Healthcare

It's amazing how quickly one can become familiar with something new. I now take it for granted that every time I go to the doctors with one or other of the children, I will introduce myself to the receptionist ("Hi. How are you?...") and then produce my insurance card and allow them to swipe my credit card. I'm buying a service, right? It's not all that different from shoe-shopping.

We regularly attend four different clinics (I sometimes feel as though my life is being lived out in waiting rooms). The Boston Children's Hospital is huge - an industry in itself. The entrance foyer is filled with sculptures and art work. There are several different cafes and food outlets to choose from. There are car parking valets, rows of wheelchairs of all shapes and sizes (think about the banks of shopping trolleys that you see at the supermarket - it's not that different).

We are registered as patients of the Harvard Vanguard practice. To understand the practice, one would need to imagine something midway between a hospital and a GP's surgery. The girls have a nurse who regularly phones us for a chat to see how they are both getting along. The accounts manager now knows me very well (although that might relate more closely to the amount of bills we have recently generated rather than as a principle of the practice). Our general doctors are located at the local Harvard Vanguard practice; Iola's ear and nose specialist is at a larger Harvard Vanguard practice in Boston. The practice has it's own pharmacy who will telephone me when Maya's inhalers need updating. They have cafes and smart waiting areas. They employ all kinds of doctors from general practitioners thru oncologists, orthopaedic specialists, midwives, behavioral therapists and acupuncturists.

And, last but not least, we attend twice-weekly appointments at a physical therapists (where I continue to confuse the receptionist by talking about physio). Again, the practice is glossy and comfortable. Maya has worked closely with a physical therapist who is 'awesome' and she's now walking without crutches, to the amazement of her surgeon. They have equipment which would not look out of place in a top-of-the-range gym and they have a swimming pool.

There are themes to these experiences which contrast to our experiences in the UK, and most of them relate to money.

Money buys time. The old adage that 'time is money' is turned upside down when you look at health care. These practices are not being subjected to huge cost cutting, which means that they have more time than one can imagine within a UK context. When we attend an appointment with our general practitioner, we can expect the appointment to last at least half an hour.  A nurse will weigh the girls, measure their growth, take their temperature, chat to us about any general concerns and then escort us to a room where the doctor will see us. There is no sense that we have 6 minutes (or however long a UK GP would have for a standard appointment). We are given as much time as we need. It's nice for us, it must be wonderful for the doctor to have fewer patients to that they can spend more time considering their case.

Money buys stuff - lots of stuff. There is no shortage of equipment, medicines or technology. This is the 'all-singing, all-dancing' end of the health system. When Maya was in hospital in Albuquerque, she had a bed which vibrated and moved to ensure that she did not get bed sores; she had an inflating cuff on her non-broken leg to reduce the chance of clotting in that leg; she had a choice of 6 different menus at every meal; she had a television with hundreds of channels; her own en-suite; an arts specialist; three physical therapist; a nurse who was allocated to only 3 patients...

Money makes stuff work. The computers in the hospitals talk to one another because there has been the money to pay the technical experts who can make this happen. I don't know if the computer strategy for the NHS has been resolved, but when we left the UK it had been a very expensive failure.

Money buys space. These hospitals and health centers are vast. They are surrounded by acres of car-parking (free in Albuquerque, affordable in Boston). The corridors are crammed with art work and sculptures (Iola and I spent over an hour trying to look at all of the art work in the Children's Hospital in Albuquerque).

Money buys good manners - it shouldn't, but it probably does. When you get lost, people stop to help you - lots of people - nurses, volunteers, doctors, surgeons. Because they don't have to treat as many patients, they probably have more time to stop and help people... they probably have more time to be human. When Iola went through her endless weeks in oxygen tents in Lancaster hospital, we saw different doctors. We didn't have a choice, it was just that whichever doctor was allocated to our ward would appear. Some of them were very good, but they didn't all say the same thing. It's confusing and terrifying as a parent to meet different people and to hear their different opinions about how your child should be treated. Maya has had two doctors for her broken leg - Taylor Jobe in Albuquerqe, who looks and talks like a surf dude and still telephones us to see how she is getting on, and Dr Kasser in Boston who, despite being one of the world experts in pediatric orthopedics, has the time to be polite and gracious and to listen to what Maya has to say (which often takes quite a lot of time).

Money makes things ridiculous. I was charged $100 for a bottle of ear drops; our helicopter ride to hospital cost $48,000, the hospital bills continue to land on our doorstep. However, when I talked to a friend whose father visited from England, without insurance, and had a heart attack, she told me that when you explain that you have no insurance the bills tend to be instantly halved. There is little logic to the numbers of dollars written onto the bills that you are given. We have insurance and savings and we would pay (and are paying) whatever we could to mend Maya's leg and to ensure that both girls are healthy. Not everyone has that choice and that's the ongoing debate in Senate at the moment. There are philanthropists everywhere - no-one would be turned away from either the Boston Children's Hospital or the Children's Hospital in Albuquerque because they couldn't pay their bills - and that is highly commendable. But, at the opposite end of the spectrum, there are also whole industries growing rich, really rich, out of the amount of money which is pumped into the medical care system in this country. Coming from a country with the NHS, I struggle with the ethics of people making sizeable profits from healthcare when there are so many people who struggle to pay their medical insurance each month and have to pay the excess of their copay with credit cards.

But, when I attend our appointments (about 3 a week at the moment), I obediently open my wallet and take out that credit card. The time and place for ethical dilemmas is elsewhere. We've been told that Maya can start running on July 1st.