By Robert Surcouf
CURRENTLY I am in Los Angeles visiting an elderly aunt who recently underwent surgery for skin cancer. Sadly, she lost her husband just before the first outbreak of Covid and had to cope during the lockdowns all alone. You might be wondering why I am sharing this with you? The answer is that it has exposed me to the very real horrors of the US medical system and made me question what type of health system we are moving towards in Jersey.
The US does not have a primarily free health system. All citizens are expected to obtain their own health insurance, which is very expensive and can materially vary in cover, and there is a small safety net called Medicare for those who cannot. My late uncle worked into his late 70s and my aunt into her early 60s paying all their taxes in the US and acquiring what they believed was a suitable health insurance. They own a small apartment and have a pension and a little savings that should have been sufficient to see them through their retirement.
Sadly when my uncle, a veteran who served as a Marine in the Pacific during the Second World War, was 93 he was diagnosed with dementia and his health slowly deteriorated and, at the age of 95, he caught an infection which spread to a number of his organs.
He was taken to hospital for a few days and then discharged and then had to be readmitted and this happened time after time with bills for the ambulance journeys not even covered by the insurance. On one occasion my aunt was contacted by the insurance company and told that she had to arrange to move my uncle to a nursing home within two days or face a bill of $8k a day that the insurance would not pay as my uncle had been ill for too long and they would not cover any longer stay in hospital. In reality, in total he had spent fewer than three weeks in hospital.
Unable to afford this type of bill and not knowing how long my uncle would need care, she arranged for him to be moved to the insurance company approved nursing home, where he would receive palliative care. The family doctor visited them both and informed my aunt that the care offered was so poor that he would be better at home with her if she could afford to pay for specialist nursing care to come in and assist. This is what was arranged and my uncle passed away peacefully in the comfort of his own home a few weeks later.
We then move forward just over two years and my aunt is diagnosed with a malignant skin cancer. Thankfully her health insurance does cover her initial treatment for the mole but she is told she should now arrange to see a specialist to examine her in case she has any other such cancers.
Following the US process she contacts the health insurance company, who provide a list of consultants. As she contacts each in turn none of them will give her an appointment as the rate the insurance policy pays is now far below their new post-Covid rates. Thus begins another challenge of renegotiating her insurance arrangements and eventually managing to find two specialists who will even consider making an appointment, but they are a long way from where she lives, which is only five minutes from an excellent hospital whose specialist consultants treated her cancer but refuse to see her due to her insurance.
So my now 86-year-old aunt continues to navigate her way through the complexities of the US health insurance system while she is still grieving the loss of her husband and the loneliness of nearly two years of very strict on/off lockdowns in the state of California and worried that she might need to undergo further treatment with a starting response of ‘look at the website’, which is of no help when you do not own and have never used a computer.
So this Englishman in LA is trying to see what we can achieve in what is both a frustrating and very sad state of affairs.
But what is the relevance to Jersey?
Over the past 15-plus years we have seen the UK NHS system suffer from under-investment and much Conservative talk of slowly moving towards some form of privatisation and reliance on health insurance. This is already creating a two-tier health system with short waiting lists for those with private health insurance and a lottery as to how long everyone without might have to wait, and growing reliance on charitable support akin to Victorian times.
In Jersey, we have seen many proposed changes to our health system over the past ten years and the Jersey Care Model of the last government seemed heavily focused on delivering savings as a key metric and heavily based on failed policies from the UK. Having now seen first-hand the impact of the US health insurance system, the failing changes in the UK that we have been replicating and the growing waiting times to see our local consultants if you do not have private health insurance, I fear we are moving towards a similar situation.
Unless as a society we recognise the importance and benefit of a well-funded health system in the 21st century that can help ensure suitable treatment for all in our community, irrespective of their wealth, then we are failing ourselves, our families and our community.
Robert Surcouf comes from a Jersey farming family, though his mother was Spanish and moved to Jersey in the 1960s. He became an accountant and now specialises in risk and enterprise management. A father of two school-age children, he still helps organise and participates in local motorsport events and was one of the founding members of Better Way 2022 before the last election. The views expressed are his own.