Different Slants

Seeing the World from a New Angle

Letters from Europe – Health Care

Filed under: Travel — Rick at 9:04 am on Sunday, September 13, 2020

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/


Comment by Bob

September 13, 2020 @ 3:30 pm

Excellent article. Funny thing: I received A bill from some company three years after Joy’s death. I called them and told them I’d forward it because we were no longer together.
America is unique aside from its current emotional breakdown. There is no national identity. A person can be a color–lighter is always much better–or being part of a group, like Irish, Italian, Jewish, German and so on, and find insurance sold within it. Or by profession. Or being a cop or fireman, insured by their cities. Soldiers have their own hospitals in the USA, which has some resemblance to combat, with a higher chance of death. Frequently, former soldiers in my country are treated as irritating residue from old wars and not as the volunteers they once were.
More like: “Take what you get and shut up about it. Who do you think you are, someone special?”
Or by age, i.e. social security (SS) where the acceptable age fluctuates and is a mystery. The recipients of SS receive relatively small amounts each month, and about 10% of that goes to pay for more insurance for drugs, doctors. There are, oh, 50,000 plans to choose from. Surviving on SS without that deduction puts an American below the povery line.
Because America is composed of citizens from more than one hundred countries, there has never developed a national cohesion in terms of caring for each other. I don’t understand this, but if everyone were Greek, or Mexican or German or whatever, there might be a greater concern for how an injured one of them was being treated.
The current world disaster, Covid-19, if it causes Biden to be elected, I believe will create a new comprehensive national health insurance. Americans are dropping like flies, about 200,000 dead by now, and there is a sort of national awakening that inequality of care can still make someone die.
Congress has never forced drug companies or hospitals to sell drugs to the government at low prices like they charge other countries, because politicians need donations from lobbyist to endlessly run for office. Hospitals are owned by shareholders and are corporations. The profit motive is overwheming. Only Congress can change the insanity of health care in the US. Biden will be 78 when he takes office. He might not live out his term. I think he wants to actually DO SOMETHING before he goes.
Or, I sure hope so. My best to you an Mary.–love, B

Comment by Nikolaos

September 14, 2020 @ 12:18 pm

Rick, many thanks for having shared your insight.
A quick question: When you were in the U.K., you had or didn’t have insurance coverage? You wrote that “I was a foreign national and had insurance”; yet, reading the Lisbon part of your post, I think that the “I was a foreign national and didn’t have insurance” version makes more sense. So, I wonder what was the case: When you were in Britain as a foreign (American) national, you had or didn’t have insurance?
Regarding the cost of medicines, even within the European Union there are striking deviations. A noteworthy example is liothyronine’s (https://en.wikipedia.org/wiki/Liothyronine) price in the U.K. and in Greece. According to a 2019 Daily Mail article (https://www.dailymail.co.uk/health/article-7076005/In-Greece-thyroid-pill-costs-1-month-firms-justify-drug-daylight-robbery.html), the price of liothyronine increased by 4,583% over a period of twelve years (i.e., from 4.46 GBP in 2007 to 204.39 GBP in 2019 for a 28-day course). A British authorities investigation is ongoing since 2016 (https://www.gov.uk/cma-cases/pharmaceutical-sector-anti-competitive-conduct); four years later there is still no verdict… Meanwhile, the same pack of liothyronine that costs 258.19 GBP in the U.K. (https://www.pharmaceutical-journal.com/news-and-analysis/news-in-brief/cma-investigates-1600-price-increase-of-liothyronine-over-eight-year-period/20206079.article), in Greece is priced at 1 GBP. All this occurred long before Brexit, when the U.K. was still a full member of the European Union.

Comment by Rick

September 15, 2020 @ 2:54 am

When we left the US in 2010 we bought international health insurance from a UK company. It covered us any place in the world outside of North America. As we aged the premiums increased until we dropped the insurance just before actually needing it in 2019.

Comment by Nikolaos

September 15, 2020 @ 5:44 am

Rick, thank you so much for the enlightening clarification.

Comment by enea

October 16, 2020 @ 12:52 pm

ascolta Rik, prima che gli americani attaccassero la Russia nel 1986 creando il gran disastro del Nuovo Ordine Mondiale obbligando tutti gli stati a dissolversi e privatizzare all’americana la sanità, in Italia (dove vivo) l’assistenza sanitaria era gratuita in tutto (analisi, medicine, cure mediche interventi chirurgici. Ciò valeva anche per gli stranieri che si ammalavano qui da noi. Lo stato italiano poi mandava il conto alla Assicurazione sanitaria del cittadino straniero, se per caso ilo straniero era sprovvisto , l’ospedale mandava il conto allo Stato italiano che lo spalmava su tutti i cittadini nelle tasse indirette. Dopo la privatizzazione cui siamo stati obbligati ad attuare con la vostra pistola puntata alle notre tempie (Nato) il sistema sanitario sta crollando. I medici hanno aumentato le richieste per prestazioni e adesso ne paghiamo di tasca nostra una parte direttamente nel suo studio. Nonostante la deficienza sanitaria gli italiani votano sempre i parlamentari su modello americano e l’Italia ora è privatizzata. Resiste ancora una frangia di ospedali sul fronte sociale, ma si stanno rassegnando perché la Borsa statale tarda arrivare per coprire i costi delle medicine di aziende farmacologiche mafiose. Un Kit di trattamento per la cura della Epatite C , qualche anno fa costava 80.000 dollari, mentre la stesso kit in india costava 4.000 dollari. Per gli ospedali italiani era proibito comperare il kit in India, ordine Nato. L’italiano che fa?…. va in India a curarsi. Entra come turista e finge di essersi ammalato li da loro in vacanza. In tutta risposta, i Marines italiani creano un finto incidente diplomatico marino con l’India per rompere le relazioni diplomatiche e commerciali e sospendere di fatto tutte le forniture mediche. Ho altri mille esempi tutti uguali Il problema nella Sanità mondiali chi lo ha provoca secondo te?

Google translation:

listen to Rik, before the Americans attacked Russia in 1986, creating the great disaster of the New World Order by forcing all states to dissolve and privatize health care to the American, in Italy (where I live) health care was free in all (analysis , medicines, medical care, surgical interventions. This also applied to foreigners who fell ill here. The Italian state then sent the bill to the health insurance of the foreign citizen, if by chance the foreigner was not equipped, the hospital sent the bill to the Italian state that smeared it on all citizens in indirect taxes. After the privatization we were forced to implement with your gun pointed at our temples (NATO), the health system is collapsing. Doctors have increased the requests for services and now we pay a part of our own pocket directly in his study. Despite the health deficiency, the Italians always vote the parliamentarians on model the American and Italy is now privatized. A fringe of hospitals on the social front are still resisting, but they are resigning themselves because the state stock exchange is late in arriving to cover the costs of medicines from mafia drug companies. A Hepatitis C treatment kit cost $ 80,000 a few years ago, while the same kit in India cost $ 4,000. For Italian hospitals it was forbidden to buy the kit in India, according to the NATO order. What does the Italian do? …. goes to India to be treated. He enters as a tourist and pretends to be sick with them on vacation. In response, the Italian Marines create a mock marine diplomatic incident with India to sever diplomatic and trade relations and effectively suspend all medical supplies. I have a thousand other examples, all the same. Who is causing the problem in world health in your opinion?

RSS feed for comments on this post. TrackBack URI

Leave a comment

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>