10 Tips for Brits on Surviving the U.S. Healthcare System

University of Chicago Medical Center Emergency Room (Photo via AP)

As you may have gathered from this summer’s furor over the Supreme Court’s healthcare verdict of President Obama’s Affordable Care Act, the subject of what to do if you fall ill in the U.S. – and, more to the point, who pays for it – is a hot topic with many Americans. If they detect the slightest hint of a British accent they are liable to start foaming at the mouth about socialized medicine – the sort of thing that Canada and France does, for goodness’ sake!

While the U.S. ranks only 37th in the World Health Organization’s survey of best countries for healthcare, to some Americans that says more about the WHO’s methodology than any shortcomings at home.

But forget the politics: as a foreigner, on holiday or emigrating, unless you are a billionaire you cannot afford to step onto American soil without some form of health insurance. Here are ten survival tips:

1. If you are planning a U.S. holiday, check that your travel insurance covers you for at least $1 million. Before you even reach a hospital, an air ambulance can cost $50,000. When a normal urban ambulance took me 100 yards in April, that set me back $1,400. Hospitals can charge $20,000 a day, a surgeon might want $100,000 for an operation, and you might need a private plane home. It soon mounts up.

2. But the real minefield is reserved for immigrants. If at all possible, find a large, stable, undemanding employer that will sponsor you and sign you up to its insurance scheme and keep you on for as long as you want to remain in the U.S. Large and stable are possible, but the other qualities are increasingly scarce.

3.  If you can stick around long enough, employer-based healthcare may turn out to be blip. It stemmed from World War II pay controls from which health insurance was exempt. So that is how U.S. companies competed for talent and the practice snowballed. But more companies are dropping health coverage and the sickly economy means that if you lose your job you could be flying home within weeks — no visa, no insurance. So, make healthcare a key part of any job negotiation.

4. The main alternative is to be self-employed, as nearly nine million people already do in the U.S. The type of health insurance you can obtain will depend very much on three factors: your age, your medical history and the state you live in.

5. The Commonwealth Fund, an independent research group, has found that the northern Midwest and the Northeast and West Coasts are the best for healthcare. Worst tends to be the South.

6. If you cannot join an employer scheme, hunt down the best insurance broker in your new locality – someone who is able to navigate the Byzantine range of possible policies. Bring your medical records from the U.K., and keep them handy to answer the many, many questions you will be asked.

7. You will soon hear two sets of initials that lie at the root of health care: HMO and PPO – Health Maintenance Organizations and Preferred Provider Organizations. HMO policies are cheaper but less attractive: your choice of doctors is much more restricted, and, in many areas, amounts to no choice at all. PPO insurers allow for a greater selection of doctors.

8. But if you are self-employed or unemployed you may not be eligible for individual coverage until you have been in the U.S. for five years. Insurers will take you on only if you are part of a group. Then your best option is to form a company, because the minimum size for a group can be as low as two people.

9. Price soon becomes a major topic, not for the critical surgery but for the routine trip to the doctor or pharmacy. A good U.S. general practitioner (GP) is also a financial advisor who keeps a stock of free samples in the bottom drawer. Like Americans, don’t be afraid to ask for a discount or whether your doctor or a supplier “can improve on that price.” Often they can, if you pay cash or offer some other incentive. Europe-trained GPs are often more sympathetic.

10. Currently, if you have a pre-existing condition, such as asthma, high blood pressure or even hay fever, you may be refused any coverage, not just for claims arising from that condition. But this is due to change in 2014 under President Obama’s Affordable Care Act, and some states already have insurance pools for high-risk people — at a price.

For more consumer information: The Foundation for Health Coverage Education

What do you miss most about the British National Health Service?


William Kay

Bill Kay was a London business journalist until he emigrated to Pasadena, ten miles north of Los Angeles, from where he writes a financial advice column for the London Sunday Times. He was City Editor of The Times and the Mail on Sunday and has written a dozen books, including a Pasadena murder-mystery novel, as well as dipping into screenwriting and stand-up comedy. He attended Westminster City School and The Queen's College, Oxford, and still manages to follow Chelsea Football Club. He has two adult sons, Andrew and Ben - and two grandchildren, Jackson and Indiana - all in London.
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  • http://www.facebook.com/tracijones Traci Jones

    I never knew about #8. I managed to get individual coverage when I applied after being in the country for four years and 8 months. Maybe this was close enough!

  • Susan Koscielski

    Please don’t think that most americans are happy with our healthcare system and hate the way England, Canada or anywhere else is doing it. Some of us are just plain jealous that we can’t have a system like you’res. The other side there are a lot of americans who are slimply brainwashed into thinking they will lose their options or freedom and that the antichrist is responsible; it’s another way to control their lives and take over the world the U.S. first. I know how stupid that sounds but believe me I have had many arguments with nice people who will believe anything some politician says just because he says he is christian or quotes the Bible. What American needs is people who have had both types of healthecare to tell us honestly how the U.S. compares to other countries and how we can change things for the better. In the meantime I hope you all enjoy good health while here so you don’t end up like most Americans who get sick, broke and living on the streets.

  • http://twitter.com/JulieKirkman Julie Kirkman

    The American healthcare system is abysmal and beyond repair. I’ve actually worked in health care admin and it is just laughable what health insurance companies and hospitals are allowed to get away with legally.

  • Patricia Hendricks

    I know nothing about European health care but am going to presume it has to be similar to the National Health Service in Britain…..or the Europeans would have been up in arms wanting the superior care afforded people in Britain since the UK. is part of the European Union. Nothing but ‘brilliant’ is the word I use often to describe British Health care. President Obama appears to be doing his best but his opponents R.R.R. (Republican, RIch, Rivals) will try to stop it becoming countrywide.

  • Jess

    What it boils down to from my observations (lived here 4 yrs now) is that in the UK, the first priority of the healthcare system is the patient’s well being. In the USA, it is how much $$ can we make.

  • Humility

    Or you could go to a clinic and skip the hospitals altogether.