Healthcare At Home and Abroad

(Arthur's Seat, Edinburgh)


I have many fond memories from the past year, during which I pursued my Master’s Degree in Scotland. Understandably, I still miss hearing the Scottish brogue, eating haggis, and walking on the slick cobblestone streets of Old Town Edinburgh. But as I have progressed further along into my AmeriCorps service year stateside, I have increasingly grown to miss something from the UK that I never thought I would: its healthcare system.

I distinctly remember the first time I walked into a surgery (what the Scots call a clinic), and asked the lady at the front desk what I would owe for my doctor’s visit. The receptionist was clearly appalled and explained to me that no payment was necessary. My routine, preventive care visit was covered under the National Health System (NHS) of the UK, she informed me. I winced, realizing that I had exposed myself as yet another clueless American.

I didn’t make much of it that day, but as time has passed, my experience at that health center still stands out to me because of one simple fact: the idea of paying for basic healthcare services was anathema to the surgery employee. To her, those services were something to which patients were entitled, not a luxury they should pay for to obtain.

I cannot help but contrast that conviction with the underlying values of healthcare delivery that I see playing out at my service site now, a family health center that administers to a diverse population in central Pittsburgh. In my daily service counseling patients with diabetes, I all too frequently encounter individuals who must jump through hoops to obtain care because they don’t have the “proper” insurance coverage. Every day, I witness providers moving mountains to obtain free or discounted medication samples for patients who might not otherwise be able to afford the drugs they need to treat their condition. Thus, at my service site, I see a microcosm of the broader American healthcare system, one in which the provision of basic, preventive healthcare services is intimately intertwined with patients’ ability to pay.

By highlighting this, I have no intention of blaming the management, staff, or providers of my host site, since they work tirelessly to provide the best care possible for our patients. What I do want to stress, however, is that the centrality of patients’ ability to pay in our healthcare system would provoke outrage in other places in the world. This is not to say that the NHS is a perfect system, far from it. Wait times, provider compensation, and the increasing privatization of healthcare delivery are major challenges that have chronically plagued the NHS. But even given its troubles, the fundamental principle at the heart of the Service remains the same: that there are certain healthcare services to which citizens of a country are fundamentally entitled, regardless of their socioeconomic position.

Through my service as an AmeriCorps member, I strive daily to bring the reality of healthcare delivery at my host site one step closer to that ideal. I am able to do so because I have the luxury of counseling patients without regard to their insurance coverage or how much they can pay for their care: I am free to advise those who need it most, regardless of their financial circumstances. And as I continue on into medical school and a future career in the practice of medicine, I intend to do my part to ensure that one day, when a patient comes up to a clinic asking how much they owe, they are met by a receptionist who recoils in shock at the thought of having to pay for essential healthcare services.


This post was written by NPHC member James Lui.

James serves at Shadyside Family Health Center as a Care Coordinator.