to wonder if British people who go on holiday in the States deliberately seek out the stupidest...

[AtheneNoctua]

people they can find so they can come back and tell everyone how stupid all Americans are.

'Oh yes they do kill people here due to lack of resources etc. Big time.'

This happens big time in the US, too, particulary among people with chronic conditions who can't afford their medication.

"I would regard the medicalised approach and having an og/gyn instead of midwife led care a plus."

That is just personal opinion. Here in France you have to fight not to have an obstetrician led birth. There is, happily, a small but growing movement for more MW led care in pregnancy and childbirth.

Oh, and hospitals in the UK are dirty and gross. An American Hospital looks like a 5 star hotel compared to the ones here.

I guess it is largely down to funding but I don't think higher taxes are the answer. I think the NHS must find a more efficient way of working. For example, if I want a presription refill in the states, I call the doctor's office and talk to the receptionist/nurse/whoever answers the phone. She talk to doctor and calls me back to say prescription ready for pick up at (what ever pharmacy I asked her to call). I go pick up the prescription, usually within the hour. Here in the UK, I have to fill out a form, physically deliver it to the GP surgery together with a stamped self addressed envelope, give them 48 hours to action it, wait for it to arrive in post, and then carry it to the pharmacy. This is so wasteful on so many fronts. The paperwork, the number of people involved, the time I have to wait before I can have the prescription. I get migraines. In the states I could have relief in time to go to work. In the UK it will be days before I can get relief.

Well let's see. Working as a nurse over there I was making well over $40 dollars and hour and given health insurance for myself, my spouse, and kids, etc. I did not have to pay towards the cost of it and it included dental.

Let look at what I have here. Lower pay than a teacher considering a obtaining a degree in nursing is tougher than obtaining a degree in education. 16 hours shifts without a break because I don't legally have the right to refuse to take on more patients than I can handle, yet I am still legally responsible if anything happens to one of them because I can't be 10 places at once. Many, many hours go unpaid as well.

And my kid has been showing signs of autism since he was 3 and he is 9 now and is still waiting for diagnosis.

'the places that grandma gets admitted to if her congestive cardiac failure starts to kick off. '

And the places where American grandma gets admitted because she's a Medicare patient. She can't even get regular insurance because of her age and fewer and fewer doctors take Medicare patients.

It's no end of trouble for my 72-year-old father, who has hypertension, heart disease and no prostate because he had cancer.

The scramble to find another doctor who will take new Medicare patients because the one he's been seeing no longer takes Medicare patients.

Meanwhile, he's going without care or using ER until he finds another one.

Athene - lots of GP surgeries in the UK let you ring up for a repeat prescription! And you can collect the prescription from the pharmacy associated with that surgery or, in the countryside, from the surgery itself if it has a pharmacist of its own.

I think that you are just comparing one surgery in the UK with one surgery in the US in your example.

why don't you repatriate, pram?

that's not meant to be cruel, but truly, if things are that bad for you here and your earning potential is so much better, why stay here and be miserable?

I don't know, Ana. I have had thre GPs in three different PCTs and they have all operated this way. But, I;d be interested to know if they are all in the minority.

The NHS does have some good points. But, on the whole, I would prefer the US system.

I think surgeries operate in different ways, that's all, and you cannot generalise as much as much as all that. There are doctors you like and doctors you don't like.

Leonie, MRSA has less to do with hygiene than you think it does. Same with c-diff. It's disgusting how the british press blames "dirty hospitals" and "lazy staff" on the fact that we have superbugs. What is even more disgusting is how the public buys into all that crap. Hygiene only goes so far.

I am a pushy mother. That's how we got as close as we have to getting a diagnosis. If i wasn't pushy we wouldn't even be on the waiting list.

My English DH finally agreed to give up his safe and secure job so that we can repat. The house is on the market. Dh's visa app is in the post. I have a job lined up thanks to earlier contacts.

But I don't care if we end up living in a trailer with no running water over there. I want out.

If I wasn't a registered nurse I wouldn't mind it here so much. But being a nurse in this country absolutely blows like nothing I have ever seen.

Europeans are pretty ignorant about middle America too - and that's where the vast percentage of the population is.

Our local surgery will produce a repeat prescription after a brief call.

I imagine that the US system is better, if you can afford the insurance payments, including the increases as you age, or develop illnesses, conditions along the way, for your entire life or if you very secure job with excellent benefits packages, etc.

Clearly, if you are health professional, like pramspotter, you also benefit from the US system.

Therefore, if you can afford it, it is better.

Tragically, many people cannot.

It is not irrational to prefer the US system, as AtheneNoctua does, no less than it is irrational to prefer 5-star restaurant quality food. We can't all afford that every day, however.

What I think is indefensible, however, is that the US spends more per capita on healthcare than than UK, yet only those who can afford it can truly access the effects of that spending. At least in the UK, everyone "benefits" from the government's spending.

"There are doctors you like and doctors you don't like"

Yes, of course that is true, Anna. But I don't mean to direct any of my comments here to specific doctors/nurses/etc. My criticisms of the NHS are about the organisation. The individual doctors and other staff seem comparable to their US equivalents.

And another thing I hate might even be the thing I hate the most is the way the country is divided into PCTs and that it is VERY difficult to break that boundary. Why do I have to go to shit maternity hosipital just because I live in that particular PCT. I refused to do this incidentally and I did get my way but I had to be one pushy obnoxious patient to get there. But, everything in the health (and education) system is about where you live.

Socialised healthcare leads to less personal responsibility?
Would that be why people in the USA are all teetotal, non-smokers and maintain a healthy weight?

For what it's worth, when I worked in the USA I thought that the health care would be stellar. We had subsidised health insurance through our jobs. We chose the plan that didn't have an upper ceiling on the benefits (most would stop paying out once you'd had $1million of care, which can go scarily fast if you have something complicated). But then, when we took my DH to A&E in agony (seriously, he was vomiting the pain was so bad), we had to wait for 6 hours for them to admit him to a cubicle to get pain relief. This was after they had established that he had insurance and even though I was checking up with the desk (very politely) making sure that he didn't fall through the net. Once he was in the cubicle a very nice male nurse came to take his vital stats - not surprisingly they were really bad and things happened very quickly after that. But since then I have been very when I here that medical care is wonderful for those that can afford it.

I've also had a friend deliver her babies in the USA and for the second the nurses were telling her that she wasn't ready to push - until the OB arrived, when suddenly it was all OK. She is highly suspicious that there was no medical reason to delay the delivery and that it was either for litigation reasons, or so the doctor would get paid for "delivering" the baby.

Have to say that I don't think that the NHS is perfect either - especially considering how much money has been poured into it in the past few years. Just that the USA shouldn't be held up as a wonderful example.

Thank you for trying to kill my dream Leonie!! I am aware that the whole of America isn't like New York - I haven't actually been to NYC though (just transferred flights there) - it's that very difference in topography, climate and culture that fascinates me TBH.

There are good things and shit things about all countries are there not? But I think that choosing to live in the UK because 'it's a good place to be poor' is a little sad really......

I think that GPs have a certain amount of leeway about how they organise their surgeries - certainly, when I was in the UK and my GP retired and another GP took over her practice, the organisation changed very significantly and very quickly.

As for the PCTs - when I gave birth in the UK I was given a choice of three hospitals (although the MW made a very heavy recommendation to me - and she was quite right, in many ways) and, after I had given birth, my community MW breezily said I should have a home birth or, if I didn't want that, I could go to a birthing centre "next time" (ha ha ha). So I felt I had a lot of choice - and that was in the depths of the countryside. But then again, in that part of England there is masses of choice of schools, too. It is, of course, not neutral that it is an affluent area...

the ceserean rate in the UK is not far behind the U.S. - 23% vs. 30%.

i'm sure the episiotomy rate compares unfavourably as well - i and half the women i know had them here in the UK.

Mrs TittleMouse,

The labour and delivery nurses get in big trouble if they deliver without the doctor there. Sometimes the doc won't get there in time and it happens anyway. Labour and delivery nurses are not the same as midwives.

A friend of mine was an L&D nurse and she got raked over the coals because she delivered a baby without doc in the room. She had called him but things happened faster than expected and he didn't think that she had made a case on the phone as to how fast things were moving. Therefore he took his time getting to hospital and she got in trouble. Hard to explain to someone who works outside of healthcare. But it has nothing to freaking do with payment for the doctor and everything to do with liability.

As far as personal responsibility goes I don't think you understand what I meant.

I was told from a young age that providing healthcare for myself was my responsibility. I worked hard to be able to get the kind of job that provides good benefits and I saved money to help cover me in case I lost my job and got sick. I worked full time, went to school fulltime and didn't piss money away on pubs. I was thinking along these lines at 21 years old and not expecting the government to give me anything. My stepdad came from a poor family and he paid his way through a very expensive top university so that he could get the kind of job that would allow him to support a family properly.

Too many of the 21 year olds here are all about getting pissed, working as little as they can get away with, and expecting the government to pick up the tab for everything from university to healthcare. I don't think that is a good way for them to be, and they wouldn't get away with it as easily in the states although many Americans try.

Ah I see, sorry for the misunderstanding.

I have to say that this is one of the things that I like most about Americans. There is a real "can do" attitude in the USA that puts a lot of moany Brits to shame. But I don't think that it is a universal panacea. There will always be those in low-paid jobs who can't afford insurance. Because you have to have low-paid jobs. Society needs cleaners/hospital porters/clerical staff etc., but isn't willing to pay a load of money for them. Not everyone can be a professional.