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A 20K broken elbow makes downshifting difficult in US

I’d never enjoyed having to learn medical street smarts, but it wasn’t until moving to Spain that I really recognized just how dysfunctional our health care system was. Before this, I assumed every country had their problems. After all, in Canada or Europe with their universal coverage, didn’t they sometimes have to wait months for treatment?

Our health care is too costly.“- Obamas inaugural address

  • It’s too costly for automakers: the Detroit Big 3 claim
    health benefits cost them $1500/car, as opposed to the $150/car for
    Canadian automakers.
  • It’s too costly for the average American: 42% of the the US population aged 19-64 is uninsured or underinsured.
  • It’s too costly for the average European who breaks an elbow while visiting the States (see below).

After blogging about my fantasy to move to an $8,000 (or even $25,000) home in South Dakota,
I have had a few second thoughts. And not just because a friend read my
post and quickly emailed to let me know that it was 30 degrees below
(°F) in the state at the moment.

I started to research my options for getting out of the state to visit
family in say San Francisco. I found an 8 hour flight from Sioux Falls
(1 hour from Howard, my chosen city) to San Francisco for $375
roundtrip. Nearly equal in cost and time spent to fly cross country.
And hating the idea of flying, I looked into trains: about 33 hours
just to Seattle (another 17 to the San Francisco Bay Area).

But what really grounded my dream was my husband’s fall off a bicycle
during our last week visiting my parents. After landing hard on his
elbow in front of my parents’ house, we called his Spanish insurance
who sent him to a local hospital about 20 miles away in Healdsburg.
After an x-ray, the very Californian pony-tailed and jeans-wearing
nurse returned to tell us he had bad news. The bone was broken and he’d
called in the surgeon from his tennis match (it was a Saturday).

The surgeon, who knew a lot more about Spain than most of my friends,
explained that it was a simple operation involving a couple pins and a
wire to bind the bones back together. But it would require a night in
the hospital. This turned out to be our problem.

We called Nico’s insurance in Spain who told us he was covered for up
to $12,000. Feeling confident this would cover this “simple” surgery,
we told the surgeon we were interested and asked him how much he
thought it would cost. He told us the $12K would cover it and he would
guess it would be about 6 to 8 thousand total, as his fee was just a
small fraction of that.

Once word got around that we were limited by cost, a financial planner
stopped by our room to give us more specifics. When she found out our
cap, she shook her head and said, “twelve thousand won’t even come
close. It will be closer to $20,000.”

When the surgeon returned to hear our news, he was very apologetic.
“I’m embarassed. In any other country in the world, your $12,000 would
have covered the procedure.” Then he added, “I’m sure if you went to
the financing office on Monday and told them your limit, they would let
you do the operation here for the $12,000.”

Once he’d left the room, Nico looked at me and asked, “Where are we,
Morocco? You haggle over hospital costs?”. My argument that we should
live in the States for awhile had just lost some momentum.

When it’s too expensive to pay for cardiac medicine 

Back at my parents, Nico got on the phone with his insurance who
quickly booked him a new ticket home, obviously relieved to trade
flight costs for the money pit of American health care.

After dropping Nico off at the airport on Monday, I turned on NPR on
the car stereo for the 2 hour drive back to my parents’ place. The
story was about how people were cutting back on doctor’s visits due to
the economic hard times. Even cardiac and diabetes patients were
skipping medications because of the co-pays and instead ending up in
emergency rooms.

I listened to one couple talk about how they’d switched their insurance
to one with a cheaper monthly, but bigger deductible last year to cut
costs and now they were having to forgo the surgery the wife needed for
treatment of her gall bladder, or some non-life-threatening illness,
but which left her exhausted and barely able to work and look after the

As soon as I arrived home, I googled “South Dakota medical insurance”.
Blue Cross Blue Shield (who I’ve found to be the cheapest in
California) offers several options. For our family of 3, either we could pay $847.20 per month
(and $10 copays) with a $1,500 family annual deductible or we could
hope for good health and pay $292.40 per month (and $30 copays) and
risk the $22,500 annual deductible.

I know I’d be tempted to go with the $292.40 per month- $847.20 is a
lot to earn with just a website-, but this just brought back memories
of all those years pre-Spain that I spent as a freelancer and either
uninsured or underinsured.

Surviving life as an underinsured American

That period cemented my fear of hospitals and doctor’s office: not of
the medical attention, but of what stepping inside one of these places
might set me back. I’m lucky as I had never had a serious health
problems, but dealing with even less-than-critical issues had honed my
skills at avoiding American market rates for health care.

A couple years ago I fainted and cracked my head open on the bathroom
floor. As I lay unconscious, my mother began to dial 911, but I came to
and stopped her in time. I convinced her I’d be fine holding a towel to
my head during the short cab ride to the hospital.

As I entered the emergency room in downtown New York, it suddenly hit
me that just by stepping foot into the place I was agreeing to hundreds
of dollars of care. As a clinic worker approached I quickly turned
around and started to leave, but he tried to stop me with a “Can I help

I told him I was fine, but he must have noticed the blood still oozing
from my wound onto a now-stained-towel and tried again to stop me with
a “But you might need a CAT scan”. That was enough to send me running
for the door.

Since it was 7 in the morning, I waited until my doctor’s office opened
and made an appointment for the fainting spell. I’d been having a lot
of them lately and I was afraid if I told her my head was cut open
she’d send me to the hospital.

I was right. When she saw my head wound, she told me she hadn’t done
stitches in years. But knowing that I always came in paying cash, she
took pity and found a colleague down the hall, a plastic surgeon, who
still did stitches and sewed me up.

As for the fainting, she advised me to have my heart murmur checked out
by a specialist. I nodded as I always did to doctor advice that I knew
I wouldn’t take during those years, and then I waited 3 years until I
had Spanish universal coverage to get the echocardiograph.

Where you never see a doctor’s bill

I’d never enjoyed having to learn medical street smarts, but it wasn’t
until moving to Spain that I really recognized just how dysfunctional
our health care system was. Before this, I assumed every country had
their problems. After all, in Canada or Europe with their universal
coverage, didn’t they sometimes have to wait months for treatment?

But now I marvel at the quick and quality care we get here in Spain.
Every neighborhood in Barcelona has a CAP, a local clinic, and ours is
just two blocks away. So whenever my daughter comes home from school
with pink eye, or bronchitis, I don’t call every doctor I know for
advice and perform extensive online searches for home remedies, but
simply call for an afternoon appointment.

Our doctor is very competent (even offering homeopathic options if
we’re interested) and gives us all the time we need, not to mention she
treats us like a people and not just another number that is slotted for
10 minutes in her day.

It’s true, there are waiting lists for non-critical medical procedures
and to see specialists, especially in Catalunia where government
spending is less than in other regions of Spain. But it’s never for
anything life-threatening or incredibly urgent and the options to go
private are extremely cheap: less than 100 euros per month with no
deductibles or copays.

Nico couldn’t get an answer from his Spanish surgeon on what his
surgery would have cost- I’m sure he assumed Nico was suffering
side-effects from the painkillers for even asking-, though our US
surgeon had guaranteed us it would cost much less here in Europe. I
wanted to know why.

We pay the cost of universal coverage in the U.S in exchange for high end marketing

By the time I got back to Barcelona, my husband was one step ahead of
me. He showed me an Economist article with a World Health Organization
graph showing that not only does America spend about double, or more,
than what the rest of the world does on health care per person, but
more surprisingly, government spending on health care is more per person in the U.S. than in any other country with universal health care (except Germany with whom we’re equal).

So much for our fear of big government. We already have the biggest
government spending and we don’t even have much to show for it. We’re
the only developed country in the world without universal coverage and
even hardcore free-market types can’t argue that our “freer markets”
have led to less big government or lower costs.

The most expensive health administration in the world

I was still curious to find out where all the money was going. When I
asked the nurse in Healdsburg, he said something about all their high
tech equipment, but from what I’d seen of Spanish clinics they had all
the same “high tech” equipment.

I found a great series in the New York Times examining “Why Does U.S. Healthcare Cost So Much?” that found we’re not paying for higher quality equipment, but for more expensive health care administration.

We spend nearly 40% more on health care per person than our GDP would
predict. According to a McKinsey study, 21% of this “excess health
spending”, or 150 billion (enough to pay for universal health care for
the country), is going toward “health administration and insurance”.

Rather than spending more for better care, we spend more for things
like product design, underwriting and marketing. All that extra money
we spend is more than 5 times what we’d need to pay for universal care
in the U.S.

Perhaps I’m a dreamer to think I can ever downshift in a country where
the typical family of four spends, on average, $15,600 on health care
every year. Though I’m still tempted.

After all, my sister just earned her medical degree so if I rely on her
diagnoses via Internet video phone calls, I may be able to avoid most
of that $22,500 deductible on the $200/month South Dakota family plan.
And I could fall back on those uniquely American health care system
survival skills, that is, until Obama- or someone- finally makes some
changes to our too costly system.