Birth by Government: Part I

I apologise for my hiatus during the past few days; I’ve been struggling with an ongoing gut complaint which, inevitably, has me pondering the issue of healthcare. In the UK, where I’m from, healthcare is paid for in taxes and is thereafter free at the point of use. Here in the US, healthcare is paid for on an individual basis, either by employers (if you work at a company which offers benefits), by the government (if you’re poor, disabled or elderly), by the US military (if you’re a veteran) or by individuals themselves, schmucks like me, directly – if you dare – or with the help of health insurance.

My employer doesn’t offer health benefits. That puts me in the same situation as about 9 percent of Americans, where the responsibility to buy health insurance falls to me alone. I don’t mind this, but my deductible (the amount over which my insurance will pay for my healthcare) is such that if I break my back or need hospitalised for another reason, I’ll be forking over $2500 out-of-pocket. This is a choice, of course: I could pay more on a monthly basis and reduce my deductible, or I could find an employer who’ll pay for my healthcare (like the 60 percent of Americans who are insured as part of their salary). Anyway, I pay my monthly insurance premium and what I’m assured of in the case of a health problem is that $2500 is the most I’ll have to pay, and my healthcare will be excellent in that event.

Still, it’s a constant stress to think that I’ll have to come up with $2500 if I get sick. In the UK, I wouldn’t need to worry about monthly costs: that money was taken from me before I even got paid. You can’t miss what you never had, right? Neither would I need to worry about out-of-pocket costs in the event that I need treatment: it’s free at the point of use. There’s no financial questions involved.

But things aren’t really so rosy. First, it isn’t just my income tax that goes up to pay for the health problems of UK society at large; it happens every time I buy something at a grocery store (sales tax is 17.5 percent of every purchase), every time I fill my car at a gas station (where 85 percent of the cost of petrol is tax) and upon almost every other intervention with the rest of society. By the time I come to use the National Health Service, I may have already paid for my ‘free’ healthcare many times over. And, arguably, it isn’t even as good when I get it: the quality of UK care is drastically worse in comparison to the US. Sure, the nurses are great (as people always insist), but the system sucks.

(The question of whether it sucks more than the US system is complicated. It is not my purpose here to suggest that the UK system is worse, necessarily; just to argue that universal health care has its own serious issues and should not be thought of as a default solution. The World Health Organization ranks UK health at #18 and the US at #37.)

When my wife Melissa and I had our son Tyler, we were living in Belfast, Northern Ireland. Our first interactions with the system were decent, and it’s difficult to be analytical about the system when your wife has a human head springing from her vagina. But afterwards I began to realise what shit I’d had to endure for my tax money. We were promised that one of the five midwives who we’d dealt with throughout Melissa’s pregnancy would be present at the birth to ensure that our wishes were honoured and our plans implemented: none were available on the morning she went into labour. Instead, a ginger-haired freak of a woman was in charge of the delivery room. She had no name, apparently, and the combination of a hairy facial mole, pale complexion and sweaty brow made me a little nervous.

Ginger left us in a room before the birth until things were ready to go, which was a very welcome development. As Melissa tried to relax in a chair, we were timing her contractions. After 45 minutes I became convinced this baby was ready to make an entrance. I was no expert, for sure, but I was pretty sure judging by the look on Melissa’s face and the space between contractions that I was right (hey, I’d seen Junior). Ginger seemed irked at being called in so early – clearly she’d decided that Melissa could wait at least a couple of hours – but, upon my insistence, she came and checked. “Oh God, you’re almost 10 centimetres. Okay, hold on, we need to get you lying down.” Duh. I wasn’t exactly sure I wanted this dullard anywhere near the birth of my kid.

A few weeks before Tyler was born, one of the midwives had estimated his weight using ultrasound. The reading on the machine was 11 pounds. This seemed a little outlandish to the nurse, since babies over 8 pounds are considered to be on the large side, and the average is around 7-something. So, rather than verify the accuracy of the measurement in some way, she fiddled with the machine a little, pressed this button and that, until the readout had changed to 8 pounds. “That’s more like it,” she said, and wrote 8 pounds on the form. Now, this may not have seemed significant at the time, but it should have seemed so to a trained professional of the UK National Health Service. You see, Melissa opted for natural childbirth on the basis of these measurements, without drugs (apart from the help of breathing a little nitrous oxide).

What followed after Ginger realised that Tyler was ready to pop (and perhaps that midwifery was not for her) were two hours of extreme pain and exhausting exertion for a woman in the throes of childbirth, two hours during which Ginger had given up and sought the assistance of some more adept midwives. It was now apparent that something was wrong. This baby was no 8 pounds, and should never have been delivered by natural childbirth. He was almost 11 pounds, and was in the process of being born complete with a schoolbag and braces. A quick intervention later, and we had a son, two weeks overdue (but of course we’d never have known that because they’d screwed up the date too).

As if that weren’t enough, Melissa had to put up with the ward for the next few days. My friends came to visit and described it as a “baby factory”. The women were crammed in as though it were a morgue, eight of them (and their babies – 16 individuals) in a space no bigger than my living room, which is big, but not that big. The place was smelly, dingy, and had the feeling of uncleanness.

After a woman has a baby, she’s recovering from the most immense exhaustion of her life. Not only that, but she’s supporting the first hours of a newborn infant’s life with the nutrients of her body. Given these rather pertinent facts, you’d assume the hospital would be serving up some wholesome, healthy, nutritious food. Right? Wrong. The food was heinous pizza, dreadful quiche, cheap chicken nuggets, chips, all of it heated from frozen; and once in a while a woman would start eating her own baby just to avoid it. (The cheeks of an infant, I’ve heard from countless old ladies, are delectable, though I’ve never worked out whether they are referring to the face cheeks or ass cheeks; either, I suppose, would do when faced with the alternative horror of eating NHS food.) I snuck Melissa some Subway sandwiches against hospital rules, which helped her find the will to live.

Contrast this with the care in an American hospital, where healthcare companies must compete for your business; where it’s not unusual for a mother and baby to occupy a private room complete with TV and sofa, where sometimes the father can stay too, where the food is actually edible. Of course it costs a bloody fortune, which is part of the reason that the United States’ healthcare system ranks poorly for access and equity (more on that in a minute).

Another thing. During my mother-in-law’s pregnancy, she suffered from an iron deficiency and became anemic which left her short of breath, with an off-coloured skin tone and a craving for ice. When Melissa started experiencing the same symptoms, she informed the nurse who said it was normal to be tired after having a baby and not to worry about it. She was wrong. This alone was a major error, since 120 people die of iron deficiency anemia every year and you’d think they would want to be on the safe side. By the time they figured out that my wife was right, she’d gone through two days in hospital eating shit food, crammed into the farting space of eight other mothers and their ugly babies, with a green face, gasping for air with Tyler attached to her unnourishing boob.

Am I exaggerating? A little. But not by much. It took us a while to analyse the quality of her care during this experience since in the UK it’s considered fairly normal and it’s not within most people to think that there might be alternatives. But for Melissa, who’s American, it was clearly crap. Why so? Because the government is running it!

Most intriguing about the arguments of those who wish to bring universal healthcare to America is that they cite the statistic that America is alone among developed nations in continuing to have a private healthcare system, without ‘universal’ government care. Take it from me, as a citizen of the United Kingdom who grew up on the government version, and take it from Melissa, who’s body has recovered exceptionally well from the experience, it ain’t all that.

How can we improve things?

In the UK: There are some systems in which healthcare is provided by the private sector but insured for citizens by the government using taxes. This could solve a lot of the quality issues in the NHS, and would certainly be a step forward for the UK. It would get the government out of running hospitals and clinics, and competition would finally be a factor in healthcare. This is a little like the ‘voucher’ system proposed by the Tories a few years ago, only better, and it would be a step in a more libertarian direction.

In the US: If I weren’t a libertarian, I’d quite like to be comprehensively insured by the government here in the US, so that I’d hold on to that $2500 if I broke my leg. Perhaps a somewhat libertarian solution, from a federal point of view, is the idea that the federal government should stay out of healthcare, but that localities should have the option of a public insurance program. That way, perhaps a city here or a county there might take up the challenge of issuing higher taxes to its citizens in exchange for a universal healthcare program, and if the citizen didn’t like it he or she could move elsewhere. This is the US system of government’s strongest element – and the one its critics understand least – the fact that fewer laws are enacted at a federal ‘universal’ level and that more of that decision-making is left to states, counties, cities and small communities. In the case of healthcare, it may be that libertarian values could be honoured in a system whereby choosing where you live constitutes a voice on whether you want government involved in your healthcare.

The US government insures over a quarter of Americans ‘for free’ already. That takes care of those who can’t take care of themselves. Perhaps the next step is to reduce the spiraling costs of healthcare by putting a stop to frivolous lawsuits, and by reducing government interference in the free market. Actually, one may do no better than to look to libertarian 2008 presidential candidate Ron Paul, who is a physician himself, and has delivered over 4000 babies during his career. If he’s familiar with any of the issues more intimately than the others, it’s healthcare. Here’s Paul On Healthcare.

Bottom line? Someone has to pay for it. A socialist approach is wrong in principle. An individualist approach is better in principle, but the American system has some serious shortcomings which need to be addressed (and which can be without resorting to a ‘universal’ healthcare system). The UK is a prime example of a healthcare system that would be disastrous for America.

But, I wonder, will any nation ever be particularly happy with its healthcare system? After all, we only use it when we’re sick or in labour. Frankly, those aren’t the most enjoyable experiences in our lives. Course, after watching what Melissa did, I can at least be glad I’m not a woman.

To read the second part by Stephen Graham, click here.