A few years before I moved to Spain — we’re talking around 2002 — I did my yearly medical checkups in the Planned Parenthood down the street. I think it was on Vermont Boulevard in Koreatown. Though I am eternally grateful for Planned Parenthood for providing me and millions of other women and girls with virtually free healthcare (I think it cost $40 for an annual checkup), the first sign that this wasn’t an ideal situation was the filthy, graffiti-covered interior of the elevator. The second was the dingy, crowded waiting room and the very long wait to see the physician.
The third was the consent form all clients had to sign upon entering. It looked like this:

I remember reading that last question and thinking: Yeah, my mom would be mad. She should be. She should be mad that I’m 34 years old and still going to a pregnant teenage girls’ clinic for my primary health care. I mean, what does that say about me?

Since I had never lived outside the U.S. and therefore never experienced anything different, it never occurred to me to ask, What does that say about my country?

I was fortunate enough to never have had any kind of serious illness or medical emergency. But I knew a lot of people who had. Starting with my roommate, who got drunk one night and tried to kill herself by slitting her own throat. She appeared in the living room, where my then-boyfriend and I were watching TV, wearing a tank top and her chest smeared with blood from the wound in her neck, smirking defiantly at us, her eyes sparkling with rage and whisky as she said, I think y’all better call an ambulance.

The ambulance came and whisked her off to the hospital, where they stapled her neck shut and committed her to a psychiatric hospital for a month. This was the early 1990s and we were in our early 20s. But even then, when I visited her in her unhappy room in the hospital, I had to hand her an envelope which had arrived for her in the mail. It contained a bill for $500, from the ambulance company.

I have no idea how much her hospital treatment cost her. But as a video store clerk — and after her month-long involuntary absence, an unemployed clerk — she didn’t have health insurance, and she certainly didn’t have $500 to spare.

Getting presented with a $500 ambulance bill sure as shit couldn’t have been a positive influence on her recovery.

Since then, I have known many people who had hellish experiences with U.S. healthcare, or the lack of it. More than one of my friends without insurance almost died as they waited for hours in overcrowded emergency rooms for easily-treated conditions that worsened with neglect. One, an independent filmmaker, came with an infected cut on his finger, developed sepsis while waiting nearly 6 hours for treatment, and almost died when his kidneys started to shut down.

Just the emergency room itself in Los Angeles was usually a hellscape: people with contagious diseases, folks with gunshot wounds, and gravely mentally ill unhoused people all crammed into the same space and watched over not by a caring medical professional, but hostile, underpaid security guards only trained to handle problems with force. And unless they were bleeding to death, most of them obligated to wait for hours on end, rudely and disrespectfully treated by frazzled staff, with little or no communication as to what was going on or how long they’d have to wait. And then, at the end, everyone was expected to pay for that “service”. "Best country in the world", right?

The only time I had ever had my own insurance was when I briefly had a job where I earned enough money to be able to afford the premiums. That lasted less than a year, and then I was back in Planned Parenthood. In fact, for most of my adult life until I moved to Spain, Planned Parenthood was my only source of health care.

I’ve now lived in Spain for 20 years. I’ve had medical emergencies and I’ve never experienced denial of care, poor-quality care, or being hustled to pay any extra money for my care.

Never.

In Spain, like the rest of Europe, there is a public system, which all citizens and legal residents are automatically enrolled in. You are given a public health card, like a credit card, which has all your information in it and you just present it at any public center — which, by law, exists in every neighborhood in Spain — and you’re in. You use this card for instant admission to medical facilities for treatment that you pay nothing for, as well as for getting your prescription drugs at 10% of their normal cost. No, this is not a privilege offered only to the poor or elderly. This is for everyone. And it's not "free". Our taxes have paid for it.

Now, because the right wing and neoliberal forces have been chipping away at the Spanish public safety net for decades, any time you ask a Spanish person over 40 about the public heath care system, their faces will sour and they’ll say, “Ach, it sucks now; it was much better before.” Before, they didn’t have to wait weeks for an appointment with a specialist. But it still is 1000% better than what you have in the U.S., which is a sadistic capitalistic system that is programmed to separate you from as much of your money as possible and then deny you the services you’re paying for.

Such practices are unfathomable here. If that happened here, people would be marching in the streets and setting fire to cars. They’re already furious about the politically-engineered shittification of the public health care system — which still happens to be one of the best in the world. (Let’s Google it right now: “health care in Spain ranking.” Number 6 in the entire world in 2023.) And they know why it’s happening: because certain neoliberal powers that be are intent on driving the population into private health care to make more money.

Because of this trend toward privatization, I am one of the growing number of people that chooses to pay for private health care as well as enjoy the public system. I tend to use my private health care more, for the wider choice of doctors and the generally quicker appointments. However, when I’ve used the public system, to see my primary care doctor, the wait time to see them was the same or even less.

The public system is also preferable for getting prescriptions. If you get a prescription through a private health care, you have to pay the full price, which is still just a fraction of the cost of medications in the U.S. But if you get the prescription from a public doctor, you generally pay 10% of the cost (the percentages change according to your age bracket or residency status), because drug prescriptions are subsidized by the government. It’s not so damned hard. So, for monthly supply of a hormone replacement medication, instead of paying €11.30 (about $13), I pay €1.13.

Interestingly, it is common knowledge that the public hospitals, at least in Barcelona, offer better quality of care than the private ones. That’s because public hospitals are subject to more stringent regulations than private ones. I’m not saying that private health care is unregulated — it certainly is regulated! — but that the regulations are not as strict. So actually, you are more likely to see better doctors and get better treatment, as well as have more rights, at a public hospital.

Obviously private health care is regulated here; otherwise I would not pay a mere €99 a month (about 104 U.S.D.) for my private plan. 20 years ago, when I was 35, I paid about €60 (63 U.S.D.) a month for a comprehensive plan. With age, of course, the premium price goes up. Yet over 20 years, my premium has only increased by about €40. That is amazing to me.

With my plan, I get basic dental care, plus access to any medical tests necessary. Unlike the U.S., there is no gatekeeper standing in the way of your doctor’s instructions and your treatment. For an MRI, CT, or other costly sophisticated tests, you need to obtain authorization from your insurer, but it’s a matter of a phone call and it’s granted instantly. Never once have I been denied. I have had between 30 and 40 MRIs, 30 CTs, yearly clinical blood analyses, years of physical therapy, a complicated foot surgery that required an overnight hospital stay and a €5000 piece of metal to be grafted to my toe bone… and never once have I had to pay a penny more than my monthly premium. There is no such thing as a “copayment”.

“Copayment?? What copayment? Get outta here! You’ve already paid!"

And there is no such thing as medical bankruptcy here either. Because the system is set up to treat people as effectively and efficiently as possible, not to make money for healthcare corporations and drug companies. Sure, there are greedy corporations all over Europe, but they're not in the healthcare sector.

Not yet.

Also, whenever I have gone to the emergency room on my private insurance — which averages about once a year, because I don’t think twice about using it when I think I need immediate medical attention — I have never had to deal with a dirty, chaotic, crowded waiting room or rude, overworked, unempathetic staff. Every time I’ve gone, there may be more people or there may be less, but there is a efficient triage system in place, and usually I’m out within an hour. The last time I went, just a few months ago, I was out within a half hour.

Another thing I forgot to mention before: My partner and I use different private insurance companies, but both of our plans offer 24-hour house calls from the doctor. Numerous times in the middle of the night, when one of us thought we had the flu or some other exhausting ailment and the last thing we'd want to do was schlep to the emergency room, we would call a number and describe our symptoms to the doctor taking the call. Then another doctor would ring our bell within an hour. This kindly, humane, old-timey feature of our health care blew our minds for years. Every time the doctor arrived, set his black briefcase on our kitchen table, and either accepted or declined our offer of something to drink, we always felt like we were in a movie from the 1950s.

When I had my foot surgery, I had to stay overnight in the hospital. My insurance covered not only all of my treatment and stay in a private room, but also the overnight stay of my partner, who was also provided a bed. This is just routine.

How the hell is this possible for only €99 a month? OBVIOUSLY the private healthcare system is regulated here! OBVIOUSLY it is not a barbaric, profit-driven business built on sucking as much money out of us as possible and then denying us the treatments our money has paid for. I do not know the details of how it is regulated; it is just obvious that it is and that behaving as U.S. healthcare companies do toward their customers would be utterly illegal.

I have probably received over €100,000 worth of medical treatment in the last 20 years (and my partner, who emigrated to Spain weeks after being diagnosed and operated on for cancer, even more) and have paid under €100 a month for it. When I have had any sort of problem, there is real customer service to handle it, and it gets handled.

This is all because health care if taken for granted as a human right. To live like people in the U.S. have to live would not just be insane, it would be cause for revolt.

And my partner’s case is even more amazing. He got private health insurance in Spain, as a non-citizen (he was here on a student visa at the time) who had just been diagnosed and treated for cancer. Since then, he has received better-quality treatment for it than he ever did in the U.S…. and paying less than $150 a month for it. He has his own oncologist, who every year prescribes him a battery of MRIs, CT scans, blood work with special cancer screening. And, as always, he pays not a cent extra for it.

I’m not sharing this information to gloat. I’m sharing it to show what is possible in a sane society. I'm sharing it to counteract the constant bullshit that U.S. citizens hear from their politicians: "How are we gonna pay for it?" "That's impossible here!" "That's communism!" etc. They're all bullshit excuses to keep you in the dark and thinking small, as if you were a tiny, impoverished 3rd-world country. And because of this brainwashing and the systematic neglect and destruction of the public infrastructure over my lifetime, the U.S. actually is a 3rd-world country.

To me, it's obvious that because we have a humane health care system in Spain, the entire society is not just more physically healthy, but more mentally healthy than the U.S. (The average life span in Spain is 83 years; in the U.S., it's 77). Spanish people are less sick, less stressed, and less angry than in the U.S. because there is no system of obvious injustice and exploitation feeding off them and mindfucking them. This translates into less rage directed at each other, and an infinitely more peaceful and happy culture.

Some Spanish people will argue with me about this point*, but their point of reference is completely different from mine. They have not lived in a dystopia such as the U.S., where people who have the means pay hundreds of dollars every month for “access” to a health system designed to suck as much money out of them as possible, while denying as much care as possible. They have not had to deal with any sort of medical gatekeepers. They have never had a doctor tell them that they will not sign off on a medically necessary treatment. Their requests for medical authorizations, when required, are routinely granted. They have never been told to pay up front before being admitted to a hospital, or to pay for the ambulance ride, as my friend was.

Yes, every place has its problems, but not every place is the same. There is an actual scale to measure data by, and the U.S. is an absolute shit show in comparison to even third-world countries like Vietnam, where as a foreigner I received excellent medical care by a wonderful doctor for about 20 USD. And Cuba, the 3rd-world country which the U.S. has been trying to economically destroy for over 50 years but which nevertheless has the highest rate of doctors per capita in the world? Remember when Hurricane Katrina happened and Cuba offered to send over hundreds of doctors to help our abandoned and suffering citizens?

But the health care system is not guaranteed to last forever. Neoliberalism and increasingly ravenous, exploitative capitalism are endangering the public safety net in all the European countries. The difference between the U.S. and here is that the citizens here know exactly what’s going on. They know what they’re entitled to, and they demand to receive it. Yes, “entitled”, because public health care is not “free” health care; we’ve already paid for it with our taxes! This is the concept that most Americans can’t grasp. Perhaps because the U.S. infrastructure is so degraded on so many levels — public transit, roads, schools, health care — that they’ve never seen their taxes going to anything that makes their lives tangibly better. But we do know our taxes to go defense spending ($820.3 billion, or over 13% of the entire budget, as opposed to Spain, which spends 1.5% on defense) and bailing out banks and giant corporations, so it’s little wonder that when people pay their taxes every year, they feel like they’re being robbed.

My experience living in Spain has been the opposite. (To be clear, I live in Barcelona, which is part of the very well-organized and efficiently-run Catalonian autonomous region.) The comprehensive public transit system of buses, metro, and trams runs on time. The trash is picked up several times a day. (There are electronic sensors inside the trash containers that alert sanitation services when the containers are full.) If you have a health emergency, you will be attended to, without any obstacles, no matter if you are a citizen, resident, or not, and regardless of if you can pay for it.

I want to share a story that was all over the local Barcelona news in 2017; I remember when it happened:

An Argentinian family on vacation in Barcelona brought their young son to a public hospital to be treated for severe bronchitis, which required an overnight stay. The hospital informed the parents that the whole thing cost €5,000, and it forced them to make a deposit of €1000 before they would treat the kid.

The parents made the deposit but complained to the doctors treating their kid that if they paid the entire hospital bill, they wouldn’t have money left for their hotel. The doctors were alarmed and told them that they shouldn’t worry, they would be treat their son no matter what. A patients’ rights organization was alerted to the situation; it informed the hospital that it was breaking the law, which states that

“Urgent care is guaranteed until medical discharge and that minors must be treated as Spanish residents”.

The hospital immediately recognized the error and returned the family’s deposit. From the media reports, it seems it ended up not charging them anything at all.

Do you see how just this one example of kind of being treated like U.S. citizens are routinely treated by their health care system sparked an absolute outrage over here? The wrongness was so apparent that the doctors said, “Fuck the hospital; they’re wrong, we’re gonna do our job and take care of your son.” And this story was viewed as an embarrassment to the city, that a family of tourists visiting our city would be treated so shabbily.

Again, I’ve written all this just to let you know how my experience has been with the public and private health care system in Spain. I think it’s important to have a view to the larger world, in societies similar and not (like Vietnam), to see what the reality is there, to see how it is possible to not live the way you are made to live there. And Spain is just one example! There are 27 countries in the European Union. They all have some form of public health care. But as I pointed out, it’s not just the U.K. or E.U. countries that have a much better, humane and more functional system. It’s nearly any country on earth, as far away as Vietnam or Cuba. (Yeah, I know Cuba’s not that far away for you, but for me it is).

I really hope more U.S. citizens can become aware of what else is out there in the world, and start to demand the basic, logical, humane services even the poorest countries in the world enjoy. As for us over here, we are all hoping and praying — and many of us demonstrating in the streets to this point — that our brilliantly effective and humane system isn’t replaced by that of the so-called “Greatest Country in the World.”

*Some Spanish people will argue with me about the state of their health care system because they are far more critical of it than I am. They are not wrong! Their perspective is different than mine because they grew up in a 1st-world system of a European welfare state, not a 3rd-world system like I and every other U.S. person. I was not here to witness the downsizing of their system, so I mostly only see the good that’s left. As I said, the Spanish system is NOT perfect; it has been getting eaten away by neoliberal policies pushing healthcare towards privitization, which must be — and is being — resisted.