TABLE TALK

Have you Medicare in England?

DENTS BROGAN

Washington—I have just emerged from my first experience of an American hospital. One of my liveliest memories is of being asked as I registered, first, had I Blue Cross (an elaborate system of private insurance against medical costs), then, had I Medicare (a government-subsidised system of help for the aged, of yvhom I am one, in their medico- financial problems), and then, was there Medicare in England and could it be called on to help pay for the cost of my treatment in this famous hospital? I said that we had something like Medicare (I didn't say we had something •better), but that there was no chance of the National Health Service pay- ing any of my American hospital or doctor's bills. I added that I was quite solvent and that a number of well-known inhabitants of Washington would certify to that fact. But I had to produce $100 in cash (which I was fortunately able to do) before my admission, arranged by a very eminent Washington physician, could be arranged.

So began my first experience of an Ameri- can hospital. Since I am accident-prone and have a number of built-in complaints, I have often entrusted myself to American doctors. I have been uniformly impressed by their care and apparent competence (I say apparent because I have no real means of judging). I have visited doctors in their 'offices' and others in clinics (usually on the recommendation of knowledgeable friends). I have never, allowing for the high cost of all services, been overcharged. Indeed, in a small college town I was looked after by a doctor who had come back from work as a medical missionary to take over his dead father's practice. He was famous for his rudeness and, while that was an exaggera•

tion, he wasted no time on bedside manners but gave me a thorough examination and charged less than most British doctors would have done. He was, no doubt, an eccentric, but not all American doctors are rapacious (none of those I have consulted has been).

Yet the American public has developed a strong belief that the 'beloved physician' of tradition is now a rather ruthless business- man, a kind of medical Elmer Gantry. A spokesman for the profession a week or two ago had to defend himself and his brethren at a Congressional investigation against a persistent Congressman for whom all doc- tors were at best Shylocks. Enlightened leaders of the profession (who are not neces- sarily the leaders of the American Medical Association) know this, regret it, and, off the record, admit that the public suspicion of the successors of St Luke is not totally un- justified. At this moment, the city of New York is investigating the accounts of doc- tors employed in another welfare system, `Medicaid', over the protests of the AMA that it can police its own members.

The cost of medical attendance can be great, and so can the cost of medical insur- ance in America. It was therefore with a sense of relief that I reflected that I had in- sured myself before I left England and, barring some catastrophic escalation of my ills, I should be covered. As it turned out the hospital charges, though high by our stan- dards, were not outrageously high by general American standards. Had there been any danger of expenses like those incurred by some of my friends, I should have flown home, breaking all engagements, and thrown myself into the arms of the National Health Service.

in in

As a frequenter of hospitals, I Aas terested in how this one was run. It 'sag very well. For one thing we (I was sha a room with one other patient) were waken at a less ungodly hour than is or vvas tomary in Britain. For another, there see to be more nurses. And they were mei' trained nurses. I was given tests every fe hours and the skill and manner in ssh,

.c,

these tests and injections were administer suggested good training and admirable ho pital discipline. Of course, the food was d pressing, but that is uniformly true of ho pitals. I quoted to myself from an Engh poet on Nebuchadnezzar:

'Said as he chewed the unaccustomed It may be wholesome but it is not good

• But none of the nurses were 'Wasps'. The were not even any of the formidable lii sisters I have had to deal with. (Nor there any equivalent of the lively mint.

• aged nurse from Skye into whose highl competent hands I once fell in a Glasgo nursing home, who sang fluently in Gad not only the melancholy masterpieces of t Hebrides, but 'Stop Ye'r Tickling, Joc recognised the tune and accepted her assu ance that the translation was faithful.) The was one elegant dark English girl fro Somerset who dropped in to chat with She got twice as much pay in Washington she had in Bristol, but she had some ni talgia for her mother country.

But among the nurses who attended was a Puerto Rican who was as formid —and competent—as any Irish sister; Korean ; several Chinese ; one or Is Filipinos. And there were several extreme cheerful American black women (Negr is now banned), whose warm, rich volc. and the fact that they spoke an English could always understand, set them off In the others. I left the hospital very come! with my treatment, not too worried by expense, and again asking myself why b a. American women have such attractive voi. and why so few white American wo have voices that are more than bearable.

I was equally impressed by the services my specialist who took many more tests the hospital and later in his office. ttl receptionist was a most encouraging woman with a light but un-grating No one less like a TV doctor could he ceived. He had a serious but slightly iror manner as he went over my medical hidt much of which I had forgotten. He ta more candidly than most British male tors do and listened as well as British w 0 doctors do. He was obviously a hi civilised human being, conscious that ta blood out and putting drugs in was not art of medicine.

He would, I am sure, have been ironic

amused by the young man about to grad

from one of the best pharmacy schools the United States who confidently asse that the only function of a doctor was diagnose; then it was all up to the Pha cist to prescribe and produce the d supplied, ready-made, by the great companies. He expected to make a £5,000 a year as soon as he was Rea That was only a beginning. No wonder m cal costs are high. And they would be higher (as they would be in Britain) if t were not so many nurses from the back' parts of the world (including the Amer black community). It is a thought for Powell.

I I

di