As an American living abroad, I tried to follow the debate over healthcare reform in the US, but I had to drop it for my own sanity. How could so many of my fellow Americans say that people like me, with chronic diseases we never asked for, should pay more for healthcare because they don’t want to participate in the risk pool? How could people like me, who live in fear of losing health insurance, be blind to how badly Americans with type 1 diabetes can get ripped off? I had to remind myself, “It’s okay. I don’t live there anymore.”
In October 2007, after living for a few years in the UK under the NHS, then spending several months uninsured in the US, and finally working in California with health insurance for two years, I emigrated to Britain. Beyond my appreciation for the culture, I feel that as a person with type 1 diabetes, I am better off here.
Top 3 reasons I am better off in the UK than the US:
1. Lobbying doctors, health authorities, and elected officials can really make a difference. I first moved to England for grad school in September of 2001 and stayed until April 2004. As a full-time student, I was covered by the National Health Service. On January 1, 2002, my US health insurance expired. My doctors agreed that I should keep using my pump, but I had to lobby local health service administrators to get my pump supplies covered. The battle I faced was similar to the ones my parents fought on my behalf in Virginia when I started using a pump in 1995. I was surprised that the UK was so far behind the US in terms of pump use. I joined a grassroots, patient-led organization to increase access to pumps. I still meet with members of Parliament on a regular basis to discuss diabetes care in the UK. In mid-2003, the NHS decided to fund pump therapy for type 1s who are likely to benefit from a pump. With my doctors’ support, I was the first person in Oxford to get funding under that decision. Today, about 7 percent of UK type 1s have a pump, and we’re getting closer to the European average of 15 percent.
2. No co-pays or deductibles for diabetes care and supplies. I had to pay for my pump supplies until September 2003, but I was grateful not to have to pay for doctors’ appointments and prescriptions. In the UK, only tourists pay for medical care, at the point of service. All type 1s and type 2s taking at least one diabetes drug do not pay the usual £7.10 per item prescription charge. For reference, the national minimum wage is £5.80. Even insulin pumps and supplies are covered at 100 percent. There are no out-of-pocket costs for blood tests either.
3. Economic independence. When I decided to change jobs a few months ago, I didn’t have to think about whether I would get insurance, whether the insurance would be good enough, or whether I would be able to meet the deductible. My access to healthcare is guaranteed, no matter what job I hold. I need to t least £20,000 per year to keep my visa, but that’s less than I can afford to live on anyway. When I worked in California, I couldn’t quit my job when I was beyond ready to leave because I couldn’t afford the $350 per month (plus co-pays) for COBRA that I’d have to pay if I walked out and took the first thing that came up. I became depressed. Keeping my health insurance had to take precedence over my mental health and my professional goals, which I deeply resented.
On balance, the NHS works well for me. It’s not perfect, but I haven’t heard of a healthcare system that is. There are no “death panels” – in fact, the UK’s National Institute of Health and Clinical Excellence (NICE) does cost-benefit analyses using almost all the same criteria as US health insurance companies… Except for the profitability ratios.