Jersey Sicko

The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged. - Aneurin Bevan

The fees charged by doctors in general practice in Jersey varies tremendously. Doctors are entitled to charge whatever they wish.
- Jersey Citizen's Advice Bureau information page

I watched Sicko last weekend. Sicko is a 2007 documentary film by American filmmaker Michael Moore that investigates the American health care system, focusing on its health insurance and pharmaceutical industry. The film compares the for-profit, non-universal U.S. system with the non-profit Universal Health Care systems of Canada, the United Kingdom, France and Cuba.

It is true that Michael Moore does not focus on the problems with waiting lists, or the difficulty in obtaining some kinds of cancer fighting drugs - weaknesses seized upon by his critics with glee. But their focus is purely on the weakness of his case for what Americans call "socialised medicine", and they don't deal at all with the massive deficiencies of the American healthcare system, where (1) you need medical insurance and (2) that leads to all kinds of problems where the insurance cover runs out, or the insurance company disputes treatment, just at the moment (obviously) when you need it most.

Of course, if you can't afford the insurance, the situation is even worse. But he shows how even if you have insurance, the system fails, as Moore shows. One of the most moving sequences was at the end 9/11 volunteers, not employed by the city, and whom the city authorities refused to help with the serious respiratory ailments many incurred. Moore takes them to at the U.S. Guantanamo Bay detainment camp, where the inmates get free the medicine denied to the 9/11 rescue workers. When a siren is blown from the base, the group move to Havana, where they purchase inexpensive medicine and receive free medical treatment.

Aneurin Bevan laid down the principles for free health care, and in doing so he attacked any kinds of means testing remorselessly, whether for private health insurance systems or by the State.

Where a patient claimed he could not afford treatment, an investigation would have to be made into his means, with all the personal humiliation and vexation involved. This scarcely provides the relaxed mental condition needed for a quick and full recovery. Of course there is always the right to refuse treatment to a person who cannot afford it. You can always 'pass by on the other side'. That may be sound economics. It could not be worse morals.


Some American friends tried hard to persuade me that one way out of the alleged dilemma of providing free health treatment for people able to afford to pay for it would be to 'fix an income limit below which treatment would be free while those above, must pay. This makes the worst of all worlds. It still involves proof, with disadvantages I have already described. In addition it is exposed to lying and cheating and all sorts of insidious nepotism.

And these are the least of its shortcomings. The really objectionable feature is the creation of a two-standard health service, one below and one above the salt. It is merely the old British Poor Law system over again. Even if the service given is the same in both categories there will always be the suspicion in the mind of the patient that it is not so, and this again is not a healthy mental state.

Having watched Sicko, I am certainly glad that our health service is not based on the American lines. Nevertheless, when you consider Jersey and compare it with England, some important and significant differences emerge - in particular that while in England, Doctors form part of the National Health scheme, in Jersey, people have to pay for their Doctors. There are also inconsistencies - look at this for instance:

The fees charged by doctors in general practice in Jersey varies tremendously. Doctors are entitled to charge whatever they wish.


In 2005, fees varied for a home visit at the weekend between £65.00 and £105.00, and night visit between £65.00 and £125. A sick child is often worse at night, and for a serious gastric disorder for example, a surgery visit may not be possible or prudent. When an adult I know had chicken pox extremely badly (as often happens with adults), it was important for home visits to take place regularly, especially given the dangers of high temperatures, and the doctor obviously wanted to keep at eye on matters. Sickness is no respecter of times of day. But look at this - if you are a visitor, and taken ill at night, and did require a call out:


The service is provided free of charge for visitors (and people who have been in the Island for up to six months) who are from the UK, Northern Ireland and the Isle of Man. Medication prescribed is free..

Visitors get better treatment than locals! As do, of course, those in Prison at La Moye, where doctor's visits are free of charge to inmates. Now where have we come across that before?

It is true that - as Nye Bevan pointed out - there is a health exemption scheme, but many hoops have to be gone through, a labyrinth of forms to fill in. A person whose income is below a prescribed limit can apply for Health Insurance Exemption, and thus qualify for the above-mentioned benefits without payment. In fact the language of the Government health site is appalling:


If you have a low income and meet certain other qualifying conditions, you may be available for additional help under the Health Scheme.

But don't count on it! Ask anyone who has applied how easy it is, and it is not so different from the US insurance companies looking for loopholes to avoid letting people into the system. Complain, and there is always a lingering fear (which may or may not be justified) you may receive a rougher ride next time.

Consider this example from Nye Bevan, which I know is true of many mothers of young children in Jersey:

Preventable pain is a blot on any society. Much sickness and often permanent disability arise from failure to take early action, and this in its turn is due to high costs and the fear of the effects of heavy bills on the family. The records show that it is the mother in the average family who suffers most from the absence of a free health service. In trying to balance her domestic budget she puts her own needs last.


I wonder if the bureaucrats (who now refer to people who apply for benefits as "stakeholders" -see the States website) will ever get the message.


One thing that is extremely interesting is that "Sicko" was available in shops such as Woolworth locally in large quantities on the day it was released. On a visit to the shop the following day, I was told that there was a problem with the DVD so it was being withdrawn. It is still on sale in England at Woolworths, but I have not noticed any shops here selling it. It remains "withdrawn".

Please let me know if you find it otherwise.

Remember...


Preventable pain is a blot on any society. - Nye Bevan

"It has been said that a country's greatness can be measured by what it does for its unfortunates." - Tommy Douglas

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Links:

The full texts of "In Place of Fear", Nye Bevan, laying out the reasoning behind the NHS
http://ed.acrewoods.net/node/204

Benjamin Langlois on Dentistry - yes, it is free in the UK
http://www.stateofjersey.co.uk/2008/06/is-having-healthy-teeth-really.html

Government Website on Health Insurance Exemption
http://www.gov.je/SocialSecurity/Benefits/Health+Zone/Health+Scheme/#Seven

Tommy Douglas (Canada Medicare)
http://www.tommydouglas.ca/