This is one of those issues where a generous fraction my countrymen and women have made spectacles of themselves. This is why the British ask me why Americans don't want health care, I imagine. That and all the fervent cries of 'Socialism!' about the British system.
What's the truth about the Affordable Care Act? Well, it has made certain things easier. For example, people with pre-existing conditions can now get health insurance that doesn't have to come from their jobs. That right there is a HUGE step forward.

It doesn't seem to have changed much for people who already had insurance through their jobs, especially where the insurance was already good insurance. (I know someone is going to disagree with me on this, but from what I can tell, those whose insurance plans changed had insurance that didn't cover the new required items.)

I don't believe the ACA has made insurance affordable, though. I did the math. It is still expensive, even with tax credits. My take-away from researching getting coverage in two American states my boyfriend and I considered moving to, is that for freelancers like us, our out of pocket would still be around $10,000. That's on a 'plantinum' level plan, the best I could find.  I think this will be true for anyone who has pre-existing conditions that require expensive drugs, or many doctor visits to specialists.

On the moderate salaries required to qualify for the tax credits, a $10,000 deduction for health care looks a bit devastating.

I'm not downplaying the importance of the ACA. It is, as I said before, a huge step forward. But it's just a step. A lot more needs to be done. I'm definitely not saying repeal it. But what I am suggesting is that big insurance companies shouldn't be in charge of what happens to health care. Insurance companies are, by and large, motivated by profit. Profit and people's health being linked is a dangerous model. It was dangerous before the ACA and it's dangerous after.

I'm sure some are wondering about whether Medicaid fills the gap here. When a person's wages won't allow them to comfortably or even bearably buy ACA coverage, won't Medicaid do the job for them? Again, on investigation, not really. It will do some of the job for some people, but for others Medicaid will not cover certain important things. Last I looked, it won't cover organ transplants, for example.

On top of that, individual states can deny expanded Medicaid coverage money, meaning a lot of people who might be eligible for it won't be. Texas is such a state. Montana. There are others.

What about Medicare for the elderly? Again, somewhat but not really. For example, in the time of life when deafness is most likely to be a problem, and when the enhanced ability to hear might help an older person stay mentally active and live longer and more independently, Medicare, the coverage for people over a certain age, doesn't cover the cost of hearing aids. How is this even possible? Does the NHS cover hearing aids? I'm  told it does.

I do applaud President Obama for getting us into the twenty-first century, finally. But universal, single payer health care works. It doesn't have to work exactly like the British model and I don't think it would. American doctors have their ways of dealing with patients. I don't think this would change. Doctors need to be at the forefront of designing such a plan for America. Patients also need to be involved. It would also be helpful to have doctors from countries that already have such a system to give advice about what works and what doesn't.

No system is perfect and different cultures are going to have different expectations of their system. But right now, I feel that the American system is still being led by the money. Money is helpful, but it's not the most important thing. I note that here in the UK, everyone has equal access to health care. If you go to an NHS doctor, you have the same opportunity to get good care whether you're poor or rich or middle class. There are no disabled people in wheelchairs being asked to spend the night out in the cold in order to sign up for a spot at a free clinic.

It's hard to imagine yourself being disabled. But  if you think about it, any of us is only an accident away from it at all times. What would happen to you if you suddenly couldn't work a full-time job? I'd like to live in a country, a world in fact, where people's medical care doesn't depend on their income.

And now I'll put 'Dear President Obama,' on top of this and put it in an email.

I had been to Britain a few times before moving here. It's quite a different experience being a tourist than actually living here. Some of the biggest immediate surprises were words.
As they say, two countries divided by a common language.

Here are just a few of the words that surprised and confused me.
British-----------------------------American
Flannel                                        Wash cloth
Cling film                                     Plastic wrap
Hob                                              Stove
Kitchen roll                                 Paper towels
Loo roll                                        Toilet paper
Toilet/Loo                                   Restroom
Toilet                                            Bathroom
Washing up liquid                    Dish soap
Chips                                             French fries
Crisps                                            Chips
Biscuits                                          Cookies or crackers
Scones                                           Biscuits
Aubergine                                     Eggplant
Courgette                                     Zucchini
Maths                                             Math
Trousers                                        Pants
Pants                                              Underwear
Bottom                                           Fanny
Fanny                                              Slang for female genitals
Footwell                                         Floorboard (of a car)

Then there are all the different words for nether parts. This can be particularly embarrassing when, like a small child, you announce, "What's a quim?" You just don't know what things are going to mean here. I thought it was a fruit.

It's the autumn of 2010. I've been in London as a student for a couple of months. Today I'm going to register with a GP, the equivalent of a PCP in an American HMO. This will be the doctor in charge of my general medical care, who will refer me to any specialists I need to see, who will write all my prescriptions. I've chosen a surgery (what the Brits call a doctor's office) based on recommendations from friends in the area. It's about five minutes walk from my apartment, and just around the corner from a pharmacy (or chemist, as they say).

The doctor's surgery is in an old building. The waiting room is lined with about twenty plastic and metal chairs. It's painted in pastel colors and looks nothing like any doctor's office I've ever been in in the US. In those, everything is shiny and new looking, and very clean. This office is clean bu well used , which doesn't bother me. But it is different from what I'm used to. I realize I feel slightly embarrassed to be getting what seems to be free medical care.

There is a strong stigma in the United States against receiving government benefits. Even at my poorest, I never signed up for Medicaid. I have to resist the urge to flee, as there really is no other way for me to get treatment. Also, the other patients in the waiting room are well dressed, and obviously not hurting for money. I ask a British friend if rich people go to other doctors. He assures me the rich are the first to take advantage of free things. And anyway, he tells me, the NHS has a much better survival rate than private doctors.

At my sign up visit, I have to show my passport and immigration documents. I see a nurse who takes my medical history and explains how the British system works. She spent some time in America, she says, so she knows that our system is different. The big reason for the sign up visit, from what I can tell, is that they want to make sure you're not diabetic. She gives me a container and sends me to the toilet to provide a urine sample, which she tests in front of me. She pronounces me free of various illnesses based on this. I blink at her awkwardly and hand her a letter from my American doctor which reveals that pretty much everything she just told me was wrong. I find this worrisome.

I give her a list of my medications. She writes them down, asking me what each one is for. About one of the important ones she tells me 'we don't do that here.' This makes me extremely worried.

I leave the appointment signed up for a GP, but feeling concerned about what kind of care I can get where so  much is wrong about what I've been told.

A week later I see the doctor, a young blonde woman who looks barely old enough to have finished university. My doctor at home was in her forties. This doctor is timid seeming. She asks me questions, but never comes close to examining me. This will be my experience with most doctors in the UK. Only once has a doctor listened to my heart or lungs or felt the glands in my throat. Every doctor I had in the US found some reason to examine some aspect of me. The hands off approach makes me a bit nervous.

I repeat to her what the nurse told me about my prescription. She assures me that the nurse was wrong. They do in fact use the drug I take to treat my condition.

On this first doctor visit, the doctor gives me a printed out green form with my prescriptions on it. I leave the surgery without  paying a penny and take the form to the chemist around the corner. Patients pay £7.20 (now £7.45) for prescriptions. It's possible to get out of this co-pay for various reasons written on the back of the form. If you're poor, or have certain serious health conditions, for example.

Every time I need a prescription filled, I have to take the refill request to the doctor's office and drop it off. It takes two days to get a new prescription and occasionally the doctor will want to see you again before giving you a refill.

That's all there is to it. Every once in a while, I will get a form in the  mail asking whether I'm still at the same address and  confirming which surgery I'm registered with.

The things that are different about this experience have more to do with interpersonal relationships than the medical systems. In the US, I was on a first name basis with some of my doctors. I could email them prescription renewals directly. I could call them on their personal lines. Nothing like that happens here.

Before I came here, my father warned me how much I was going to hate the English medical system. His business partner is English and he complains about it all the time. I hoped he was wrong. There are things I don't love about it. I often feel talked down to. There is not nearly as much explanation about what's wrong or why something is being suggested. I often feel as if I have no choice but to do what the doctor says.

There are techniques to get the patient to comply. I'm not in favor of these because they don't take into account what I know about my own health. But these are just signs of the difference in our cultures. They have little to do with whether the medical system is working.

I've also noticed that there is a general lack of the sophisticated equipment that my doctors had access to in the US. Of course, I was at a fairly prestigious University teaching hospital, so they had a lot of money. As far as I can tell, the lack of this equipment has made no difference to my health. At worst it means test results aren't instantaneous.

In my next article, I'll compare emergency room treatment.

The past three and a half years have changed my views about health care. As an American, I had a lot of different experiences of health care. Because of my experiences, I've long been an advocate of universal health care. I've supported the Affordable Care Act all along, and hoped it would solve many of the problems that I'd witnessed first hand. In two parts, I'm going to write about my experiences with both systems, recognizing that mine are not the only ones out there.

As a fairly healthy kid and young adult, I have no idea what kind of health insurance my family had when I was growing up, or if we even had any. I know that when I was really sick, I went to the doctor, I got medicine, and I got better. I don't remember hearing about people who didn't get to go to the doctor when they were sick until later.

I do remember that when I was 18, I struggled with depression. I asked my parents to help me see a doctor about it and they refused, saying that they couldn't afford it. So I know it must not have been covered by insurance.

I went away to college (university, as the Brits call it) and I was covered by the university health service. In my third year, I was diagnosed with a rather serious health condition. The university doctor wanted me to go to the hospital for treatment. When I told him I didn't have health insurance, he seemed dumbfounded. The university I attended was the University of Michigan, and most of my classmates were from families with more resources than mine, so this probably wasn't that usual for this doctor. He agreed to treat me himself in a series of daily visits to the student health clinic. Because I didn't have health insurance, it was several years before I really came to grips with this health condition or got proper treatment for it. I was studying acting in school and dreaming of moving to California to take my shot. If you know anything about this situation, you'll know that actors work as waiters or barristas until they 'make it.'

What having a chronic health condition meant for me was that I wasn't eligible for insurance except through work. And not just any work. An hourly wage job would offer, at best, major medical, meaning it would cover part of the cost if I were in an accident or were hospitalized for a serious illness, like appendicitis. At 22, the cost of this relatively useless insurance didn't seem worth it to me. I gave up my California dream and took an hourly wage job as a costume designer, paying for my medical bills myself, or more often, just not going to the doctor.

Being in a relationship with someone who was a graduate student allowed me to have health insurance for a few years in my twenties. I got regular treatment for an eating disorder  including medication and therapy. I began to get see a doctor for my chronic health problem. Then, after a couple of years of feeling that my job was a dead end, I decided to go to Africa and teach.

I'd always been a writer, but while I was in Africa I began to take it a bit more seriously. I started a memoir about my experiences there and wrote every day. I hadn't thought about getting published since  I was a teenager, but now the dream of writing for a living began to haunt me again.

I had no access to health care in the North African country I was teaching in, and at around the year mark, I got seriously ill. I returned home and lived with my parents for five months. During that time, my chronic health issue became an acute health issue. I couldn't stop vomiting and hadn't been able to keep food or water down for a couple of days. My poor dad had to take me to the hospital. He was obviously panic-stricken. I remember him picking me up and carrying me under his arm like a small child. He was so shaken that when he checked me into the hospital, he couldn't remember what year I was born. (He told the hospital registration office I was born six years before I was, and three years before he even met my mom.)  I spent several days in intensive care hooked to monitors and an IV bicarb drip. I remember one of the nurses commenting on how thin I was and asking if I had an eating disorder. I'd gone off the medication when I left the country. My eating disorder was in full swing, but I denied it.

I had no insurance at this point. I hadn't been back in the country long enough to even begin looking for a job. I checked out of the hospital a few days later. I was never able to pay the bill. I don't even know how much it was. My dad asked me if I didn't feel some responsibility to pay it. After all, they'd saved my life. I didn't know how to make him understand that whatever sense of responsibility I had didn't come with a built in ability to pay. I knew he wasn't suggesting that I (and he) should have let myself die because I couldn't pay for the life-saving treatment I'd received. So what was the solution?

I moved back to Michigan and went back to the hourly wage job I'd had before I went to Africa. I started getting acting jobs on the side and hanging out with actors and writers and other creatives. I began a search for a better job, one that would give me health insurance. It took a couple of years, but I got one. It was a demanding job, sometimes requiring me to work 60 hours a week with no extra pay. That's what I was salaried for, right? It began to impinge on my ability to do creative work on the side and there were other issues with my boss. I quit when I found another job with a lawyer friend who was also one of the part time actors I'd met while doing a show.

I had a succession of three jobs with health insurance. It became the main goal for me in choosing work. Not what I was good at. Not what I wanted to do. Not whether there was opportunity for advancement. Not what the salary was. Did it have good health insurance?

The first insurance I had was Blue Cross/Blue Shield, a not for profit insurance company. It paid 80% of my medical bills. Later I changed jobs and got a great HMO (health maintenance organization) through the university hospital. I had $15 co-pays for doctor visits (even specialists) and $10  co-pays for prescriptions. My third job was for the university itself. I kept the same insurance. The university paid a big chunk of my premiums, leaving me to pay around $50 per month. I didn't have to think twice about seeing a doctor. Which was lucky for me, because right after I started this job, I had an eye injury that would have blinded me if I hadn't had immediate treatment.

My job involved helping low income people with legal issues, including helping them get government benefits. I saw a lot of people without proper health care coverage, many of them in dire need of it. One of our clients, Maria (not her real name) had MS and was in a wheelchair. She was from a Latin American country. She'd been married to an American, but they'd divorced. She wasn't eligible for Medicaid because she hadn't been in the country long enough.

There was a low income medical clinic that she could have used, but their open enrollment happened only every few months. People lined up to get registered, some spending the night outside to ensure they got a spot. Maria couldn't do this. She was very nearly paralyzed from MS and didn't have the physical strength to manage a night outside in the cold.

Many of our clients were dealing with the effects of not having health insurance. One woman would have been eligible for Medicaid when her  daughter was born with a disability, but because she didn't know this, the time window passed when she could have retroactively applied and had her daughter's birth covered. She was being pursued by collections for her bill and her tax refunds were being garnished. There was no legal remedy for her.

I saw Medicaid provide a safety net for the poorest people, but it didn't cover everything and it didn't give them an opportunity to get themselves out of dire financial straits. Like all public benefits in the US, medical coverage under Medicaid is income dependent. If someone goes out and gets a job that gives them a wage above the cut off, which to be honest is scarcely enough to live on, much less go to the doctor on, their Medicaid will be the first thing  to go. Slightly better household income. No health care coverage. Hmmm. For some, this isn't an option.

In contrast to the people I worked to help, I had world class medical treatment at the University hospital. I feel very lucky to have had the doctors I did. I've even kept in touch with some of them. The worst of it for me was that sometimes I couldn't get all my prescriptions filled on time because the co-pays added up to more than I could afford at the moment. This was rare, but it did happen. I made a good salary,enough to qualify for a mortgage and to buy a car. But still sometimes money was a little short. Not really such a terrible thing given all I'd been through.

The other thing that troubled me was that I really wanted to leave my job for creative work. I was bound to my job by health insurance. Even one of my doctors commented to me during a check up, "You will always have to work." She didn't know she was touching a nerve. I started thinking about how I could get out of my life of working for the man. My father had been a constant entrepreneur while I was growing up, always trying to start a new business and get out of working for someone else. But I was mostly just thinking of doing something that felt like what I was meant to do. I was lucky to have meaningful work, and that was important to me, but it was not creative work and it was very stressful. I could feel myself burning out, becoming too anxious to talk to yet another person in dire poverty, with a host of life-altering problems I might or might not be able to help them fix.

I'd stopped acting because difficulties with my vision prevented me from sight reading scripts at auditions and the idea of having to explain that I had a mild visual impairment to a director I didn't know put me off auditioning completely. I changed my focus from acting to writing, which I called 'acting on paper.'

I started a graduate degree in writing fiction in 2007, working full time and going to school full time. What I hoped was that I'd be able to get a job teaching writing, which would allow me to keep my health insurance and still be close to what I loved doing. It was hard work, but it seemed  worth it. When I graduated in 2009 I was full of hope that I might actually be able to work in my chosen field and have insurance at the same time. It didn't take long for that hope to fade. The teaching jobs were few, the applicants many. I was stuck writing in my 'spare' time.

I started taking editing work, hoping that I could build a clientele and quit my job. I was willing to live on less money in exchange for more freedom and more time to write. But the insurance problem wouldn't go away, and it was extremely risky for me to try and live without it. Even if I could have qualified for health insurance, it would have cost a fortune. Anyone who's done freelance work knows that it's feast or famine. Editing is not scalable, meaning I couldn't just get other people to work for me. I had to do every job myself. I could make a wage I could live on, with some sacrifices, but health insurance would sink the whole boat. I took a low wage internship for experience, living with friends and strangers to make it possible. It got complicated.

In 2010 I decided to leave my life and go back to school, this time in the UK. It would only be for a year, but it would be a year focused on writing, one in which I'd hopefully get a book published. Then maybe I could get my dream teaching job.

In the airplane on my way to England, I heard two American women talking. One of them lived in the UK and the other didn't. Would she move back to the US? the visitor asked the resident. The answer: Not until the US gets this health care situation worked out.

In part two, I'll talk about my experiences with health care in the UK.