There are a lot of differences between Europe and America: more cobblestone streets and more appreciation for the game of soccer. They also, for the most part, live in countries that provide healthcare either free of charge or very inexpensively — which is a pretty huge difference. That, in turn, means Europeans have questions about the American healthcare system — and lots of them.
And where to even begin? Like the ability to walk on cobblestones with heels — seriously, how do they do it? — the assumption that healthcare will always be available is something that most Europeans simply grow up with. They don't question it, because why would they? No politician would try to take it away, because it would be political suicide. No one would make the absurd statement that people should make the choice between buying a new iPhone and paying for necessary healthcare. For the most part, they see healthcare as a basic service that the government should provide, a human right, along the same lines as clean water and public transportation (although that's another conversation).
It's a tough perspective to wrap your head around, but I've talked to some of your European peers about their thoughts on the matter. Here, then, are what some Europeans and Canadians are wondering about the American healthcare system.
1What Happens If You Have An Emergency & You Don't Have Health Insurance?
Michael from Scotland tells a story of a time he got bronchitis on a trip to the United States and needed to get antibiotics to cure it.
"All was pleasant and I got a little check over by the nice lady doctor, just a few minutes, nothing fancy, then she prescribed antibiotics, as I really did need them," he explains. "They were fairly expensive but nothing I wasn't expecting." And then he came home to a bill for the healthcare bill he received.
"I think it was $1,600 or something crazy," he says. "Growing up with free health care you just take it for granted, and it was truly unbelievable how much these things cost."
Michael had travel insurance, which covered his costs, but the whole experience left him asking the question of what would have happened if he didn't have the insurance to cover it. Unfortunately for so many Americans — and even more, if the Republican Obamacare replacement plan gets approved — they have to pay for the service, with or without insurance. This is undoubtedly a large part of the reason that medical costs are the biggest cause of bankruptcy in America.
2Do Hospitals Have To Prioritize Patients Based On Wealth?
Sara, an American living in London, repeats a question that she hears often: "What happens if a homeless man and a wealthy man both come into the ER with the same life-threatening injuries? Surely one will not be favored over the other?"
The answer is that both will be treated, and then the hospital will chase down their payment at whatever cost — and then absorb it only if the patient truly doesn't have any income. What this question really gets at, though, is equality. Making people pay for their healthcare creates a fundamental divide between those who can afford it and those who can't. If everyone has right to their life — I'm pretty sure that they say that in the Declaration of Independence — then that should extend to healthcare.
3Can Insurance Companies Really Use Pre-existing Conditions Against People?
"Is it true that 'pre-existing' conditions such as having had a yeast infection have been used in order to be able to deny people their insurance?" asks Anna from Finland.
With Obamacare in place, people cannot be denied health coverage based on pre-existing conditions. This will still be true if the new Republican plan passes, but it still hurts low-income people and people who are chronically ill. That's because of the continuous coverage requirement, which states that insurance companies can't deny coverage if the person hasn't gone without insurance for more than 63 days. But what if they've had to stop working, and the insurance is tied to their job? No matter what the reason, insurance providers would then be allowed to increase their premiums.
4What If You Really Really Want A Job That Doesn't Provide Health Insurance?
Anna asks the question above, and Kaisa, a Finn currently living in the United States, has a comment along the same lines.
"In the US, in addition to other financial considerations, you must think carefully [about] whether or not you dare or can afford to pursue a career change or quit your job, simply because you probably won't have insurance afterwards," she says. "I find this fact very interesting, given that Americans always boast about the idea that the United States is the Land of Opportunity." And then comes the heavy hitter.
"Yet, the health care system is a serious hindrance limiting one's opportunities to take risks and pursue one's dreams," she adds.
I'll just leave that there.
5Why Do Insurance Companies Make It So Hard?
Sheila, a Canadian senior (Canada also has a socialized healthcare system), once suffered a serious injury while on a trip to the United States, and then had to spend the next couple of years forcing her travel insurance provider to pay their share of the bill.
"It took me going to their offices and meeting with the insurers face to face and really being pushy and desperate [to get them to] pay their share," she says. "All that said, if I had been a very passive person, I do not think that this would have been solved the way it was."
Michael also emphasizes the time and international calls it took for him to get his check-up covered. Why, when you're paying for a service, should the insurance providers make it so difficult for you?
6Where's The Incentive For Preventative Care?
Anna makes a point that you'd think fiscal conservatives would have taken into account: why isn't there a bigger incentive to provide preventive care?
"How can you estimate the huge costs of complications of diabetes that never occurred?" she asks. "And who is going to pay whom for having made sure people don't develop cardiovascular diseases that leads to stroke that leads to .... ?"
It's no secret that not treating people until they're sick creates huge and unnecessary costs, and yet the American system provides no incentive to getting regular check-ups or going to the doctor as soon as you notice a problem.
7Why Do People Want A System Where Things Cost So Much?
"Does paying for healthcare encourage providers to offer more extensive treatments than are necessary, so they make more money?" asks Amy, a Scot currently living in the Republic of Georgia.
Peter, a Canadian studying in London, has a question in a similar vein. "Why do Americans want to preserve a health insurance system that encourages hospitals to charge such high prices for treatment and services?" he wonders, and now it has me wondering the same thing.
Maybe the answer is America's dedication to capitalism? That seems like a flimsy excuse, however, to charge $1,600 for a check-up lasting a few minutes (from Michael's experience), or $77 for a box of gauze pads (an example Peter cites from America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System by Steven Brill).
8Don't Americans Understand That Their Blind Support Of Capitalism Is Robbing Them Of A Basic Human Right?
Jussi, a Finn living in the Czech Republic, asks the question above, and he's not the only one with the same thought.
"It is strange that there is a significant portion of the population that sees free healthcare as a socialist overreaching of the government," says Katarina, a Croatian who lives in Belgium.
"Why are Americans against the idea of a single payer universal healthcare system?" asks Amy — and I have to guess that part of it comes down to how much negative power the word "socialism" still seems to carry for so many people.
John, a Brit, says that he came face to face with an American who probably falls into that segment of the population.
"Paying an extra tax so that people aren't left to die seems pretty reasonable to me, but as I have never known anything else, I don't begrudge paying it," he explains. "I was amazed to hear from a U.S. dentist that he saw the extra tax as state interference and a threat to national competitiveness and therefore living standards."
It's all a matter of perspective, I suppose.
9Where Better To Put Taxpayer Money?
Madelein, who is English but lives in Sweden, has that question for the American public. This comes down to a matter of opinion, and surely Republicans in Congress would have their own answer for it. Madelein, however, is very appreciative of the care that she's received.
"The National Health Service is, in the eyes of many at least, a precious and integral part of our welfare system," she says. "The idea is you are looked after from cradle to grave, and I can't comprehend any other way of running healthcare as entirely fair, having received free treatment my whole life."
Kaisa puts it another way. "The point is that, you never really need to worry about whether you can 'afford to get sick' or if you will go bankrupt if you get seriously injured," she says.
Our tax dollars allow us to travel on well-kept roads (in some states, at least) and eat at restaurants with high sanitary standards — why shouldn't they go towards our personal health more directly?
10Why Do The Republicans Want To Repeal Obamacare As Soon As Possible?
Katarina wonders about the political reasons behind the Obamacare repeal: "Is it just because it was a system set up by a Democrat? Will they just fine tune it and then call it Trumpcare?"
Peter, the Canadian in London, has a similar query: "Why do Republicans work to take away Obamacare, which as far as I understand gives medical insurance coverage to those least able to pay for it, when it is based on a system originally put forward by Republican Mitt Romney?"
This isn't the first time, of course, that that question has come up, and Katarina's supposition seems like a likely one to me — yes, I think they want to get rid of it because it has Obama's name on it.
As Kaisa points out, though, this could end up hurting them in the end. "I also think that it is sad that a lot of people who voted for Trump felt like other politicians had forgotten them," she says. "Yet, many of those people will be the ones suffering when the Affordable Care Act gets repealed. People basically voted against their own interests."
11Why Is There So Much Debate About Healthcare In Such An Advanced Country?
Fanda, a Czech, expressed his disbelief that something so basic and fundamental in his country could be so hotly debated in the United States. "The more advanced the country, the better the healthcare should be," he says. "Why should Americans go to, like, Thailand for healthcare when they're so advanced as a country? I'd expect that from a developing country." He's not making it up that Americans go abroad for healthcare, either.
"It's fascinating, and it surprises me that this could be possible," he goes on. Why should they be discussing something that for us is such a certainty?"
Katarina, hailing from a country (Croatia) that has never been listed among the world's wealthiest, brings her own perspective. She "[finds] it strange that one of the richest countries in the world accepts the reality where you need to choose between bankruptcy or a medical treatment." Amy, the Scot in Georgia, put it another way.
"Undeniably America is at the forefront for medical innovation, and if you have the means and the money to access it, it's the best place to be," she adds. "But I think the European systems are better for lifting up the average wellbeing of the country as a whole."
12Are Americans Fine With Being Considered Incompetent By Europeans?
That's another of Peter's questions, and he spells it out a bit more here: "Europeans have lower costs, higher standards, and manage to deliver it to their populations free or with minimal admin charges," he said. "Something seems wrong."
For now, it seems that American lawmakers are perfectly okay with being considered incompetent by Europeans. In fact, I bet many would take it as a compliment.
13Why Don't Americans Understand How Much Worse Off They Are?
"Why don't they take to the street and revolt?" Jussi asks, in addition to the question above. I guess maybe because they don't realize how nice it is just to go to a doctor's office without worrying about having to pay for it? Because they've never experienced things from the other side? Because somehow the word "socialism" is still poisonous, even a quarter century after the end of the Cold War?
The good news is that some people have been revolting lately, both in the streets and at town hall events with their elected representatives. Maybe, if the fight continues, then America's healthcare system will progress to a point where all of these questions won't apply anymore. For now, though, there's a lot to fight for, and the European continent shows us that it's possible to provide universal health coverage without society crashing to the ground.