Back in 2009 at Bill Moyers Journal, we asked all our guests to share with us their vision of the future of the American dream. We’ve followed up with some of those guests and they’ve shared their thoughts with us on where the American dream stands today. Now we’ve heard from some readers and want to share their stories with you. Marsha Coupé has today’s story of being “Exiled in England.”

In 2003 I married Richard Atkins, an English scientist, on the Canadian side of Niagara Falls. A short time later, I moved to England to share his home in an ancient market town, 24 miles outside of London. At the time, health care was the furthest thing from my mind. I had no idea how the British health care system worked. I was so used to going without doctor visits, it wasn’t on my radar.

I have worked for myself most of my life. When I ran my ad agency in Northern California, I provided excellent health insurance for my employees. It wasn’t until I closed my agency and struck out solo as a freelancer that I realized how impossible it is to get affordable health care in America. Save for the occasional visit to cash-and-carry style medical clinics, I did without, as did many of my friends.

When I arrived in England, I was gobsmacked to discover that as the spouse of a British citizen I qualified for Britain’s much-admired National Health Service (NHS) There was no waiting period. No exclusion for pre-existing conditions. No penalty for being a woman. No co-pays, not even for the Levothyroxine required to keep me alive since my early 30s. Everything was free at the point of service. And at this writing it still is, with the exception of a $10 prescription co-pay, for those between the ages of 18 and 60. But even then there are all kinds of generous exceptions.

Three years after moving to England, my husband was diagnosed with osteosarcoma of the jaw, a rare and often deadly cancer. During the three-and-a-half years we hunkered down to save Richard’s life, he endured seven surgeries, along with the lifetime maximum for chemotherapy and radiation. With each new treatment intended to eradicate the disease, my husband lost another vital part of himself.

No longer able to work, Richard was forced into early retirement at the age of 54, forfeiting 25 percent of his pension. Because of his debilitating illness, I shelved my career too, becoming his full-time carer. Had we lived in America, we would have ended up bankrupt the first year of his illness. In England, we were supported by community nurses who helped us with his complicated regime at home. When Richard was too frail to leave the house, doctors made home visits. One Saturday morning, I assisted a highly skilled ophthalmologist in our living room as he operated on my husband’s left eye. Compassionate nurses taught me how to give him post-chemo injections in his belly, so he could come leave the hospital quicker. Stays in a comfortable, private room at our local hospice eventually made the unimaginable almost the norm.

Richard’s exhaustive treatment likely cost the NHS millions. Other than travel costs, which we voluntarily handled ourselves, the NHS never billed us for anything. There were no mountains of mind-numbing paperwork to struggle through; no endless phone calls pleading with insurance companies; no bargaining or cajoling required. This allowed us to focus our attention on Richard. Between surgeries and treatment, we were able to live our lives without the constant fear of becoming homeless. The NHS and hospice made our horrific situation tenable. They gave us strength, even as we were hobbled with grief. Throughout it all, we marveled at the care we received.

When Richard died, I thought I would return to live on America’s West Coast within the year. I have no family in Britain, though I am blessed with precious friends who have become my family. My parents, now in their 80s, live in Oregon. At least half their income goes to health care. One basic prescription can set them back with a $400 co-pay. Sometimes their insurance refuses to pay for a test, procedure or prescription, requiring me to spend hours sorting it out from 6,300 miles away. Every year they worry their premiums will go up and every year they do.

My daughter and her family, in California, have good health care through her husband’s employer, but it’s expensive and many things are not included. My grandson’s medication would cost over $1,800 a month if his father’s job didn’t come with prescription coverage. Even with this, there is paperwork, long waits to see specialists and always some kind of a co-pay involved.

Many of my friends are paying tens of thousands of dollars a year for health care, regardless of who they work for. This applies to entrepreneurs, union workers and physicians equally. Their deductibles, co-pays and premiums are eye-wateringly expensive, far exceeding what I can afford. And these are the lucky ones. Even with Obamacare, I still have friends without health care.

Illness is neither an indulgence for which people have to pay, nor an offense for which they should be penalized, but a misfortune, the cost which should be shared by the community. — Aneurin Bevin, founder of the National Health Service

Given the age of my parents and my mother’s deteriorating health, I feel I have no choice but to return to the land of my birth. My 88-year-old father is my mother’s caregiver, without the support he would have if they lived closer to family, or here in Britain. At the same time, as a self-employed, 61-year-old freelancer, I struggle to see how I can help my parents without dramatically compromising myself. I have a number of autoimmune disorders that severely limit my health plan options in America. As a woman with unreliable health and modest economic resources, I may end up sacrificing everything Richard and I worked for in order to see my parents through the last years of their lives.

No other wealthy country routinely denies its citizens access to affordable health care. No other culture I’ve encountered, save for a stunning number of ill-informed Americans, view health care as a privilege rather than a right everyone deserves, regardless of circumstance.

Aneurin Bevan, the founder of the NHS, famously declared: “Illness is neither an indulgence for which people have to pay, nor an offense for which they should be penalized, but a misfortune, the cost which should be shared by the community.” How can anybody argue with this? The NHS has been caring for everyone in Britain for nearly 70 years, while America continues to allow corporations, lobbyists and politicians to rob us of this most basic human right:

The right to not suffer needlessly or die prematurely.

The right to not have to beg, borrow, steal or go bankrupt for health care.

The same right to health care those living in Britain, Canada, Europe, Scandinavia and numerous other evolved countries enjoy.

I have long been a champion of single-payer health care. Having witnessed firsthand the tremendous benefits of socialized medicine in Britain, I am positively zealous in my support of health care for everyone. I write letters; send emails; sign petitions; make hundreds of phone calls and actively participate in social media championing #MedicareForAll and #SinglePayer in the States. More and more I also find myself fighting to save the NHS from the threat of privatization, as the British government cozies up with American corporations eager to take over the NHS.

If we don’t have our health, if we don’t have access to affordable health care, if we don’t have the freedom to live near our families, if we can’t choose how we live our lives — frankly, not much else matters. — Marsha Coupé

Though always politically active, I have been in overdrive mode these past couple of years, on both sides of the Atlantic. Increasingly, I feel my life’s work must be devoted to championing health care for everyone. Britain is at risk of losing the NHS to privatization, while America seems intent on increasing health care rationing, ensuring that only politicians and the wealthy have access. By keeping us in a state of chronic distraction, with Britain leaving the EU and Trump trashing everything, both governments seriously threaten our democracy, livelihood and health.

While there are loads of important issues facing our world, if we don’t have our health, if we don’t have access to affordable health care, if we don’t have the freedom to live near our families, if we can’t choose how we live our lives — frankly, not much else matters.

After 12 years on this hospitable island, I will be making my way home later this year. I have no idea if I can get health care, where I will live or how the rest of my life might pan out. Like many of us, my one certainty is a constant state of uncertainty.



Marsha Coupé is a writer, designer and political activist in Kent, England. She lived the first 46 years of her life in Northern California before setting off to see how the the rest of the world does it.

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