UK and USA - compare and contrast

[KateandtheGirls]

Turquoise and I were talking a little bit about this earlier this week and we thought it would be interesting to start a thread.

Now I know there are many problems in the USA, and I'm still feeling quite sickened by the way the majority of people in this country voted the other day. But in a lot of ways things are so much more pleasant and civilised here.

For example:

*Halloween. Trick or Treating is a fun activity for the kids. No-one's house gets vandalised if they don't have treats.

*Bonfire Night/July 4 (i.e. the night when there are fireworks). Again, this is done in a fun, civilised manner. There certainly aren't gangs of teenagers roaming around letting off fireworks at all times of the night.

*Houses/cars being broken into. Happens a lot more often in the UK. In fact a lot of people here don't even lock their cars, and some people don't lock their house doors when they're out. There's a level of trust here that you don't get in the UK.

Thoughts? Comments?

this is from an american friend of dh's who has just moved back to the US afer 5 years in london...

'I love the return to the Imperial system from something so useful as the metric system. Here we have freezing at 32deg F. We made apple sauce with apples picked by the peck and half peck. The cider I am making is 5 gallons worth and it is bottled in pints. I just raked almost an acre of lawn (0.97 acres to be exact, although I like to think it is 15/16ths of an acre). Finally I have finished stacking 2 cords of firewood. Why did the UK give all these measurement up for rational ones? Boring.'

Supermarket us - bags packed for you & collect shopping by driving through a collection centre. Easy no stress.
**Supermarket uk - bags packed whilst you deal with kids , payment & all other customers waiting their turn. Push heavy trolley through car park with kids in tow & loadup car.

Supermarkets offering the US system would quickly make a profit. Of course can internet shop but delivery slots can be tricky sometimes etc. **

Not in my experience! Where we lived in the US, one supermarket chain would bag your groceries between 4 and 6pm when there were high school kids around; the others would leave you to get on with it. There weren't any places that took your bags outside, let alone to your car.

Here in the UK, they will bag (Sainsbury's, Tesco, Waitrose IME) if you ask and take out to the car if you ask. I always get asked if I want help with packing, and I usually refuse because I like to do it myself.

I lived in Connecticut for several years. I loved the sense of community - bolstered by effective and well organised local democracy - the local towns control their own schools, police and fire depts. There is such a sense of community spirit which simply does not and could not exist in the UK. However, I realise not all the States are the same - on a simple level, the East, Middle and West are like three different continents let alone countries.
The media is crap - ignorance about the 'outside world' can sometimes make you gasp. Food and TV was iffy but the weather was great.
It is incorrect to think that there isn't a class system in the US either - if anything we found it stronger than here. One thing that really annoyed me was the presumption that every non US person wants to be one!
However, I love the 'can do' positive energy of the Americans and the strong respect for family values...but like all things, it can go too far and overstep the boundary into arrogance and ' preaching'.
On balance, I think the UK has a lot to learn from the USA.

Medical care tends to be more conservative & aggressive in the US, due to (1) fears of lawsuit (2) resources that the NHS doesn't have.

When I went to my NHS gp last week about a 3-wk cough, she suggested I come back & be re-examined in 2 wks. This week (I'm in the US) my parents insisted I see their doctor. Doc said my chest sounded awful and walked me to his xray room, and gave me a chest x-ray. Turned out I had (mild) pneumonia which needed antibiotics. I've had other experiences, too, which are versions of this one.

On the downside, US medical care, if you don't have good health insurance, can leave you positively broke. It's sad, it's wrong, it's greedy, it's frankly disgusting. But medicine seems more advanced in the US and some US physicians who have done some training in the UK just don't have very good things to say about UK medicine. (Others do, though.)

I think both systems are very problematic, and that people who try to argue that one system is "so much better" than the other are misguided.

Interesting on the Med care thing ExpatKat. I have a very good friend in the U.S. who is flying back to the U.K. to give birth as she is petrified of giving birth U.S.-style, despite being able to afford "the best". I think there are cultural differences in what people in the U.K./U.S. expect from their medics. Although a colleague who works for MSF likes to say that her U.S. volunteers are completely unprepared whereas training in the NHS gives you an advantage in Refugee camps!

I'm just back from two weeks in Orlando and had a great time. One thing I really noticed was how polite and friendly the people were.
People opened doors, let us pass first, let us get out first from the Disney rains/monorail, made room for us on the seats etc etc. Lots of people started conversations with us, asking where we were from etc. One couple in a restaurant compliment me on my good-looking children (surge of pride) and how well-behaved they were (not typical of my boys I must add)

I think both systems are very problematic, and that people who try to argue that one system is "so much better" than the other are misguided.

I think it is fairly safe to say that the US system is not as good as people make out, and that the UK system is not as bad as people make out. I also think that it is a tad unfair to compare a private system in one country with a public system in another. I wonder how people would feel if they compare systems overall, or private v. private and NHS v. Medicare.

I think the medical cultures, apart from litigation and torts, is that the US system is very specialist-based and the UK system is more evidence-based and holistic. Even if both systems received the same resources, there would always be this cultural difference.

Medicine has to be rationed, otherwise it would eat up all your resources as it gets more advanced. In the UK, the rationing is via the waiting list and in the US, it's by excluding 50% of the population. You can argue which method is more ethical.

I've spent a fair bit of time in the US & love it.

One thing has always puzzled me-why is it women in the US are viewed as weird if they use a midwife.Also why they don't have gas & air in labour wards? I'd love to know.

Just my impressions... but I've been told that Gas+air was used in the USA regularly in the 1930s, but it went out of fashion. I imagine no proper safety studies had been done and then epidurals/spinals/caudals just seemed so much more effective... I've heard gas+air is coming back in (finally!). I feel so lucky having my babies in the UK -- but some Americans think it's terribly slap-dash how pregnancy is handled here.

Midwives... weren't properly regulated for a long time, obstetricians were seen as better trained, more modern. That must be why my mother got prescribed diet pills by her OBE in the 1950s! Anyway, Americans have a passion for embracing the new, modern, "better". Midwives are still struggling to regain a professional status. In some states they are illegal -- or good as.

I have never heard of a supermarket where you drive through a collection center to pick up your food. Where was this Cardigan? They will bag for you, which I find helpful when I have my kids with me, and they will also help you out to your car and load the groceries into your car, but I always do that myself.

Marialuisa, I don't understand why your friend is petrified of giving birth in the US. I delivered both of my children in the US, and have never exerienced it in the UK, so I don't know what the difference would be. Why does she claim it's so much better in the UK?

Mirage, I don't think women who use midwives are considered weird. Midwives work in hospitals alongside doctors. Are you talking about someone using just a midwife with no doctor?

And what is gas and air, anyway? What's the gas? Does it really work? (Maybe when I understand what it is I might be able to comment on why we don't have it here.)

I agree there are good and bad things about both healthcare systems. Ameriscot, you're absolutely right that there has to be some sort of rationing otherwise costs would be too great. And I think it's a disgrace that so many people in the US are uninsured. (I don't think it's as many as 50% though, is it?) Yet when someone like John Kerry suggests something like letting people buy into the health plan that federal employees use, people panic and think he's talking about socialised medicine. (I was pretty interested in Kerry's plan personally, because in 7 years I will no longer have health coverage. Luckily I'm in a position to be able to afford it privately.)

They do in Southern Oregon, Kate. Fred Meyers (a local supermarket chain bought by Kroger a few years ago) does it here, but it might have something to do with the large population of senior citizens.

And while we're on the subject of labor and delivery, what is a TENS machine?

Ameriscot, I agree with you- don't think it's 50%, but the number of people who are uninsured is terrifically high. The insured people are better off than the people who rely solely on the NHS. I should qualify that by saying the insured people can afford to use the insurance are better off. Some people can't afford to use the insurance except in catastrophic cases and some people only have catastrophic insurance. Some state health insurance plans are fantastic, others suck.

That having been said, I agree with expatkat also, being here has been really frustrating for me at times because of the lack of up to date drugs and technology. My then 2 yo son needed to take an adult version of a drug he needed when we first came (yes, I assessed the risks) and a friend of mine had to move back to the US because the drugs she needed for her MS weren't available here. Plus, as health insurance companies know, it pays to be proactive, which the NHS isn't so much, because the immediate resources aren't there. By proactive I mean a yearly pap smear, for example.

But I don't think that the US should adopt a NHS style system and I don't think the UK should go America's route of health insurance as a necessary thing. As Ameriscot says, there's a cultural difference and it's necessary to work with what's in place. My mom infuriated me by saying Kerry was wrong in proposing universal health insurance -- she said she told people it was because I don't like the NHS! Uh, two different things entirely, Mom.

When we moved here the first time, we had the expat insurance with everything included. So ... private vs private? Private here is surreal! I felt like a queen. Especially at the GP's.

Sorry for raving on. It's something I care deeply about and was the reason I found mumsnet! I was looking for a paed for my son (I had no clue about the system here!).

Oh shoot, I crossposted through the posts after Ameriscots!

So true JJ. Even if you have health insurance, doesn't mean you can always afford to use it. Example, last week I took my 2 year old to the doctor because she'd gotten tons of mosquito bites trick or treating and they were swollen and itchy. He prescribed antibiotics in case they got infected, and a prescrition strength anti-itch cream.

So it cost me $40. ($10 co-pay for the doc's appointment, and $30 for the two medications.)
If money was really tight I probably wouldn't have taken her. Not everyone can afford $40 for something that's not serious - just an annoyance and an inconvenience.

Staying out of the health discussion - don't know enough of either to comment really - but we had a drive-thru (ahem) supermarket bag pickup in Minnesota; might have something to do with the terrible winters, you don't have to get out of your car that way.

Obviously anybody living somewhere warm and pleasant like Florida wouldn't have that problem, Kate!

colinsmommy, TENS is a thing you strap on which sends little electrical charges to your nerves (I think that's what it does) to reduce pain. People use them for backache and other muscular pains too.

babycentre on TENS

Thanks, JanH.

babycentre on gas and air (entonox)

The gas is nitrous oxide, Kate. (They used to call it laughing gas and dentists used it.)

You're welcome, colinsmommy!

(That's one of the things I really love about Americans, they are so good at being polite and gracious. That sounds sarcastic but I promise it isn't!)

The % of uninsured is getting on for 20%, but there is also a large number of people who are under-insured and the two groups, ISTR, makes up at least half the American population.

Regarding access to the latest drugs - that's more to do with the Medicine Control Agency rather than the NHS, and probably more importantly, the marketing strategies of the drug companies.

The NHS won't put a drug on its lists unless it has been shown to be clinically effective - which seems pretty reasonable to me.

As for midwives, they are legal in all 50 states. I had a board-certified nurse-midwife, and they are getting increasing common in Ohio, a tort state. My midwife was in a practice with 2 old-school obstetricians, and they would cover for one another. One of the practice policies was that the mum had to see each of the HCPs during the ante-natal phase, so I did my obligatory visit with each of the OBs. Neither of them was very comfortable with my evidence-based approach to childbirth, so they were more than happy for me to go to the midwife. So much so, that when I went into labour on her day off, she had to attend me as one of her "specials". They were a bit bummed at being cheated out of C-section fee by my producing a breech baby without any help from anyone.

Incidentally they don't use gas and air in France either, or mobile epidurals, ggglimpopo was complaining about that; her obstetrician was being disdainful about the mobile one and when she said it meant you could get up and walk about, he said (you can just imagine a superior French consultant saying it too!) "and where would you walk to?"

Some interesting thing I have noticed is that people in US tends to work a lot to have a big house in the suburbs and fantastic cars to reach it, while many people here spends the life trying to get a perfect location where you can cycle to your work.

I like the walk-to-your-destiny culture here, but dear how much do I miss a proper free car park full of empty spaces!

I'm sure I read something about how certain US states made it impossible for new midwives to be officially registered, but that was a while ago, so things maybe have changed. I thought West Virginia was one of those states. I found this article about the history of midwifery in the USA , which seems relevant.

Kate+Girls: About Gas and air/Entenox/50% oxygen, 50% nitrous oxide. It makes you very dizzy & off your head. I found it very effective in childbirth -- better than narcotics, anyway. But some women it makes them nauseous or feel paranoid. It leaves your system very quickly, and is believed to have neglible effect on the fetus. Queen Vic was one of the first to use it.

I'm actually moving over to America in a few weeks and can't wait. I love the place. We are moving to Florida...probably Seminole.

We live in Liverpool at the moment and it is awful. The amount of murders happening, burglaries, etc is not great. I want a better life for my children and Liverpool cannot offer this(plus....escaping from crazy MIL!!!).

I would love to hear from anyone who knows Seminole as any advice on areas would be wonderful.