Two Men, One Injury, Two Very Different Experiences
How the UK’s National Health Service and US health insurance handled an ankle injury
Last month, my friend “Chris” in Colorado posted on Facebook about a bill from the hospital for an ankle injury. He hashtagged the post #murica and friends responded to commiserate about financially ruinous medical events. Meanwhile, over here in the UK under the National Health Service, my husband “Hugh” had a similar ankle injury a few months before, but he had a completely different financial experience.
As a formerly poor American who scrambled into solid middle class about five years ago, and last year moved to England, I am hyper-aware of the differences between the levels of healthcare I’ve had access to over the last decade. Omitting cost when talking about health is one of the larger culture shocks I’ve experienced as an expat.
I wanted to put the US and UK experiences and expenses side-by-side, because I think it adds to the conversation about socialized and single-payer healthcare. I interviewed “Chris” and “Hugh” (not their real names) to compare their experiences and expenses. These interviews are condensed into one to avoid repetition of my questions and lightly edited for length.
Chris, you live in Denver; Hugh, you live in London. What do you do for a living?
Chris: I’m a cloud infrastructure engineer, doing website server automation essentially.
Hugh: I work as a web operations engineer. Which is a bit like a sysadmin.
How did you injure yourself?
Chris: I was about halfway through one of my favorite trail runs at Castlewood Canyon State Park when I stepped on a rock or tree root or something. I found a dead tree branch to use as a crutch and used my trail map to make my way to the nearby service road. I was lucky enough someone was driving past who was willing to take me back to my car.
Hugh: I was sitting weirdly in the park having my lunch with a colleague and my leg went to sleep. I got up and then tried to stamp some life back into the numb leg. And then everything was pain.
Did you go to the hospital right away?
Chris: I called both insurance companies for advice. Both said that I should go to an Emergency Room that took my then-current insurance and find specialists that would take both companies. Fortunately, the closest ER did honor that insurance and their recommended orthopedist and physical therapist honors both my old and new insurance companies. Knowing about that going into it has made care pretty seamless.
Hugh: Nope. I went back to the office with the help of my colleague and tried to get some first aid and to see if it got better by itself. It did not. I got wheeled down to the lobby on an office chair to a waiting taxi, then one of the security guards carried me to the taxi. I still kick my foot to this day with one of the guards to show how well I’ve recovered.
So when you got to the ER/A&E, how did that go down?
Chris: The intake paperwork was minimal, but my deductible was $500 for the visit. Despite how few people were there, it took almost an hour to get seen. I got to the ER around 8:00, was seen around 9:00, and left for home around 11:30 PM. The scary part was another person broke his ankle and the doc temporarily got us mixed up.
Hugh: I was triaged by a nurse soon after getting there. But it must have been a couple of hours before getting care. I was wheeled off to get an X-ray and then given some crutches.
And with the idea of understanding how much this injury cost overall: x-rays? MRI, a cast?
Chris: So the $500 at the ER got me x-rays, a temporary cast while waiting to get fitted for the boot (just a couple of days), and a pair of crutches. The two Orthopedist appointments were $30 each as determined by my insurance, with $140 for the boot.
Physical therapy is $30/appointment for the first 30 of them per year, then all out of pocket after that. I had a pain killer prescription, Percocet I believe? I only filled it once, my co-pay was $20.
My portion of the [insurance] cost is about $100/mo, I believe it’s an 80/20 split with the company paying the larger [part].
Hugh: I got a phone call from another doctor, I assume an X-ray specialist, saying that they had had another look at the X-ray and I should get another look taken at it … I got plastered up, and I think X-rayed in a different angle.
What about work?
Chris: The hard part was, having just switched to a new job, I didn’t know my expectations. I assumed the worst. It happened on a Wednesday night and I tried going into work the next day in case. They sent me home and I stayed in bed the rest of that week. I feel lucky that there wasn’t pressure to work through the pain.
Hugh: Yup, sick leave. There wasn’t any kerfuffle about it at all. About 2 weeks. I think I tried to work from home a bit.
Did you get paid for your time off?
Chris: Unfortunately not. My company doesn’t specifically offer sick time and I had already used what little PTO I had accrued.
Here are the costs so far. Hugh clarified that he did pay for a taxi to the A&E.
Taxi £20 (USD $26)
Hugh Total: £20 ($26)
ER visit: $500
Orthopedist: $60 ($30 per visit)
Pharmacy copay: $20
Chris Total: $720
To get a better picture of the costs, we can include their relative annual tax burden supporting healthcare, and annual insurance. For taxes, I’ve used figures based on their area average salaries for “Senior Systems Administrator,” which is a close match for both their job titles.
Healthcare related taxes: £3,460 ($4,525)*
Hugh Grand Total: £3,480 ($4,551)
Healthcare related taxes: $4,400**
Health insurance: $1200
Chris Grand Total: $6,320
*According to Wheredoesmymoneygo.org, if Hugh makes £50,000 per year, he pays about £3,460 ($4,525 USD) per year for NHS via taxes.
I followed up with Chris and Hugh to run these totals by them.
Are there any other expenses we haven’t talked about?
Hugh: I had a bit more travel expenses going to get my boot put on and an MRI. But I think those were buses. £25.
Chris: I did get a surprise bill from the ER visit after we last talked about this. The original total bill was around $5,000, insurance covered all but $1,200.
Chris’s surprise bill probably sounds familiar to American readers. A bill from a healthcare provider for what insurance refused to cover is almost routine.
Even without surprise bills, the cost of healthcare occupies a large space in the American consciousness. For the unhealthy it positively looms. We walk around with untreated sprains, breaks, mental illness, rotting teeth, yeast infections, heart disease, UTIs, and influenza because we cannot get past the cost of care.
For the US, the reasons for looking at other systems are plain. For Brits … well, they may have already deemed this article irrelevant to them and puttered off to make another cup of tea.
Danielle is an American expat in England. She works in software and finance and can point you in the direction of that big ferris wheel where the queen lives.
ETA: This piece has been updated
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