Kaelin and her son Graham. All photos courtesy of Brigid Kaelin
Kaelin and her son Graham. All photos courtesy of Brigid Kaelin

(Editor’s note: This really is the land of Bourbon brains. The boozy-sounding swap of Scotch for Scottish in the old headline is entirely my fault and not the fault of freelancer Amy Miller. Apologies to all. – Melissa Chipman)

Singer-songwriter and accordionist Brigid Kaelin is back in Louisville after a year in Scotland, and she’s frustrated.

One year ago, Kaelin and her husband David were having a baby in Edinburgh, Scotland, where David was earning his MBA. Upon returning to Louisville after David graduated, they began jumping through the bureaucratic hoops of managed care, a frustrating process compared to the socialized medicine they had enjoyed in the UK.

If she hadn’t had a baby and a mortgage, Kaelin doubts she would have bothered getting insurance after they returned home.

Kaelin has been writing about her prenatal and birth experiences under the British National Health Services (NHS) on her blog The Red Accordion Diaries. In two blog  series Kaelin calls “Having a Baby Abroad” and “Birth Story,” Kaelin recounts how she discovered everything she had heard or assumed about socialized medicine was a lie.

She says: “I guess I was expecting to have to wait, to not get good care, all the things you hear over here [in the U.S.]. Someone always has a friend who had to wait six months [to see a doctor] for a life-threatening disease, and I never saw that. At all.

“I found everything to be better.”

Newborn in the birthing center
Newborn in the birthing center

The first assumption Kaelin had about socialized medicine was shattered before she was pregnant when she and David looked for a general practitioner and a dentist. Kaelin was surprised she could choose her own doctor, one whose office was near their home.

The couple were able to schedule their first wellness exams in a week.

David got a dentist appointment the next day and his exam only cost the couple 19 pounds, about $30.

Several more surprises awaited Kaelin when she began her prenatal care.  First, Kaelin was seen by a midwife who came to the couple’s home with a black medical bag, a la “Call The Midwife” on PBS.

Next surprise: the midwife performed routine tests, took a family history, then asked if they would be having a home birth.

The couple tried not to laugh.

Until this point, Kaelin wanted to be knocked unconscious while delivering a baby.  She was terrified of giving birth. She also never expected government-sponsored healthcare  to cover midwives, let alone home births.

In the US, according to a 2010 Time Magazine article, only 27 states allow Certified Professional Midwives to attend home births. Kentucky is not one of those states. Most states allow Certified Nurse Midwives to attend natural births, but typically these midwives only work in hospitals.

On her blog, Kaelin writes, “Why midwives and not obstetricians? Well, assuming you don’t have any major health issues and your pregnancy goes smoothly, you are tended to by midwives over here [in Scotland] – the way pregnant women have been for most of history. If there are any signs of a problem, you are sent to an obstetrician.”

Kaelin did end up seeing an obstetrician briefly, and her experience was even more surprising than her first visit with the midwife. When Kaelin’s doctor couldn’t answer a medical question, she asked another doctor, who on his lunch break, had the couple sit in his office for an hour while he researched the question and chatted with them.

“It was insane the amount of attention we got!” she says. “There was no, ‘We’ve got 50 patients to see so get out of here.’ I went in with low expectations, but this surpassed those and it surpassed any kind of care I’ve gotten here [in Kentucky].”

The main difference Kaelin sees between medical care in the States versus the UK is that the doctors she saw in Scotland were more relaxed and willing to spend quality time with their patients because they weren’t concerned about billing.

“The focus over there is on wellness as well as illness. Whereas here a wellness appointment takes months to get, over there wellness is every bit as important as sickness and in the long run, it saves them money, as it should. The whole birth and pregnancy was about keeping me well.”

At the birthing center with the midwife and David
At the birthing center with the midwife and David

When Kaelin was ready to deliver her baby, she actually was nine days past due. Rather than induce her, the midwife sent Kaelin and her husband to a birthing center.

Not a hospital, a birthing center, where Kaelin soothed her back labor in a warm pool while her midwife knitted a cap for the baby and David sat nearby.

She compares the birthing room to Joseph’s Salon.

“It was gorgeous!”

Kaelin explains that she could have given birth in a hospital, but she’s very happy she chose to have a natural birth in a birthing center. She even admits that if she had been pregnant for two more months, she might have given birth at home.

Kaelin understands why the NHS would advocate for birthing centers. “Because it has better outcomes and it’s cheaper! It’s significantly less than a hospital birth.”

Had Kaelin lived in Kentucky and wanted to deliver her baby at a birthing center, she would have had to travel to Goshen, Indiana.

Clark Memorial Hospital has the Family Birth Place for natural births, but midwives there work hand-in-hand with doctors, and the center is attached to the hospital.

Forty states, including Guam, have independent birthing centers, making Kentucky one of ten states without one.

“I never thought I’d be an advocate for birth in any sense, but hearing my friends’ stories –  and even my friends who have good experiences with birth over here – it still seems so insane. Like I have a current friend who is trying to have a natural birth and they tell her that’s fine, but you still have to have an IV hooked up to you the entire time.”

Kaelin found her own birth experience comforting and easy.

Once her son was born, he was given to her to nurse immediately. No cutting the cord. No injections. Something Kaelin says hippie moms call “kangaroo care.”

Kaelin realizes that her birth experience was similar to midwife and doula deliveries in the States, but she worries that American women fight to control the amount of medical intervention in their deliveries.

After Kaelin and her family returned home – only twenty-four hours after her delivery – they continued to receive care from their midwife, who made regular house calls.

Once the midwife was discharged, Kaelin saw a Home Health Visitor, essentially a Nurse Practitioner, once a week to make sure everyone in the family was healthy.

Had they stayed in Scotland, the Home Health Visitor would have visited weekly until Kaelin’s son turned three!

And yes, all of this is paid for by the Scottish government.

Home health nurse measures Graham on their living room floor as David looks on.
Home Health Visitor measures Graham on their living room floor as David looks on.

But Kaelin did leave Scotland, and since her return she feels like she is constantly faced with the burden of healthcare, despite the family’s good health.

There was a point when Kaelin’s baby was sick after arriving back in Louisville, and she and her husband weren’t sure what to do. Both were working as small business owners and not earning as much as they wanted.

Kaelin confesses that she and David had a difficult decision to make, “Do we go to the doctor or do we buy groceries?”

Kaelin wonders why more people aren’t outraged by this imbalance.

Catch Brigid Kaelin in concert at Headliners on September 1 with Rumors (a Fleetwood Mac tribute) and a late set by Those Damn Torpedoes. Tickets are $10, doors at 8 p.m.

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Amy Miller
Amy M. Miller is a freelance writer, graduate student, adjunct professor, and native Louisvillian. Her writing has appeared in local and national magazines, newspapers, online journals, and blogs, including The Paper, Under The Gum Tree, Skirt! Magazine, Underwired Magazine, and Offbeat Families. On weekends, you may run into her and her family at every local festival in town. You can read more of her ramblings on her blog ADDled at addledliving.com.

11 thoughts on “Is Scottish healthcare as good as its whisky? What Brigid Kaelin discovered about having a baby abroad

  1. While I find this an interesting and encouraging story, my question is who’s paying for Scotland’s socialized medicine? Sounds like an incredible program, even enviable. But who’s footing the bill and can the government afford this? And if so, how highly are Scotts taxed? It’s all good and well to have affordable medicine, but at what cost?

  2. Who cares who pays for it as long as it works?! According to World Bank data available online, US spends $8808 annually per capita on healthcare. UK spends $3609. The infant mortality rate in US is 6 deaths/1000, UK is 4/1000. Their life expectancy is also 2 years greater than U.S. It doesn’t take a genius to do the math. The system we have costs more than twice as much with results that aren’t as good. Obviously, we are doing something wrong.

  3. Who cares? Really? It’s not Fantasy Island. I’m all for affordable healthcare, but I want to know that it’s not one of many government programs that drive nations into unmanagable debt.

  4. If you have single payer healthcare, you pay more in taxes, but a lot less for medical services, so it balances out in favor of everyone. Medicare is one of the best, most successful government programs, and why it isn’t offered to everyone is a mystery to me. Single payer insurance doesn’t outlaw private insurance, it’s just there as a backup.

    It’s the same argument as educating everyone. If you provide everyone in society with access to education, you improve society as a whole.

  5. I think J W. explained it. Taxes are indeed higher, but overall cost is lower.

    The overall cost in socialized medicine is lower for a few reasons.

    One is that large parts of the health care industry are not profit driven, reducing the need for frivolous expenses like advertisements or money wasted on the medical facilities arms ace. Don’t you cringe when you see hospital adds? You – yes you, are paying for that. Or what weirdo cares the waiting room in the hospital has flat screen TVs or massage chairs?

    Another is that a large insurer – for example, the government in a single payer system – has more weight in negotiating prices for the hardware, services and drugs offered by the for-profit health care industries. This is a similar negotiating power enjoyed by Medicare or Medicaid. Basically, a large insurer enjoys the same purchasing power as Walmart. And walmart is dirt cheap.

    Large insurers are also better able to keep buy-in cost low because risk is spread across a large customer-base. This is actuarial science 101. Furthermore, the forced participation of all age group ensures that people contribute to the system at all stages in their life. In the US, the young and healthy may opt out, but when they are old, these pragmatists will be the first to suckle at the teat of Medicare. The same for the uninsured who end up in ER.

    And lastly, health care in the USA is more expensive because buyers are not free participants in a free market. Buyers are forced to participate when they are most vulnerable; when they are sick, wounded, and frightened. This vulnerability leads to health care providers taking advantage of its customers. How can you put a price on your broken wrist? It needs to be fixed, dammit, and right now. At that point, you will not go shop around for the cheapest hospital. So what if they tack on 30$ for the laundry of the scrubs. Hospitals in the US are like the mob extorting the mom and pop from the corner grocery store: “wouldn’t it be a shame if something happened to little johnny, eh, say, break his wrist when playing ball down the street, heh heh… now pay up.”. As it happens, little Johnny’s wrist is already broken, but the dynamics are identical. Seriously, try and estimate how much you are willing to pay to fix that broken wrist: 300$, 3000$, $30000? The correct answer is all of it: you would pay all of it. Because little johhny is in pain and crying, and you are missing work.

    These are the causes for the hard numbers that demonstrate why the USA health care system is expensive, and why other systems – such as single payer health care – are less expensive.

    This is not taking into account all the inconveniences and misery that the US health care system causes: the threat of financial ruin many families face when a medical emergency occurs (and the emotional exhaustion), the fragmented provider networks that are just a headache to deal with, the byzantine regulations for premiums, copays, deductibles, the hours wasted calling your insurers, etc… I am sure you know, and if not, you are not old enough.

    This is also not taking into account the low quality of the care because medical professionals do not have the time to dedicate their full attention to their patients. They need to spent it on paperwork, or pay staff to do their paperwork. And that staff ends up buying some fancy content management software to help them with their paperwork, but of course that goes down, so they end up paying support for some trans-pacific call center, who tells them to upgrade their PCs to a new operating system, for which they are not licensed, so they need to go check with Dr. Boss, who’s exhausted because he needs to work so much to be able to pay for all this cruft, and why are you pestering me with this again during my lunch, I need to see 12 more patients this afternoon… Multiply that times a 1000, and you get an idea of the wasted time and resources.

    And this is also not taking into account the ongoing lies about socialized medicine. Long waiting lists, death panels, the threat of communist rule. Yawn indeed. Single payer does not need to mean unmanageable debt for a healthy country in which confident citizens have pride in and take ownership of their institutions.

    A free market system is fine for consumption articles (cars, gadgets, boobjobs), not for healthcare.

    Obamacare is a step in the right direction – as it is an attempt to alleviate some of the problems, but whoever is next better carry the torch all the way to single-payer.

    Sorry, I should be more clear. It does not have to single-payer, I will settle for any health care system that:
    – does not waste part of its profits on dumb shit
    – can keep the cost of medical services and products low
    – that has a large participation in the system across all incomes and ages, spreading out risk.
    – and in which purchases are not made under the threat of bodily harm

  6. Great response. It’s difficult to find fault or add info, but here’s two thoughts that crossed my mind:

    1) American hospitals, like universities, seem to be engaging in a “war of comparative opulence”. That is, they’re always building new things and designing the most pristine, swanky facilities when they build new. If anyone has been in a newer hospital lately, they know what I mean. They’re like 5-star hotels. This all must contribute to the higher costs.

    2) The Walmart example perhaps worked until they achieved market dominance and driven out most of the mom-and-pop’s. Their prices on non-imported items (i.e. most groceries) are really not that low any longer and are rather comparable to Kroger. What I’m saying is that they are a for-profit entity as opposed to the British health services, which are not. With Walmart’s market dominance, they don’t have to hold down prices as much any longer. The Brits obviously don’t have an interest to drive higher profits (really, any profits) from their dominance.

  7. What they are not paying for is the 25-30% of their health insurance premiums that fund the overhead, marketing, and profit of health insurance companies and the massive bureaucracy that they use to try to AVOID paying for healthcare services of their customers.

  8. That makes sense. I guess what’s tough about our system is that it started out with a significantly non-profit component 150 years ago, and it gradually became for-profit, likely in order to survive. Switching from free market options to government control rankles many, and I think we call can agree why since government has a terrible record of screwing things up. But where there are proven models, we should look and learn. Perhaps this is one of them.

  9. It’s nice to know that all those reports about problems with British health care were lies. No one has ever had a problem. Let’s compare health care in Scotland to that in London. Just saw a British movie, “Quartet.” The Maggie Smith character says she is on a waiting list for a hip operation. A waiting list. Of course a hip operation can wait compared with a birth. And, yes, costs were MUCH lower before we brought insurance into the picture. In fact, some doctors and hospitals will charge much less if you don’t insurance.

  10. Thank you for this story. I think it’s important for more poeple to hear that there ARE options. That the way things are done in the US (typically) isn’t the ONLY way.

  11. I would say government has a mixed record, rather than a terrible one (seeing I look at these things pragmatically and not through a conservative lens). On the good side, it has managed health-related programs and Social Security generally well. Of course, I’m sure you can find exceptions. Education is where the federal government is terrible.

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