Four months after I graduated from college, I moved to Greece and had my first experiences with a universal health care system. Before that, I had been a dependent on my parents' health insurance, and didn’t have to think about the care and feeding requisite to having one’s own private insurance policy. And so as a young adult, I was a recipient of universal health care before I ever owned my own personal insurance policy. Back then, I didn't know that health care could be a headache.
I didn’t have any money to support myself when I arrived in Europe and I didn’t have any connections to help me find a job. I just threw myself into Greece’s lap, like the presumptuous upper-middle class American kid that I was, and trusted that she would take care of me. After all, I’d hitchhiked all over the United States and never had a problem. I’d ridden every Amtrak train line in America thanks to the free train passes my father received as an Amtrak employee. I had visited every state and every capital with no money, just my flute, which I played for money in train and subway stations all over the country and the gift of the gab. Again, no problems. And so I arrived in Europe believing that the world is a friendly place, people are mostly good, and I would be okay no matter what.
It turned out busking didn’t pay in Greece. I had been a gardener in Marin County, California the summer before, which paid for my rent and food in California and as well as enough for a plane ticket to Europe and a couple hundred dollars. I figured they would need gardeners in Greece, too. Olives to be pressed and oranges to be picked.
I showed up too early for olive and orange season. Back then, I was a screaming with my head up the ass type of feminist. Meaning I reacted with indignant horror when any cleaning or cooking jobs came my way in Greece because that meant serving the man. (I am still a feminist – I just love cooking and cleaning and serving good food to my man now, too.) The only non-domestic job available to an illegal immigrant girl like me who spoke no Greek during non-tourist season was bargirl. And so it became my job to wear a flattering dress, stand in the middle of the bar looking pretty, and if I felt so inspired, I was encouraged and paid in cheap champagne to climb onto the bar top and dance. Somehow this was a more feminist way to go in my 22 year old mind.
But I digress.
We were talking about health care.
I barely got paid at this Cretan bar. I made enough money to support my cigarette and diet coke habit, plus maybe eat one gyro a day, and pay for my bed at the hostel. When my dress became too grody to wear any more, my boss would grousingly buy me a new one. It was like that.
Then one night I nicked my thumb on a beer bottle cap. When I awoke the next morning, a strong dark line was running from the nick in my thumb to my wrist. An hour later, it had traveled another few inches up my arm. So this was what blood poisoning looked like, right? I had an idea that blood poisoning could potentially kill you. And so I walked to the hospital. When I arrived, there were no people in the waiting room. A doctor came out to see me in about five minutes. He looked at my arm. He gave me antibiotics. I took them. The line faded. I realized later that I hadn’t paid anything for the doctor visit or the medicine, but just figured I was being sneaky and had gotten away with a free visit.
Seven months later, tourists were trickling in, and I spoke a little Greek, so I got a job working in a restaurant. (I was an awful waitress. Once I accidentally made Greek coffees for a couple of English tourists with salt instead of sugar and forced them to drink it, telling them that they had horrible manners if they didn’t finish it all. English people care more about polite than anyone. I also routinely served people the wrong food, forgot orders and was known to burst into tears if Greeks made fun of my pronunciation. It is good that I am not a waitress anymore.) One day, I was carrying out the garbage, I swung the bag over my shoulder to carry it out, and a broken ouzo bottle grazed my leg, slicing a 6 inch gash open in my calf. My blood actually did that pulsing thing as it pumped out. My boss took me to the hospital. They gave me a tetanus shot and stitched it up. Again, it didn’t cost anything, although my boss complained about the mess I had made in his car. It wasn’t like they did a great job stitching. They used a bigger gauge thread than I would have liked and only gave me 9 stitches for this huge cut. But then I didn’t take care of it, kept on walking around, and swimming every day in the not so sterile Mediterranean sea, and my cut got infected. All in all, I'd say Greece took care of me. It was a tough kind of love, but I came out a better dancer. That scar on my calf? It's my Greek souvenir.
After a year in Greece, I lived in Spain for a year, still poor as dirt, trying without much success to sell timeshares. Spain, too, had some sort of universal health care in place, so I didn’t have to think much about getting medical attention when I or someone I knew got hurt. When I threw my back out and had to go to the doctor, when my friend Majo had to get her wisdom teeth out, when my enemy Andy got his face glassed by the Spanish mafia for being awful, those pain pills, extractions, stitches were all free and high quality, too! And I suspect in part, since Spain is a richer more educated country than Greece, Andy barely had a scar at all.
I had my first psoriasis flare up when I was 18. The dermatologist told me I had an incurable skin problem which would only go into remission if I lived a low stress life in the tropics. If I chose to live a stressful life in the cold, I would need to become familiar with the rotating and ever evolving battery of treatment options. I wasn’t ready to live a low stress life in the tropics just yet when I was 18, so thanks to my parent’s health insurance, dermatologists had me bath in tar and stand in UV beds in hospitals every day for weeks to get my scabby angry skin back under control. It worked. In Greece, during the cold rainy winter, my skin flared badly for a while when I was working at the bar, and there were no tar baths or UV beds available. I did go to the pharmacy in Greece and told them what I needed for my skin and they ordered it. When it arrived, it cost me nothing.
When I returned to the US, I got a job at the Exploratorium, a great science and art museum in San Francisco. The job came with health insurance. Along with the stress of a 40+ hour job and the requisite administration that it takes to run one’s life in America, came my psoriasis. Although I had insurance, I had to go first to a primary care doctor, who would diagnose me with psoriasis, then send me to a dermatologist. It was up to the dermatologist to decide what to prescribe for me. I really appreciate that doctors keep up on this stuff, but I also really appreciated being able to self prescribe for something straightforward and not have to go to two doctors before making it to the pharmacy. Especially because those doctor visits are rarely covered on the first try. Luckily, we had a great HR department at the Exploratorium, and they dealt with my insurance paperwork for me when it got too challenging.
In the eleven years that I’ve had an insurance policy in America, I have often been unable to get reimbursement for visits to doctors offices. Sometimes it’s a box that got checked wrong, or a form I neglected to fill out. There’s always a bureaucratic dance to do, which always takes hours. I have managed to navigate the daunting bureaucracy which comes with attending a massive college (22,000 students in the undergraduate body) and traveled all over the world. I’ve built many businesses from the ground up and successfully reinvented myself a few times in ways that others thought couldn’t be done. One of my clients has nicknamed me the Pitbull Research Librarian for my research abilities and follow through. But insurance claim rejections do me in. The customer service death spirals. The impenetrable agents. The tornadoes of forms. I have cried many times with frustration over insurance claims and I don’t normally cry easily.
I am not alone in this. My best friend is in credit card debt because she couldn’t afford to pay the $10,000 for her bunion surgery (she’s a high altitude mountain guide – the job pays crap and doesn’t come with health insurance) in addition to her student loans, which were for a state school. State schools are supposed to be cheap, not send you into a lifetime of credit card debt. It’s not as if she keeps buying too much fancy underwear and diamond tennis bracelets and that’s why she’s in debt. A budget college degree and foot surgery are the root of her debt problem. She may be a great climber but her mountain of debt may be insurmountable.
(Sidenote: Obama put some controls on the credit card companies so that they can’t mess with people as much as they have been doing in the past by jacking up their interest rates to levels that couldn’t ever reasonably be paid off. I didn’t hear conservative republicans complaining about that.)
Today I am 37. I work for myself. I am not married to my partner and so I am not eligible to be on his health care plan. (And I am almost glad in a way, because keeping a job just so that you can keep your health insurance is a horrible kind of golden handcuffs to have to wear and I would feel guilty contributing to his continuing need for those shackles.) And so I have private insurance.
Over the few years that I have had private health insurance with this particular company, I have been to the doctor twice. Once for a torn muscle, which happened when I was working out, and one for some persistent itching in my, umm, nether regions, for, it turns out, eating too many tomatoes. It was relatively painless to go to the doctor both times. For the torn muscle, my doctor prescribed a pain relief patch, which I could apply directly to the injured area instead of having to ingest a whole lot of ibuprofen. But I was worried that my insurance wouldn’t pay for it, so I never picked up the prescription. For the too many tomatoes problem, after making sure I didn’t have worms with a piece of scotch tape, my doctor diagnosed it as too many tomatoes but suggested that I get a battery of testing done just to be sure. I was pretty sure that my insurance company would fight back about paying for those tests, and I would end up having to spend at least one full day dealing with paper work or just coughing up the money to pay for them. And so I learned to control myself around the tomato bush and the nether regions problem ceased to exist. It would have been nice to get that patch and to get those tests, but that is a luxury which those of us with ghetto insurance and/or little time on our hands to manage life’s bureaucratic snarls cannot afford.
Then last November, I was a month late paying for my super basic health care policy. I was distracted because I was busy getting audited by the IRS. (It took me, my accountant and the IRS about 150 hours to figure out that I owed them $191.25 for 2007.) Because I paid late for my health insurance policy, I was dropped. I re-applied. A month later, they sent me a notice to let me know they had received my application. A month after that, they sent me a letter saying I might be denied because I had had problems with my torn muscle and nether regions which I hadn’t disclosed. I wonder if the IRS and the insurance agents go to the same school. They are real pitbulls with their research. It was an honest mistake. I truly had forgotten about those visits, or I would have happily disclosed them. I wrote a long letter describing in excruciating, even graphic detail my history as a muscle tearing tomato eater and the resulting doctor visits. Because both issues were completely resolved without further problems, they gave me a new health insurance policy. If I had had any previous issues that made them raise more than one eyebrow one centimeter more, I probably would have been rejected, as have most of my friends who are bad candidates for health insurance because they are: over 40, went on an antidepressant once, travel too much, etc. I decided to lower my premium, since I had been paying $120/month and didn’t think those two doctor visits without medicine or follow up were worth all of that moolah. So my health insurance premium costs me $67 a month and has a $7500 deductible. When I got the welcome package in the mail, I called them to make sure I understand how the thing works, as the welcome package didn’t explain it very well. My new plan allows me to go to the doctor three times a year, but it has to be a check up or one of two urgent care visits, not to be confused with emergency visits. The muscle and the nether regions problems would have counted as urgent. I am to pay a $35 co-pay at each visit. I am not covered for any prescriptions. If I go to the hospital, for example, if I break my arm, I must pay for the first $7500 towards costs before my insurance policy pays 60% of the remainder. I have to pay $7500 before anything really kicks in at all, besides those three $35 doctor visits. Sometimes I wonder how my blood is doing. I wonder if I should get a mammogram. I wonder if those weird shaped moles shouldn’t come off. I wonder if there’s a way to fix my ingrown toenail without it costing me a fortune. I can’t go to the doctor for any of these things and not pay out of pocket for it. That’s what the insurance agent told me. And so I am happy that universal health care is coming to America.
Did you know that the US is the only so called ‘modern’ country in the world, which up until March 23, 2010 did not have some sort of universal health care?
It is true.
Here’s a map of countries that are covered by a single payer universal health care policy (blue), have universal health care coverage through other means (green), or have no universal care/data is not available for them (gray):
And I gotta say, the blue countries you see there are pretty darn impressive with all of that health care. My kiwi roommate used to tell me bedtime stories about health care in New Zealand that made me gasp and drool as if she was talking about Caffe Mario’s zambaglioni tiramisu in Florence. My British friends kvetch about their system plenty. They complain that foreigners get faster better emergency treatment than they do. But when I press them for examples, how did that free laser eye surgery they had go? what about the time they had to have their shoulder operated on in a pinch? what happens when they have to go to the hospital, the British people I have spoken with are actually quite proud of their medical system. And they would like for it to get even better.
Let me tell you the story about my Canadian uncle Sean...
Sean was diagnosed with brain cancer right after he turned 70. He had several tumors in his head and was expected to live only a few months. But despite his terminal diagnosis and his age, there was no question that Sean would receive the highest possible level of care. His personal finances and complete lack of private health care premium were non-issues. In addition to receiving the highest levels of treatment available in the world for treating his kind of cancer, Sean also had a nice private room at the hospital with a beautiful view. The food was pretty good. There is no doubt in my mind that he had access to the best doctors available, and that they treated his cancer with far more sophistication than a 70 year old man without a ton of money and fancy private health insurance would have received in the US. When it came time to die two years later, the hospice care was amazing. His wife, my aunt Sarah, was attended to as well, not only with help around the house so that she could focus on Sean, but also with therapy. I wouldn’t be surpised if they paid for her massages either. Sean’s passing was the most graceful, dignified death I have ever heard of. And it was in part because of Canada's universal health care system.
And now I will tell you the story about my expat uncle Roger in France...
My uncle Roger smoked his whole life and he had a crappy set of lungs with an autoimmune disease which did nothing to support that smoking habit. He got sick and then sicker, then split for Paris, where he could live that writer/artist’s life, and die in peace without burdening his family. While in Paris, he collapsed from having such funky lungs. And they went and gave him a lung transplant. They gave a fresh pink lung to a dying smoking man in his 50s! In America, you have to be a 7-year old white kid with rich, resourceful parents and a high IQ, or you have to wait a very long time in order to get a fresh lung. They gave him a new lung and he wasn’t even French. They have extra organs in France because when people die there, their bodies become property of the government. (I bet if you had some religious belief that prohibited the government from chopping up your body so that others could live with it, they would leave you be, but most people die and their bodies get harvested for their organs.) And so that is how my uncle Roger became the world’s longest living lung transplant recipient. He lived for 15 more years and kept on smoking. French doctors had him on a boatload of drugs so that his body would accept the lung. He didn’t have any money but he had a really good life over there.
Roger's daughter adds, "I think it's somewhat relevant to note that he was a *guinea pig* of sorts - (which he agreed to do, and understood the potential risks) this was a *very* exploratory surgery (as I understand it, the first in France of an alfa1-antitripsin to have this surgery)...and in fact I believe the lung donor had the *wrong* blood type for him which caused him to have to take boatloads of anti-rejection medicines. I think a big part of the reason that he received good care was because he was being "studied" by a lot of medics and researchers. Also, he did maintain a regular payment schedule with the hospital, and he did have to pay out of pocket (reduced cost) for a lot of his medications. He died owing an enormous amount of euro to the system but that did not preclude him receiving care, and since he diligently made an effort to make a payment (very small, about $100) each month I think it kept the health system "happy" and by extension did not interfere with his resident alien paperwork which he was always terrified would be challenged (and he believed would have been much more likely to be challenged if he did not make payments.)"
So then about 15 years in to his new lung transplant, Roger came to visit his kids and meet his grandkids in America. While visiting two of his kids in the woods of northern California, he had a car accident. He was out of driving practice from living in France for so long. He drove it his loaner truck straight off of a cliff and crashed into a bunch of redwood trees. They airlifted him out and got him to the nearest hospital. His kidneys went septic from being off of those drugs and his body started falling apart, probably in part because of the stress of that accident. He spent three days in the hospital sitting bolt upright, hallucinating a bedside chess match between a non-existent French man and a non-existent Algerian while his distressed adult children tried to get him to snap out of it. Meanwhile, his French doctors made themselves readily available to do anything and everything to make sure he had the medicines his body was now used to. By the time he got out of the hospital, his kidneys were shot. He was 64 at that point, and it unlikely that he would be able to get a kidney transplant in America due to lack of donors. A 64-year old smoking, drinking lung transplant is just not as worth saving in this country. Meanwhile, his kids were getting buried alive in Medicare papers. They bickered about where he would live, in the country where it is peaceful or the city where it is stimulating. He would now need dialysis every other day, unless he got new kidneys. The day before his 65 birthday, he got himself on a plane and flew back to Paris. He disembarked, demanded a proper cup of coffee, collapsed again, and woke up in the hospital. A new pair of kidneys was much more likely to happen for him in France. In the meantime, his dialysis was paid for by the French government. The subway in France is cheap and easy. Unfortunately, he never fully recovered from that accident, but his last days were dignified, and he received excellent medical care.
Both of my uncles could have come to the US and gotten medical care and both of them chose to leave the country because they believed they would receive better care elsewhere.
And this is what health insurance looks like to me for W-2 employees in America...
My partner, Joseph, has a good job. And he’s been at it for 12 years now. His health insurance currently costs about $1,300.00 a month (yes, that’s over $15,000 U.S. dollars per year). He pays $171.24 per month out of his paycheck, and the balance is paid by his employer. Both of his kids are covered by it. Both of his kids actually have double coverage because their moms have jobs, too, and Joseph STILL ends up paying something for doctor visits.
When Joseph had to go to the hospital because he was in a motorcycle accident, it cost $100 at the outset and we are waiting with dread for the bill to come. Joseph didn’t even go to the hospital right when he had his accident (despite what turned out to be multiple rib fractures) because he knew that in spite of his high-end insurance policy it would end up costing him money ($100 co-pay plus $300.00 deductible before any coverage applies, then the insurance covers 90% of the rest (if he goes to a preferred provider plus the paperwork and hassle of the administrative follow up). It was only after he started coughing, a lump suddenly appeared on his back and he didn’t recover right away from the coughing spell that I demanded we go to the hospital. In the middle of the visit, the insurance information person came in to get all of the facts about our visit. I would have preferred to focus on Joseph’s diagnosis and treatment in the middle of the visit rather than how he would be paying for it. It felt like a waiter asking to see the contents of our wallets before delivering the main entrees to our table. When we told them it was a motorcycle accident, everything changed. They said his “medical” insurance would reject the claim altogether and car insurance would have to pay for it which would be an entirely different set of co-pays, deductibles, limits and increases in premiums (none of which is included in the aforementioned $15,000 per year). We'll see what the bill says when it arrives.
A couple months earlier, Joseph’s 6 year old was sick in the middle of the night. They had to go to the emergency room. They were treated fast and well. In spite of the double coverage, that visit also cost several hundred dollars out of pocket. Between Joseph and the child’s mother they pay over THIRTY THOUSAND DOLLARS A YEAR for medical insurance.
Last year, Joseph went to the doctor for a routine check up. He’s healthy as a horse. Has the body of a 30 year old and he’s 47. It turns out annual check ups (or bi-annual or apparently any preventative check ups) aren’t covered by his insurance either. That routine check up with routine lab work cost Joseph $518.00 out of pocket. Since Joseph is paying over $15,000 a year for insurance, I’d think he’d be getting massages and his own in-house chicken noodle soup chef every time he gets the sniffles. Instead, Joseph, too, is now indebted to his medical caretakers because of limitations in his health insurance policy.
And so like my best friend, Joseph, too, is in danger of sinking into credit card debt because although he has some of the best health insurance that money can buy, it doesn’t pay for him when he gets sick.
And now we’ve got some sort of universal health care coming our way. And all of these people are freaking out about it. And I just don’t understand why. I’d be really psyched that if I broke my arm, I wouldn’t have to pay the first $7500 + 30% for it. And I’m psyched that if I got sick for real, I wouldn’t be denied future health care because of it. I’m not worried about the level of care going down, because I don’t have the kind of insurance that covers much of anything anyway. I don’t dare go to the doctor or fill a prescription because I don’t know how much it will cost me and just don’t want to end up with a surprise bill for hundreds of dollars, leading me into that quicksand trap that is credit card debt.
So there you have it, my personal experiences with universal health care. I don't think it's the best thing since chicken noodle soup when you're sick, but I think it's a lot better than what we currently have going on. I am very glad that we’re getting some sort of Universal Health Care. I have been perplexed as to why we don't already have Universal Health Care, but then again, I have also long been perplexed as to why higher levels of education are not free. And now I am most perplexed as to why everyone is fighting so hard against what seems to me should be common sense. I voted for change and I’m glad to see we’re actually getting some. I like knowing that I might be able to get old and be cared for in this country, even if I don’t hold down a w-2 employee job until 65 or until my benefits kick in. Until now, I thought I’d have to make myself look real appealing to Canada or New Zealand or some other country with an kinder, gentler way of getting old and sick so that when my health starts waning, as everyone’s will, I can focus on healing well or dying with dignity rather than who is going to pay for and deal with my medical bills and administration.
I did a little follow up research on this subject.
Here is a list of countries with some sort of Universal Health Care
Visit this guy's website to click on links for source material and get a lot more information than is available in this picture on each country's health care system:
 Roughly 15% of Americans lack insurance coverage, so the US clearly has not yet achieved universal health care. There is no universal definition of developed or industrialized nations. For this list, those countries with UN Human Development Index scores above 0.9 on a 0 to 1 scale are considered developed.
 The dates given are estimates, since universal health care arrived gradually in many countries. In Germany for instance, government insurance programs began in 1883, but did not reach universality until 1941. Typically the date provided is the date of passage or enactment for a national health care Act mandating insurance or establishing universal health insurance.
Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.
Two-Tier: The government provides or mandates catrastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.
Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.
The above information comes from here:
Which in turn, got its data from the World Health Organization: http://www.who.int/en/
Wikipedia also has some useful and interesting information about Universal Healthcare