When you think about the entire globe, the cultural differences between people in North America and Europe aren't that big of a deal. But the one thing that separates specifically the United States from say, the rest of the developed world, is lack of affordable health care. I can not emphasize enough how huge of a deal this is, but I'll try by way of example.
I moved to NYC from Paris in October 2006, and a few weeks later I accidentally cut my finger pretty badly while I was at home in Brooklyn. I was working full time, but I didn't have health care, which is entirely normal. I bandaged it up myself, but later in the evening the wound opened up again while I was out at a bar. It looked worse than it was, honestly, but blood always freaks everyone out. I was shuffled outside, and a nice Scottish girl demanded that I go to the hospital right away for stitches. It was pretty obvious that's what I needed - again, the cut wasn't going to kill me or anything, it just was too deep for a simple bandaid. The thing is, I didn't have health insurance. So I couldn't go to the hospital. That was that, there was no "well maybe I should anyway....," the fact was that there was no way I was willing to pay hundred and hundreds (if not thousands) of dollars to get stitches in my finger - and also wait for hours in the emergency room until someone could see me. I just couldn't afford that. Every single one of my (American) friends that I was with understood that, but the Scottish girl just kept saying "but this is crazy, you need stitches, then you'll be fine, why won't you go to the hospital?" as though I was trying to prove something about how tough I was being. It wasn't about being tough, it was about reality. In the US, just because you happen to live there and work full time and pay taxes, that doesn't mean you have the right to get stitches if you cut yourself. This is the way I was raised, this is what my society taught me. This seems normal to me.
Anyway, I bought a huge pile of supplies from a pharmacy, bandaged myself up properly, and my finger healed slowly - there's still a scar, and the inside knuckle of my left pointer finger is still incredibly sensitive, but that's all fine. I don't have a big, scary story about getting hit by a car or breaking my leg without health insurance, because honestly, if something like that happened, there's no way I would be in Europe right now. I would be in debt for the rest of my life, like millions of Americans are right now.
I mentioned a few weeks ago in this blog that I fell off my bike, right? I was pretty banged up, but it didn't occur to me to go see a doctor, even though a couple different people told me I should just get myself checked out. First, I thought "it's nothing, I just scraped up my leg." But second, I still have this American mentality in me that says "you can't afford it, and you don't deserve it" - even though I know both of those things aren't true. So I didn't do anything about my cuts and scrapes, I just tried to keep everything clean and bandaged. Then, a few days ago, I noticed that shit, my right ankle was still swollen, it had been over two weeks, and it seemed to just be getting worse. The wound on the top of my foot wasn't scabbing up the way it should have been (which meant it wasn't healing), and this was becoming not only painful, but annoying. I haven't been able to wear heels in over two weeks! I would avoid running after a frisbee if someone threw one my way! Not good. So I finally freaked out and went to talk to a pharmacist in my neighborhood this past Saturday.
The pharmacist took one look at my foot and told me to go see a doctor right away, because I had an infection. Since it was a Saturday, I had to make arrangements to go to the hospital, rather than just go see my doctor (I actually haven't picked a doctor yet). Just the words "go to the hospital" scared me to death, though I kept telling myself, "okay, this won't be like it is in the states, it won't be like it is in the states," but I still took 200 Euros out of the ATM machine. The thing is, I do have Dutch health insurance, but I just literally signed up for my plan and I don't think I'm in the system yet, so I had to do the whole thing as if I'm not insured. This wasn't a problem, and I kept getting assured that I would be reimbursed by my insurance company.
When I got to the hospital, the American in me expected to be there all day, which was a bummer, since I had been planning on enjoying my Saturday. Instead I waited about 3 minutes before someone called my name. I wasn't asked to fill out forms or show ID. The doctor took a look at my foot, said "yup, you have an infection, but it appears to just be local and you simply need to treat it 3 times a day with antibiotics." The entire process took no more than ten minutes, he wrote me a prescription, shook my hand, and sent me on my way. And that's... it? Does anyone need to see my passport? Anyone want to charge me 50 Euros just for walking in the room? No? Right... because... this isn't the US.
The pharmacy was just down the hall from where I saw my doctor. I handed the woman my slip, give her my phone number, and waited for it to be filled. Ok, my brain is thinking, this is where I get charged. This is the scary part. Five minutes later, my prescription was ready. "That will be 9.70 Euros please. And keep this receipt, be sure to use it to get reimbursed from your insurance company." And that was that. Less than ten Euros. That's what the entire process cost me, and if I feel like it, I can get that 9.70 reimbursed. At no point did anyone ask me for ID and make photocopies. At no point was I ever given a different type of treatment because I'm a foreigner who doesn't speak Dutch. It's very simple, very obvious - but so incredibly foreign to me. Imagine that, Americans. Health care being a basic human right.
I've been using these antibiotics for just a couple days and my foot is almost totally fine. After 24 hours, the wound started shrinking and the swelling went down significantly. If I had just done this when I fell off the bike, I would probably would be walking around in heels right now.
I'm sure that somehow, in the US, there are clinics and doctors and special programs that would provide something somewhat similar to what I described above. But I'll tell you something: I wouldn't really have any idea where to find them, and I have tried. I went to a public clinic once in New York for an exam - the type of place that exists specifically for people who don't have health insurance. It took me about 30 minutes to fill out all the forms, I had to provide my ID, social security card, pay stubs, and some other paperwork. Then they charged me $175 USD and required me to pay up front (before I even saw the doctor) and in cash. When I told them I only had $100 on me, they gave me directions to the nearest ATM machine. I had to leave the office, walk down the street, get more money, and hand it over before anyone would see me... and this was, again, a "public health clinic." The actual exam took about 10 minutes, and I was in the office for over 2 hours. I spent most of my time looking at advertisements for different drugs, which were hanging all over the walls.
It's not about the language, or the food, the religion, the time we eat dinner, or even the legal drugs and prostitution that really create such huge differences between the Dutch and Americans. It's not a Dutch vs. US thing at all, it's a US vs. The Rest Of The Developed World type thing. And I've got to say, I just don't see myself ever being able to give this up - this amazing privilege of being treated like a human being if I'm sick. There will always be a part of me that sees this as really special, and not just the way everyone else is doing it. I hope so much that Europeans fight against the privatization of health care, which is slowly starting to happen (but is nowhere near what it's like in the US), and pressure their governments to keep health care affordable for everyone. No matter who wins the next US presidential election, I'm not holding out hope for universal health care in that country anytime soon, and that is just simply a disgrace.