Three things are inspiring me to write this. First of all, I was asked about it. Secondly, health care is kinda sorta in the news nowadays. And thirdly, my upcoming jaunt back to mi patria is bringing back memories…and anger. Why anger, you ask? OK, I’ll start with the last part then…
When I discovered I was pregnant in the States, I was just finishing my degree and didn’t have health insurance or money. I was, however, shocked and delighted to find out that I was eligible for LAMoms, a program of public health care that focused on low-income Louisiana mothers-to-be and their small children. Hurray! And this brings me to my first point.
1. Picking doctors
Under LAMoms, I was allowed to pick my own doctor. Huzzah! And so I did, carefully researching the best OB/Gyns in the area. Turns out, none of them would take my poor ass. Finally, after cold-calling every doctor within a 100-mile radius (no kidding), I found someone who would be willing to take my gubmint insurance. 70 miles away. In three months. Which is a bit late for a first trimester checkup.
Here in Spain, I was not allowed to pick my doctor or my midwife (midwives do the delivering here). I have to say, though, it didn’t bother me for a few reasons. Most notably, I’m not really picky when it comes to doctors, and the very distinct impression given here is that every doctor is equally qualified. Plus, if you really can’t stand a doctor (which happened to me later when visiting a pediatric specialist), you can bitch and moan and change doctors. So, yes, your doctor is determined by your zip code here in Spain, whereas, in the States, my doctor was determined by my insurance coverage. Which reminds me…
2. Public insurance
What exactly is public health insurance? This is a question that should be asked more often, since I think it’s unclear in the States. I say this because I was just researching whether or not our daughter would be covered under the much-ballyhooed CHIP (children’s health insurance) program while we’re visiting. Turns out that, in the state where we’ll be visiting, there does exist a CHIP program to cover all minors. For $147 a month, per kid (capping out at around $400 a month for three or more little buggers). In short, this makes us buying travel insurance for all three of us more cost-effective for the weeks we’ll be there.
That’s not public health insurance, silly!
Spanish public health insurance is a given. It’s a right for all citizens and legal residents, rather than a privilege. And, when I say it’s a given, I mean that: it’s given. Free. Sin pagar. Punto.
As for illegal immigrants, they can go to the doctor too in the ER, for a fee. Just like all us po’ folks in the United States. Oh, and, speaking of ERs…
3. Quality of public health care
This has been a matter of substantial debate, and rightfully so. A lot of people have heard horror stories about huge lines in Canada, and lackluster treatment availability everywhere but the Good Ol’ U S of A, right? While I won’t deny that public health care = waiting, I will describe what I mean. All appointment times for doctor’s visits are what they call “orientative,” and they are granted in blocks. The doctor comes out periodically, tells everyone the order in which they’ll be called, and then the patients police themselves (I still find the Spanish queue system fascinating, but that’s a topic for another day). Given that, I have never spent more than 25 minutes waiting to be seen. Going to the ER, I’ve never spent more than 40, and that was for a routine checkup when I first landed here, was still undocumented, and was not an emergency by any stretch of the imagination (I got a bill for that visit later for 200 euros. However, the health office contacted me, since they had been notified that I was a legal resident, and rescinded that charge, all without me saying anything).
As far as the quality goes, I’ve been pretty impressed, for the most part. My prenatal care was fine, if a bit impersonal (I’ll get to why in a moment), the delivery was expert, and the recovery was brilliant (you stay for three days minimum in a private room). My daughter’s care has been wonderful, and I couldn’t ask for more to be done for her. If I did, it would get done (really, they ask all the time if I’d like to test to verify/negate my various and sundry concerns). Which reminds me…
This is a bit of a pain here in Spain, in that every single doctor has his/her own specialty. Your GP, OB, pediatrician, and various specialists are all different people (of course), but a lot of times they’ll be in different places around the city. I found it to be the worst with the prenatal care, since my OB was different from my ultrasounder from my blood analyzer, etc…However, I was still undocumented when they assigned me all these people, so I didn’t have a set doctor to refer me. Still, you will never give blood or urine to your doctor in the next room; it will usually be a separate appointment on a different day. Since there’s no such thing as “sick days” here, it doesn’t so much matter to the Spaniards, but it is something that would have to be modified if the U.S. were to adopt a similar system.
Another thing that is always brought up as a terrifying phrase when impending “France-ification” is feared upon us is “strikes.” Yes, the unions in Europe LOVE to strike, and doctors are no different. However, since health care is a right, and not a privilege, the doctors inform their patients of their strikes ahead of time, they only last for one day, there are always subs available, and the ER never ever closes. For example, I know that, if I want to see my daughter’s pediatrician, I can’t go on August 11, since she’ll be on strike. No joke. Which is why…
5. Driving private sector out of business?
Could never happen here in Spain. Native Spaniards, who are accustomed to the luxury of free health care, don’t like the waits or the impersonal nature of the visits. So, they virtually all currently have, or have had, private health insurance. And they can, since it’s quite cheap and doesn’t turn away anyone who may have sneezed once in 1974. So, yes, the private sector is huge here, but it’s inexpensive and inclusive. God forbid that should happen to us.
So, there it is, in a big, fat bloated nutshell. That can go get its arteries unclogged gratis at the local hospital.