An American in the UK: Healthcare for Type 1

Melissa Ford

| Dec 29, 2009

As an American living abroad, I tried to follow the debate over healthcare reform in the US, but I had to drop it for my own sanity. How could so many of my fellow Americans say that people like me, with chronic diseases we never asked for, should pay more for healthcare because they don't want to participate in the risk pool? How could people like me, who live in fear of losing health insurance, be blind to how badly Americans with type 1 diabetes can get ripped off? I had to remind myself, "It's okay. I don't live there anymore."

In October 2007,  after living for a few years in the UK under the NHS, then spending several months uninsured in the US, and finally working in California with health insurance for two years, I emigrated to Britain. Beyond my appreciation for the culture, I feel that as a person with type 1 diabetes, I am better off here.

Top 3 reasons I am better off in the UK than the US:

1. Lobbying doctors, health authorities, and elected officials can really make a difference. I first moved to England for grad school in September of 2001 and stayed until April 2004. As a full-time student, I was covered by the National Health Service. On January 1, 2002, my US health insurance expired. My doctors agreed that I should keep using my pump, but I had to lobby local health service administrators to get my pump supplies covered. The battle I faced was similar to the ones my parents fought on my behalf in Virginia when I started using a pump in 1995. I was surprised that the UK was so far behind the US in terms of pump use. I joined a grassroots, patient-led organization to increase access to pumps. I still meet with members of Parliament on a regular basis to discuss diabetes care in the UK. In mid-2003, the NHS decided to fund pump therapy for type 1s who are likely to benefit from a pump. With my doctors' support, I was the first person in Oxford to get funding under that decision. Today, about 7 percent of UK type 1s have a pump, and we're getting closer to the European average of 15 percent.

2. No co-pays or deductibles for diabetes care and supplies. I had to pay for my pump supplies until September 2003, but I was grateful not to have to pay for doctors' appointments and prescriptions. In the UK, only tourists pay for medical care, at the point of service. All type 1s and type 2s taking at least one diabetes drug do not pay the usual £7.10 per item prescription charge. For reference, the national minimum wage is £5.80. Even insulin pumps and supplies are covered at 100 percent. There are no out-of-pocket costs for blood tests either.

3. Economic independence. When I decided to change jobs a few months ago, I didn't have to think about whether I would get insurance, whether the insurance would be good enough, or whether I would be able to meet the deductible. My access to healthcare is guaranteed, no matter what job I hold. I need to t least £20,000 per year to keep my visa, but that's less than I can afford to live on anyway. When I worked in California, I couldn't quit my job when I was beyond ready to leave because I couldn't afford the $350 per month (plus co-pays) for COBRA that I'd have to pay if I walked out and took the first thing that came up. I became depressed. Keeping my health insurance had to take precedence over my mental health and my professional goals, which I deeply resented.

On balance, the NHS works well for me. It's not perfect, but I haven't heard of a healthcare system that is. There are no "death panels" - in fact, the UK's National Institute of Health and Clinical Excellence (NICE) does cost-benefit analyses using almost all the same criteria as US health insurance companies... Except for the profitability ratios.

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Posted by josegiles2 on 28 December 2009

Thanks for updating the status on Medical Insurance industry today. But there Low cost medical coverage on group, family, or individual available at

Posted by Anonymous on 29 December 2009

"I was surprised that the UK was so far behind the US in terms of pump use."

That says it all.

Posted by Anonymous on 29 December 2009

I am also a type one that lived in Australia for many years with a similar system. Once on their national system (also called Medicare), it paid for EVERYTHING, including my new pump (under the "prosthetic device clause").

Having good insurance was so much better for my health. It wasn't until I moved back to the US that I realized how far behind THIS country is in treating diabetes.

When will insurance companies realize that it is in their BEST INTEREST to cover preventative care (like my test strips, office visits, lab tests, etc)? Very frustrating to hear people talk about the evils of "socialized medicine" without having experienced it.

Its better people with diabetes. Way better.

Posted by Anonymous on 30 December 2009

As a UK person with type 1 diabetes, who come into contact with American republican thinkers, frequently (I am studying divinity at Edinburgh University, there are a number of American students on our degree, which is a blessing) who argue against the American healthcare reform. I find this article particularly interesting.

Yes, it is true that pump use is behind America, it is totally a cost thing! However, I am a pump user, my pump is funded by the NHS, it is great. This is in a way a blessing because I don't have to worry about paying my medical bills, I am able at the age of 42 to return to university, study the Bible, the history of Christianity ethics and theology AND meet nice American people!

Posted by Anonymous on 30 December 2009

I live in Israel after having moved from the US. I use an insulin pump that is made in the US that is 90% covered by my medical insurance. In addition all of my pump supplies, insulin, other medications, visits to a doctor I choose, and hospital stays are for the most part covered. The system is not perfect here, but given the choice, if you have diabetes, Israel is way ahead then most other countries.

Posted by Anonymous on 30 December 2009

It was really great to hear from someone with actual experience with National Health Care. It confirms what I have believed. Everyone is better served when all are served equally. I'm so glad the US is finally headed in the right direction!

Posted by Anonymous on 30 December 2009

1. The fact that Britian is/was so far behind the US in pump usage should say something about their system.
2. No co-pays or deductibles - somebody IS paying for that - what is the tax rate in the UK? How much income can you actually take home - how much tax on goods and services?
3. Economic Independence -again the tax issue - are you really independent if you are dependent on the government? Why not have more choice? Why am I restricted to one health plan offered by my employeer? I am not restricted in the type of car, life, home oweners insurance I buy and they are not tied to my employement - and by the way - I purchase them from a different state. Why not the same freedom to chose when it comes to healthcare.
I don't have all the answers to the healthcare debate, but I don't want my health to be held in the palm of a large, inefficient, corrupt government. Give us more freedom and choice and the "good" insurance plans with thrive and the rest will either get their act together or fail. That is the American way.

Posted by Anonymous on 30 December 2009

the NHS decided to fund pump therapy for type 1s who are likely to benefit from a pump......this is MY concern...WHO decides who is most likely to benefit from pump use? I don't want some non-medical bureaucrat sitting in an office somewhere making medical decisions that should be made by physicians and diabetes educators - so if you are not the "correct" age, weight, or you have an A1C that is not acceptable will you be denied even the opportunity to try the pump? What about the use of Lantus in UK?
Thank you for sharing your comments but this new so-called health care bill will not cover medical devices - unfortunately no-one knows what is considered a "medical device".... glucometers??? wheel-chairs??? pumps???
Until we know much more about this health care bill I want to keep the current system and ADD more coverage for diabetic care but not throw out the entire system for the unknown.....additionally, most people do not realize that if any part of their current health care plan changes, they automatically lose it and go on the "public option" - not for me or my patients!! thanks for listening to my side of the issue.

Posted by Anonymous on 31 December 2009

I love how people say "It" pays for everything, meaning the government. In reality, it is other citizens that are paying for the healthcare that you can't afford. I don't care if you are a type 1 diabatic or have terminal cancer, when you force (via taxes) for someone else to pay for your medical care, it is called looting. You can't afford a pump? Try syringes. I can't afford a mercedes, that's why I drive a toyota.

Posted by AnnetteUK on 31 December 2009

I was under the British National Helth System in 1958 when as a kid was rushed into a hospital. After 2 months in two different hospitals was sent home.. where my GP would make house calls many evenings at 6pm to watch me put insulin in my syringe and inject it. My parents received no bills for the hospital care, related prescriptions, doctor visits or house calls. I cannot complain about my care there [even when I am there to visit family]
I am a 50 year medalist with Harvard/Joslin in Boston.. and am so healthy I am in the study to discover why/how one can live 52 years [tomorrow] and have no complications, in their search for the cure ...
I must say that I have great medical care in America too.. but am not afraid of a gov. health care system.

My brother in UK has had JD for about 30 years with the NHS care.
Just my opinion.

I am pumper and CGMS user :)

Posted by Anonymous on 4 January 2010

The trouble with "can't afford a pump - try syringes," is that it's a short-sighted solution. In the long run, those on syringes will have higher A1c's and poorer health, and more trips to the ER, and more complications. As to the fear of "inefficent, corrupt government" making these decisions, I am so unimpressed at the decisions made by the health insurance companies that government bureaucracy couldn't be worse. And at least they wouldn't have the profit incentive to deny coverage and take the short-sighted approach.

Posted by Anonymous on 5 January 2010

As a UK citizen with both type 1 and another serious health condition (Crohn's Disease), I am very thankful for the NHS. I have Lantus as my long-acting insulin, it is widely used. Regarding pump use, we are admittedly behind the US with this purely because of the cost, however this is changing. People with high HBA1Cs are most likley to benefit from this as they would be considered good candidates and the decisions on who is suitable are made by healthcare staff rather than bureaucrats.
I would like to add in support of the comments on focussing on preventative medicine that because I have received such good care, I am able to work full time in a demanding and pretty well paid job (paying my tax burden!) rather than being dependent and sick.

Posted by Anonymous on 10 January 2010

The problem with UK NHS is that cost drivers affect clinical decisions; I have a pump because of other medical factors influencing my BG diabetes control;

There in an uneven approach across NHS boundaries within the UK (but how is this different from America? in America states have their own law systems).

I live in Scotland which generally has a better approach than many other parts of the UK. Part of the reason for this is the Scottish mindset towards neighbour ethics (loving your neighbour, and making this real, putting it into practice) another reason, is because Scotland is legally separate from England and have more freedom to operate along different guidelines (or rather diverge, from standard approaches). This at times is welcomed by the rest of the UK because Scotland with it's small population offers a good test-bed for new ideas. Like the hated poll tax, in the 1980's, under prime minister Thatcher; which was tested on the Scots before rolling out across the rest of the UK.

Scotland often go their own way for the purpose of trying things out. Scotland are the first in the UK to apply procedurally, islet transplants. I am quite certain that the health boards across the UK are looking to Scotland for a lead in many area's; islet transplantation is one. Rolling out insulin pumps is another.

The NHS are more critical about new things in medicine than they are in the USA generally I think. This is done out of prudence, we don't want to waste money of hair brain idea's, but the downside of this is to quash good idea's before they really develop..

I heard Jonathan Ives of apple computers talk in this way recently. This british designer left the uk, over the last decade or so he has helped to revitalise and revolutionise Apple computers, and brought great designs to the computer industry, which previously was a bland world ... I benefit here in Scotland from this designer as I type this on my MacBook pro..

I think it important to look to each other in these things. America and UK are rich in personality and our different perspectives help to add shared experiences.

Posted by Jody on 18 January 2010

how ridiculous to say that if you are on medicare that others are paying for your health care, try syringes. I am a Type 1 diabetic for 39 yrs. I was using syringes for 37 yrs. I was taking injections 2x a day most of the time, eventually I was up to 14x a day before going on an insulin pump. Working since the age of 15and contributing to medicare out of every paycheck. I am unfortunately now on medicare due to hypoglycemic unawareness & I am checking my BS every 2 hrs. But medicare only covers checking it 4x a day. I am on an insulin pump & need a cgms but medicare will not cover it & the company that supplies the tubing & reservoirs does not have a payment plan for the cgms. How dare you say use syringes I did for 37 yrs. My A1c is a 6.7 & hypoglycemic unawareness is my only complication. No glaucoma or kidney damage or neuropathy bc I took care of myself. Screw you for not understanding the necessity of an insulin pump and a cgms which is not covered. Trya educating yourself a little better befor criticizing & condeming the use of a pump which is now necessary for survival.

Make it a great day. Jody

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