[0:04] Hello everyone, and welcome to this fifth episode of the ShiftEnglish podcast! I’m Joseph, and I’m really happy you’re here. It’s my pleasure to welcome you to the podcast if it is you first time listening. And if you are a returning listener, welcome back. I am delighted you have decided to continue your English learning journey with me.
[0:32] As mentioned, my name is Joseph, I am a British-American living in New Orleans, Louisiana. And my objective each episode is to share something original and interesting on a wide variety of subjects, that is fun for you to listen to. Using English in a natural, conversational way, and highlighting for you any time the American English is different from the British English in a significant way. Knowing those little differences, can really make you sound like an expert in English.
[1:10] Because I have lived in America for over 10 years now, sometimes I make the mistake myself of using an American phrase while in Britain. One funny example recently with my family I told them I was going to “take” a shower. Well, we don’t say that in the UK. We say we are going to “have” a shower. Anyway, my family thought that was rather funny and wanted to know where I was going to take the shower to. Was I going to take the shower to the park? Was I going to take the shower to the cinema? Much hilarity, much joking at my expense.
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[2:04] But words and phrases are not the only difference between the UK and the USA. Well, there are many differences of course. But one that personally affected me, was the difference of the American healthcare system, versus the British healthcare system. And that difference was something I found out when I got sick in America. Today, I will be sharing with you my personal experience of getting unwell, getting sick in America. Without insurance I should add. What my personal experience was of the American healthcare system. And also, some more general reflections and facts about that system. You will find a full transcript of this episode for free along with a list of useful grammar over at ShiftEnglish.com. So, without any more delay, let’s get into our topic!
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[3:16] Before I get into the weeds of the story about how I got sick, I want to explain why I didn’t have any health insurance. Ah yes, and when we say “get into the weeds” of something it means “get into the details” of something. But yes, I didn’t have health insurance in the USA. Naughty boy. Not a good idea. The reason I didn’t have it is simple, and one you may have probably guessed. It is really expensive. How much you pay for private health insurance really depends on a lot of factors. It depends on what state in the USA you are living in. It depends if you have any previous sickness or health conditions. It depends on what level of coverage you want. For example, if you will pay some of the costs yourself or if you want the insurance to pay all of the costs.
[4:25] All these factors and more, go into the price or cost you pay every month. But even for someone relatively young and healthy, paying around 200 or 300 dollars per month is normal. And I have friends who pay more like 500 dollars per month, and even more. So, it can be super expensive.
[4:47] When our story begins, it is in the middle of COVID times. That joyful time when we thought maybe the world was going to end. And a lot of us, including myself, didn’t have a job. So, paying several hundred dollars per month for health insurance wasn’t really an option. And besides, I told myself, if I started getting sick, if I started feeling unwell, then I could always get an emergency plane ticket over to the United Kingdom and get seen by a doctor there, where it would have been much more affordable for myself.
[5:29] It was a great plan. There was just one small hiccup in the plan. That means there was just one small problem with the plan. When I actually got sick, taking a transatlantic flight was not exactly possible…
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[5:47] The first indication, the first sign, that something was not quite right was a belly ache. I had a pain in my belly, nothing too crazy, but definitely sore. So, I went to my bed and had an early night. I went to sleep early, hoping to wake up more or less fine again the next day. Well, that didn’t work. I had a very uncomfortable night and by the next day it was clear that this belly pain was getting worse. So, I decided it was time to go see a doctor. My friend took me to the nearest hospital, we walked in to the emergency department and presented ourselves at the reception. The lady asked me what the issue was. What my name was and what my address was. And, very importantly, she asked me who my health insurance was with. Me answering – “I don’t have any” made my belly pain get a little worse.
[7:00] We sat for a time in reception and eventually were told a doctor would see us now. The doctor did some poking around. Feeling around where in my belly was hurting. He asked me some questions about when it started, and how sore it was. And then he told me something I was not hoping to hear – he told me, that he thought my appendix might be the problem. The appendix is a small, thin piece of tissue, a little tube, that’s attached to your large intestine — near the bottom right of your stomach. The funny thing is, scientists aren’t even completely sure what it does! It might have helped our ancestors digest certain foods a long time ago, but today, we can live perfectly fine without it.
[7:53] When this appendix gets inflamed, when it gets infected, it can be very painful. We call that appendicitis. And usually the safest thing to do is to surgically remove it. Because if the appendix explodes, then that can be really dangerous, even deadly. The doctor told me that he wasn’t 100% sure if it was appendicitis, and to confirm we would have to do a CT scan and get some blood work done, or get some blood tests done. CT stands for computed tomography — but don’t worry, no one really says that, everyone just says CT scan!
[8:48] A CT scan uses a type of X-ray and a computer to make very detailed images, almost like slices of your body. Doctors can then look at those pictures to find problems, like infections, injuries, or even things like appendicitis. I know I am throwing some technical medical terms your way, I suggest having a look at the handwritten transcript on my website at ShiftEnglish.com, to see how those words are written. Makes it easy to remember.
[09:25] But anyway, the doctor suggested I get the CT scan and blood work done. How exciting for me. Uh, just one question doc. How much would that be? Around 3000 US dollars he told me. Just for the scan and blood tests. That’s really just super I thought. I didn’t have much money, and the pain was around a 6 out of 10 in terms of how sore it was. So, I told the doctor I’d rather wait one more day. I would hate to pay all that money and find out I just had a regular belly pain that went away by itself.
[10:10] So here’s the first fun thing I learned. If you go to see a doctor, and he or she tells you to get something done, like a CT scan, but you say you don’t want to because, it’s too expensive, or whatever, you just don’t want to. Well, you have to sign a few documents before you can even leave the hospital.
[10:38] Basically, the doctor will make you sign a document saying, he or she gave you the advice to stay, and against their advice, against their recommendation you have decided to go home. The document says, if you happen to go home now and die because of the illness or injury, it’s not the doctor’s fault, and you can’t sue them. You, or I guess your family since you would be dead, can’t bring the doctor in front of a judge and demand money for malpractice.
[11:17] So I signed the document and off I went. Back to bed. A few hours of sleep, and I woke up feeling right as rain. Right as rain is a common expression that means, fit and healthy, feeling great. So, after a few hours sleep woke up and I felt right as rain… Yeah, right. Actually a few hours later that 6 out of 10 pain was now 9 out of 10 pain. I was crawling on the ground, no longer able to even stand up from the pain. It was horrible! My friend took one look at me and told me were going back to the hospital. It was no longer my choice!
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[12:12] But we didn’t go back to the same hospital. While I was in lying in bed in pain, my friend had done some research and asked around. Asked others for advice, where to go if we had no health insurance. What a great friend, huh? And here is the first thing to know, one of the most important things I learned about American healthcare. Not all hospitals are run by the same type of organization. The first hospital we went to was run as a private system of hospitals. That means it was run as a business. It was operating for profit, to make money. The second hospital was a local, nonprofit hospital. It’s goal was to provide affordable healthcare to people of the city. Why this is really important, is that a local nonprofit hospital will try to help you more if you don’t have insurance. Their goal is not to make money out of you, the patient.
[13:33] And this difference was immediately obvious walking in the door of the second hospital. Sure, it was a little busier than the first. And remember, all this was happening during COVID times when things were generally busy in hospitals. But immediately there was less emphasis on my insurance. I was not even asked what my insurance was initially. They wanted to know first, what the problem was. Where the pain was. And when later I said I didn’t have insurance, their reply was “baby, don’t worry about it, someone will come help you with that later”. Side note, if you do ever come to New Orleans, you will get called ‘baby’ by men, by women, by everyone, pretty much 20 times a day. Don’t take it personally, people here say it to absolutely everyone, regardless of age or gender.
[14:47] Anyway, after around 30 minutes of waiting I was told to come through and see a doctor. She did the same prodding around the stomach, the same feeling around the stomach. Asked some questions. And then gave her diagnosis. “It’s probably your appendix” she said “and it’s probably close to exploding”. Naturally, I didn’t love this news, but it also didn’t surprise me considering how much pain I was in. And this time I did not resist at all when she said we needed to get some blood tests and a CT scan done.
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[15:34] One interesting thing I would say I learned at this point in the story is that these more community-focused hospitals are significantly busier, and therefore the doctors need to be very discerning on who gets medical attention and when. They need to prioritize which patients will receive medical care, and in what order. And so, they need to be very good at noticing small but important details, that others might have missed. That is what it means to be discerning.
[16:15] Specifically in my case, I overheard the doctor make a couple of comments to a nurse I thought were curious at the time. She made reference to me being a “stoic” type of person, probably because I was making a heck of a lot of effort to not be showing the real pain I was feeling. I can thank my British side to that. The British have a bit of a reputation of not showing too many emotions even in difficult situations. Which I admit has it’s good sides and bad sides. But anyway, the doctor also mentioned the fact that before the current illness I had never even been to hospital. I’ll admit that I had a bit of a phobia in general of hospitals. I had a fear of hospitals.
[17:13] The doctor made these comments not to make me feel good about myself or to inflate my ego. But she made these comments essentially to underpin, to emphasis that I should get the CT scan done ASAP, as soon as possible. And she was absolutely right. One hour later I was back in front of the doctor, with the image results in hand. And she gave me the good news: “your appendicitis is extremely inflamed and is going to burst at any second”.
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[17:57] By this point I wasn’t really in any pain. I had been given morphine by a nurse, that magical, and highly addictive drug that is very effective at reducing pain. And by a funny coincidence, the nurse who was assigned to me was someone that I played with on my soccer team! So, all in all I was feeling quite relaxed, almost giddy, almost happy.
[18:28] And I must say that even without the drugs, without the morphine – There is a real kindness, a real human kindness in American hospitals that I hadn’t quite expected. I think I had a certain level of mistrust, that doctor and nurses would somehow be unkind, would be cold. But it wasn’t the case. Without exception the nurses and doctors I encountered were very caring. I got the sense they wanted their patients to feel relaxed. To feel taken care of. They took the time to get a sense of who I was as a person. I felt seen. Of course, this is a personal recount, perhaps elsewhere, in another hospital it would have been a worse experience, or just a different experience somehow. And certainly, I would be interested to know if you had an experience in an American hospital, and what you think about American health care. Leave a comment or contact me at ShiftEnglish.com.
[19:47] The news that I would be undergoing an operation sobered me up from the morphine a bit. I wasn’t feeling quite as happy to be there anymore. And somewhere in the back of my mind there was a little accountant starting to worry if now I was going to be in debt for the rest of my life. If I was now going to be paying back the money for the rest of my life, for this operation. And past the side of money, I was deathly afraid of operations. It was really a phobia of mine.
[20:29] A funny anecdote, a funny story, as they were preparing me for the operation, I started trying to convince the nurses and really anyone that would listen that I felt totally fine now and I would be happy to go home. No need for an operation, I said! I was literally lying on the bed outside the surgery minutes before the operation and I was trying to convince the anesthesiologist I was fine. Anesthesiologist, oof, that is a hard word to say. Even harder to spell. But it is the name for the doctor who, among other duties, puts you to sleep before an operation.
[21:21] By this time, I had already signed all the legal forms, however. I had signed the documents saying they could put me to sleep. That they could do the operation. So, this anesthesiologist already had the ‘green light’ to do his job. He could put me to sleep without listening to my not so convincing argument about how I was magically better now. But even in that moment he was kind enough to be reassuring. He told me it was a routine operation, a simple operation. ”I will give you a little something to feel calmer now” he said.
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[22:07] And the next thing I know I am waking up in a different room. No memory of time passing. Not like sleeping. Just instantaneous from one moment to the next. Me telling the anesthesiologist I have self-healed by positive thinking and next waking up in the recovery room. Such a strange feeling. Later on, the doctor passed by to see how I was feeling and confirmed it was indeed the appendix the problem. But now it was removed there would be no more problems with it. Ciao, appendix. And then there was one final visit. The medical biller. Which as you may have guessed from their title is part of the team responsible for making insurance claims for patients and making sure the bills are processed and paid.
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[23:04] Again, this person was very kind and knowledgeable. I was preparing myself for the worst. But she explained that because of my situation. A resident of the USA, and unemployed at the time with COVID, I was eligible for Medicaid. Ah yes, the golden word. Medicaid. A word I had heard before but never fully understood. And yet this Medicaid was about to save my bacon. To save one’s bacon is a popular way of saying getting out of a difficult situation. And Medicaid was about to save my bacon because it reduced my bill of $40 000 US dollars down to $0 US dollars. Yep. Pretty big deal. I would still have been paying for that operation today if it wasn’t for Medicaid. And so, I want to take just a minute to go over a bit of the background of Medicaid and what it is.
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[24:26] Before my little trip to the hospital I thought Medicaid was created by Obama. But not at all apparently. Medicaid began in 1965, way before Obama was president. It was created by the U.S. government to help low-income Americans get access to healthcare. The idea was that everyone, no matter how poor, should be able to see a doctor when they’re sick. Well done, America, we had some good ideas back in the day. It’s funded by both the federal government and individual states, which is why the program can be very different depending on the state, increasing the overall confusion of the program.
[25:18] It’s not based on age, like Medicare, but on how much you earn. Medicare is a program started at the same time as Medicaid which they decided to give a similar name to confuse as many people as possible. I joke, but yeah seriously why not give those two programs more distinct names. But the important difference is that Medicare is specifically for people over the age of 65.
[25:53] So, you have these three programs of insurance essentially – Medicaid for the people that earn very little, or no money. Medicare for people over the age of 65 or with specific disabilities. And for everyone else the option is either private insurance, which you pay for monthly. Or, I suppose the fourth option which is called cross your fingers and pay for anything that goes wrong out of your own pocket. Pay for the health care with your own money.
[26:36] Do you see the cracks in the system? There is no true universal healthcare. There is a safety net, but it has holes in it big enough for a bunch of people to fall through. If, for example, you make a bit of money from your job, but you don’t have private insurance, and you go to hospital one day, well, bad luck. You are one of the unfortunate ones that make too much to be covered by Medicaid, but you don’t make enough to pay for private insurance. You will be charged personally for the health care you received. And you might be paying that back for a long time.
[27:22] Medicaid is designed to protect those considered to be the most vulnerable, those who are the poorest, and to a certain extent it does. But because Medicaid changes according to the state and because it is not always easy to know who qualifies, it can be a bit of a maze to understand. It can be difficult to understand. Many people fall through the cracks and have no insurance.
[27:50] Obama did take certain steps, certain measures to try and reduce the size of these cracks when he was president. In 2010, Obama introduced the Affordable Care Act, also known as ‘Obamacare.’ One of the main parts of this law was expanding Medicaid coverage. This meant that more low-income people could qualify for healthcare, especially adults without children who hadn’t been covered before. Thanks Obama.
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[28:36] So, in conclusion one of the biggest things I learned was that I was being reckless, I was being irresponsible by believing I could just go back to the UK if one day I got sick. Had the appendicitis happened only a few months earlier when I still had money coming in, before COVID, I would have been one of the many people that fell through the cracks. I would have had no private insurance, and no option for Medicaid and therefore I would have been personally billed for the care I received. I got extremely lucky! Not only did I receive excellent treatment from professionals that cared, but I was also lucky enough to be eligible for Medicaid insurance.
[29:25] I want to thank you for listening to this episode. I know this episode was a little different from the previous episodes, so let me know if you liked this style of episode by leaving a comment or sending me a message over at ShiftEnglish.com. And there you can of course get the free transcript so you can find out how to correctly spell anesthesiologist. Actually, I have no idea how to spell it and it just gets autocorrected every time I misspell it. But maybe one day I’ll get it right… Anyway, thanks again, and next week for the next episode of ShiftEnglish I will be discussing dreams, why we have them, what they mean. I hope you will tune in again for that one, but in the meantime have a lovely week!
— Vocabulary List —
- Hilarity: great laughter or amusement. Example: The comedian’s jokes caused complete hilarity in the audience.
- Naughty: behaving badly, especially used for children (but not only). Example: The naughty puppy chewed my favorite shoes.
- Hiccup: a small involuntary sound your body makes when your diaphragm jumps suddenly. Example: She couldn’t stop laughing between her hiccups.
- Poking: touching or pushing something with a finger or a pointed object. Example: He kept poking the fire with a stick.
- Appendicitis: a painful infection or swelling of the appendix, a small organ in your stomach area. Example: She had to go to the hospital because of appendicitis.
- Malpractice: serious mistakes made by a professional, especially a doctor or lawyer. Example: The lawyer lost his license because of malpractice.
- Prodding: gently pushing someone or something to get a reaction. Example: My friend kept prodding me to wake me up in class.
- Diagnosis: the name of an illness or problem after someone studies the cause. Example: After the medical exam the doctor gave her diagnosis.
- Discerning: able to notice or understand things clearly; showing good judgment. Example: She’s a discerning shopper who only buys quality items.
- Stoic: someone who stays calm and doesn’t show emotions, even in pain or trouble. Example: He remained stoic during the long, stressful meeting.
- Morphine: a strong pain medicine often used in hospitals. Example: After the accident, the nurse gave him morphine to ease the pain.
- Giddy: feeling light-headed, silly, or overly happy. Example: She felt giddy with excitement after getting the job.
- Sobered up: became serious or clear-headed after being silly, drunk, or shocked. Example: The news of the storm quickly sobered everyone up.
- Debt: money that you owe to someone or a company. Example: He finally finished paying off his student debt.
- Anesthesiologist: a doctor who gives you medicine so you don’t feel pain during surgery. Example: The anesthesiologist asked her to count backward from ten.
- Maze: a complicated network of paths or things that is hard to find your way through. Example: The old city’s narrow streets were like a maze.