America is understandably outraged that Michael Jackson was able to buy himself a personal staff of Dr Never-Say-Nos, who supplied with him the IV-drip of “liquid sleep” — among other hospital-grade drugs — that probably helped to kill him.

But it can’t have come as that much of a surprise.

Here in the US, medical care isn’t something that’s administered when the Government thinks you need it. It’s something you buy when you want it — as long as you have the cash. For Britons like me who grew up with the NHS, that can be quite a culture shock.

Most jarring are the TV ads that treat prescription drugs like hamburgers or running shoes. After Jackson died, you could be watching a news broadcast about how he abused sleeping pills and it would cut to a commercial break for Ambien CR, a kind of supersized insomnia medication that releases a second dose into your system halfway through the night.

Drugs companies spend about $4.5 billion a year on this kind of consumer-directed PR.

But that’s not to say I prefer the NHS.

If you can afford a decent health insurance plan, America is a hypochondriac’s paradise — seeing a specialist requires little more advance planning than buying a ham sandwich, very few doctors say no to writing a prescription and because money talks so loudly here, this is where the very latest technologies and procedures tend to be developed.

Despite all that, the Obama Administration and millions of its supporters are pining for a system that bears more resemblance to Britain’s. And given that the US spends an astounding $7,900 a person every year on healthcare (about twice as much as the UK) while about 15 per cent of the population go uninsured, it’s not hard to see why.

But America should be careful what it wishes for. As much as Jackson’s death was a lesson in everything venal about the US medical system, the culture of healthcare as a consumer product cannot be easily undone. And if they think that costs can be cut in half by government intervention while keeping that culture intact, I fear they’re kidding themselves.

Facing the axe

I was debating this with a British friend the other day, and he claimed (during a heated moment) that if you walked into an American hospital emergency room with an axe embedded in your forehead but no health insurance, you’d be given a sympathetic smile, and told to go home and take an aspirin.

But that’s not true. The Emergency Medical Treatment and Active Labour Act, passed in 1986, requires just about every hospital in the country to provide axe-removal services free in such cases. The problem is that the 46 million Americans without health insurance use this law to get treatment for things that wouldn’t have been so serious if they’d seen a doctor earlier. As one medic described it to me, it’s like waiting until two in the morning to replace a box of cornflakes, then buying it from a 24/7 convenience store outside a popular tourist destination.

Maximum danger

Having been rubber-gloved by both the NHS and the American healthcare system over the years, I can report (guiltily) that if you have a decent insurance plan, the latter is usually superior. I’d certainly rather get prostate cancer in America, where the survival rate is 92 per cent, compared with 57 per cent in Britain — a statistic that you won’t hear from the NHS-loving President Obama.

Nevertheless, there’s always the nagging fear on this side of the Atlantic that if you get anything really serious, your insurance will max out. And then you’ll be left with just the bare-bones Medicaid scheme — which typically kicks in only after you’ve bankrupted yourself.

Actually, it’s enough to make you feel ill just thinking about it.

Stitched up

And there are other annoyances.

For example, when my son had to get stitches in his head in the local ER one Sunday night, I paid the standard $50 “co-payment” fee, then the hospital sent me an invoice showing how much the treatment had cost (a whopping $2,859) and how much of it my insurance had covered (everything). Great, I thought.

But then a few weeks later they sent me another invoice saying that, actually, sorry, the insurance company had disputed the charge, so would I mind paying them another $138. A bit irritating, I thought. Then a third invoice arrived, this time from the doctor himself. Apparently his fees ($874) weren’t included in the hospital’s price, so I had to contribute another $65.62.

Americans have a great expression for this kind of thing. “Being nickel and dimed,” they call it.

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