mind the gap

American conservatives have, I gather, been attacking the NHS. (Guardian)

There's something they somehow miss.

If you live in America and happen not to have health insurance, it's complicated to organise treatment. By 'complicated' I mean that you might well be able to clear the bureaucratic hurdles if you had spent the last 6 months training for a marathon, were in peak physical and mental condition - but if you are, um, you know, sick, you are unlikely to have mental and physical stamina required.

In 2000 I had a breakdown. I lay on a bed in my mother's house, unable to move. What was needed was, I suppose, some sort of medication. I had no health insurance in the US. To organise the required medication it was necessary to make phone calls. Phone calls I might well have been able to make had I not been in the middle of a breakdown. I did not have the necessary social skills to take this on from a state of insanity, but there was something I could cope with. I could book a ticket online to Britain; I could get on the plane. Once in Britain, all I had to do was walk into a clinic.

The treatment offered by the NHS was flawed. I was living in short-term accommodation. I had no permanent address. I was offered cognitive therapy at the Whitechapel, in addition to the medication prescribed; by the time I turned up for my first appointment for cognitive therapy, I had moved. As it turned out, I had moved out of the district covered by the Whitechapel; I was no longer eligible for its cognitive therapy programme; it was necessary to start again from scratch. It would have been simple enough for the clinic to give me a map with the boundaries of its district; if they had done so, I would have taken care to find a new room within its boundaries. They didn't; the results were not good.

If I'd stayed in the US, on the other hand, I would not be alive today.

why the nhs looks like a friend in need

Kwak’s parenthetical about how insurers can’t examine applications before they’re approved on the grounds that that would be “impractically expensive” misses the true evil here: the insurer wants to cash the insurance-premium checks of people who made fraudulent applications. Those are the most valuable insureds of all, because the minute they make claims which cost more than their premiums, their policies can be immediately rescinded. As Taunter puts it, you are free to play, you just aren’t free to win. And that’s why you get people being denied breast-cancer surgery on the basis of having had acne in the past.

Felix Salmon on Conditional probabilities and evil insurers, the rest here.

paperwork

It's 6.50 am. I got up at 6.02 to put more coal in the ovens before they went out. It's tricky because you have to leave the flu open for a while to get the carbon monoxide sucked out, but it can't be open too long or all the heat leaves and the coal burns down. TAR ART RAT has given me a number to call for compressed wood briquettes.

Johanna Thompson likes the idea of the pret-a-parler language lessons, though our meetings lately have been taken up with abortive attempts to get me signed up for health insurance. Since April having health insurance has been a legal requirement in Germany, and insurance companies are legally required to provide insurance to people who have jobs that offer benefits, but they are not required to insure people who are self-employed.

We talked to the DAK, her insurance company, and they said that they could not insure me because I was self-employed, but if I signed on with the Kunstlersozialkasse they would then be able to provide insurance. The KSK paperwork takes 6 months to process, but the longest journey starts with a single step; we got the forms, which required a survey of my employment history from the time I finished my doctorate to the publication of my first book; they also required a form from the insurance company I proposed to use. So Johanna got the form from DAK, and we filled it in and went back, and they explained that they could not sign off on it unless I was already insured. If I took out private insurance they could then sign the form; otherwise not. If I had been overseas and had proof of insurance there that would be all right. So it might be necessary to go back to Britain and get a certificate from the NHS. Or it might be possible to sign on with Sozialhilfe, claiming phobia of the spoken word as a mental disability presenting obstacles to employment (this is not a dodge, just a statement of fact, but that does not necessarily give it a better chance of making the grade).

I once knew a woman who wrote a novel about German bureaucracy. She had been knocked off her bicycle at Checkpoint Charlie and had had to go through a complicated procedure to get compensation. For some reason there were penalties associated with not claiming compensation.

The next room smells strange. I open the windows. The air is fresh and sweet.

Mark Greif has been sending the proofs for the excerpt from Your Name Here which will appear in the next issue of n+1. The designer has not yet finalised the Arabic so it's hard to tell what it will look like.