healthcare in three countries: personal experience

Warning: this entry is very long. It describes my personal experiences with the healthcare systems in the US, Netherlands, and Taiwan. If you’re not interested, you may want to skip it.

(However, if you have strong opinions about universal health coverage for the US, I’d gently point out that it would be a trifle irresponsible to skip reading about how it works in other countries, from one American’s direct experience, in an effort to make your opinion as informed as possible.)

There’s a meme going around that anyone who reads this has probably already seen: a reposting of a post by suricattus that begins,

There is a move afoot in the nation -driven by the GOP – to repeal the new health care laws, to protect corporate interests, to defend against fear-mongering (and stupid) cries of “socialism!”, and to ensure that people are forced to choose between keeping a roof over their heads or getting necessary health care.

This movement is killing people.

I’m not going to repost the whole thing; that’s her story, not mine, and I don’t see how merely echoing it will do any good. Also, unless those fighting against universal health insurance are far stupider than I think they are, they know many Americans support it. I am one of those, as anyone who reads here must know by now.

I do think many of those who are against universal health insurance are fairly stupid, however, and this is why: they’re making decisions without direct experience, without studying the experience of others. Without enough data. (Not everyone, of course. I do know a couple of political conservatives living here in the Netherlands or in Taiwan – I need to remember to ask their opinions. Given that one of them is planning to stay here permanently, I suspect I know the answer in his case.) Decision making without data is a regrettable necessity sometimes, but not in this case; the US is in the position of being about to look at a hundred countries with universal health care – a hundred little ‘labs’ – to see what works and what doesn’t.

This is why I think more Americans should travel or live abroad; when you go to different places you learn that the customs of your tribe are not laws of nature. If you don’t have that opportunity, try an experiment. If you’re reading here, you probably have online friends in other countries. Ask what they think. Ask them, if their country has universal health care, if they’d prefer to switch to a system more like the one in the US. If my experience holds, you’ll find exceedingly few who would. (But take their opinion with a grain of salt. Remember that they hear all the bad things about the US exaggerrated, just as you probably hear about the problems in their country.)

I’ve had the chance now to experience the healthcare system in three different countries, as a resident: the US, the Netherlands, and Taiwan. They’ve all got plusses and minusses, but if I had to choose, there’s not much thinking required to say that I’d always choose a system where everyone gets care.

US: I’ve been one of the lucky ones. We had insurance through my Mom’s job from about 1980 on. I stayed on her insurance through college, since I was in the same city and was still covered. Two months after graduation I started my first job; since I was working of engineering companies I have always been covered through my job, except for a sixth month period when I was unemployed and was covered via my husband’s job. There were also a couple of periods where I was working as a contractor when I could have been covered by my job, but elected to be on his because they had better coverage. Granted, I’ve always been relatively healthy, but my family has had all kinds of health issues and have all had excellent care through them. I think a lot of people outside the US get the impression that American healthcare is awful, and in my experience that is completely wrong – US healthcare is worldclass *if* you can get it. Our flaw (flaw is not the right word; more like advanced gangrene) is that so many people don’t have coverage and that so many people find their existing coverage mysteriously denied when they do get sick.

Netherlands: the downside is that I’ve heard a few stories of people waiting to get treatment for illnesses. On the other hand, at least in one case I know of it was a medical decision rather than an economic one – a coworker had a back injury and his doctors wanted to give it time to get better on its own before scheduling surgery. But every time I’ve needed a doctor’s appointment I have been able to get it within a week; colleagues with serious illnesses and a friend with a mysterious heart-rate issue have gotten the treatment they need, promptly. When my husband went to the doctor with a knee that was making crunchy noises, they were able to get him x-rayed immediately, instead of having to schedule an appointment at another facility as in the US. I’ve also heard that Dutch doctors were reluctant to prescribe medication, but that doesn’t match my own experience; if anything my doctor is only too ready to medicate. (Prescribing blood pressure pills without changing the diet first?) There has been NO charge whenever I’ve gone: not for visits, not for a 24-hour blood-pressure monitoring, not for meds.

I haven’t been to a dentist here; we avoided it in our previous year here, and since I got checked out when I went to Taiwan in October, I’m not due for another couple of months. I’ve been told Dutch dentistry is pretty bad, and a look around at people’s teeth tends to back that up.

Everyone here has the basic coverage but when I began working here I had the opportunity to sign up with higher levels that would cover mental health care, dentistry, physical therapy, etc. I don’t fully understand the Dutch system but I suspect those are covered to at least some level for people who can’t work. The best advertisement for the Dutch system is an online friend of mine: she can’t work due to serious mental health issues, but she has a decent place to live, enough to eat, and the medical treatment she needs. From what she’s said she doesn’t live in luxury but she does get to live in dignity.

All prescribed meds are covered, as far as I know. The Dutch are also very sensible about birth control – once it’s been prescribed, you can just keep refilling it. I suppose glasses are probably covered under some of the more expensive healthcare options; don’t know if the basic ones do. You get your eyes examined (free) in the eyeglass shop, and then if they see a problem they send you on to a doctor.

Taiwan: I don’t entirely understand the system there (life as an expat is an unending exercise in never quite understanding what’s going on around you) but it’s got some wonderful points and some things that would never work in the US. Most doctor’s offices are within hospitals and they work like US urgent-care clinics; you go and take a number, sit in a very crowded room with lots of other people and a high level of noise, and wait until you’re called. Most of the office staff doesn’t speak English (no reason they should, as it’s not one of the national languages). If you are willing to pay cash, you can go to a special expat clinic where you can make an appointment to see a doctor, the waiting rooms are plush and quiet and the staff will all speak English (rich Taiwanese people go to these as well.) Prices are quite low: a first visit to a new-to-me clinic plus a lung function test plus a chest X-ray ran me around $200 US. Some of the expat clinics have the English-speaking staff just take you to the regular doctor (you do get bumped up in the queue so you don’t have to wait long) so when I say that the standard of medical care I’ve seen there is very high, it includes regular doctors as well as fancy ones. Most doctors do speak English and many are educated in the US or Europe. Dentistry there is also good, though our dentist wasn’t covered by insurance so we had to pay cash, but also our Taiwanese dentist had the gentlest hygenists ever to lay an instrument on any tooth of mine. I’m rather dreading a big, brusque Dutch hygienist in contrast. When I had LASIK, the surgery wasn’t covered, but follow-up care was; I only had to pay for eyedrops.

The downside to the Taiwan system is that nursing care doesn’t seem to be covered, and I’m not sure about food in hospitals. Patients’ families stay with them, bring in food and take care of some of the easier nursing chores. Also, I’m told that the national health insurance is great on preventive care but doesn’t cover catastrophic. I think we had extra insurance through work that covered catastrophic care, nursing, and so on. The people I knew who had babies while living in Taiwan seemed to be happy with the care they received.

Speaking of babies, if a new mother’s mother or MIL can’t come stay with her, she spends a month or so in a new-baby center. I missed the chance to visit one of these (I was out of the country when everyone went to see a coworker’s new baby) but I’m told they are very nice. The idea is that the new mom needs a lot of care taken of her, is supposed to eat certain foods and stay indoors. She isn’t even allowed to shower for a week or wash her hair for a month (Taiwanese people are usually appalled to learn that American mothers generally shower soon after giving birth.) I don’t think these are covered by national insurance, but they’re reasonable enough that a normal worker – say, a young engineer – can afford one.

When I said that the national system is very good on preventive care, I meant *very* good. Every employer is required by law to pay for all employees to have an annual checkup. I think my company paid for the upper end of these; they were the most thorough checkouts I’ve had in my entire life. They did a CT scan, an abdominal scan (ever seen your own pancreas?), all the usual blood and urine tests, vision, hearing, and I don’t know what all. The company is required, but the employee may choose not to go; you’re not forced into it. I do not know how much information the company is given about employees’ health, but it’s not something that anyone seems to worry about. There’s one other thing to mention about Taiwan: Americans tend to think that countries with universal healthcare systems tend to tax away half your paycheck, but it isn’t true there. Taxes are quite low.

I do not believe that the Taiwanese system could be transplanted in its entirety to the US – we’d never stand for having families be expected to do their own nursing – but the emphasis on covering preventive care seems like it would be a good thing, saving lots of money and lost production by catching illnesses early on. I don’t see why we couldn’t also borrow the idea of having a basic system with better / more luxurious care for those who can and want to pay extra. Yes, it means rich people would still have better care than poor people – just as they now get better clothing and food. But at least poorer people would have decent levels of care, which would be a drastic improvement. I’d like to see medicines fully covered as they are in the Netherlands, and to be able to get an appointment in the next couple days even if I’m not deathly ill, as I can in either country.

Feel free to ask questions about either my first-hand experiences or what I’ve heard from other people while living in these countries.

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