My American hellscape or my broken Britain: where would you rather seek treatment?

For the second time since I moved to the United States 15 years ago, I had to call 911 this week. The first time, six years ago, was when smoke poured into the elevator from a fire in the laundry room and four fire engines arrived within minutes. This week it was to request an ambulance for a sick neighbor. Between dialing the number and a stretcher and two paramedics materializing in our hallway, it was about seven minutes. I found myself thinking about something I used to think about the NHS: what an amazing service.

My understanding, at this distance, is that most ambulances in the UK don’t show up within 10 minutes, even when the emergency is serious. A friend who had a heart attack on the streets in London this year was, he told me, lying on the pavement for 40 minutes before the ambulance arrived. It’s terrifying, and yet still slightly less terrifying than the common American experience of urgent care, in which gratitude for efficiency is undermined by the dim but thrilling possibility of losing one’s home when the bill arrives.

All of this is at the forefront of my mind as we plod through the season of health care renewal. I have to stop talking about this, I know. Unless I move to Canada or join a powerful union that I don’t qualify for, there is nothing to do about it. Yet the sheer, punitive opacity of the system has never shocked me as much as it does now, when, after years of renewing an existing policy, I finally decide to go shopping.

“Do you know how it works? says a sales agent. I just asked her if she can send me a breakdown of coverage and exclusions for a policy that costs around $10,000 per year. “How it works, we can send you full policy details after you sign and pay, then if you want to cancel you have 30 days.”

There’s a pause while I digest this. “Isn’t that…pretty weird?” I say. She laughs nervously.

“I mean…that’s just how it works.” Enlightening, she said, “But you can ask any question about politics and I’ll answer it!”

After calling three other agents expecting a different response, I understand that no one here is acting in bad faith; it’s, as she says, exactly like that: an Alice in Wonderland system in which you don’t know what you’re buying until after you’ve bought it. And so we go through the preliminaries. No pre-existing conditions; no one smokes; no interest in maternity coverage. All this delights the agent endlessly, as it results in a relatively attractive quote.

I ask the one question that is essential to ask in New York when buying health insurance for your family. “If someone has cancer, can we go into Sloan Kettering?”

His voice instantly sharpens. “Do does anyone have cancer?

“No. No one has cancer.

“Well, then, yes. It is a PPO (Preferred Provider Organization), it will be accepted everywhere.

But of course, that’s not the whole story, and when I ask why the provider she’s whipping isn’t listed on my doctor’s board of accepted insurance, she gets testy. “We are accepted by 80% of medical providers in the United States.” Ah. You can guarantee, in this scenario, that the 20% of doctors who don’t accept this sketchy insurance are in New York, where you can’t cough without someone billing you for $350 (£290) .

In the midst of it all, I visit my wonderful primary care physician for my annual physical. She sympathizes with me and tries to find a workaround to outsmart my existing insurers. Public health policy in the US recommends routine colonoscopies for everyone over 45 – ha, you wouldn’t get that in Britain, I thought, when she told me about it l year, before checking my policy to find it wasn’t covered. A colonoscopy costs more than $5,000 (£4,130) in New York. “They just want you dead,” my doctor said grimly, a statement more blunt than I expected. But I guess on some level it’s true.

So this is it. Broken Britain or this hellscape? It’s a tough call. Today I’m going to pick up the phone to try to find a loophole in the system, a unicorn policy that covers both routine screenings and major medical events; one that, in an emergency, will bring an ambulance to my door in less than 10 minutes – assuming I’m not too terrified to call.

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