June 23, 2008

The biggest difference

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.


sarah said...

I'm so glad your foot is healing! Health insurance is one MAJOR thing that I'm very much looking forward to when I move to The Netherlands in August. It'll be the first time I've had insurance of any sort in five years & I can finally go get some things checked out without going broke.

Anonymous said...

This is the same old Anonymous as usual! I find this just so incredible. I grew up in a country with FREE public health care, so I even find paying for the insurance here a bit funny. It's terrifying to hear your story from the other side of the fence. It's one thing I've never understood about the US.

Once you get your insurance papers, your local pharmacy will just hand over your prescriptions with no cash or ID needed. They will already know your insurance details from earlier, and will tell the company directly, so you can sort it out directly with the insurance co. (I just wanted to warn you so you don't fall over from shock when that happens!)

BTW isn't it cute how some Dutch people say "recipe" for "script" in English? The Dutch word for the two is the same.

Another American Expat said...

Sarah - I know exactly what you mean. I can't WAIT to go to the dentist for the first time in 4 years. Dental insurance is almost becoming unheard of in the US, isn't it?

Anon: one thing I'm grateful for is Michael Moore's Sicko, because it helped my non-American friends understand a bit about why health care is such a huge deal to me.

Also, let's say I was lucky enough to have health insurance in the states (which my employer and myself would be paying for). I'd still have to pay a co-pay to see a doctor (anywhere from $20-$40), and then I'd need to pay a co-pay for prescriptions as well (again anywhere from $10-$40). So the fact that for 9.70 Euros I have actually paid for my medicine completely... that just astounds me. That is LESS than a co-pay would be in the US. amazing.

Tooms said...

Some people don't just go into debt. Some people just die.

When I was working as a celebrity assistant, my boss was working on a project where she was interviewing people influenced by the insurance system, and I was coordinating everything from setting up the appointments to following up and transcribing the interviews from the tapes. Basically I spent every day for six months or so with people who had lost daughters, husbands, and (were about to lose, because they were terminal) their own lives due to lack of health coverage. There isn't always a clinic who will help you. Sometimes there's just nothing. And most Americans are unaware that these people even exist.

I know you think I represent the Evil man when it comes to corporate infrastructure in the US, but this is one of my pet issues as well, in part because I work with insurance companies and my family works in health care. On my own end I just do a lot of petitioning to add people to the system when possible - domestic partners, older children and dependents, etc. - because every person covered is another person who doesn't have to live with those fears of what might happen. I lived without insurance for about ten years myself, and it was very very scary whenever I got sick, to wonder, am I just sick? Or am I seriously fucked?

Anonymous said...

My God, Tooms, that's just horrible.

Tami: I have got Sicko here and will watch it in the next week or so. I picked it up the other day, I'm always interested in learning about foreign cultures so naturally the US is high on the list (a good dose of reality to counter the bizarre pop culture we're showered with!)

BTW you most likely will have to pay a 'co-pay' (called eigen risico here, literally 'own risk', but I only know about my own personal insurance so won't give you info that could be wrong. I think that most people have a small eigen risico, maybe 200 euros a year, that they're responsible for. How it works is, once your insurance is set up, the pharmacy will hand you medicine (or the doctor or specialist will see you) and you don't ever pay them anything. If you have an eigen risico amount to pay, the insurance company will send you a bill for it. Once you hit your eigen risico amount for the year, the insurance co will just send you a statement.

If you don't use any services, or only a small amount, for the year, you will get a small credit, but sadly for my health I've never been in that situation :-(

Also, once a year you can change your health insurer if you want. That's always at the end of the year. It seems to me that they're all pretty much the same (and they certainly cost the same) and I'm happy with mine, so I've never bothered, but just so you know. You will see posters/ads about it, and you can ask your colleagues if you're curious at the end of the year, they'll translate for you. You can also change your policy at the end of each year if you want.

Don't assume anything when it comes to insurers here. You can change your policy to something with a lower eigen risico and even pre-existing conditions/medications will be covered (weird I know).

Hmmm what else. If you ever have to pay up front for something (I can't think what, but once or twice I have had to) then you can make a claim on your insurance. They always seem to process and pay up really quickly. Yes something in this country is actually efficient! (Probably the only thing!)

Anonymous said...

Ugh that was really badly written.

To clarify one part:
Once you hit your eigen risico amount for the year, the insurance co will just send you a statement.

What I meant was, once you have hit your eigen risico amount for the year (let's say it's €200), then the next time you have to go to the doctor or get a script, you naturally won't receive a bill. Instead, you'll just get a statement through the post letting you know how much it was and that you don't have to pay it.

If any of my other gibberish is confusing and you're curious, let me know!

Another American Expat said...

Thanks for all the info, Anon! one of these days, you'll have to leave your name in your comments. :) let me know what you think of Sicko when you're done.

Anonymous said...

Last comment on this post I swear! The legal minimum eigen risico is €150 (for the year). I'm afraid that I don't think that there is much info on health insurance in English (for obvious reasons!) but this (http://www.kiesbeter.nl/zorgverzekeringen/)is the site you need when you have any questions. Perhaps a friend or colleague could help you navigate. Kiesbeter.nl is your go-to place for any and all health coverage questions, so if you have any I recommend asking a friend for help with it. Just to grab a random example or two: You have the right to see your own files (that a doctor or specialist has on you), and the health insurer can legally charge you for a copy. Or: You don't need a referral in order to see a physiotherapist. Everything you could possibly need to know is in there.

A Touch of Dutch said...

Very good post!

I agree. The health care in America is very poor. And very sad. Unless you have health care. Then it is a different ballpark. If you've ever had Kaiser insurance, you have a 90% chance of not seeing your usual doctor and feeling as though they've put you on a conveyor belt.

Nomadic Matt said...

The health care in america is great....if you are a senator. for the rest of us, it's expensive. we spend the most per capita on health care, and contray to what most americans think it's not the best in the world.

Zany Zen said...

This post made my eye well up because it reminded me about the compasion that exists in the world that's largely absent in the US. I too have been a victim of the US "health care" system. I don't want to go into the details, but I had to owe tens of thousands of dollars for an apendectomy. It just sucks having to walk on egg shells even with decent health insurance, as there are deductibles and co-payments to be made; and there is always the possibility of the insrance company refusing to pay for certain medical services.

I once had a dream that took place in Canada. I walked into an ER for some ailment and got treated on the spot. I remember asking how much I owed for the medical I receiced and was told I had to pay nothing. I cried tears of joy and felt overwhelmed by a feeling of lovingness for having been treated by such a very compasionate health care system. But then, I immediately woke up in on my bed, in my room, in the United States.

Contrast the walk in and pay nothing hospitals in otehr developled nations to the US system. When I visited the ER for adominal pain, I had to fill out numerous paper work while suffering in great pain. The nurse asked me if I had health insurance and a whole bunch of other questions. My total wait time after completing the paper work was around 2 hours until I was seen by a doctor. The pain was so incredible, and I was feeling extremely cold, that I walked outside in the warm sun and curled up in the fetal position on the sidewalk. yada yada yada, I was slapped with tens of thousand of dollars for an apendectomy.