Letters from Spain #11: The European Way of Life

At long last, here is my first podcast of the new year. Some of my older podcasts are unavailable on iTunes now, but they are all on YouTube, including this one!

https://podcasts.apple.com/us/podcast/letters-from-spain-11-the-european-way-of-life/id1469809686?i=1000463500918

(For the transcript, see below.)

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Hello.

Happy New Years to all five of my listeners! It feels good to be back.

For this letter, I want to finally talk about something that has been on my mind a long time, and that is the contrast between the American and the European ways of life. I think this is especially relevant now, during our endlessly long election season back in America, because this contrast between America and Europe has actually exerted a strong influence over progressive American politics. You could arguably boil down the progressive platform—championed by Bernie Sanders and Elizabeth Warren—to the following statement: that America should be more like Europe. So what’s Europe like?

One of the most obvious contrasts is healthcare. Spain, like Germany, France, or Denmark, has a nationalized healthcare system. That means that every citizen is automatically covered at all times, free of charge or nearly so (although some people do supplement their public healthcare with private insurance). This is radically different from the United States, where most people have private healthcare, usually tied to one’s job. The difference is profound. In America, people really worry about the cost of healthcare. Even relatively well-off people.

The cost of an ambulance is one example. If you pass out in the street and somebody calls the ambulance for you, you can wake up in debt. There’s a famous story of a woman who fell between the subway car and the platform, who begged people not to call an ambulance because she couldn’t afford it. People go bankrupt in America because of illnesses and injuries—something almost unheard of in Europe. It’s not uncommon in America to see GoFundMe campaigns for people struggling with medical costs. But this isn’t just a question of insurance. It’s also because anything related to healthcare is absurdly expensive in the United States. A hip replacement, for example, is six times more expensive in the US than in Spain. That means you could take a nice long vacation in Spain, and then get your hip replacement, and it would still cost less money. And medication prices are wild in America. Insulin is so expensive that some people try to ration it, and a few have died in the process.

There are lots of reasons for the high cost of healthcare in the USA. One is the bureaucratic complexity needed to deal with all the different private insurers. Some hospitals need just as many administrators as hospital beds to process all the intricacies of insurance claims. Another reason is that, in most countries, medicine is bought in bulk by the government from the drug companies, while in the United States each person buys directly from the drug companies—and there’s no bargaining power in that situation.

Anyways, I don’t want to set myself up as some expert on healthcare, which I’m clearly not. What I can say is that I’ve never heard a Spanish person worry about whether they’ll be able to afford going to a doctor, while in America the financial costs of getting sick are at times even scarier than the actual sickness. On the other hand, I have had a bad experience with a Spanish dentist here. They often try to rip you off. (Though admittedly most dentists are private in Spain.)

Speaking of health, another big difference between America and Europe is our eating habits. We eat a lot in America—a lot of food, and a lot of junk food—and as a consequence obesity rates in America are over twice as high as they are in Europe. This tends to make us sick, which only exacerbates our healthcare problem. One thing that we Americans do have over Spain, at least, is that fewer people smoke in the United States (15%) than in Spain (about 22%). But America definitely loses when it comes to physical activity. Since so much of our country is designed for driving, the average American walks less than 5,000 steps a day, as compared to more than 9,000 for Spain. This, combined with other factors like Spain’s diet, led Bloomberg to proclaim Spain the healthiest country in the world. (The United States ranked 35. In fact, the average life expectancy in America has been falling for the last three years.)

So much for health. But there are still more striking contrast between Spain and the United States. One big one is maternity leave. Every European Union country guarantees at least 14 weeks of maternity leave, and several also give paternity leave. This means that a new mother can take over three months with her new baby, while receiving full pay, and guaranteeing a job when she returns to work. I have no idea why this isn’t a more outrageous issue in the United States, where the government guarantees no days of paid maternity leave—everybody likes mothers, after all. By the way, America is also unique for offering no minimum paid vacation days, and no guaranteed paid holidays. Spain, by contrast, offers a minimum of 22 working days off, plus a mandated 12 paid holidays, and an optional 2 more holidays that local governments can choose.

The last major contrast I’ll mention is university. The cost of going to college in America is incomparably higher than it is in Europe. Even a public university can cost tens of thousands of dollars per year. Student debt has become a way of life in the US, and virtually everyone graduates with at least a few thousand dollars of loans they need to pay off. This has a huge effect, not only on our economy, but in our educational decisions and philosophy. It influences everything from what we study, to grade inflation, to job choices after college. Meanwhile, in Europe, getting a degree is cheap and in some places even free. With a stipend, you may even be paid to attend a university. As you can imagine, this makes a big difference.

There are many other differences, too—the strength of workers’ unions in Europe is a big one—which combine to make Europe substantially more egalitarian than the United States. Here are some figures. From 1970 to the present, the share of total income going to the top 1% in America rose from 8% to 20%. In Europe, it also rose, but from 7.5% to 10%. That is, in America it increased by 150%, while in Europe by about 33%. That’s a big difference. In this same time period, the share of income going to the bottom 50% of the population fell by 7% in America (to 13%), and by only 2% in Europe (to 18%). To sum up, in America the gap between the rich and the poor has grown far wider than in Europe. 

And this brings me to a central contrast. In America we talk about the American “dream.” That is, our model is based on the idea of people “making it”—pulling themselves up by their bootstraps into another economic echelon. And of course there are success stories. But this narrative hides the fact that, if you don’t “make it,” then life in America can be rather harsh. Even more importantly, getting to the top is extremely rare. Besides the fact that having a highly unequal society means that there is less room at the top and more room at the bottom, America does not score particularly well on social mobility. According to the World Economic Forum, the United States ranked 27th globally. The top 13 countries, by the way, were all European. And the top five are the Nordic countries, famed for their socialist policies: Denmark, Norway, Finland, Sweden, and Iceland (in that order). 

Admittedly, Spain ranked just below America, at the 28th spot. But the important thing to note is that, in Spain, social mobility is not vitally important to well-being, since a robust social security program guarantees a high minimum standard of life. This is why I refer to the “European Way of Life” rather than the “European Dream.” Because the idea in Europe is that the good life should not be a longshot, rags-to-riches, one-in-a-million dream, but something taken for granted.

My point has not been to convince you with statistics. These issues are extremely complicated, and of course Europe has its own problems. My point is this. When Americans, especially younger Americans, look across the Atlantic and see all of these differences—healthcare, education, maternity leave, vacation—many of them naturally wonder why we cannot do the same thing in our wealthy country. Why is America so exceptional in these rather unfortunate ways? I can’t say I know the answer to this question. But I know that awareness of this discrepancy is growing, and has already had a major effect on our own politics as more and more voters react with outrage. Americans put up with many things that, in Europe, would cause mass protests. But will Americans continue to do so?

Thank you.