You get what you pay for?

So, we walked into the chiropop’s office last Thursday to see a picture of El Jefe on the wall. It was a familiar stance — arms crossed in that easygoing, iconic posture, blinding white smile, and the stars-and-stripes ’08 motif above. T. blinked, and wished she’d brought her camera. Mr. O. A big poster. Right there.

D., getting a drink from the water cooler, straightened to find himself facing the larger than life leader of the nation, and asked aloud the question on both of the minds of the only Americans in the room. “Why do they have a picture of the President of the United States on the wall in a chiropractic office in Scotland?“

Good question, that.

The receptionist, an Australian girl, noted our bewilderment and came over. “It must seem all a bit much to you,” she said ruefully. “I can see that you’re not fans.” We assured her that it’s not that we’re not fans (can you be “fans” of a president? Fan, being the spin-off of the word “fanatic,” the answer is a distinct YES, in this case…), but that it was just…weird. “Well, it’s just that we like what he’s said about chiropractic,” she said warmly, pointing us to the letter on the poster, which he’d written sometime during his campaign. “We just love that he supports us.”

The first sentence of the letter reads, “Dear Friends, I am glad to have this opportunity to again share my thoughts on the role doctors of chiropractic play in the American healthcare system.” Right. Dear Mr. President: thank-you for supporting our chiropractors on Regent Street. Sort of.

We were presented with the a statement, when we made the appointment to have T’s last wisdom tooth extracted, which had comparison rates on it — one for NHS patients, the other for patients with “private care.” For two x-rays, NHS patients pay £4.40, while private care patients pay £11.40. For a tooth extraction, the NHS patient pays £11.43, whereas the private care patients pay £128.00. At the top of the statement, it states that those who opt for private care will receive, up-to-date, cutting-edge dental techniques. Meaning, D. wondered, that NHS patients would receive …a tooth extraction with a pick and a hammer?

At the dentist’s office, patients must pay per visit, per procedure, so at the end of T’s excruciating extraction last week, D. stopped by the front desk with his wallet, to pay the NHS fee. Meanwhile, the still bleeding T. stomped out of the building and weaved her way up the street, clutching her head. (People stepped briskly out of her way, you can be sure. She had that “dangerous, drunk brawler” look about her.) T. was on the street literally two minutes after the tooth was out, a tissue at the corner of her mouth to staunch the flow of blood, with a “there ya go,” and instructions on how often to rinse out her mouth. No antibiotics needed, he says: you’d have to be very unlucky to get an infection. No medicine given: just take some ibuprofen, if you feel any pain. A little pouch of gauze: “bite down on one of these if you start to bleed again.” NHS dentistry – straightforward, no-frills, and maybe not the way everyone would want to go.

“Oh, I always pay private care price, cash,” the receptionist at the chiropractic office confided shamefacedly. “I’m afraid… well, like it says, what if NHS patients don’t get the best, up-to-date care? I’ve had to have four fillings; I’d rather pay cash and have the white ones than go cheap and get those poisonous mercury ones they put in.”

Hm.

The point isn’t so much the NHS dental care, nor the hysteria over mercury fillings, which some insist are safe, while others insist they’re toxic. Our “hm” moment came when we realized that the U.S. is striving to come up with a national healthcare that some people want to model off of the UK’s. While it must be said that the UK system is not at all a bad system, we’re realizing just how much work there is ahead for those who are working on this change. For one thing, Scotland itself could fit into California twice over, with a little room around L.A. for the islands. In Scotland, it can take up to eighteen weeks to see a specialist on the NHS system. And that’s normal, and it’s fine if you’re not in dire straits. Our country is so much larger and …the pull on any healthcare system is going to be massive. It’s got to happen but it’s got to be built better –stronger– than this one. Also, one thing that has to be built-in is a sense of equality.

There are people who, like here in the UK, will always keep their private health insurance because they believe that “you get what you pay for,” and they feel the need to pay. That’s fine. But I would hope that those who aren’t able to pay don’t actually get less. T. recalls growing up basically dirt poor — or as “dirt” as you get in suburbia in the 80’s. In college, she remembers finding a decades-old check stub

from one of her mother’s early childhood teacher salary checks, and seeing the heart-stoppingly tiny amount with which her mother got by, paying the mortgage, putting three kids in private school, and keeping herself and all of them fed and clothed. She remembers going to the doctor at the county facility and sitting in the waiting room, swinging her feet in the molded yellow chairs while lines of men in orange jumpsuits and ankle chains shuffled by. And yet, she had the funniest, brightest, kindest doctor; despite the wait, and apparent poverty in that place, she received very good care.

Paying or not, that’s how care ought to be, for everyone: cutting edge, up-to-date, quality for all.

Or, it’s worth nothing.

– D & T

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