As an American living abroad, the emotional debate about a government-run health-care option could be amusing were it not such a serious issue. In the past six years, my family has lived in three European countries, all with government-run health care. I believe that experience provides me with a “boots-on-the-ground” perspective that few Americans possess. Given the upcoming election, where this is a major topic, I think it is appropriate to give my two eurocents-pence-dinars’ worth.
Let’s start by comparing apples to apples: pregnancy. My son was born, prematurely, in Chicago in 2004, after an emergency caesarean section. Luckily, I had the most expensive and comprehensive coverage provided by my banking job. Nevertheless, the hospital tried to eject my wife after only two days. Without insurance, the caesarean and hospital stay in Chicago would have cost $16,000, along with a $36,000 bill for 10 days’ neonatal care. Five years later, my daughter was born, full-term, in London, under the British National Health Service (NHS). The NHS provided impeccable care in one of London’s finest and busiest hospitals. My wife stayed in the hospital for four days and could have elected one more day. Out-of-pocket cost? Zero.
Later, one November evening, my then-6-year-old son cut his head on the fireplace mantle in our London home. As he was bleeding profusely, typical of even a minor head wound, my wife called the British equivalent of 911. Within about 10 minutes, two burly NHS paramedics arrived and took him to the hospital. No questions of HMO, PPO, or insurance cards. When he was patched up, my wallet was not the worse for it. Contrast that with an emergency-room visit we needed to make with him while we were on vacation in the United States some years earlier. The treatment was considered out of network and made a $200 dent in our wallet.
Currently, we live in Serbia, and now, at the slightest hint of a sniffle, I take the kids to the local clinic, where a pediatrician examines them, providing any necessary prescriptions, which are free for children. There is no cost for children’s visits; adults pay a 50 dinar (60 cent) “participation fee.” Any citizen or resident of Serbia is entitled to health care. Do we wait? Yes, sometimes, but I also have waited sometimes in the United States and paid a lot more afterward.
This said, what about the drawbacks of “socialized” health care? Lines, bureaucracy, spotty quality? Yes, these things do exist. They also exist here in the form of waiting for insurance companies to verify coverage and to pre-approve patients for treatment. There are often situations where insurance companies delay payment, sometimes even after treatment has been “pre-approved,” in the cynical calculation that patients will just give up and pay the bill rather than deal with “customer service.”
In Europe, the insurance risk has been spread throughout an entire population, not just one particular pool. The services are available for all, and they are “free,” in that the cost is prepaid through the tax system. Those with greater means who wish to be seen more quickly or want to avail themselves of the latest advances are free to pay privately, either out of pocket or via additional private health insurance.
In any system, it pays to be an educated consumer. You don’t always get what you deserve, you get what you demand. It does not mean that some people in government-run health systems don’t fall through the cracks. The real point is that there is a floor, in contrast to a system, like ours in the United States, where pre-existing conditions have precluded coverage, along with a cap on lifetime benefits. Recent legislation is supposed address these issues. The question is, will it remain or be repealed?
Most Europeans, even the highly conservative, free-enterprise types I worked with while a London banker, viewed govern-ment-run health care as a moral imperative in a democratic society. It’s also good for business. While this may seem counter-intuitive, consider this: Most British firms—especially small businesses—don’t have to offer private health insurance because a government option exists. Fewer personal bankruptcies arise in Britain as a result of catastrophic medical costs.
Finally, I often wonder how many great American business ideas remain unexplored and unfulfilled because the potential entrepreneur is understandably fixated on keeping his or her day job that provides the family’s health insurance.
It is past time that the United States joins the ranks of other wealthy democracies to provide a standard level of general health-care coverage for all Americans. I do not advocate this based on any ideological agenda, nor exclusively a moral one. I believe it because I have seen it in action and, though not perfectly, it works! It frees citizens from the burden of worrying about providing a basic level of health care for their families, allowing them to consume, to change careers, to innovate. No doubt there are costs involved, but the United States already spends a greater proportion of GDP on health care than other first-world countries. It is time to investigate how other countries mitigate costs while providing a reasonable level of quality care.
My family and I look forward to returning to the United States early next summer. I believe America is the greatest country in the world. I have had the advantage over many of my fellow Americans in that I have been able to justify that belief because I have lived elsewhere. I do not believe that America’s greatness precludes us from learning from others. It is both smart policy and smart business to adopt best practices, particularly in the area of health care, and to improve upon them.
Alexander Billinis is a Salt Lake native. A banker by trade and an author, he currently lives in Serbia.
