Brits who have lived in the US know exactly why health insurance is a bad idea

Mary Dejevsky asks why the concept of an insurance-based health care system evokes such horror in the UK.

I lived in the US for 12 years, my husband is American, and we count amongst our closest friends in the US a medical anthropologist whose work for years focused on inequities in the insurance-based health system. Insurance-based health care is great for those for whom money is no object. For the rest? You don't have to be poor to be poorly served by insurance-based healthcare.

We had our health insurance through my husband's employer. Every year, we paid more money for less coverage. We could go to the dentist twice a year, but not twice in any six month period, which meant that if we had an emergency, we'd have to pay out of pocket. Indeed, one of my husband's colleagues was in exactly that situation – it cost him over $3,000 (£2,800) to have emergency dental surgery, which took out most of his savings, despite him being in a reasonably secure, decently paid IT job at a well-established institution. When I got gastroenteritis on a family holiday in another state and spent a couple of hours in a hospital being pumped full of antibiotics and antiemetics after a 30-second "consultation" with a doctor, we spent several very fraught months fielding bills from the hospital for almost $5,500 (£4,000) which our insurance company was supposed to be dealing with, until it was eventually sorted out. Even with one of the better health insurance plans available in our state, a host of services we take for granted were not covered, or were only partially covered depending on the circumstance.

We knew a paramedic whose employers didn't provide health insurance, which meant that he was routinely providing services he couldn't access, his child hadn't had a regular check-up since she was a toddler, and any illness in the family meant a hard decision: take the chance that it would get better on its own, or go to the emergency room and wipe out the family's ability to pay rent for the next couple of months. The family was evicted every couple of years because they'd had to choose between medical care, food, utilities, and rent.

We knew middle-class families who had no choice but to go into debt because of unforeseen medical issues, accidents, children born with not even terribly complex medical conditions which required ongoing treatment denied by health insurance companies.

Several of my American family members cannot get health care insurance because they're skilled building contractors who go contract to contract and can't find an affordable health care plan; one lost their job due to Covid-19, and the stimulus cheque took them just over the income threshold that would have allowed them to access Medicaid (which is extremely limited). One family member has been researching the possibility of health insurance through a foreign provider because he can't afford decent health care for his family despite his decent current income – being self-employed can be a big red flag for insurance companies, unless your turnover is in the millions.

Thank goodness for Hilary Clinton's successful campaign to get children's health insurance covered by the state. Adults, though? Millions of Americans can't afford any health insurance; many millions more can afford only expensive plans with high premiums which don't cover their ongoing medical expenses and don't include a slew of basic provisions (like vision and dental). The single biggest cause of bankruptcy in the US is medical bills.

If you want to know why people are horrified by the idea of an insurance-based system, ask anyone who's fallen foul of the US system, or just look at the health care outcomes for the US population by demographic. If, like me, you're middle-aged and had grandparents who remembered life before the NHS, recall their experiences; if not, check out a decent history book. And then look at the sheer cost to the taxpayer of insurance-based health care systems vs single-payer systems and then check out the health outcomes and mortality rates and see which systems come out on top in cost and well being overall.

Maybe Mary Dejevsky can afford to access solid health care come what may. The vast majority cannot, and as we stare down the barrel of long-Covid (a "pre-existing condition" if we shifted health care systems) and Brexit, I guarantee that even fewer will in the near future. Taking us down the insurance-based health care system route will make a few fat cats much fatter, but it'll be a disaster for the other 90 or so per cent of us.

Karen Abbott

Address supplied

As a coalition of leading providers of care and support to vulnerable children and young people, we echo the call by the Scottish Association for Mental Health in its manifesto for the Scottish parliament elections for “radical action” to combat a growing mental health crisis.

For some time, we have raised concerns over a potential lost generation of vulnerable children and young people, whose mental health is being impacted even further by the pandemic.

It should however be highlighted that prior to the pandemic, cases of poor mental health were at unprecedented levels and there are a growing number of vulnerable children who cannot access services. 

Our children are remarkably resilient, but the frightening statistics on the mental health of our young people create a compelling case for a national crusade to address what is a mental health pandemic, underpinned by considerably greater resourcing. 

Unless the government takes urgent action now to improve access to services, this young generation will be destined for a future of mental ill-health, with resultant longer-term consequences. 

As the Scottish parliament deliberates the draft budget in advance of the elections, we would urge the political parties to make this a budget for mental health, massively increasing investment in support services and intervention strategies, well beyond current provision.

This mental health crisis is one we can address, but it will require a similar energy, drive and commitment to that which was demonstrated for Covid-19 if we are to achieve this and prevent this generation of young people from giving up on their futures – and themselves. 

The Scottish Children’s Services Coalition:

Kenny Graham, Falkland House School

Lynn Bell, LOVE Learning

Stephen McGhee, Spark of Genius

Niall Kelly, Young Foundations

What is truly dreadful is that Priti Patel openly describes Black Lives Matter protesters as "dreadful”.

She is Britain's home secretary and yet she sees fit to attack the movement for equal rights and opportunities for Bame people. It is a disgrace. A total disgrace!

This government is clearly hell-bent on playing these dangerous cultural war games in a deeply misguided and immoral attempt to appeal to racist voters. No government should behave in this way. A good government should lead and unite, not bow down to dog-whistle populism and bigotry. Yet again, I am ashamed of my government. 

Sebastian Monblat 

Sutton

Whilst welcoming NHS reform, it is appalling that improvements for social care are once again being pushed to “later in the year”. Reforming NHS care without reforming social care is like rebuilding a house without mending the roof.

In a country where around £7.7bn has been cut from social care budgets since 2010, some 1.4 million people are living without the care they need and there are 110,000 vacancies for social care staff, we shouldn’t be waiting any longer.

Talk of closer integration is all very well – every government in the past 30 years has talked about it – but the reality is, it never happens. Social care needs urgent, root and branch reform to put it on a par with NHS healthcare and make it fit for purpose. Anything less is just window dressing.

Mike Padgham

Chair, Independent Care Group, York