The Great American Heathcare Debate

Entering a clinic in the US for the first time many years ago, I was shocked to find that the very first office door that greeted me was labeled "Financial Consultant." Shocked is not too mild a word to use. I think my Wife was surprised by my reaction. I really found it offensive. She was just used to it.

Healthcare is a huge issue in the news right now, as one of the things that President Obama promised if he got into power was "universal healthcare." Because I come from a country with so-called "socialized medicine," I have been asked many times just recently about how healthcare works in Britain. This is hardly surprising, since opponents of the proposed plan have often said things like, "We don't want a system like Britain or Canada" as if this is a bad thing. Even my own Doctor, during a routine check-up, started quizzing me about whether I preferred the US or UK healthcare system. I told him that, although not perfect, the National Health Service in the UK did ensure that everyone, whether they could afford it or not, was covered. His response was that anyone in the US could get free treatment in hospital emergency rooms. I didn't get a chance to say what I really wanted to, that I thought it would be really nice if the poor didn't have to wait until it became an emergency. Those who cannot afford health insurance either put off treatment, often until it's too late, or fill emergency rooms with non-emergency cases, stretching those already overworked departments.

Criticism of the National Health Service, mostly unfounded, by American opponents of Obama's plan has had a surprising effect amongst the British. A British friend wrote to me, "4 million Brits twittered in defence of the NHS almost crashing it. The debate is happening here---Fox news found an MEP (not MP), who defended the American 'healthcare only for those who can afford it' system, to spout some hysterical rightwing piffle. It has had a dramatic effect---the conservatives have gone from a shoe in, to an even contest in a week." He was talking about the opinion polls comparing the incumbent Labour party with the Conservative Party.

Conservatives in the US have been raising a very noisy protest against the proposals. Past vice-presidential candidate Sarah Palin started talking nonsense about Obama creating "death-panels" of bureaucrats who would make life or death decisions about our nearest and dearest. While Obama and his supporters have talked about 47 Million people in the US being uninsured, there are people who deny those figures, mentioning illegal immigrants (who wouldn't be included in the count anyway), Millionaires (this includes property which people would have to sell if they needed healthcare) and people who are in the process of switching insurance. The figures are probably much worse, because poor people often take a gamble on health insurance, taking it out some years and not others.

The right-wing have also gotten many ordinary working people scared that they are going to lose their choice of coverage. In the UK, if you can afford it, you can take out insurance and be treated privately. However, if you cannot afford to do this, you're still covered. This is what's being proposed in the US. In fact people will have more choice, not less.

These scare tactics take advantage, I think, of a deep-rooted "take care of yourself" ethic in the US. Another friend of mine, this time in Canada, said, "They keep saying 'I don't want to be socialized' like public health care and caring about our neighbours is a bad thing." I think that not only is universal healthcare the right thing to do, especially for the richest country in the world, but it's short-sighted for individuals to only consider their own situation right now. What happens if you get laid-off from your job, or want to start your own small business? US healthcare is big business, and that is where I believe things go wrong. The health of our people is essentially an issue of infrastucture.

Do you still think the US healthcare system works just fine now? The World Health Organization would disagree.

What do you think? I'd love to hear from you.

And Finally, ESTA!

I dearly remember those forms I had to fill out on the plane every time I flew into the US from England, before I moved here permanently. As Britain is one of those countries not required to apply for a visa in order to travel to America, you nevertheless had to complete a short form to hand in when you landed.

Yesterday, the Department of Homeland Security implemented a new electronic system known as ESTA (Electronic System for Travel Authorization), which replaces the aforementioned form. Travelers from Britain (and a number of other visa-waived countries) are required to complete the on-line form 72 hours in advance of flying. Once completed and approved, the (free) application is valid for two years.

There were problems anticipated on the day of implementation, with predictions of Brits being sent home, big delays and so on, but so far that doesn't seem to be the case. The biggest problem seemed to be confusion about the new system, and panic about the 72 hour period. The Department of Homeland Security allayed fears somewhat by assuring people that they should be able to process an application made from an Internet connection at the departing airport if necessary.

I do have a few concerns about this system. As the child of computer-illiterate parents, I'm worried about people who have never touched a computer in their life being able to fulfill these requirements. Somewhat related to that, Google searches for ESTA reveal several companies offering to complete the (free) ESTA applications for a hefty fee. No doubt there will be businesses springing up on the high-street (and probably in airports) all too willing to take money from the unwitting. I was also shocked by the scary 219 word pop-up disclaimer from the US DHS on the ESTA page at the oh-so-catchy address: https://esta.cbp.dhs.gov - as one person summarized it: "We own you."

But the biggest problem at the moment is ignorance about the requirement. This story warns travelers that those who have not completed the ESTA form and are turned away by the airline before the flight, or at US Customs, and are thus unable to take their US Holiday (vacation) will not be covered by their travel insurance.

If you're in the UK, I'd be interested to know whether you were aware of this. Also, if you have computer-illiterate friends or relatives who travel to the US, who might be affected, I'd love to hear your comments.

(Bonus Points if you recognize this entry's title as a play on one of the catch phrases from classic British TV show "That's Life!")

Library Love

When I first moved to the USA, I did not yet have a work-permit (it would take a few months to be approved), and I was worried about becoming bored being home all day, while my then fiancee was at work. I desperately did not want to be vegging out in front of daytime TV. I was not driving at that time (for the reason why, please see my entry: Cops, Cars and a Cuppa - my first visit to the US (part 2)), so there was a limit to where I could get. I discovered that my nearest public library was within walking distance, so the first thing I did on my very first day by myself in the US was to visit my local branch, apply for a library card and look around.

Not being used to the way these types of organizations work in the US, it was a little confusing at first, especially as the first librarian I encountered was a little less than helpful. Fortunately, I got through the ordeal, and before long, I was the proud carrier of my first US library card.

Although I've been a book lover all my life, I didn't spend a lot of time in public libraries in England, with the exception of the mobile library (bookmobile) that I spent a lot of time in as a child. That was to change once I moved to Edison, New Jersey. I became so involved with my local library that I soon became an active member of my local Friends of the Library group, a nonprofit organization formed to support the activities of the library by supplementing the dwindling public funding they receive. I'm now proud to be the President of that group.

Libraries can be a great source of information, education and entertainment for new US residents. English as a second language (ESL) classes, information about immigration procedures, help and resources for finding jobs, computers with Internet access, expert reference librarians, as well as programs, newspapers, books and movies are among typical library offerings. Our libraries are especially important in times of economic hardship, the very time when public funding is usually reduced. There was a great piece recently on the Diane Rehm radio show about this.

I was alarmed to read today about the imminent CPSIA laws, which looked set to prevent us from selling used children's books at our annual fundraising book sales. Fortunately, a public outcry to the ambiguously worded and poorly publicized laws resulted in a clarification by the U.S. Consumer Product Safety Commission, and it looks like it will not affect our sales after all. Still, there may be implications for libraries because new books do seem to be included in these regulations.

There's No Sleeping at the INS!

Did you ever see the movie Green Card, with Gerard Depardieu and Andie McDowell? An American woman and a French man marry in order for him to get a Green Card. They spend much of the movie studying each others' habits, living arrangements, etc., so they'll appear to be a genuine couple. Ever think that it might present a realistic view of what it's like for an American woman to marry someone from outside the United States? Think again!

Bear in mind that the events I describe took place pre-9/11, so heaven only knows what the process is like now. It was also a grueling bureaucratic procedure that I've tried to push to the back of my mind, so the sequence of events is probably off, and I've no doubt forgotten many aspects of it.

Pretty much as soon as I'd proposed to B. we started researching what we'd have to do to get me into the country. Fortunately, we were both net-savvy, and there were online discussion groups full of couples who had been in, or were going through similar situations to us. We found out that, although tedious, the process was something we could do ourselves, without the help of an attorney, which would save us some money.

So first B. had to apply to what was then the INS (Immigration and Naturalization Service) - what is now USCIS (US Citizenship and Immigration Services) - for permission for me to come over to the US on what is known as a "Fiance Visa." We didn't know how long that would take to process, so we couldn't, of course, make any plans until we received the visa. When we received the go-ahead, we only had a 90-day window in which to get married. Yep, that's right - we had to plan a wedding in addition to planning for me to get over to the States within 3 Months. We got our approval in December 1998. I was over by Christmas 1998, and we were married in March 1999.

I have to say, even given the limited time we had, we had the best wedding! It fitted our personalities perfectly. It was held at a little tea-room which we had often visited together. It had a small art-gallery attached, so we had the wedding in the art-gallery and the reception in the tea-room. Unlike many couples, we actually got to enjoy our little wedding, surrounded by family and friends, one friend providing the music, another performing a song she'd written for us.

Of course, the immigration process was still not over for us. Once we were married, we had to initiate the Green Card procedure. Once we'd completed the paperwork and submitted the various documentation and filing fees, it was a waiting game, but one with some rules that we had to be aware of.

Firstly, if I wanted to work, I had to apply for a separate work permit. That was worth doing, because it takes a long time to get a Green Card. One other thing we had to take care of was something known bizarrely as "Advance Parole." This means that if we wanted to leave the country for any reason, we needed permission for me to do so, otherwise I would be considered as having abandoned my Green Card application and wouldn't be allowed back in the US. This has sadly happened to some couples, resulting in them being separated for months on end.

We were dealing with Newark INS. They did not let you make appointments to see them to get Advance Parole. All we could do is line up on the street at 4am with the several hundred others waiting to get into the building when it opened. They would only allow a certain number of people in during the day, so if we didn't get there in time, we were out of luck. When we eventually got into the building, there was a further wait during a shift change. Many people sat on the floor while waiting. B. actually lay down and rested her eyes for a while, during which time a security guard prodded her with his foot, saying "There's no sleeping at the INS!" Eventually we got herded into another room, which had its blinds closed. It'd all taken such a long time to get this far, that we had no concept of the time. We pulled the blinds aside a little to look outside and almost immediately a head popped up above a partition, telling us that we were not allowed to look outside! After going through all this, at least I had my Advance Parole approved, which allowed us to visit my parents in England.

Eventually, my Green Card came through. We were given an appointment at Newark for an interview prior to getting it. That was the closest we ever got to the situation portrayed in "Green Card." Our one and only trick question came when the woman conducting our interview asked Becky how I spelled my surname. I've spent just about my whole life spelling my name for people, so I started blurting it out, before B. shot me a look, and I realized that she was being tested. And she did get it right!