Sick and uninsured in the US

BBC North America editor Justin Webb spares a thought for the 15% of Americans without health insurance, after his son needed hospital treatment - and the bills started arriving in the post. The US spends about $2 trillion (£1.37 trillion) per year on health Washington Children's Hospital could easily be part of the British National Health System. The staff are helpful enough, but brusque and overworked. There is a lot of waiting. The lifts do not all function. There are signs scribbled on paper and stuck on doors. And there are doctors trying, amid the hurly-burly, to do what they want to do - to treat patients, to ease suffering. I was there, traumatised as any parent would be, with my eight-year-old son who had just been diagnosed with a chronic and life-changing illness: Type One diabetes. It was just before Christmas. A piece of paper on the bed informed us that we were entitled to select a present for Sam, free of charge, from a room in another part of the hospital. I imagine the NHS has similar kindnesses at that time of year and I imagine the parents' tears and the doctors' efficiency are also much the same. But there the similarity ends. Mounting bills Late on Christmas Eve - with Sam out of hospital - I went to the chemist to pick up the kit: the syringes and emergency injections that will now be part of our life. We are very well insured but I still paid more than $200 (£134) in so-called co-pays... amounts for each medicine that an individual is expected to fork out for, even when the recipient is a child. Fifteen percent of Americans - including eight million children - have no insurance

For a person with no insurance or inadequate cover, amid the sadness and the stress of the diagnosis, this would have been a further blow. To be followed by more. Days after Christmas, as we were still struggling with our syringes and Sam was still wondering innocently if his disease might soon be cured, the real bills started arriving: $2,700 (£1,815)... then another $800 (£538). "Urology", it says starkly. I assume that was a urine sample. It seems a bit pricey but there is no way of challenging this tsunami of reckoning. The insurers wrote as well to say they had decided to pay the first bill. On the other - urology - they are so far silent. Fifteen percent of Americans - including eight million children - have no insurance. Diagnosed with diabetes, as Sam was, they would have been treated at Washington Children's Hospital - it insists proudly that it turns no-one away - but probably only after collapsing, because uninsured people tend not to go to the doctor to investigate symptoms. And the parents would now be facing the kind of added burden that I find almost unimaginably awful: a sick child and a dependence on charity. Gifts from churches and drug companies, or a life of increasingly threatening letters, ending in bankruptcy. Wealth divide And so to my other Christmas destination, the Four Seasons Hotel in Miami, where we decided to go to cheer ourselves up and spend the money we had been saving for a later longer holiday. "Carlos, I will not fly commercial! I just won't do it - it's too far." What highs and lows there are in the America Obama is inheriting

This is not an argument. Carlos appears to know he has lost and he is looking indulgently at his gorgeously turned-out wife. We are in a lift, my three children open-mouthed at this intrusion of wealth and glamour into our little world. The deal was settled by the 11th floor. She would fly in his private jet. I noticed that Carlos had a very expensive watch, but I doubt he would have to sell it to pay for her trip. These folks - America's uber-rich - have certainly lost money in recent months but most of them are still pretty comfortably off, and there are many of them. What a nation! With sick children chased for money while the rich bicker about their flying options! What highs and lows there are in the America [President-elect Barack] Obama is inheriting! Cautious changes As it happens we could see from our hotel the glittering tropical sand bar of South Beach - the art deco part of Miami - which is, in an unequal nation, the most unequal place. It has the highest income disparity of any corner of the United States. Would changes to US tax polices help bridge the wealth divide? The enamel white yachts - some of them the size of cross channel ferries - are in sight of rooms, tiny rooms, literally under roads in some cases, where the poor live. America is a place where money can be amassed and frittered away on private plane travel - a place where grieving parents face unpayable medical bills. Obama will tax the plane owners more, and help the parents more, but within limits. Because he will not want to mess with the essential fact of American life, that the cruelty and the hedonism are a by-product of an extraordinary energy, freedom and sense of ambition. Places like Miami - as meretricious as they seem - are also a magnet for the world's doctors, researchers, investors, thinkers and dreamers. Obama knows that. He will change the US over the next four or eight years but he will not want to flatten its spirit. A British friend who is a paediatrician tells me that the US is the place where the cure for type one diabetes will be found. And when it is found, millions will benefit. And I would add that the researchers or the bosses of the drug company that funds the research, will never fly commercial again. Which is fine by me. From Our Own Correspondent was broadcast on Saturday, 17 January, 2009 at 1130 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.



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