Cheque it oot, man!

People in the US like to personalise things because your average USian is very exacting and has very specific needs. For instance, in Starbucks or similar such purveyors of coffee, it's not uncommon to hear something like "I want a tall double skinny cinnamon soy latte with extra foam and served at 170F, and only Bob the Barista can make my coffee because only he knows how I like it". 

When we first got here, we had a man in a mobile phone shop tell us that it's not uncommon to ask for your favourite server (apparently, waiter is too egalitarian a term) because "he knows how I like to order my food so I ask for him as he's someone I can work with". Seriously, I'm not shitting you here.

In some ways it's a good thing, because the customer service here is generally phenomenal. It's actually quite disconcerting at first, when you have staff in shops or bars actually pretending to take an interest in you and being all friendly and shit. In the UK, I've gone into an empty bar and still had to struggle to make the barman become terribly inconvenienced and interrupt scratching his balls to do something as futile as actually serving me a beer. So, in that respect, I can enjoy the US customer service even if it is kind of weird.

But sometimes, it's just plain weird. We ran out of cheques today so we thought it would be a simple task of contacting our bank and ordering some more. Of course, that's obviously a silly idea. Why would a bank actually make chequebooks? Banks only deal with forms of currency, after all. And what is a cheque? Oh, actually, it's a paper promise to pay money, sort of like cash but less useful.

Instead, our bank links to this website where you give them your routing number (equivalent of your sorting code) and your account number, and then you can personalise your cheques so that you can 'Find designs that express your personal style!". For instance, those of an infantile persuasion can get Disney characters on their cheques:

 

The more fundamentalist Christian, Tea Party supporting types have several options:

 

 (note the quote "He who believes in the Son has everlasting life. John 3:36")

 

(subtitle: "America, Fuck Yeah!")

If you believe in the rights of cute, fluffy animals:

For an extra 5 dollars, you can add your own little logo (they had examples like the Jesus fish) and add inspirational little saying as well. Amazing. You really can't make this stuff up. What you can't do is just click on a button to say "I bank with Wells Fargo. Give me some cheques from my bank like what I can use in lieu of money please." Except you'd have to call them checks and not cheques. This also highlights the fact that USian banks rip you off so badly that, not only do you have to pay for your own cheque books, but you have to use a 3rd party to get them made.

Dom spent some time trying to put together the most vomit-inducing, tacky cheque book that she could manage. But it all got a bit overwhelming, so she gave up and is now nursing a gin and tonic. I think I may join her.

 

Guid health tae ye

I've been meaning to write about healthcare in the US for a while now. I'm not going to talk about why the European model is far superior and that governments should be responsible for the well-being of their people. Nor shall I mention that the US government spends $2051 per capita on health when the UK government spends $1429, but US citizens pay through the nose for healthcare (source). While these things may be true, I don't want to have my visa revoked for attempting to subvert the American way of life with my socialist views, and I'm certainly not going to argue about public spending during an election year!

I want to focus on the actual experience of the American health care system because, after experiencing the NHS, the system here is bloody weird. We're lucky because my employer pays for our health insurance and the plan would cost us almost $1000 per month if we had to pay for it ourselves. After signing up for our health insurance, we got provided with a list of GPs (family doctors in this country) who our health insurance will cover. It's then down to you to choose your family doctor. This sounds fairly straightforward, but this is where things start to get weird.

There is a website called HealthGrades which allows you to search for medical doctors in your area. We went down the list of medics provided by our insurance company and started searching through this website. It's basically Amazon for doctors, right down to having star ratings and patient reviews! The website also has the professional record of the doctors available for all to see.

The first doctor that we liked the look of turned out to have been through disciplinary action twice for failing her cocaine test - we could actually read PDFs of the transcripts from the disciplinary hearing. In the second practice that we liked the look of, the doctor who ran it had been censured for fraudulently signing her employees signatures to fake records. Yikes! (I'm not linking to actual pages here because I don't want to get sued by disgruntled GPs, who are obviously used to lawyering up..!)

The other thing which is different is that you get family doctor practices which are similar to those in the UK, with a health centre which hosts several doctors. But you also get practices here which are in residential areas and are just people working from a room in their house. While I'm sure they are excellent doctors, it just seems like a really odd way of running medicine.

After we had actually chosen a clinic which looked good and didn't seem to be run by the criminally-minded, we had to get a medical, etc. Actually, mine is next week, so I'm basing this on Dom's experience. As well as a physical, they also top up vaccines which are out of date and test our blood for absolutely everything (cholesterol, kidney function, etc etc). At every step of the way, you have to sign a bit of paper saying that you authorise the procedure to be carried out and will accept financial liability in the event that your insurance company chooses not to pay for that procedure.

(As an aside: Dom's brother got faced with a bill for several thousand dollars when his insurance company decided that a test to look for a blood clot was not an essential procedure. Yikes!)

A wee while after you have been tested for everything (with doctors horrified that you had never been tested before by the barbaric and backward practices in the UK), a letter from your insurance company comes through the post telling you every procedure that had been carried out on you and how much they would cost. It's REALLY detailed: consultation, $400. Several lab tests individually priced at $18, $15.25, $10.94, $9.94, etc etc.

The form also shows that haggling which has occurred between your insurance company and the provider. For example, the consultation was billed at $400 from our provider, but our insurance company paid $206.55 in the end. Therefore, it seems, if you're poor and can't afford health insurance then you actually pay more the treatment than someone who can afford the insurance... perhaps it's the European in me who find this kind of appalling.

In the UK, your GP acts as the first point of call for all NHS services, so if you need to see a consultant neurologist / physiotherapist / etc, then you go via your GP first. While this can delay treatment, it also acts as a buffer to stop cardiologists being hassled by someone with indigestion or a neurologist being called about a headache. In the US, however, you contact the consultant directly because the consultant is happy to bill your insurance company for the time. I now understand why, in Oxford, newly-arrived Americans would often whine about not being able to see a physio / etc.

Another thing which I'm still not used to is billboard adverts for hospitals in places like the metro stations. You can see posters saying things like "What if your headache is more than just a headache? Come to hospital X for the best stroke treatment in Montgomery County". Seriously, I'm not exaggerating here.

I understand the principle of having a market in the health care system: competition should drive up standards because it people can take their business anywhere they want. However, if I'm sick, I would much rather know that every hospital had the same baseline level of excellence. If my leg is hanging off, or I'm shitting blood, the last thing I want to think about is choosing which hospital to treat me. I think that people in England and Wales should be very cautious about the Tories trying to bring more of a market into the NHS - what I see in the USA is the logical extension of what happens when you let the market get involved. And I won't even talk about the madness of paying hundreds of thousands of insurance salesmen and other bureaucrats...

This post is turning into a long one, so I'll stop soon. Take home message: the US healthcare system is very, very different to what we have in the UK. It feels very alien. On the plus side: because we have good health insurance, this is probably the best health care that we'll ever have, so we're very lucky to have that privilege here. On the down side: I don't like the idea of paying medics for each procedure that they do. Imagine paying Fire Fighters on the basis of how many fires they extinguish? You wouldn't want to live in a wooden house when it was time for the Christmas bonus...

(nb I've used "doctor" here as short hand for medical doctors because that's the common usage. We all know that medics are not proper doctors; proper doctors have PhDs...)