In 2010, I moved to Australia from the United States and stopped in Thailand to go diving. While walking back to my hotel, I started to have trouble breathing. When it didn’t go away, I took myself and my chest pain to the emergency room. It was sparkling clean and almost empty; the young Thai doctor was thorough and gentle, and I walked away with an EKG, a chest X-ray, and a prescription for antibiotics. The total cost of my visit, for which I had to pay out of pocket due to not being a Thai citizen? About $40 USD.
There is a lot of misinformation passed around in the United States about socialized healthcare. You can wait a year without treatment. There are only two MRI machines in all of Canada. Nobody actually likes the system, or uses it. But the one thing most Americans never do is actually use universal health care. So I asked residents of multiple other countries to tell me what their experiences were like.
Health care in Israel is universal and participation in a medical insurance plan is mandatory. All Israeli citizens are entitled to basic health care as a fundamental right.
Abby: “I never used the medical system for emergencies. Doctor’s offices seemed more like walk-in clinics than private practices, but Tel Aviv is very crowded. Even with an appointment, wait times were often 40-60 minutes.
I paid small co-pays, only to see specialists. Generally, the system was very low-cost and easy to use. I had to pay for prescriptions, but they were very cheap, especially compared to the States. A downside for me was that, while the doctors spoke perfect English, often the receptionists, nurses, and other office workers didn’t, so I had to get my Israeli boyfriend to make the appointments for me.”
The NHS is the state healthcare provider in the UK. The service is free at the point of use; services are free, and running costs are covered by taxation. Private insurance is used by only 8% of the population of England.
Tim: “I have used the NHS many times, although, where possible, I go to private providers to save resources. Emergency work is almost always done on NHS. My mother was recently diagnosed with lung cancer and the NHS could not have moved faster; she also gets a choice of where she can be treated. She got a biopsy yesterday, the results ought to be back in five days and then treatment will start immediately. You would not receive any better with private insurance (and I say that as Tory).
Going to Emergency (A&E) is usually good, which I know from all my rugby injuries. You can get patched up and sent on your way in a reasonable amount of time. Getting a GP appointment (a general doctor, who will give you a referral), on the other hand, is almost impossible. The waiting time for my area is about three weeks. On the whole, the NHS is a good thing. It still has many flaws, though, and is in desperate need of a restructuring.”
Australia has universal healthcare, called Medicare. It covers all general medical care, but some services are only partially covered and individuals pay a gap fee – this is usually still reasonably affordable, however. Individuals who earn high annual salaries are encouraged to take out private insurance.
Jenny: “I had an abnormal pap smear at my GP’s office, and she sent me a referral onwards to the Royal Women’s Hospital. I’ve had a lot of anxiety about pap smears in the past, and she specifically notified them about these issues. Since my issue was not urgent, she told me to expect a wait of several months for an appointment. The hospital recommended a colposcopy.
I contacted the patient advocacy department at the hospital and asked for assistance with my anxiety and PTSD. On the day of the procedure, all doctors and nurses were helpful and calming, and I managed to get through the experience without too much fear. They recommended that I get laser surgery to remove the abnormal cells from my cervix.
All of this has been totally free -- which is to say, paid for by Medicare. My original appointment for the pap smear was in May, and my laser surgery is scheduled for December...I received the appointment at the hospital in August. The abnormalities that showed in my report were not of an emergency nature; for similar issues, the brochure I received said patients can sometimes wait up to a year for treatment. I really appreciated the personalized care and support I received; it would have been so difficult to worry about payment while trying to deal with my emotional reactions to these procedures.”
All French residents pay compulsory health insurance, which is automatically deducted from paycheques. Patients pay fees at the doctor or dentist, which are then reimbursed 75-80% by the government, except in the case of long-term or expensive illnesses (such as cancer), which is reimbursed at 100%
Aliyah: “My father, who is Kenyan, was on a business trip in Paris. He tripped getting out of the subway and had a nasty gash above his eye. He was rushed to hospital, treated and held overnight for one or two days. When he was released, with medication, I kept bracing for the bill. None came. I told Dad to ask about it and he did. Answer: there is no bill, it is your right to be treated for free under our system.”
The Swedish health care system is government-funded, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities.
Kelly: “Giving birth, tests, and one ultrasound were free. They charged me for extra ultrasounds and non-essential testing. The only thing they give you at the hospital for the baby is diapers, cream, and formula.
Generally, in Sweden, the health care works if you are dying or having an emergency. As long as everything's normal, no one will look twice at you or even WANT to see you more often than needed. The drop-in clinics (vårdcentral) never have enough staff or resources, so if you need to see a doctor, you exaggerate your symptoms or they just tell you not to bother coming in.
I have been struggling for 3 months to get a pediatrician for my daughter. Since I started trying, we went to the emergency room once, the nurse’s office 4 times, and I called the helpline a million times. No-one wants to actually see her.”
Canada's health care system provides coverage to all Canadian residents. It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government.
“Everything is covered, whether it's something minor or surgery under anaesthetic. I've had MRIs, CT scans, x-rays, ultrasound, mammograms, you name it. The times I've had to go to emergency, I've received variable treatment, depending on the hospital. My longest wait was 13 hours. The shortest was ten minutes when I was afraid I had an aneurysm. For that one, I saw a specialist right away, which was also free. When my father had necrotizing fasciitis, he went to the hospital and was treated immediately. If he'd received treatment even 30 minutes later, he may very well have lost his leg or worse. In Canada, vision and dental are not covered by universal health care, and neither are things like physiotherapy, massage therapy, or alternative medicine like acupuncture, chiropractors, and so on. That being said, private medical insurance often covers a certain percentage of these things. Prescription medicine is also not covered by federal system, but between provincial plans and private insurance, can be greatly reduced in price if not free. Flu shots are free every autumn, and I remember getting vaccinated against rubella at school when I was a little kid. If you step on a rusty nail and go to emergency, your tetanus shot is free. Travel vaccinations and more unusual vaccinations, however, cost money. When I planned a trip to South America, I went to a travel clinic. The consultation was free, but I had to pay for my yellow fever and cholera vaccines.
I wish vision, dental, and physio were covered by national health care, but I am so grateful that everything else is covered. If they weren't, there's a chance I might not have survived as long as I have.”
The United States is one of the only developed countries that doesn’t provide universal health care for its citizens. A friend of a friend had a baby at 28 weeks (extremely premature); the baby was in the NICU for several months. Fortunately, they had very good health insurance and ended up only having to pay $250 of the $850,000 bill -- but they were lucky. The United States healthcare system is a labyrinthine mess where insurance administrators make possibly lifesaving decisions about patient care, rather than doctors. The care you receive is based on what you can afford, not what you need.
Even with these astronomical costs to the consumer, the U.S. government still ends up paying more per capita for healthcare than countries with socialized medicine. Citizens of the U.S. have a life expectancy lower than other developed nations, and more elective surgery at higher costs...and paying more does not mean the service is better, as the U.S. also has fewer doctors than comparable countries. The systems elsewhere are not perfect, but the perfect is the enemy of the good: anything would be better than ending up in debt for the rest of one’s life, or worse, suffering (and dying) in silence because the cost of treatment is too high.
Clair Litton was born in Canada, moved to the United States, went to graduate school in Australia, and recently relocated to Sweden. She has written for a series of online and offline magazine, and once had a young adult novel picked up by an agent, who then had to back down due to signing a little book called "Twilight." You can most commonly find Claire arguing about human sexuality and watching her toddler open and close doors.