the case). UK immigration law changes frequently, but if you want more information you can look on the UKBA website.

      If you read this piece more carefully, you would have noted that this was about the registration appointment, which is required to register with a local GP in the UK. I now have an NHS number, which I have to bring with me to appointments. The pre-registration happens before an NHS number is issued, which is why I did not have to show one.

      I am hoping to remain here due to my personal circumstances, and I am happy to contribute to the taxes that fund the NHS. The reason I felt like a “criminal” is that I was raised in the US, where I could never have had even a preliminary registration appointment without a co-pay or paying the full amount. That’s why it is interesting, not because I’m stealing from the NHS or failing to comply with UK law.

      When did you live in England?

      • Too long ago to want to state publicly but I had the same status as you. I was a student and used the NHS and I registered at a primary-care trust and that is where I got my NHS number, after having shown my visa (if I recall correctly). International students don’t cost much to cover so I suppose the government is happy to include them just for the benefit of good international relations.

      • Firstly, the laws have (recently and frequently) changed.

        This appointment was after the initial showing of passport, visa, statement of student status, bank account, and proof of address (x2). I didn’t include them because those steps are published on the UKBA website.

        Anyway, be careful about assuming based on your past experience here. Immigration laws have tightened considerably, and it’s a lot harder, more expensive, and more time-consuming than it used to be.

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