For the second time since moving to the US 15 years ago, I had to call 911 this week. The first time, six years ago, was when smoke poured into the elevator from a fire in the laundry room and four fire trucks arrived within minutes. This week, it was to request an ambulance for a sick neighbour. Between dialling the number, and a gurney and two paramedics materialising in our hallway, was approximately seven minutes. I found myself thinking something I used to think about the NHS: what an amazing service.
My understanding, at this distance, is that most ambulances in the UK do not show up in under 10 minutes, even when the emergency is dire. A friend who had a heart attack in the street in London this year was, he told me, lying on the pavement for 40 minutes before the ambulance showed up. This is terrifying, and yet still marginally less terrifying than the common American experience of emergency care, in which gratitude for efficiency is undercut by the dim but thrilling possibility of losing one’s house when the invoice arrives.
All of which is at the forefront of my mind as we slog through the season of healthcare renewal. I have to stop going on about this, I know. Short of moving to Canada, or joining a powerful union I don’t qualify for, there is nothing to be done about it. Still, the sheer punitive opacity of the system has never shocked me so much as it is currently doing, when, after years of renewing an existing policy, I finally decide to go shopping.
“Do you know how this works?” says a sales agent. I have just asked if she can send me a breakdown of coverage and exclusions for a policy that costs in the region of $10,000 a year. “How it works is we can send you the full policy details after you’ve signed and paid, and then if you want to cancel, you have 30 days.”
There is a pause while I digest this. “Isn’t that … quite weird?” I say. She laughs nervously.
“I mean … it’s just how it works.” Brightening, she says, “But you can ask any question about the policy and I’ll answer it!”
After calling three other agents expecting a different response, I understand that no one here is acting in bad faith; this is, as she says, just how it is: an Alice in Wonderland system in which you only know what you’re buying after you’ve bought it. And so we grind through the preliminaries. No pre-existing conditions; nobody smokes; no interest in maternity cover. All of which cheers the agent no end, as it results in a relatively attractive quote.
I ask the single question it is vital to ask in New York when buying health insurance for your family. “If someone gets cancer, can we get into Sloan Kettering?”
Her voice sharpens instantly. “Does someone have cancer?”
“No. No one has cancer.”
“Well, then, yes. It’s a PPO (preferred provider organisation), it’ll be accepted everywhere.”
But of course, this isn’t the whole story, and when I ask why the provider she’s flogging isn’t listed on my doctor’s table of accepted insurance, she gets tetchy. “We’re accepted by 80% of medical providers in the US.” Ah. You can guarantee, in this scenario, that the 20% of doctors who don’t accept this sketchy insurance are in New York, where you can’t cough without someone sending you a bill for $350 (£290).
In the middle of all this, I visit my wonderful primary care doctor for my annual medical. She commiserates with me and tries to find a workaround to foil my existing insurers. In the US, public health policy recommends routine colonoscopies for everyone over 45 – ha, you wouldn’t get that in Britain, I thought, when she told me about it last year, before checking my policy to find it wasn’t covered. A colonoscopy costs upwards of $5,000 (£4,130) in New York. “They just want you to die,” says my doctor lugubriously, a starker statement than I was expecting. But I guess at some level, true.
So there you have it. Broken Britain or this hellscape? It’s a tough call. Today, I will get on the phone again to try to find a loophole in the system, a unicorn policy that covers both routine screenings and major medical events; one that, in the event of an emergency, will bring an ambulance to my door inside of 10 minutes – assuming I’m not too terrified to call for it.
Emma Brockes is a Guardian columnist
