Uninsured in the USA

Money & Stethoscope - Vangelis Thomaidis

I left London in early last month and will become a resident of Canada in a few weeks. In the meantime I'm in the US, where the healthcare battle is raging. And I'm pregnant and uninsured.

In London, knowing we were moving, we booked appointments at the Fetal Medicine Clinic on Harley Street and paid £100 for a seven-week scan, then another £150 for a 12-week scan. Since we were about to move I didn't bother involving the NHS, and let's be real, it's not like they were going to do anything interesting in these early days.

Now it's time for my 20-week scan, the one where a radiologist counts fingers, toes and heart chambers.

I called up the local hospital.

"Can I just book an appointment and pay?"

"No, sorry, you need a referral from a doctor."

"So I have to see a doctor who will tell me I'm pregnant, due on the 4th of May, and should really go in for a 20-week scan."

"That's right."

"And how much will the scan be?"

"You said you were self-paying, correct? Then it'll be $140 - we give a 50% discount if you're self-paying. Plus $80 for having the radiologist look at the scan."

"So if I had insurance, the charge would be $440 but my total will be $220."

"That's right."

I called the doctor's office, who told me I could see a nurse practitioner or a doctor.

"Well, if either could give me the referral and I'm paying myself, then I guess I should see a nurse practitioner since she would be less expensive."

"Actually, no, they're the same price, which is $95.16, and that includes a 15% self-pay discount. But you can come in tomorrow."

So, what exactly is wrong with US healthcare?

"Nothing," says my well-insured step-father. "We don't have to cross the border to get good care like that couple from Canada that we met in Mexico."

"The fact I have to pay $700 a month for out-of-pocket insurance," says my unemployed, middle-class friend.

"The fact I had to pay $1300 a month for my family's insurance during my maternity leave, since my company hadn't bee around for a year before I had my baby," says my employed cousin.

"The fact doctors can't afford malpractice insurance out of a group practice," says my orthopedic surgeon brother-in-law.

"Malpractice insurance," says my mother. "We get great care, but they have to give it, otherwise people will sue."

So really, there are two problems. Private coverage is out of control. If the US culture wasn't so litigious, malpractice insurance wouldn't be so high, doctors wouldn't have to charge so much, and insurance premiums would then be lower. But do people with insurance really care, since their insurance is paying and for the most part, their jobs provide that insurance?

What they do care about are their tax dollars paying for those without insurance - the poorest people (whose emergency coverage already gets begrudgingly absorbed by the medical community), or those in the next socioeconomic bracket (who have some assets but no insurance, and who will be chased by collection agencies until their assets are gone).

Although many insured Americans may give to charity, supporting initiatives that allow people to live off the state is just not the American Way. Work hard and make money. What you get for working hard should be yours to keep. And therein lies the problem.

In the meantime, I'll pay more in small town America than I would in a world-class establishment and be glad I'm moving on.