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“Hi! Have you just arrived from Britain? Really? You’re hoping to stay permanently? Well, let me tell you a bit about the place. Oh, and by the way – welcome to the asylum!

It’s been more than twelve years since I emulated Columbus and stepped onto American soil for the first time. As a Brit who’d traveled around quite a lot I was confident I could handle whatever America would throw at me. It couldn’t be that different from Europe, could it?

Maybe I was less fortunate than that dubiously intrepid explorer who’d preceded me by some five hundred and ten years. After all, he got to go home. I was an immigrant. I got to stay.

It wasn’t just the indignity of being constantly referred to as an ‘alien’, or even the Immigration Department’s female doctor, built like a Russian crane driver and with a face like a bulldozer, who rammed a finger resembling a German sausage up my ass before grabbing my testicles and declaring of one, “You’ve got a varicocele. It’s what we call a bag of worms.”

She’d failed to notice I’d had a vasectomy fifteen years previous, hence the unusual knotting within the scrotal sac. I didn’t bother to enlighten her. I was too busy trying to get my rectum back into some sort of order.

Nor was it the Mantoux TB test that showed up positive. Despite my protestations that – yes, of course it would be positive because I’d been given a BCG vaccination when I was fourteen – I was forced to take large doses of Rifampin that near wrecked my liver and almost put me in the hospital.

Did you get the BCG vaccination at school in Britain? You did!

You’ll find US doctors have no knowledge of BCG vaccinations for TB. It’s almost never used in America. They shrugged off my protestations by stating the BCG was only good for ten or fifteen years, so I must be a tuberculosis carrier. They’d obviously never heard of the BCG studies done on American Indians and Alaskan natives in the 1930s that proved conclusively BCG vaccine efficacy persists for 50 to 60 years.^[1]

It was about this time I began to doubt that everything we Europeans had been taught over the years, concerning this medically and technologically advanced nation, was actually true.

Twelve years on, I’ve had little reason to change my mind. Admittedly, when a blocked artery caused a bad angina attack that sent me to the emergency room, I couldn’t have asked for better treatment. Within three days I was back home and feeling better than ever. One week later, I got the hospital bill, which almost saw me back in there again.

I’ve spoken lots about the abomination that is the US Health Service, so I’ll not bother with further enlightenment. You can read about it on Sparrow Chat. How, or indeed why, Americans put up with it is beyond comprehension. That they do says more for the American mentality than, perhaps, any other aspect of US society.

Except, that is, for their fanatical obsession with firearms. Never mind the thousands who die every year as a result; sod the schoolkids massacred routinely by twelve or fourteen-year-old maniacs armed with Daddy’s AK47 for the fun of slaughtering their classmates, and who cares that any nutter can walk into Wal-Mart or Target and shoot up the place?

There is a positive side to it all. It gives the good folks of America the opportunity to show their love for each other by donating teddy bears, or balloons with holy messages of comfort, or even just a nice bunch of flowers to shove into the school railings. And let’s not forget the candlelight vigils. Oh, you’ll love those candlelight vigils. They just tear your heart out.

Americans will do almost anything to express their grief at such times – anything, that is, except demand their government enact legislation to curb this unnecessary slaughter.

Did I say “Welcome to the asylum”?

If you’ve any remaining doubts that the United States is doing a good impression of the world’s finest institution for the mentally insane, then a steady dose of US media will eventually assuage them. The evening news bulletins may not have an immediate impact on your nervous system. It takes time to realize that what passes as news in the rest of the world rarely makes it onto John Doe’s seventy-eight inch flat screen.

Basically, if it’s not American, it’s not news. For the first six months of American life I confidently expected the evening news would eventually inform me what was happening on Planet Earth. I was doomed to disappointment. For ‘Planet Earth’ read ‘United States of America’. Nowhere else exists, unless the US happens to be fighting a war there.

It doesn’t matter that three hundred Iraqis are massacred in cold blood by ISIS, or a European spacecraft is performing numerous firsts in space that will culminate in it landing on a comet. It likely won’t make the US evening news program. The only ‘Rosetta’ most Americans have heard of is the Mexican illegal-immigrant woman who serves them their Caramel Macchiato down the local Starbucks.^[2]

Perhaps the most maddening trait I’ve encountered in twelve years is the overall arrogance portrayed by the US media towards anything ‘not-America’. Superciliousness oozes from every pore of those whose job it is to sell America to Americans through the internet or television. No matter how disastrous the news of the day; however many kids shot in this week’s school massacre, or the latest corrupt failings of the seat of government in Washington, the broadcast will always end with a segment designed to show the viewers just how wonderful their fellow Americans are. Like, no-one else in the world bakes cookies to raise money for cancer research, helps a blind man cross the street, or donates their spare kidney to save a sibling’s life!

Do you know, over here people live in their cars? I’d never heard of families living in their cars before I came to America. The idea of people still existing in shacks and shooting squirrels for food was a lifestyle associated with third-world countries. Forty-six million Americans live in dire poverty! Surely it could only occur in Africa during a drought?

When I first arrived here I never expected the motorways to be riddled with potholes, or fifty-miles to the gallon diesel cars a non-entity, or electricity to be strung from poles that come crashing down with the first strong gust of wind.

Moving to America was rather like traveling back fifty years in time.

But, hey, don’t worry. You get sorta used to it eventually. And anyway, it’s too late for you to go back now. I just hope you don’t get the female Russian crane driver with the face like a bulldozer for your physical. Just make sure you take plenty of KY jelly with you.

Oh, and did I say, welcome to the asylum?”

^{[1] “Long-term efficacy of BCG vaccine in American Indians and Alaska Natives: A 60-year follow-up study.” PubMed.gov}

^{[2] “Rosetta mission: Can you land on a comet?” BBC, November 5th 2014}

George, from “George Says”, who is one of the very few true English gentlemen left in Great Britain today, made a comment on the last post asking for clarification of the term, ‘co-pay’, as it relates to medical insurance, so for the sake of all Her Britannic Majesty’s citizenry, who have the advantage of socialized medicine at no cost other than a paltry prescription charge (though none of this will last much longer!), allow me to explain the workings of the capitalist system as it applies to the average US citizen:

Medical insurance is now compulsory, since the advent of what’s commonly called ‘Obamacare’. But just like car or home insurance the vultures demand their pound of flesh in the form of co-pays. In some way it’s similar to the ‘excess’ you agree to pay up front if your house burns down, or your car is wrecked. However, that’s a gross over-simplification because, rest assured, nothing about US capitalist medicine is ever remotely simple.

One obvious difference is that the insured doesn’t have a choice when it comes to the amount of his co-pay. The insurance company sets the amount. Because my wife worked for the federal government for thirty years we have what is considered one of the best medical insurances available. It costs around $1,450 (975 GBP) a month, but the federal government pays 60% of that.

Beginning January 1st each year, we pay the whole of any medical costs incurred, up to $750. Once that threshold is reached the insurance company will usually pay 90% of any future costs that year. The remaining 10% is down to us. Hence, when I had my artery stent fitted, the bill came to about $32,000. We had to find a co-pay of $3,200 out of our own pockets. However, for some lesser costing items, such as doctor’s visits, the co-pay increases. A fifteen minute appointment with a family doctor (GP) costs $120, of which the co-pay is $20 and the insurance covers the rest.

And remember, this is one of the best insurance plans in the nation. Many don’t cover half as much, and demand greater financial input from the insured, making many medical procedures way too expensive for ordinary folk to even consider.

It may appear that $32,000 (20,000 GBP) for an artery stent is quite expensive. If we’d not had insurance our bill for that procedure would have been over $50,000 (33,000 GBP). Why? Because the insurance companies have this nice little arrangement with the hospitals whereby said company sets the price it will pay for any procedure, from a heart transplant to a doctor’s visit, and the hospital/doctor agrees to abide by that. It means that by paying huge insurance premiums you get a cheaper hospital/doctor rate, well – in reality, the insurance company does.

For many years, a vast number of Americans couldn’t afford health insurance. Traditionally, it’s always been part of a ‘package’ offered to employees by their employers. So, ‘out of work’ meant no health insurance. The lowest paid jobs (Wal-Mart, McDonalds, etc) usually offer medical plans, but often they’re too expensive and don’t cover part-time workers. Small businesses often can’t afford the premiums for their workers.

Wal-Mart, hardly a ‘small business’, just announced it’s scrapping its healthcare plans for 30,000 part time workers, and raising the premiums for other employees. The reason given: the additional cost of meeting the provisions of Obamacare. The company estimates it’s healthcare costs for 2015, without these cuts, would have increased by $500 million. Obviously, with over $100 billion in the bank (after all costs/expenses have been deducted) they can’t possibly afford this.^[1]

One of the quickest routes to bankruptcy (and the one most often taken in the US) is to become ill. Without insurance, my artery stent would probably have bankrupted us. We’d have had to sell our house, or at best, take out a massive loan against the property to pay the hospital.

Has Obamacare changed all that? No. It’s helped, but thanks to enormous opposition to the bill from Congress, and amazingly from the public at large, it was watered down to such a degree as to be even less than a token effort to provide affordable healthcare for all in America.

But rest assured, if David Cameron and Jeremy Hunt get their way, you Brits will be enjoying the same wondrous world of capitalist medicine as do your cousins across the pond.

I hope that clarified the situation for you, George?

^{[1] “Wal-Mart to End Health Insurance for Some Part-Time Employees” WSJ, October 7th 2014}

When I first arrived in America from Britain, back in 2002, I could see a doctor. Once my health insurance was sorted out and I’d ‘signed up’ with a family doctor I had only to pick up the phone and I’d have an appointment that day, or possibly the day after, or, at the very latest, the day after that.

To quantify the extent of my need the receptionist would take pains to ensure I was seen within a time-frame relative to my suffering. Rarely was my wait longer than three days, unless the doctor was on leave, or himself sick, in which case I could see another doctor, or choose to wait until my own was back in the office.

Then the family practice was taken over by a Catholic hedge fund.

Almost immediately a letter from the Pope was needed to get within spitting distance of my doctor. His appointment book was full for weeks. They could fit me in, “…let’s see, there’s a vacancy next month – how about the 27th?”

Of course, if it was urgent, I could always see the Nurse Practitioner.

The what? Isn’t she the one who combs kids’ hair for nits?

Does anyone ever visit a doctor if they DON’T consider it urgent? I suppose some do – like poor old Mrs Johnson from down the road. She used to be a regular every week with her sciatica and ingrowing toenail. She really only went for the company, and because she thought the doctor was wonderful. They can’t fit her in anymore since the Catholic hedge fund took over.

The last time I saw her was just before we moved. They were carrying her out of her house on a stretcher. Poor soul, she was eighty-one and dying of loneliness. The weekly visits to her family doctor were the only thing that had kept her going.

It was much better when we moved to our new place. It was five hundred miles away, and in a different state. The new family doctor was a woman. She was quite pretty. I liked her. And we didn’t have to wait months for an appointment. It was just like the old days.

“Oh, yes, Mr Adams, would you like to come in this afternoon? Or, we have an 11.30 tomorrow morning?”

It was the same at the local hospital, run by the town council. All the staff were cheery. They seemed very happy in their work, and ever so friendly.

Then a hedge fund bought out the whole medical system in the area. I didn’t find out until I tried to make an appointment to see our doctor.

“Well, if it’s urgent we advise people to go straight to the Emergency Room,” was the response I got one morning, after being told it would be three weeks till the doctor was available, “…or, you can see our Nurse Practitioner. She’s very good.”

“Is she a doctor?” I asked.

“No, she’s a Nurse Practitioner.”

I gave in. I could see the Nurse Practitioner the next day.

After receiving a prescription for my minor medical condition, I was waylaid in the outer office by the receptionist.

“Mr Adams, you have a copay of twenty dollars.”

Oh,” I responded, somewhat taken aback. After all, I didn’t see it was any business of theirs what my insurance copay would be. “Okay, thank you.”

I headed for the exit, only to be called back. “You’re expected to pay it before you leave.”

Now, I’ve always prided myself on being a mild-mannered individual, but this was too much. “I beg your pardon?”

The receptionist had the good grace to blush slightly. “They…” she began, looking down at her desktop, “…want you to pay it before you leave.”

“And who are ‘they’?” I asked.

The girl hesitated, unsure. She stammered, “It…it’s the new rules. I have to ask everyone.”

I leaned over the counter towards her, “Well,” I said, in a loud voice so the whole waiting room could hear, “‘they’ will have to learn that ‘they’ cannot always get what they want. I’ll pay when I get the bill, and my insurance company has confirmed the amount, and not a moment before.”

As I turned to leave I noted in the waiting room a well-built, white-haired gentleman in a fancy cowboy hat. He was grinning profusely at me while giving the thumbs-up.

That was two years ago. I’ve never again been asked to pay at the doctor’s office. Apparently, there’s a note on their computer to that effect, though I can only guess how it’s worded. What amazes me is how many patients do dutifully hand over their credit cards at the counter without so much as a word of dissent.

“Mr Cartwright, I’m so sorry you’ve just learned about the cancer and that you only have weeks to live. That’ll be two hundred and twenty dollars, please.”

I later learned from members of the hospital staff that the new ‘owners’ had installed credit card readers on every ward.

“Good morning, Mr Jacobson, we’re just about to take you down to theater for your heart bypass. The total cost, with taxes, is fifty-seven thousand, three hundred and twenty-two dollars and fifty-five cents. Sadly, I’m afraid your insurance only covers one third of that, so I must ask you to slide your Visa card through this machine. But don’t worry, if the operation’s unsuccessful, you can apply for a partial refund.”

The mind boggles.

A few months back I needed to see the doctor.

“Well, Mr Adams, I’m afraid the Doctor’s rather booked up at the moment but I can get you in with our P.A..”

“Pardon?”

“The P.A. – Ms Fassbender. She’s very good.”

“Excuse me, what’s a P.A.?”

“Oh, she’s our new Physician’s Assistant.”

“And what exactly is a ‘physician’s assistant’?”

“Oh, well, she assists the doctor…”

“So, she’s a nurse?”

“No, she’s a physician’s assistant.”

I could sense this conversation was going nowhere. “I’ll wait and see the doctor.”

A few minutes of research on the internet convinced me I’d made the right choice. A physician’s assistant is nothing more than a poorly qualified stand-in for the doctor. All that’s required after college is a further two year course and they can make diagnoses, prescribe medicines, arrange admittance to a hospital, and generally do everything a fully qualified, four years at medical school, three years of residency training, family doctor can do.

What’s more – and here’s the crunch – you’ll be charged the exact same amount for a visit to a P.A. as you would when seeing a doctor. Yet the P.A.’s salary is only a fraction (40%, or less) of the doctor’s.

American hospitals and medical centers are fast becoming nothing more than cash-cows for the greedy, capitalist, corporate-controlled hedge funds that are now running America.

There was a time when a doctor’s office or hospital was considered a Temple of Healing. They’re rapidly being converted into the Wal-Marts of medicine.

The time is surely approaching when the receptionist in the doctor’s office will be replaced by a computer screen. A locked metal gate will separate the waiting room from the medical staff. At the time of your appointment a digital voice will instruct you to enter the treatment area by sliding your credit card through the reader on the gate. It will check your credit, deduct the fee, and only then, open the gate. If your credit is bad and doesn’t cover the fee, the only door that it opens will be the exit.