If you want enough medication to tranquilize an elephant, CSI-style forensic testing, or the highest standards of litigation-proof risk management, the healthcare system in New York is for you.
If you want to have sane conversations with sane people, or retain a sense of emotional or spiritual welfare…or indeed combine both of these things with preparing for the birth of a child, I recommend you give it a wide birth.
As with many things, Monty Python explained this situation many years ago better than I possibly can.
“OK. Take her into the foetus-frightening room”.
“And get the most expensive machines, in case the administrator comes.”
“Don’t worry, we’ll soon have you cured.”
“NOTHING DEAR, YOU’RE NOT QUALIFIED!”
Of course, this clip is from 1983, and needless to say it was a bit of a shock to me (to say the least) to see that this is still the prevailing approach in New York hospitals. (And rather worse…for example there are hospitals near hear with a C-Section rate of nearly 50%, and rising.)
Why is this?
Well, lots of reasons. The first is that actually, in lots of respects, New York is actually quite an old-fashioned place, its psychology laced with a strong dose of 1920 gothic ambition and a prevailing undercurrent of 1980s materialism – which combine to support an undercurrent of faith in the power of money and pharmaceuticals and surgery that can seem jarringly antiquated. Also, more obviously of course, this is the most litigious place on earth, and everyone is absolutely terrified of doing anything wrong for fear of having these guys after you.
But there is something else going on as well. The single biggest difference in being treated by the NHS vs the New York health system is the bias that money puts on the care you receive. The NHS is of course constantly strapped for cash, and thus trying to minimize the care you receive – particularly when it comes to testing and medicine. In New York, the only people who want to keep your treatment costs low are the insurers and the patients.
Thus it is in the interest of everyone who treats you to test you as often as possible, to interpret those tests in a way that requires further tests or treatment, to give you as much medicine as possible…but at the same time to get you through beds as fast as possible (because you don’t pay by the hour.) Honestly, for those guys who haven’t experienced this system, you would not believe how scary it feels to require medical treatment but feel like a walking cash machine.
Throughout of course, this money-driven compulsion to treat is presented as evidence of the extent of progress and capability in the health system – and in some cases this is true. It is certainly easier to get some forms of expensive and useful treatment in New York than in London. But overall, the system stinks. Because it is driven by money, not humanity (my next post will be on some other aspects of the flaws of money as an incentive to progress.)
I wanted to end with a thought, which has occurred to me a few times – which is that resource in this kind of area is a neat balance. There is never ‘enough’ money for health. Having more money in your health service is generally better for patient outcomes. But there is also something to be said for what has been elegantly described as ‘the design constraint of ultra-affordability.’ Because we shouldn’t assume that the right thing to do and the most expensive thing to do are always the same.