“I worked in the NHS before. It’s an incredible thing. British people should really protect it.”

I’ve been waiting for an hour now. There’s nowhere to sit, little room to stand and when I ask the staff where all the huddled and sick should go, they smile and nod politely and suggest any number of chain-eateries in the adjoining building. “Won’t I have to buy something to sit there?” I ask. “Yes sir,” is the efficiently delivered response. “But there are plenty of eating options including McDonalds” is the follow up. I decide to keep on standing.

Welcome to the world of private medicine. And this is only the end-point of a journey through private medical care that takes in two leading hospitals in two first world countries. The above account relates to my wait for medication at the pharmacy in what many described as “the best private hospital in the country”. An hour. For paracetemol and a few other meds. When I asked why the wait was so long, “we’re understaffed,” was the response from the stressed-out pharmacist. “They just won’t give us enough people,” she added as she ran from counter to dispensary.

It all began two days earlier in a city that will remain nameless but which is famed amongst Western politicians and commentators – particularly the kind who are dogmatic about “free-market” solutions – as the embodiment of hard work and good organisation. So, when I fell ill on a work trip, and with adequate travel insurance in hand, I felt secure that any treatment I’d receive would be first rate. After all, the city was also famous for its state of the art private medicine.

“They clean the poor out,” says the doctor as we chat about local private health care and how the more vulnerable pay for it. “They take their savings, make them sell their property, squeeze them until there’s nothing left,” he adds. Lucky for me I’m just being prescribed an inhaler and some antibiotics. “I worked in the NHS before. It’s an incredible thing. British people should really protect it,” the doctor continues. “In private medicine we’re pushed to over-prescribe and over-operate. It makes more money for the hospital and sometimes care suffers.”

I’ve heard similar stories before. A friend with a back problem once went to a private hospital for advice. “You’ll need multiple operations to put this right. It will take a long time with a long recovery but it will be worth it,” she was told. The bill for this course of treatment was astonishing. Then, seeking a 2nd opinion, she waited in line at a public hospital to see a specialist many locals considered to be the best in his field. “You just need to do some proper exercise. Why are you wasting my time with this?” came the terse reply. She took the latter option and in a week was feeling better.

Back to my sojourn through private medical care and I’ve now arrived in a 2nd city, almost equally prosperous with equally first-rate private facilities. Except now I am really sick. The first doctor, despite the hefty bill, didn’t pick up on my underlying condition and I am far worse.

“You have type A flu,” says my new doctor at the best private hospital in the country. “Either bird or swine, we’ll figure out which later.” Service is slow, the doctor is kindly and friendly, the staff sympathetic. With its worn-out furniture and peeling paint it reminds me of, well, one of the UK’s public NHS hospitals. The wait for my medication, as outlined at the top of this story, is entirely different from the NHS as is the shopping-mall like ambience of the facilities (McDonalds included) – everything seems designed to squeeze as much money out of you as possible. I feel very much like a consumer and not a patient.

A few days later and I’m back home in the UK. I pop in to see my GP and show him the sack of medication – inhalers, pills, cough medicines, more pills etc etc – I’ve been given. He picks up the inhaler – “Why on earth did they give you this?” I respond with a shrug and that I don’t know. But that it was very expensive. £50 in fact. Just for an inhaler. “It can induce pneumonia,” he says. “Don’t use it again.” I nod in emphatic agreement.

Later that evening I chat to a medical practitioner friend. She’s from the same country where I was just treated and knows the name of the best private hospital in the country. “Private medicine has so many pitfalls,” she says. “A friend of mine once had a scan and was told she had cysts that needed to be removed. They cut her open and found, in fact, she was perfectly healthy. The operation was completely unnecessary. She still got given a very large bill at the end though.”

Over the next few days as I sit and recover, the UK twitter and blogosphere is filled with discussion about the present government’s NHS bill. The outsourcing of care to private companies is at the centre of Coalition Lib Dem and Conservative policy. “Nothing will really change for the patient,” say the privatisation cheerleaders. Yet the real-life consequences of the commercialisation of healthcare are being avoided and free-market dogma replaces everyday pragmatism. What’s missing from the Coalition’s sales patter is that the price for all this could be far more than tax-payers pounds and pennies. Not least if you take on board comments by Dr. Arnold Relman a Professor Emeritus of Medicine and Social Medicine at Harvard Medical School who once wrote a paper entitled “Medical professionalism in a commercialized health care market” for a US-based medical journal. Dr. Relman is unequivocal:

Endangered are the ethical foundations of medicine, including the commitment of physicians to put the needs of patients ahead of personal gain, to deal with patients honestly, competently, and compassionately, and to avoid conflicts of interest that could undermine public trust in the altruism of medicine.

The good doctor goes on to say:

The essence of medicine is so different from that of ordinary business that they are inherently at odds. Business concepts of good management may be useful in medical practice, but only to a degree. The fundamental ethos of medical practice contrasts sharply with that of ordinary commerce, and market principles do not apply to the relationship between physician and patient.

At the end of the day the choice is simple. Does the UK want a healthcare system where treatment is driven by profit or one that is driven by the patient? After my recent experiences I know which side of the argument I’m on and I’m pretty certain most of the country is with me.

(h/t and thanks to @cpeedell for the Dr. Relman introduction.)