Sick in Spain: Or, What's Wrong with Healthcare in the United States

Yesterday, I went in for a check-up with my doctor here in the States. I work at a public health center here in Washington, DC (yes, the same one where I worked before moving to Spain!), and chose to become a medical patient there not long after I started my job in 2015. I'm so glad I did, because (1) my doctor and her team (my coworkers!) take amazing care of me, and (2) it's ridiculously convenient to go to a doctor's appointment when the exam room is down the hall from your own office.

After checking a few boxes - my medications, standard labs I wanted to get done, the usual - she asked me if I had any other health concerns. I fiddled nervously with the hem of my shirt.

"Well, in Spain, I kind of...passed out and had a seizure."

Needless to say, I have a referral to see a neurologist this Tuesday. That said, I feel fine, and that is not the point of this story. Let me begin at the beginning.

On May 29th of this year, I went out for an easy 5k run. I'd woken up late after working a night shift at the hostel. I gulped down a cup of coffee, not hungry after my 1:00 am dinner, and laced up my sneakers. I eased into one of my favorite routes: a mile along la muralla, the ancient Roman wall on the west side of town, then across the river, and then looping back on the Roman bridge and up through the historic city center. 

It was midday and already hot, nothing out of the ordinary for Córdoba on the cusp of summer. I was a little tired but feeling good. Then, just as I reached the one-mile mark, I suddenly felt like a car that ran out of gas. My limbs turned into rubber and the edges of my vision darkened. I should sit down, I thought. And that's the last thing I remembered when I woke up on a stretcher, surrounded by strangers, over ten minutes later. I later found out that I had been unconscious for 12-15 minutes and exhibiting symptoms of a seizure, hence my speedy neurology referral.

I panicked, as one does when one wakes up on a stretcher without knowing how one got there. I had no idea what was going on. To make matters worse, these strangers were holding my arms and legs down, as if they were worried I would float away. I tried to sit up and they clamped down harder. After a frenzied minute of everyone and their brother trying to explain to me why I should, in no uncertain terms, absolutely not sit up, I realized that I had passed out and hit my head. I reached up to touch the bandanna I wore to tie my hair back and my fingertips came away bright red. An ambulance was already on the way. My first thought?

"Shit, I don't have health insurance."

In the United States, the very first question you're asked when you go to the emergency room is whether you have health insurance. It's the first question you're asked when you call a doctor to schedule an appointment. It's pretty much always the first question you're asked when you interact with our healthcare system in any way at all. Furthermore, my job title in the health center where I work is Public Benefits and Insurance Navigator, which means I spend eight hours every day helping clients apply for public health insurance, enroll in health private insurance, and generally navigate the intimidating labyrinth of the U.S. healthcare system.

I had traveler's health insurance for my first three months in Spain since that was a requirement for my visa, but I had since let it lapse since I never used it. I've seen enough ambulance bills in my work to know that one ride costs thousands of dollars, not to mention the attendant fees for the services I would need upon arriving at the hospital. 

I tried to explain my predicament to the woman-stranger closest to me, and she looked at me like I'd gone off my rocker. She probably assumed I'd hit my head really hard to be asking that kind of question, and didn't say anything in response. When the ambulance arrived and the paramedics started to wheel me towards the back doors, I repeated to them that I don't have health insurance and can't afford an ambulance. They raised their eyebrows at me in the same startled expression on the woman's face and said not to worry about it, that I wouldn't have to pay anything. 

We arrived at the hospital and the paramedics lowered me from the ambulance and pushed me through the doors emblazoned EMERGENCIAS. A man came over and asked for my ID, which I didn't have; since I was on a run, all I had was my phone. He admonished me for my lack of documentation and I apologized profusely. His stern features softened into a smile when I said I didn't have an insurance card either. I must have looked confused, because his grin broke into a full-bellied laugh. 

"Where are you from?" he asked.

"The United States," I answered. I'd told the paramedics I didn't need an English speaker and had been speaking in Spanish, as I did 99% of the time when I lived in Córdoba. 

"So that's why you're so worried," he chuckled. And so, we launched into a conversation about the Affordable Care Act while I waited for a doctor to come staple the gash in my head back together. By the time I was wheeled back out into the waiting room, I'd had my head cleaned, put back together, and x-rayed, and I didn't have to pay for any of it. The nurses instructed me to take it easy and warned me that I might be woozy or nauseous for the rest of the day. When I told them that I didn't have any money for a cab or bus home since I didn't have my wallet on me, they chirped in response:

"No problem! An ambulance can take you home."

I felt my jaw hit the floor. Not only had I received top-notch medical care for free while uninsured from a foreign country to which I have never paid a dime in taxes, I was going to get a ride home. Which in the United States would cost around $6,000. Everybody should have the right to this kind of care.

I cannot imagine getting this kind of treatment in the U.S. I'm lucky enough to have always had health insurance, and even so, I've still gotten grilled about whether I have proper coverage any time I've used emergency services. I've seen clients of mine bring in bills totaling more than half their annual pay from a single ER visit that they desperately needed. I am grateful to have the privilege of guiding clients through our healthcare system. But to be honest, I'd rather be sick in Spain, where my job doesn't even need to exist.