No credit card? No 入ること／参加（者） ― even if that's a death 宣告，判決: A 調書をとる／予約する about U.S. healthcare should make us value the NHS even more

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Society

The People’s Hospital

by Dr Ricardo Nuila (Abacus £20, 371pp)

It's a good 職業 I had my heart attack earlier this year in England.?

Had I keeled over in America, I'd now be a 死体, as their 医療の system is 冷淡な に向かって anyone 'poor and chronically ill', which is pretty much the 部類 I usually find myself in.?

In Sussex, the NHS clicked into 活動／戦闘 駅／配置するs ― ヘリコプター, 緊急 services, surgical and nursing teams giving instant and unstinting attention.?

But had I been in Texas, and never mind 存在 unconscious, I'd first have been 要求するd to produce a valid photo ID, a 公共事業（料金）／有用性 法案 (as proof of 演説（する）／住所) and a bank 声明 証明するing 甚だしい／１２ダース income for the last 30 days.

Had I keeled over in America, I'd now be a 死体, as their 医療の system is 冷淡な に向かって anyone 'poor and chronically ill'

A 名簿（に載せる）／表（にあげる） of 資産s is also needed, 含むing the value of one's house. Without a 負かす／撃墜する 支払い（額） of $5,000 (£3,900) the 患者 literally might be left for dead.

Ricardo Nuila, a doctor who teaches at the 中心 for 医療の 倫理学 in Houston, tells a horrible story of a man packed off in a taxi, going from one hospital to another with a 公式文書，認める pinned to him 明言する／公表するing, 'This 患者 is sick with meningitis, please 扱う／治療する him'. 非，不，無 did. He died in a clinic forecourt.

'Excellent care is 明らかに 利用できる,' says Nuila, 'but it's not reaching all the people.'

No wonder, when the exorbitant costs and faff are 診察するd. Though they have Medicare and Obamacare, the paperwork 伴う／関わるd in making 使用／適用s is so baffling, the system so '独断的な and vague', few get through the 過程s.

Before you sit 負かす／撃墜する in the waiting area for an 初期の 協議, the receptionist will 需要・要求する a starting 料金 of $639 (£503) from an 保険 company or the 患者's wallet.?

Orthopaedic 外科 starts at $15,000 (£11,800), and a 肝臓 移植（する） is half a million.

腎臓 透析 is $53,000 (£41,750) a year, and needles for a diabetic to 注入する insulin are 告発（する），告訴（する）／料金d at $4,800 (£3,780) 毎年.

Prosthetic 四肢s are $30,000 (£2 3,600) each, cash. A prostatectomy, 含むing pre-operative 協議s and aftercare, is $241,000 (£190,000), though hospitals may 告発（する），告訴（する）／料金 保険 companies $700,000 (£551,500).

明確に, only the 豊富な can stump up. Everyone else 耐えるs wheezes, 乾燥した，日照りの heaves, muffled sobs, sits about in sweat, 血 and 胆汁, unable to 収容する／認める themselves to what we call 事故 & 緊急.

If the 率 of mothers dying in childbirth is rising in America ― it 二塁打d between 2011 and 2012 ―this will be because the 法案 for having a baby is 'just north of $15,000' (£11,800). For each check-up, 追加する another $2,000 (£1,575).

People are understandably 'left to wonder if seeing the doctor is 価値（がある） the trouble'. Sixty-six パーセント of 破産s in America are 予定 to 医療の 法案s, 影響する／感情ing 530,000 families in 2019.

Healthcare in America is evidently a scandalous maelstrom of greedy doctors, hospital 行政官／管理者s, 株主s, and intransigent 保険 companies

The answer is meant to be 保険, but that only makes 事柄s worse, as cover is often insufficient.

雇用者s 支払う／賃金 the cheapest 率s they can 位置を示す for their 従業員s. 労働者s then find, when they 落ちる ill, that 保険 会社／堅いs quickly intercede, 妨げるing 実験（する）s which could help with a 十分な diagnosis.?

MRI, PET and CAT ざっと目を通すs, electrocardiograms, these are all 告発（する），告訴（する）／料金d as an extra. Those reliant on 雇用者 healthcare 計画／陰謀s are 率直に routinely ripped off.

With ニュース報道 否定するd, people become even more ill than they need to be. 腎臓 病気 or 結腸 癌, for example, can lead to septic shock from 血 感染s. With 治療s unaffordable, 患者s '耐える their sickness'.

What's to be done in each individual 事例／患者 is tailored to the depth of a 患者's pocket, rather than what's best for them.?

Doctors in America 焦点（を合わせる） on how (and on how much) they might be paid, rather than on the 患者's 質 of life.

Surely this is unethical? It's certainly unspeakable. 儀礼 and kindly attention are things of the past; for all the 略奪する changing 手渡すs, a 患者 is lucky to be given ten minutes; they are 単に 'numbers on a spreadsheet'.

Healthcare in America is evidently a scandalous maelstrom of greedy doctors, hospital 行政官／管理者s, 株主s, intransigent 保険 companies, 製薬の 関心s ― with everyone chasing 利益（をあげる）s, 'clawing and 非難する', inflating their invoices.

'Optimising a 法案,' says Nuila, '決定するs a doctor's success more than their surgical or diagnostic prowess.'

昇進／宣伝 depends on 存在 a good 実業家 or businesswoman, bringing in the money.

Nuila, himself still a busy doctor, or 'hospitalist', working プロの／賛成の bono at the Ben Taub Hospital, 'Houston's largest hospital for the poor', seems like one of the last altruistic men left standing, looking after the '鎮圧するd, the 燃やすd, the dismembered, the stabbed, the 発射 up.'

He is unconcerned about 患者s' wherewithal. It's why he feels 解放する／自由な to 令状 this 率直に terrifying whistleblowing 調書をとる／予約する.

What money buys, he 反映するs sadly, 'is 包括的な healthcare for some, but mostly 効果のない／無能な 緊急 care for those who cannot afford the high-end' 治療, where the cheapest professional advice ― or rather 警告 ― given by Nuila is that it won't 事柄 if you 結局最後にはーなる dead.

We are always told the NHS is in 危機, yet nothing remotely 類似の to the American model or 議定書 must be 許すd to come in here.