MS Patients in US and UK Face Very Different Treatment
We may have international cooperation and worldwide this and that, but the fact remains that countries vary drastically from one another in all sorts of ways. Take healthcare as an example, and the costs of treatment.
Yes, we have the World Health Organization and there are various health-related initiatives from the United Nations, but that is about it on the international front.
Let’s have a brief look at healthcare provisions, including how they affect people with multiple sclerosis, in two Western countries said to be close allies and who enjoy what they term a “special relationship.” That’s the United States of America and the United Kingdom.
I was born, and lived my entire life until last year, in the U.K., which is supposedly a welfare state. I say “supposedly” because, at the rate at which David Cameron’s government was cutting the welfare budget, there can be no certainty this will continue.
Anyway, a key element of the founding of the welfare state, just after the Second World War, was the setting up of the National Health Service, which includes all GPs, hospitals, and ambulance services. It is a healthcare service that took good care of me when I lived there.
And everyone living in the U.K. is entitled to the treatment they need absolutely free of charge. Yes, you did read that right. The British do not need private medical insurance, have no co-pay to worry about. If they fall ill they just visit their family doctor, or go to a hospital if their condition’s more serious, where they know all tests, treatments and stay, if admitted, will not cost one penny.
World’s apart
The only expense they may incur is the small cost of prescriptions, and only in England. Charges for these, all of which go to the government, vary by country. Residents of England face a prescription charge of £8.40 (about $11.15) for each medicine or appliance dispensed. In each of the other constituent countries in the U.K., namely, Wales, Scotland and Northern Ireland, all prescriptions are free. There are, however, charges for NHS dental and optician services.
It’s a far different story in the U.S., however. If you live outside that country, as I do, then let me assure you that what became known as Obamacare is far from NHS-style service. It still requires that hefty medical costs be paid.
Americans go to see their GP – they get a bill; they go to a hospital as an outpatient — they get a bill; they see a specialist – they get a bill; they are admitted to a hospital – they get a bill; they have an operation – they get a bill; they are taken to a hospital by ambulance – they get a bill.
The costs go on and on, and can really add up. Then there are prescription costs, which can be tremendous. A study published in May 2013 in the Journal of Medical Economics found that the total cost of healthcare for MS patients in the U.S. ranged from about $8,500 to more than $54,000 per year during the period studied (1999 to 2008), with prescription drugs accounting for a large percentage of those costs.
OK, medical insurance policies may cover most of these costs, but not all. Most policies in the U.S. come with co-pays, sometimes substantial ones. The precise level of a co-pay, or the portion of total health costs carried by patients, depends on the specific insurance policy. And then, again, patients still have to pay for their insurance, except for those whose employer pays or who qualify for help.
Clearly, even among special friends, we’re often worlds apart. And I, at least, find that sad.
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Olivier
Hi Ian, I am a US citizen leaving in California.
Let me tell you how it works for me as an American.
I have a pretty good insurance from my wife's job. It cost us (family of three) about $500 per month (and it cost about another $500 to the company).
All my MS medications are paid directly by the insurance and the last one I got (Gilenya), even the $50 monthly co pay was taken care by Novartis.
I go to see my neurologist every three months, I never saw a bill, the insurance is taking care of it.
Most of the time, when there is a co pay or others costs not reimbursed by our primary insurance, MEDICARE is paying for it.
MEDICARE is the same thing as Social Security, a health care program from the federal government for the people over 65 years old or for the disabled.
If you are younger than 65, in order to take advantage of the MEDICARE, you have to go to see a Social Security Judge and based on your condition, he will decide to give it to you or not along with SSI (Social Security Income).
Also from a certain amount of medical bills paid out of pocket during the year, which I don't know exactly how much, it is fully deductible of your taxes (meaning you have to pay taxes in order to deduct it...).
Each case is very different and It will stay the same as long as we, in the US, don't have a universal health care program established.
On the other hand, since we have Obamacare, at least no insurance company can't deny someone with MS anymore because of pre existing condition.
Hi Oliver, thanks for visiting and commenting; also for all your information. I am, in fact, well aware of Medicare, Medicaid and SSI. However, I chose to group those together into a phrase about people qualifying for assistance.
Olivier
I understand Ian, what I mean is that in the US, there is no 2 patients with the same situation in order to deal with the cost of MS.
I depends on so many criteria such as your "past life" for the SSI, such as the kind of primary insurance you have, such as if you are married or not and the insurance you can get via your spouse and of course your household income.
In one word, that is the difference between having a universal healthcare system for everybody and a system like the one we have in the US where the most important is to maximise the income of the insurance companies, the income of the big pharma and the income of the healthcare system as a whole.
During the campaign Bernie Sanders was the ONLY candidate advocating for healthcare as a right, not a privilege.
Yes we are still there...
Mike Wagner
a.) How quickly do you get treatment? in US, you get it as soon as you find a doctor (days). I heard (from a UK doctor while I was on a cruise) that you wait ~6 months in UK for most things.
b.) If you don't like how your doctor is treating you, can you fire them and get a different one? In US, answer is yes, immediately. In UK, I assume there is a process in which you must justify yourself.
I say US healthcare is better because I control it through my pocketbook, and you are at mercy of state.
Hello Mike, thank youu for your comment. If you are talking about treatment followingg MS diagnosis, that dx is provided by a neurologist who can discuss treatment options with you immediately. Delays can occur but no system is perfect. If any patient wants a second opinion, they are free to seek one and if a patient wishes to change doctor, no problem. To change GP, just register with a new one and he/she will do the rest and obtain your medical records. As far as consultants are concerned, patients can ask the GPs to refer them to a different consultant. NHS patients' rights are summarized here: https://www.citizensadvice.org.uk/healthcare/nhs-healthcare/nhs-patients-rights/
Frans Kingma
Not the treatment is different, but what you had to pay for the treatment. That's quite a difference.
Josh
I now understand that you mean treatment of the patient, not the treatment (medication) that one receives.
The information may be out there, but I'd be very interested in how treatments for MS vary between the UK and the US. What's the first line of treatment? Are certain medications used more/less often? Which medications aren't used in the US that are used in the UK and vice versa.
If there's a resource that already spells that out, I'd love a point in the right direction to find it!
Paula
Hi Ian,
I am in Canada and our system is more similar to the UK. I don't pay a cent for anything medical because what isn't covered by my government health plan is covered through my employment medical benefits.
I lived in the United States for 5 1/2 years and found it very frustrating having to switch doctors a couple of times a year because all of a sudden my current doctor no longer took my health plan. I was with my husband who was doing his masters degree and the co-pays were difficult at times.
Now that I have MS I am very happy I am in Canada as the stress of paying medical bills is something I don't need. I get into see doctors quickly (less than 2 weeks) when I need them and I have changed doctors whenever I wanted or recommend by another doctor.
I know none of the systems are perfect but you have to choose what works for you and for me, I would rather not have to worry about an insane bill that I didn't see coming.
Hi Paula thanks so much for your comment - based on your experience of two different systems. Having always lived in a country with a free health service, I really had trouble coming to terms with a system that charges for medical treatment. Then I married an American who used to work in the billing department of a health system in Florida. Through Lisa and her family I have learned much about the U.S. way of providing medical services, insurance, co-pay, the works. As an MS patient, do I prefer NOT having to pay for insurance or treatment and only a pittance for prescriptions to be filled? Of course I do. Not everyone will agree but the world would be a poorer place if we all agreed about everything.
Olivier
At the end of the day, health care should be a right to all people, not just a privilege to a few.
I have a very hard time to understand why not everyone are not going to be ok with that.
Trish
Health care should be available to all people, at a
reasonable cost. However, the free enterprise system does not always help in the US. People that live in small towns and rural areas do not have the same access to doctors, regardless of the cost.
Many people in the US with Medicare or insurance can barely afford to pay for some prescriptions. Newer drugs usually have assistance programs through the pharmaceutical companies themselves. But these vary considerably. Also when these companies decide to quit making drugs because they are not profitable enough, the few companies that make the drug can and do charge much higher prices. And there is no reason for that except corporate greed. Some of these drugs may have existed for 30 to 50 years and are not expensive to make.
It also takes a long time for new drugs to be approved by the FDA. Of course many MS drugs and other important ones are fast tracked.
Most of these companies are giant corporations and are
tied in with other companies or divisions in Europe.
I believe drug prices are set there. In the US insurance companies can change the cost to the patient every month or three months. Patients have no time to see their doctor to get a prescription for an alternative drug, if one exists. It is illegal for Medicare to negotiate for drug prices. In the US the main exception to this is the VA health care system. But this only applies to a selected group of people.
Health care is regulated by each individual state to a large degree. I think American citizens should be guaranteed a basic level of health care that should be the same no matter where you live. The sweeping differences from state to state and with insurance companies based on a patient's employer are problematic. The differences in Medicare plans are also troubling. Insurance companies often drop plans where they loose money or can completely stop offering insurance in a given state.
The whole system in the US needs fixed but as long as profit is allowed changes will be slow. Federal laws can be passed to help some. But if one part of the system is addressed and not others, it will not help enough. That is what is happening right now.