NEW YORK (Money Magazine) -
After nine months of living in London, I should have been in the habit of first looking right, not left, when jaywalking. Maybe I was distracted that afternoon by the view of St. Paul's Cathedral across the street.
In any case, it certainly wasn't the taxi driver's fault when I stepped directly in front of his cab. My body rolled over his hood and then slid sideways across the windshield before dropping limply onto the curb.
This certainly looked dramatic, but was I seriously hurt? Though I was able to stand up and walk--in jammed City traffic, the cab couldn't have been going faster than 15 mph -- I was too shaken to say for sure. The driver insisted on taking me to the nearest big hospital, St. Bartholomew's.
Founded in 1123, Barts, like most British hospitals, is run by the free, taxpayer-supported National Health Service. It boasts an 18th-century inner courtyard and a grand staircase adorned with paintings by Hogarth. What it does not have is an emergency room.
The cabbie suggested that I check in at the hospital's minor-injuries ward. Dazed and smarting, I found the ward's dreary waiting room but couldn't see any doctors or even a receptionist. Instead, on a small desk by the door, there was a telephone and a note with a number to call for help.
|America's healthcare mythology
I dialed and told the voice on the line that I had just been hit by a slow-moving taxi, and that I thought it might be a good idea for a doctor to look me over. The voice took my name and told me to have a seat. More than two hours and six out-of-date issues of Hello! later, a nurse came to fetch me. After I proved that I could wiggle my fingers and wave my arms over my head, she said that an X-ray would be a waste of money and sent me home. I never saw a doctor.
For an American, or at least a well-insured one like me, the austerity of the NHS was an eye-opener. So today when I listen to politicians and pundits debating what to do about the rising cost of health care in this country -- health spending already eats up more than 14 percent of our gross domestic product -- I can't help but think back to my afternoon at Barts. But what exactly is the moral of the story?
I can think of two possibilities. The first is pretty obvious: If Barts is what a cheaper, more accessible health-care system looks like, I'm certain that most Americans would reject it hands down.
The second possibility is that we Americans are wrong. Perhaps my shock at Barts' parsimonious standard of care just shows that well-off Americans, with our glass-palace hospitals and an MRI for every tennis elbow, have grown a touch decadent. I wasn't really hurt, and if I had been, I could have demanded that the taxi driver take me to a hospital with an E.R. I ultimately got the care I needed, at zero cost to myself and minimal cost to the British taxpayer. It wasn't pretty -- in fact, it was a little scary -- but an economist would call it an optimal outcome.
At least one in seven Americans has no health coverage right now. No one with a conscience thinks that's okay. But even if most of us would like to lend a hand to the uninsured, we are justly nervous about giving the government the power to boot Grandpa out of an intensive-care bed when keeping him there is no longer cost-effective.
We've been locked into what University of British Columbia economist Robert Evans calls the "painful prescription" school of thinking about health care, a frightening rhetoric of hard choices best captured by those Clinton-era "Harry and Louise" commercials.
Having lived there, I know from experience that the Britain's barebones National Health System pretty much works. In fact, Britons live a bit longer than we do. Still, I'd never willingly trade in my Aetna card for the NHS.
After digging deep into the economics of health care, I've come to see that both sides of the debate, the free-marketeers as much as the single-payer socialists, often misunderstand the problems we're facing. Perhaps we're all framing the alternatives too starkly. We don't have to choose between opulence for the insured and heartless rationing for all.
There are three big ideas driving America's healthcare debate. All three turn out to be wrong.
Myth No. 1: We spend too much
Myth No. 2: More equals better
Myth No. 3: We're all in this together