Paul Gibbons Op Ed in the Capital Times Newspaper, April 2007
An uncertain hold on reality – that is what you Wisconsinites have. At least if you are one of the twenty people who have held me hostage and grilled me on healthcare since my return here. Not, “how were your 25 years in Europe, did you miss Wisconsin?” Rather, “is it true that you can’t see a doctor for months”? “Can you really not get operations if you are sick?”
You are kidding me, right? Today’s posh lunch at the Edgewater was the most astonishing. No sooner had introductions been made than a besuited gentleman grabbed me by the collar: “I hope you are not a doctor.” “Why?”, I asked. “Doctors in England don’t get paid anything.” “Really, they make at least a couple of hundred grand a year once they know what they are doing.” “Well… ahh… doctors make more here…” quoth our well-dressed friend.
He was taking aim at the UK’s NHS – a free, comprehensive, program that covers you cradle to grave. Clearly doctors’ salaries are how you should judge it, not by (silly me) health, coverage, quality of life, or value for money. Pity those poor bugger doctors back in England struggling on 200K, wondering how to keep the chalet in the Alps decorated. I thought you had high schools and colleges in Wisconsin that taught people how to think? This fine fellow was wearing a suit, so someone must (over)pay him to do something, presumably something other than reading or thinking. Probably he can get a job at Fox as an expert on healthcare policy with his robust understanding of the issues.
Even educated Americans live in a fantasy about European health care, so let me answer some questions. I’ve never seen a medical bill in the UK and I have lived there 25 years. From cradle to grave healthcare is all paid for. Prescriptions cost 12 dollars, unless you are poor, pregnant or old and then they are free. Dental work and glasses are free for children under 18.
That’s it. No insurance. No co-pays. No pre-existing conditions. No deductibles.
At this point my Wisconsin friends encounter a bit of cognitive dissonance. Surely the Wall Street Journal and the AMA and the drug companies are telling the truth – universal health care is bad? It doesn’t work, right? No, it works fine. Providing free health care to 60 million people is a non-trivial activity and things go wrong, but no more wrong than here. Folks you have been duped. Here come their questions. “What about the long lines?” Here are the facts. If you are worried about your health you can see your family doctor within 48 hours. If you are very sick, you go to a primary care center where you might wait 30 to 90 minutes depending on when you go and how sick the triage nurse thinks you are. If you are dying, you go to the ER just like on TV. If you aren’t dying, you can wait a long time for surgery, such as a knee or hip replacement. Urgent surgery happens right then, urgently. Example. We got pregnant. We saw the doctor twice and had two scans in the first 90 days, and were offered a choice of midwives, water births, birth centers, and hospital births just like in the Land of Great White Private Medicine. All free. My son had an ear infection. Sunday at 8PM we drove to the primary care center (about a fifteen-minute drive). We waited 30 minutes, had him examined and walked out with a diagnosis and some Amoxicillin. All free.
More facts? Your health care is the most expensive. That is no bad thing – who would not prefer a Lexus to a Dodge. Sadly, it isn’t a Lexus. The World Health Organization reports that US life expectancy is ranked 24th in the world and 37th in overall health system performance putting it between Costa Rica and Slovenia. In fact, what you have is a very expensive 1973 Pinto. Nice.
But what is really insane is you defend it (hence my remark about your tenuous hold on reality). It is like an abused woman being told to leave her husband and beginning to enumerate all his good qualities, ending with a …”but I lervvvv him”. He ain’t worth it honey. What are you protecting him for?
Listen to these for defensive reactions. “Your taxes are crazy over there.” Well we get free health, free schools, almost free college, free social security, and free transportation when we get old. Poor people are guaranteed an income. Plus, we have police, fire, roads, and a military for helping W out. Those things cost money. How much? If you are well off (90k plus), your marginal rate is 40% and effective rate is about 30% . We don’t have property taxes, or state, or municipal taxes. Sales taxes are big, but built into prices.
Those are higher than Americans are used to but I wonder whether if the cost to business of health care plans, and the cost to individuals of health insurance are built in whether we come out so differently financially. Here are two differences. One, we cover everybody. No 46 million people and 10 million kids without coverage. Second, I have not met an American who is not obsessed with health care – hence the constant grilling since my return to Badgerland. I hardly know an American family that is not anxious about a serious medical condition wiping out years of savings, or otherwise destroying a family financially. It is hard to price ‘well-being’ and peace of mind, but never having to worry about being sick (apart from the fact of being sick), is priceless.
Hold the facts for a minute, I have to rant. My dear doctor friend in Milwaukee moans about taxes from behind the wheel of his Suburban having left his wife’s Navigator, a BMW, and a Corvette, a Harley and two boats in the garage of his six-bedroom lakeside house. Nothing is more disgusting than a rich person moaning about taxes. Nothing. God forbid some poor family should get a bit of your hard-earned cash. Sure, you don’t think they deserve it – that is because you are heartless and greedy. Get over it. Grow up. Shit costs money. You have a lot. Share some. Especially if your 750k a year was built on public education, state universities, safe streets, collected garbage, a secure country, and other infrastructure built with the taxes of the previous generation. Now pay your share so this generation can have some of those goodies and moan about their taxes when they grow up.
More defensiveness… “The climate for business must be awful.” Baloney. The UK is the 8th largest economy in the world, having just been overtaken by China. It ranks 13th in GDP per capita, and the US ranks 9th with 11% higher average income. Four of the fifteen largest companies in the world are British including the largest bank and the largest oil company. It is 1/6 the population of the US and punches way above its weight in the global economic order. I’ve been a small business owner for seven years and we get tax breaks and nice corporate welfare just like you do here.
It saddens me to say, because I love America and adore Madison, that you are getting cattle-prodded in a tender place. While prodding with one hand, the prodders send fat checks to legislators and spend millions on PR to breed the kind of pure ignorance and fear and irrationality I’ve heard today. America is the greatest country in the world in many respects; in health care, it is one of the worst. The sooner we wake up to that fact, the sooner it will be as great as we say it is.
Paul Gibbons is a graduate of West High and UW Madison who has lived in England since 1981. He is Chairman of a management consulting firm, and a writer.
