The American healthcare system is a given to life-long residents and citizens, but for residents who hail from other countries it can be confusing to navigate. As the debate about the Affordable Care Act (ACA) and other possible reforms reached a fever pitch some ex-patriots were further confused by the stories they heard about their home countries. Many of these people were perfectly happy with their healthcare at home and had never been exposed to alleged shortcomings portrayed in the American media. Three Richland County ex-patriots shared their stories with us.
Recently, the results of a new Gallup poll revealed that 69 percent of Americans rate their personal healthcare coverage as excellent or good, but the quality of the nation as a whole at 32 percent. The gap in those numbers has sparked a certain amount of debate, but for those from other countries, their question is often one of comparison to rest of the world.
This most recent poll was confined to the United States, but in 2011 Deloitte conducted a global survey of healthcare consumers. In their study they didn’t separate out the personal satisfaction from the national quality, thus the numbers reflect the percentage of people who would give the system a grade of an “A” or “B” overall. 22 percent of respondents in the U.S. gave that rating, placing the United States in the bottom third of countries studied.
Although the small country of Luxembourg ranked highest with 69 percent giving an “A” or “B” grade, countries of larger size and more logical comparison to the United States were also more satisfied. Residents of China, The United Kingdom (UK), and Canada all rated their healthcare more highly than Americans and Richland County residents from each of those countries shared their personal stories.
The United Kingdom
“A” or “B” grade: 46 percent
Ex-patriot: Christian Winterbottom
Christian Winterbottom is a UK citizen who met his wife in Japan. Shortly after their wedding the couple settled in Florida, her home state. He was working for a non-profit and shortly after hire he was instructed to go to HR and learn about the health plans to pre-select coverage that he would later have when his probationary period ended.
“He kept talking about co-pays and things like that. The longer it went on the more confused I got. He kept talking about when I’d go to the doctor or pharmacy and I’d pay ‘xyz’ so I asked him, Every week or month you take money out of my paycheck so I have insurance then when I go to the doctors I still have to pay again? And he said, ‘Yes.’ I was totally dumbfounded. I went home and talked to my wife and she said, ‘Yeah, that’s how it is.’”
Winterbottom selected coverage, but to their surprise the family found themselves expecting their first child a month before the enrollment period and thus the pregnancy was not covered as it was considered a pre-existing condition.
The family paid for all the pre-natal care out of pocket, but Witterbottom was a little shocked the day their baby was born.
“The day of the birth the nurse walks into the room and says, ‘Your bill is $20,000, but you can pay $5,000 right now and then you can leave.’ She [his wife] had quite literally just given birth and they wanted $5,000 before we could take our baby out of the hospital.”
The Winterbottoms put the $5,000 on a credit card and were able to pay the remainder of the bill over time.
While their son was still an infant the family took a trip to England for a wedding and the baby became ill over a weekend. They went to the local hospital and saw a doctor with in five minutes and were on their way back home in an hour. Because Winterbottom is a citizen, there was no charge for the visit.
Upon leaving his wife asked about the experience, “She was absolutely gobsmacked, she asked, ‘Will they bill you for this when we get back to the U.S.?’ And I said, No.”
When asked his opinion about the ACA, Winterbottom said, “I think anything that helps the poorest part of the country, the poorest citizens, who wouldn’t want everybody to be healthy and to get healthcare when they need it? It seems very strange to me that there those against people having healthcare.”
China
“A” or “B” grade: 30 percent
Ex-patriot: Pong Wu
Pong Wu came to the United States to attend college in 1993 and has lived here ever since. He became a citizen in 2007.
When Wu last lived in China, the healthcare system was a single-payer government program, but it was not universal coverage. At the time, individuals were on the government health plan if they were working, if not, there was no coverage available. At first, it would seem that many people would be without coverage, but the Chinese define family in a broader way than some other countries.
Any relative living with you is family and entitled to your employer healthcare, most people who were too old, young or sick to work would live with a relative and have coverage.
The system wasn’t perfect, there was corruption and there were some cases where a person didn’t have relatives to live with, but for the most part, families took care of each other. Once the country began limiting the number of children their citizens could have, problems arose. People had fewer relatives to provide the familial safety net and reforms necessarily began. Two rounds of reforms led to the current system, which is a hybrid of government and private sector programs and includes a medical savings account option.
The corruption of the previous system included doctors unnecessarily extending the stay of patients who are hospitalized in order to increase billing, wealthier patients bribing doctors for better or special care, and inequality of service. It was hoped that adding some private sector components to the system would make things more fair and reduce corruption, but according to Wu’s relatives only the former objective has been met.
When Wu’s first child was born he and his wife were still living in China. There were no out of pocket costs and his wife had a month of paid leave from work after their daughter was born. Wu seldom went to the doctor himself at the time because he was young and healthy.
Once in the U.S. language was the primary barrier that kept him from the doctor even though he had health insurance. At first his English skills made the type of communication required in a medical appointment very difficult, so he avoided the doctor unless it was absolutely necessary. Then he and his wife had their second child.
Despite having insurance they had to pay $5,000 in medical bills. Adding to the financial strain, his wife didn’t have paid leave as a benefit at her restaurant job, so she returned to work just five days after their son was born.
Wu is pleased that the ACA extends benefits to Americans who previously could not be insured, but he is also a believer in the benefits of a competitive marketplace. In his experience the competition and commerce that are central to the American system engender confidence in consumers. He doesn’t argue that care or outcomes are necessarily better, but Americans have more faith in their system.
“America has a lot of problems, but I believe America has the best system,” said Wu.
Canada
“A” or “B” grade: 50 percent
Ex-patriot: Theresa Ayers
Theresa Ayers isn’t exactly an ex-pat, she’s an American citizen, who is a long-time Canadian resident and just recently moved back to the United States. Ayers was born and raised in Ohio, but in 1985 she married her first husband, a Canadian citizen, and moved to Canada, where she resided until February of this year.
In October of last year, she married a high school sweetheart and the arduous task of merging their lives, and countries ensued. Her biggest reservation about marrying her second husband was moving to the United States. She didn’t want to give up her healthcare.
Ayers was very happy with her care in Canada.
“I think it’s better, it’s more personalized. When I was having problems with my kidneys the first doctor immediately referred me to a specialist and the turnaround time was nil. I thought the quality of care was excellent. I’ve never experienced a problem there,” said Ayers.
“They say in Canada you have to wait, but what I’ve seen here is longer waits. I feel a lot of things here are overlooked. You walk in the hospital and the beds are empty because no one can afford to go, but still you wait and wait.”
Ayers’ husband has had several health issues since they married and navigating the American system has been frustrating and her experiences have stood in stark contrast to those in Canada. At one point a doctor had noted in his file that he needed a sleep study, but it was never ordered, another doctor noticed the oversight later. Then they had to wait for the appointment, no one called with results.
“George has good healthcare that is really affordable, but seeing the time lapses between things is a concern. He has insurance, I can’t imagine what it’s like for people who don’t,” said Ayers.
Ayers says Americans are usually shocked to hear that she was so happy with her Canadian healthcare. One thing that is often a surprise is that many Canadian doctors still make house calls. When Ayers had kidney problems her doctor conducted follow up appointments at her home.
“Not all doctors go to homes, but it’s pretty common,” she said. In fact when her current husband was visiting Canada he became ill and the doctor came to her home, treated him, and didn’t bill him for the visit since he was an American.
Since Ayers and her husband decided to live in Ohio, she is reluctantly relinquishing her resident status in Canada when open enrollment is available for her husband’s health plan. She is uneasy about giving up her healthcare, but very happy to share a life with the man she loves.
Beyond Healthcare
The ex-patriots all brought up issues that are beyond the scope of healthcare coverage in the American understanding of the issue, but seemed inextricably linked to our foreign residents. Each person brought up issues that Americans deal with through the Family Medical Leave Act (FMLA), which is entirely different legislation outside of healtcare, but it’s important to note that the ex-pats don’t see it that way.
Winterbottom discussed American family members nearly bankrupted by medical bills, in part due to the high cost of bills, but also the inability to work to pay for those bills while recovering. “If either one of us becomes sick, we’ll go back to England,” he said.
Wu was concerned about the lack of paid leave for new mothers or others who miss work due to illness, but he hopes this too will change some day.
Ayers explained that Canadians can get up to a year of unemployment benefits if unable to work due to illness or the birth of a child. The provision is occasionally abused, but by and large prevents people from being bankrupted by illness or injury.
“I think anything that helps the poorest part of the country, the poorest citizens, who wouldn’t want everybody to be healthy and to get healthcare when they need it?,” said Christian Winterbottom.
