What’s the difference between the healthcare systems in the United States and Britain, and what’s it like to move to America and adapt to a different system?

Amanda Holpuch: Hello Adam, I’ll start this off: how long have you lived in the United States?

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Adam Gabbatt: I’ve been here almost six years now.

Amanda: When was the first time you were confused about American healthcare?

Adam: I suppose the first time was when I went to see a psychologist, who was working from a little office … after spending 45 minutes attempting to pour my heart out, she called time then said: “OK, that’ll be $30. I only take cash.”

I hadn’t got much money on me and I ended up paying much of it in quarters and bar-soiled dollar bills.

Amanda: Quarters? So you didn’t come to a doctor’s appointment with cash? How did you think you would pay for it?

Adam: Work told me I had insurance! I thought I was completely covered. In fact, I’d drawn up a list of ailments I planned to get fixed in America.

Amanda: What would’ve happened if you were in the UK?

Adam: A firm handshake, and I’d have been on my way. I’d have been referred to a specialist through my doctor, gone to the appointment, used some of their Kleenex, then left. I wouldn’t have had to pay a thing.

Amanda: That is weird to me! So, that’s routine appointments. Have you ever had a medical emergency in the US?

Adam: Yes. I broke my collarbone pretty badly about three years ago and it was terrible. It was nearly coming out of the skin. It made for a good Instagram but it was very sore. Anyway, yeah, that was made 10 times worse by the saga that followed…

Amanda: I’m guessing you weren’t swiftly patched up.

Adam: No! After the accident, a very kind woman at the local clinic, who I think was actually a volunteer, cut me out of my clothes, and they did an x-ray that showed my collarbone was very much broken. But there was no orthopedic surgeon there who could actually do anything about it, so they told me to go home (this was in Pennsylvania; I live in New York – a three-hour journey from where I’d busted myself up) and call up some specialists once I was there. I was horrified! And in a lot of pain. And immobile. My friend had to take my pants off for me. And you don’t want to know about the bathroom.

Amanda: No, no, I don’t. I’ll stop you there. So you went home, saw a doctor?

Adam: I got home, but obviously I didn’t have a regular doctor who deals with broken bones. So I sat at my table and went through about 10 people on ZocDoc – a Yelp-like app which shows doctors and specialists in your area. Collarbone pointing up out of my skin like a tentpole the whole time. I think the first six couldn’t do that day or the next. Another one seemed weird – he looked a bit like Trump’s doctor. I finally got one who would see me that afternoon, so I got a cab up and shuffled in to see him.

But then I got confused again.

Amanda: How long after getting injured is this? And why were you confused?

Adam: At this point it was two or three days. I’d broken it on a Saturday morning and no one was around at the weekend.

This guy did another x-ray, prodded and poked me, and then listed several options on how he could treat me. “Well, we could just leave it,” he said. “Or you could have surgery. It’s up to you.”

I was nearly in tears. I said to him: “Yeah, but I’m not a doctor. Tell me what I should do!” He just repeated the options. I hated him.

Amanda: That sounds awful. But it doesn’t surprise me at all. He’s worried about a malpractice lawsuit, and he doesn’t know your financial situation. One of those options was going to cost more, and you might not have been able to afford it. Every time I go to the doctor, I’m prepared to say: ‘Well, how much will this thing to make me feel better cost?’ So what did you end up doing?

Adam: I got a cab back to my house, and had to get back on the phone. I remember speaking to one doctor’s office who said I could come in in 10 days. Ten days!

I’d been covering the 2012 presidential election and was familiar with the Republican talking point about how people should be able to choose their own doctor, etc, etc. I was thinking: screw that – I just need a doctor to tell me exactly what I should do! The last thing I wanted to be doing was sitting in agony trying to select someone, then having to decide how I was going to be treated. And at the same time worrying if the doctor was in my network (many doctors will only accept certain types of insurance. If they don’t accept your insurance type, they’ll still treat you but it will cost a lot more) and how much everything was going to cost.



In the UK I’d have gone to casualty (ER), sat there for a bit, then someone would have seen me, said: “I’m going to do this to you,” then packed me off home. And obviously it would have been free.

Anyway, I eventually got an appointment for the next day with another doctor. Thank God this guy basically told me my injury was a mess, and that I needed surgery.

I couldn’t believe how relieved I was.

Amanda: But I understand why the doctor gave you those choices. A natural follow-up comment in the doctor’s room is: well, how much does that cost?

Adam: Well, since then, people have told me about the fear of malpractice suits. But they’re medical professionals! What about the Hippocratic oath? Aren’t they obliged to give me the most appropriate treatment? And I am now more aware that I can ask about the cost. At the time, I assumed that was something that was all on me to deal with my insurance company.

Amanda: Do you feel like there is a difference in the quality of care you’ve received here v what you get in the UK?

Not really. I went to the dentist the other day and they gave me a little bag with some freebies in it. But then they charged me $1,000, so I didn’t feel it quite offset the difference (that said, you do have to pay for some dental work in the UK.)

The thing that struck me since the collarbone incident is that I feel much more likely to put off going to the doctor here than at home. I feel like I have to research the cost before I go, which often seems daunting. And I’m lucky – I have healthcare. People who don’t have coverage must be not going to the doctor all the time. And presumably for some serious stuff.

Amanda: One thing I’ve learned from you and the other British people I know is that avoiding healthcare because of the cost is a very strange thing to be happening in a wealthy country. I can’t remember a time when I didn’t think: ‘Oh, you should only go to the doctor when you’re very ill, or it won’t be fixed by ibuprofen or cough medicine.’

Adam: Yeah, that was completely alien to me. I had a sore back the other day, and after some extensive research on Yahoo Answers I learned it could be a serious kidney problem.

My first thought was: well, if it is, I’m going straight back home. (It wasn’t a kidney problem. I’d hurt it cutting some grass.)

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But god forbid I got a serious illness. I would be on the first plane back.

Amanda: That would be a good place to end it – but I do have one more question! Do you have any sense, as a person who has an employer-based healthcare plan in the US, what the Senate plan could do to your healthcare?

Adam: To be honest, no. I’ve focused on the bits everyone seems to be talking about – the people who would lose their healthcare, the potential for people with pre-existing conditions having to pay more. As someone who is lucky enough to have a job I guess I’m going to be OK. But that’s the whole point, isn’t it? It’s the less fortunate who are going to suffer.