Fredericksburg, Virginia
The huge popularity of your TV show Doc Martin here in the US has nothing to do with the balmy Cornish setting. What really turns us on are the scenes in the Doc’s surgery, where no one ever pays a bill.

Contrast that with the bedlam of an American doctor’s office. A panicky patient hunched over the front desk waving his insurance card at the frazzled nurse as she waits on hold for a claims adjuster in a distant state to rule on how many haemorrhoids are covered. When the adjuster finally comes on the line she can’t hear him because the panicky patient lobs a barrage of questions and instructions at her. ‘Tell him it’s not a co-pay because I just had one operation, not two. The first time he didn’t get it all and had to go back in, so that counts as one!’ The other patients in the waiting room can hear all this. While they are reluctantly visualising it, the debate shifts to whether the problem qualifies as a ‘pre-existing condition’. Is there a haemorrhoid that doesn’t? Nothing can pre-exist like a haemorrhoid, so you’d better not have one in the good old USA, because your private health insurance might not pay for it.

We are currently in the grip of multiple hysterias but the greatest of these is health care. The Supreme Court is now considering whether the President’s ‘Obamacare’ system is constitutional. But the truth is that We the People, those freedom-loving, liberty-worshipping, government-hating, go-it-alone, do-it-yourself denizens of what our politicians call ‘the greatest country on the face of the earth’, really want a National Health Service just like the Brits have, but we are afraid to say so because it would destroy our cherished self-image as the cowboy who rides off into the distance alone, like Shane, like Randolph Scott, like all of those grimly self-sufficient sociopaths we call heroes.

What Ronald Reagan (cribbing from John Winthrop) called a shining city on a hill has turned into a landfill for exhausted, desperate, insecure Americans who crave the sensible solutions that other, supposedly lesser countries have already found.

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Loath to admit it, however, we project our fears on to people who do not have private insurance and blame them for all that’s wrong. If everybody were privately insured, we snarl, the cohort would be bigger and the premiums would therefore be lower. The uninsured overuse hospital emergency rooms, and when they can’t pay their bills the cost is passed on to the insured via higher prices to make up the difference. And if the uninsured are really poor, Medicaid — i.e., welfare — picks up the tab, which raises everybody’s taxes.

This situation has given America a brand-new persecuted minority. The word ‘uninsured’ has taken on the same freighted tone as ‘deadbeat’, ‘welfare cheat’, and ‘homeless’. But of course we must not let it be known that we think this way. Whenever you hear an American confess to having no private health coverage, check out those around him. Note the slight pause before they respond, watch for the slow blink, followed by the quick wiping clean of alarmed features back to bland neutrality. We’re good at this; nobody can do the pause-blink-wipe number like an American trying to appear unprejudiced.

There are as yet no generally known anti-uninsured slurs, but they are bound to emerge. We may call them ‘sickniks’, or ‘toddies’ for the hot lemonade and whiskey they are reduced to taking for double pneumonia, or maybe ‘branders’ after those characters in westerns who cauterised their own arrow wounds, though that might suggest an element of courageous stoicism we are unwilling to grant. The slur that comes closest to describing how Americans view the uninsured is the Southern definition of the lowest of the low: ‘poor white trash’. But the problem here is that we are so dominated by political correctness that we are compelled to make everything we say sound ‘inclusive’, even slurs. Poor white trash would have to be changed to ‘poor white trash of all races and classes’ before anybody would touch it, so it’s probably best to stick to Marie Antoinette’s ‘them’.

In addition to our Shane complex, I see two other reasons for our ambivalence over government-run health care. One is that ‘Doctor’ is our only title. If we had real titles like Duke, Marquess, Earl, Viscount, Baron, Sir, and Dame, we would not bow to doctors as we do. You have no idea what we can do with ‘Doctor’. In my day, I had men try to pick me up by claiming to be doctors, or getting a friend to introduce them to me that way. Now that our doctors can advertise, their seigneurial bent is hard to miss. In one telephone-directory ad for a gynaecologist, the Titled Person is pictured sitting on his desk wearing a jaunty smile while in the headshots surrounding him are his nurses and secretaries, all gazing adoringly down: Phoebus the Sun God, ringed with appropriate satellites. Would you make the Sun God work for the government? (American viewers of Doc Martin were delighted to learn that it’s mere general practitioners who are called ‘Doctor’ in the UK, while surgeons are called ‘Mister’. To us this is lèse majesté).  

The other reason for our ambivalence is our supposedly perfect constitution. In actual fact this revered document is a pipe dream of the enlightenment, an example of an overly optimistic view of politics and human nature that prevailed at the time it was written. We have never ironed out all the differences between federal and state governments, what each should do and not do, guide and be guided by, rule on or stay out of. The confusion is such that anything can be called ‘unconstitutional’ if enough people say it is. The good old USA is a screwed-up mess, and health care is just one of our many potential calamities.

I am so exhausted from being an American that I said to hell with it and decided to lose myself in Doc Martin. When insanity threatens, eccentricity rescues, and those Cornishmen have got to be the most eccentric people in the scepter’d isle.

This article first appeared in the print edition of The Spectator magazine, dated