Miss Thrifty

As a tightwad who has lived in both America and the UK (currently residing in the UK), I find it interesting to compare the two countries from a personal finance perspective. Although the USA enjoys a relatively low cost of living and should come up trumps on this front, my experience has been quite the opposite. In truth I’m in awe of my fellow PF bloggers on the other side of the pond, and I’m in awe of any US frugal freaks who manage to live as comfortably as they do.

This is not an America! Yah boo sucks! post. Nor is it a Russell Brand-ish plea to vote Obama “on behalf of the world”. (Naughty Russell!) These are my straight-up observations and my first-hand experiences, and I would be genuinely interested to hear what others have to make of them.

First up, why America is a great country in which to try and live very well, on very little:

• Cheap gas. USA: just $3 a gallon! Here, it’s the equivalent of nearly $8 a gallon.
• Cheap food. You can eat out at a great restaurant for not very much money, and not only are the portions huge, but asking for a take-home box for your leftovers is not as frowned upon as it is here in the UK. It’s practically de rigeur. I’d go home from our favourite Mexican restaurant with enough grub to last me for another 2-3 mealtimes. Result!
• Cheap housing. (In general, that is – I am well aware that homes in Manhattan, the Hamptons, Mulholland Drive etc. are on the spendy side!) When we lived in Arizona, I was amazed that couples with unremarkable jobs (i.e. not high-flying bankers, doctors or hedge fund managers) and average incomes could afford detached homes. With gardens! And multiple bedrooms! And garages! And enough space to swing a cat in! Crazy, huh? Lots of bang for your buck compared to here, where most couples our age are still stuck renting, and affordable accommodation is often dank and pokey.

However, what really got me – and still gets me – more than anything else, is this vexed question of healthcare. I suppose I had been spoiled rotten; until I lived in America, I really didn’t appreciate the differences between the two systems. 

Here in the UK, if you get ill you make an appointment (usually same day) and pop along to the nearest doctor’s surgery. No charge.  Or you can turn up at your local hospital and be seen within four hours, no charge. Ambulance? No worries, no charge. If you need to stay in hospital, fine. No charge. If you need aftercare, such as physiotherapy or follow-up appointments? No charge. And so on. There is a charge for prescriptions, but it is fixed. In England it currently stands at around $13 per prescription filled. No messing around trying to find the cheapest generic version of your medicine.

Of course the money for a socialised healthcare system doesn’t magically apparate out of thin air. Our National Health Service is funded from our taxes. Most people here pay 20 per cent of their income in income tax. 

The reason why I adore socialised healthcare has nothing to do with all those calculations and comparisons (both cost and quality of care) that are dredged up whenever there is a debate about this subject in America. No, it’s the peace of mind. Nobody can predict what will happen next month, next week or even tomorrow. But it’s so good to know that if you suffer a terrible accident, or you are diagnosed with cancer or a progressive disease such as multiple sclerosis, you don’t have to worry about footing the bill for your treatment.

Being fully comped – and knowing that no matter how your circumstances change, you will always be fully comped – brings with it a terrific peace of mind. You can’t put a price on that.  

I have been thinking about this today after reading David’s post at My Two Dollars. Despite paying $300 for health insurance every month, a brush with leukaemia and a removed melanoma have left him with medical bills of more than $9,000. How can that be right? And how tremendously difficult it must be, to have a bill like that hanging over your head if you are trying to scrimp and save your way out of debt, and onto a sound financial footing.

David says:

Every other single industrialized nation on earth has some form or another of universal health care, and it is about time that we step up to prevent disasters from happening to people who cannot pay their bills. I am lucky; I can pay mine. And I know this. But not everyone is this lucky, and not everyone gets away with only having to pay $10,000. Some are up to their eyeballs to the tune of hundreds of thousands in medical bills, which is not right for such a rich nation.

I think he is spot on. The comments on David’s post have intrigued me, too. Particularly the person who wrote:

Don’t listen to the media, the hype, and all of the other bull. You need to sit down and see just how bad the “universal health care” countries really have it. You might have been stuck with that cancer in your leg for a long time, as it got worse, WAITING for an appointment in other countries…Stop asking the government to fix your problems. Your a big boy now and you don’t need mommy and daddy to save you.

Our NHS isn’t perfect but it’s pretty marvellous, really. (All potential cancer cases, by the way, are seen by specialists within two weeks.) I must confess that my own experiences of the US healthcare system have been relatively disappointing. We were insured while we were over there, but just thinking about the implications of one of us falling ill made me feel anxious.  I realised that up until then, I’d taken my entitlement to healthcare for granted.

Finally, about three or four months after we arrived, my husband got a rash on his forehead that turned out to be a bacterial skin infection. He needed penicillin. I spent hours on the phone before I found a doctor who would take our particular insurance. We also had a $75 deductible on the policy, so even though we were insured we still had to cough up. (Cue unconcealed outrage – told you we were spoiled!) We turned up at this practice at the appointed time, and had to wait for more than an hour before we were seen. By this stage we had high expectations. Since we had to pay (cue further outrage), I guess we were expecting a super hi-tech consulting room that looked like… I don’t know, an annexe to the Starship Enterprise or something. With lots of white things and fancy machines. But when we were finally ushered in, we walked into a room that looked just like… a NHS surgery. Hurrumph.

American readers: am I missing something here? Is it possible to live on a modest income, and enjoy good healthcare? I am keen to know.

UPDATE: This post was selected for the 170th Carnival of Personal Finance, hosted by The Personal Financier.