As an American living abroad in England, there are lots of things here that are different for me: tea, a monarchy, warm beer, not refrigerating eggs, all stores closing early on Sundays, saying “cheers” to everything as a catch-all phrase, consistent and steady rain. But this week I experienced one of the most unknown, unrecognizable, and strangest things of all.
I’ve heard about the NHS (short for the National Health Service, the UK’s national healthcare system) for years. While it’s free for Brits, I had to pay £600 ($801) as part of my UK partner visa application (called the Immigration Health Surcharge, or IHS) for the 2.5 years of my visa to get access to the NHS. So the NHS isn’t free for me. I paid a whole lot of money for it. But based on US standards, $800 is a hell of a deal. That’s nothing compared to what most Americans can spend on healthcare.
Three years ago, I registered with the NHS (back in the good ol’ days when there were no IHS charges with a visa) as a student in Nottingham but never needed to use it. I registered at a GP (general practitioner/regular doctor’s office) in York last month, they transferred me over, didn’t ask to see my BRP (Biometric Residence Permit, my proof that I can live in the UK legally) or anything. This week when I went to the doctor to get a new birth control prescription here, I didn’t totally know what to do with myself.
I have always been lucky to have had healthcare at home in the US. I was always covered by my parent’s health insurance, and we’ve had good insurance. I’m fortunate that when I was sick, I would go to the doctor. Too many Americans don’t have that basic privilege.
Here’s some basic information about healthcare in the US, for those non-Americans who may be reading: My mom gets our health insurance for our family through her employer, and we pay a shit ton for it. But our health insurance, HealthPartners, is good. I stopped going to HealthPartners clinics though because most of those visits cost a $35 co-pay. A co-pay is a small amount of money you pay for your clinic visit—instead of paying $200-300 for a doctor’s visit (more depending on the type of visit and tests done), you just pay $35. Not all visits are that cheap though: my specialty clinic for my physical therapy cost $60. And to be honest, if my parents hadn’t had offered to pay for my physical therapy, I probably wouldn’t have gone (8 visits x $60=$480 over two months). And at the time of writing (November 2016), most (but not all) birth control was covered by health insurance, a stipulation mandated through Obamacare—so most (but not all) birth control was free. Unfortunately, this may change (and most likely will) following the election and that breaks my heart.
But the catch of it is that you can only get 3 months of birth control at a time—which meant that both when I studied abroad in Nottingham, and when I traveled extensively from March-May, I needed to pay upfront (out of pocket) to get more in advance. And they’re very serious about only 3 months at a time. Let’s not forget the time that Walgreens refused to re-fill my prescription until I was down to 4 pills because they “can’t re-fill within 3 months.” Thanks for that.
But I stopped going to HealthPartners clinics because of the co-pays, and switched to Planned Parenthood for all my clinic visits. Due to my low-income status during college and last year, I was eligible for extra health insurance, Minnesota Family Planning, at the Planned Parenthood clinic. Combined with my HealthPartners insurance, this meant that not only was my birth control free, but I no longer had to pay a co-pay either! This changed my world.
So with that info out of the way, back to the NHS. No, the system in the UK isn’t perfect. The NHS has a lot of flaws. I had to wait 3 weeks for an appointment (although you can sometimes walk in and get emergency appointments), which is a long time to wait, and especially difficult if you work a job where you don’t have the schedule more than a week in advance.
But besides that, I’m struggling to be critical about it. The price for a single prescription is about £8 (~$10), which, yes, is more expensive than the regular $5 price that I paid with my HealthPartners insurance at home. But that’s almost all your prescriptions. And if you have loads of prescriptions? You can buy a prescription prepayment certificate (PPC) for £104 (~$130) for a WHOLE YEAR. All of your prescriptions, covered, for a whole year, for £104?! I’m not kidding. I’m not totally sure about all the ins and outs of the system past this—surgeries, hospital stays, emergency room visits, etc. But there’s no busing to Canada to buy prescriptions more cheaply. No turning into a meth dealer because of medical bills like in Breaking Bad. See how I’m struggling to be critical of this system? Nationalized healthcare is GOOD.
EDIT: It was brought to my attention that not all prescription drugs are covered by the NHS. Some expensive/complicated drugs (the example used was for a type of cancer) aren’t available in England without paying out of pocket for them, as the pharmaceutical companies charge too much for them and the UK won’t pay it. So not all prescriptions are covered, but many are.
So this week, I had my first appointment with the NHS. I showed up about 5 minutes before my appointment time. I checked in at reception, wasn’t asked to pay a co-pay, waited in the waiting room, met my doctor and went into her room/office (which as clearly hers, as it had some decorations and personal touches, which was weird for me), talked with her, got a new prescription for a very similar type of birth control, and then walked out. I JUST WALKED OUT OF THE CLINIC. No checking out. No co-pay.
I JUST. WALKED. OUT.
With my prescription. MY DOCTOR’S VISIT WAS FREE. I literally just walked out of the clinic. And all of this took less than 10 minutes.
Then I went to the pharmacy—Boots is the main chain here, similar to Walgreens or CVS. I gave them my prescription, they had me sign the back of it, confirming that it was free since it was birth control, I waited for 5 minutes, and I walked out with 6 months. SIX WHOLE MONTHS! And I didn’t have to pay, AGAIN—it was all FREE! The most shocking part of all of this? This is the most basic level of care provided for women needing birth control. If it was urgent (I couldn’t wait 3 weeks for an appointment) or an emergency, apparently I can go to a family planning clinic and get up to 12 months of contraceptives, free of charge, on the spot. Wow.
I know that technically everything wasn’t free. I paid £600 for my IHS on my visa application to get access to the NHS. And I don’t know much about taxes in the UK, but they are higher than in the US. And I do know that some money from taxes goes to pay for the NHS—so people do pay for some of their healthcare through their taxes. But my mom pays a whole lot more than £600 for health insurance that covers me, and there’s always a co-pay. So when you walk out of the clinic and the pharmacy without paying anything, it certainly feels like it’s free.
I can’t believe how easy this was. It was so easy, so affordable. How are there people in the UK that can hate this system? When the system is so affordable? When they don’t pay for health insurance? Do they not have any idea how privileged, fortunate, lucky, and blessed they are, to be in a country that has a system like this?
This experience made me feel so unbelievably guilty. Americans struggle daily to afford healthcare. The outcome of this election could mean that millions (MILLIONS) of people will lose their health insurance through Obamacare. And yet now I’m in England, where I can go to the doctor all the time and pay nothing.
If you are British and you’re reading this, I encourage you to count your blessings. You live in a country with nationalized healthcare that is affordable. Be patient the next time you go see a GP. Thank a doctor or a nurse or a receptionist. Please, please recognize and understand that not everyone has this privilege of healthcare.
If you are American and you’re reading this, I encourage you to dig your heels in and fight for a national healthcare system. I know it won’t be easy, especially after this election. But fight. Fight for Obamacare/the Affordable Care Act. Fight against conservatives as they try to deny women affordable access to contraceptives and family planning. Fight for Planned Parenthood. Organize and educate and canvass for candidates—at ALL levels of governments—that support a more affordable (and nationalized) healthcare system. I will be with you across the pond, fighting for you and supporting you where I can.
A special thank you to my parents, for paying for me to be on their health insurance for 24 years. I am so grateful, today more than most.
Over to you! Have you ever experienced a healthcare system in another country? I’d love to hear your experiences in the comments below!