Letters from Europe – Health Care
When talking about the US, the first question I get from most Europeans is: “Why don’t Americans want health care?†Every country in the European Union has a national health care system that covers all citizens. Reciprocal agreements are in place that allow any EU citizen to be treated in any EU country.
The implementation of these systems vary widely from country to country but they all offer free, universal care. Free means there is little or no cost for service, the system is funded through some sort of tax. In all the countries I have visited, no one I met was satisfied with their health care system but, no one would consider giving it up and going to a market based system either. My first exposure to national health care was in 1972 in Afghanistan. There I met an American woman who needed a smallpox vaccination. She went to a doctor in Herat for the treatment. Afterwards, when she asked the charge, she was told health care is free in Afghanistan. This was before the Soviet invasion.
My next encounter was in the UK in 2010. My back had gone out to the extent I needed two men and Mary to help me off my boat and to shore. There I tried to take a taxi to a doctor but could not get in the taxi. An ambulance was called and arrived within a few minutes. The medical technicians administered nitrous oxide which gave immediate relief, then drove me to a nearby clinic. There was no charge for the ambulance. The doctor at the clinic prescribed some drugs which Mary got for me at the pharmacy. Being unable to return to the boat we took a room at the hotel across the street from the clinic. After two days I was no better and could not get out of bed. I called an emergency number and talked to a man who offered me two options: he could send an ambulance and I could wait in an emergency room at a hospital, or, he could send a doctor to my room. The second option was much more appealing. The doctor (a Nigerian immigrant) arrived within an hour. He prescribed a different set on medications and gave some other advice. When Mary went to purchase the new drugs, the pharmacist asked my age. On learning I was over 60, she refused payment even though I was a foreign national and had insurance. The new drugs had me out of bed in hours although a full recovery took several years.
Portugal spends 9.1% of GDP on healthcare, about half of what is spent in the US. The national system is funded through general taxes plus social security deductions from the employed. Supplemental private insurance is also available and about 25% of Portuguese purchase this. Both public and private hospitals operate here.
Mary and I sailed to Portugal for medical treatment. Mary was diagnosed with cancer here in Lisbon. Being foreigners with no insurance we went to a private hospital (CUF) and paid everything out of pocket. Over a period of seven months, Mary had surgery, chemotherapy, and radiation. This also involved several ultrasound and MRI imaging studies. The entire course of treatment cost about $30,000 including medications. The price of medications is considerably lower here than in the US. The most extreme example is heparin, a blood thinner. Looking up the price in the US on the internet, I found it was $93 per injection. The local pharmacy here charged less than $4. We found some other American made and branded drugs selling here for 10% of the US price. This is without any government subsidy.
Mary is now symptom free but will require periodic testing to look for a recurrence of the cancer. Another interesting feature of hospitals in Europe (at least in Spain and Portugal) is that they provide an estimate of the cost of a procedure (Portugal) or a hard quote (Spain) in advance. There are no after the fact surprises.
A side effect of universal health care is that governments have a higher financial stake in public health. For example, Portugal and some of European governments have been working with the food industry to slowly reduce the amount of salt added to processed foods. Campaigns to reduce sugar and tobacco consumption are also common. As a result life expectancy is 83.6 in Italy, 81.9 in Portugal, and 78.9 in the US.
Another side effect is that businesses do not have to spend time and money finding insurance coverage fore their employees and employees continue to be covered should they lose their job.
My travel photos are at: https://www.flickr.com/photos/rick-pic/