American healthcare is in truth already rationed

"Growing up sick in the US, and being treated by a humane NHS here, has shown me that Britain's system is far better" (Complete Guardian story by Bee Lavender here)

I grew up in the US with a series of mysterious health problems, not least two different kinds of cancer. Everything in my life – education, choice of career, job mobility, decisions to marry or divorce, where I lived, who I knew, what I wrote or talked about – all of it – was determined by the paramount need to maintain health insurance.

In the United States there is no basic protection for working people. My fully employed, doubly insured parents were pushed to the brink of bankruptcy four times before my 15th birthday. I exceeded the "lifetime maximum" coverage before I was old enough to vote. My family paid huge sums for insurance, then 20% of the cost for treatments, without assistance from any public entity. . . .

My most significant childhood memory is knowing exactly how much I cost, and regretting the expense. . . .

The truth is, healthcare is already rationed in the states – by individuals struggling to afford even basic cover, by companies negotiating (or refusing) benefits, by government agencies trying to balance budgets. . . . But since it is America, you can shop around. Just across the border in a different state, the legislature decreed that pre-existing conditions could not be excluded or made the subject of increased charges under insurance plans, leading me and many others to migrate a few miles to get a better deal.

This underscores the inherent problem – that there is no consistent federal policy, and therefore no protection for the most vulnerable citizens. Or, if you pause to think about it, for anyone. . . .

Medical bills are a leading cause of bankruptcy. It is common to engage in fundraisers for adults diagnosed with something treatable but expensive, children who need wheelchairs, or in the worst cases, someone who has died, leaving behind huge bills their family cannot afford. In the US, the greatest restriction on personal freedom that I have ever encountered in my own life, or witnessed in the lives of friends, all comes down to health insurance. Creative, innovative, talented people are unable to change jobs because they need the insurance. Small companies collapse because they cannot afford employee insurance. People die because they do not have insurance. . . .

In the US I devoted a huge amount of time to chasing appointments, finding specialists, fighting with insurance companies. With the National Health Service I have never had any trouble getting referrals, nor have I ever had criticism of the services rendered. If anything, I have felt spoiled – especially at the start of the recent flu crisis, when men in hazmat suits showed up in the middle of the night to take my temperature. In fact, though I have private top-up insurance here in the UK, I've never had cause to invoke it.

The current proposal for US healthcare reforms has fallen victim to a misinformation campaign causing needless confusion and controversy. The plan is neither radical nor far-reaching, offering a bandage instead of a cure. It isn't enough, but it is necessary.