Adventures in Public Healthcare

In the wake of the murder of Brian Thompson, the simmering anger that Americans feel for their healthcare system has boiled over. The internet is full of stories of people denied necessary treatments and medicine by our byzantine and heartless insurance industry. The alleged killer, Luigi Mangione, has even become a kind of folk hero to some, for taking revenge against a system they believe is just as guilty of murder—if not more so.

Fortunately, I don’t have a horror story about the American healthcare system to contribute. Nor am I here to lionize Mangione. Instead, I wanted to write up my experience dealing with a public healthcare system, in case any Americans are curious about what it is like in the rest of the world.

Shortly after running the Marathon, in 2023, I wanted to go to get a checkup to make sure I was alright. At the time I had private insurance through my job, which is fairly common even in a country with a robust public system. However, I should note that even the private insurance here is much better than it is in the United States. I never had a copay and, as far as I know, didn’t have a deductible. When I went to the dentist, podiatrist, or radiologist, the subject of money was not even brought up. Far from the American experience, here people get private insurance for convenience, and don’t seem to spend any time fighting with their insurers.

I went to an English-speaking doctor popular among expats. After a blood test, it turned out that I had extremely low iron reserves and was mildly anemic. My levels of ferritin (an enzyme that stores iron) were particularly low, about a quarter of the minimum level.

My doctor didn’t seem particularly concerned. He prescribed me iron pills to take for 90 days and told me to check back after the summer. By chance, during that time I got a new job, a better one, but which didn’t come with private insurance. Thus, when I went to do the follow-up, I went to the public health center in my neighborhood.

The experience was quite different. While the private doctor’s office was basically comparable to what I was used to in America—with a front desk, a waiting room, and a private room in the back to see patients—the public health center was more like an urgent care. There was a large central waiting room with metal benches and rows of doors leading to dozens of doctor’s offices.

After a brief talk with the doctor, I was told to come back in a few days for the blood test. The results were later delivered to me on the public health portal. After 90 days of iron supplements, my iron and ferritin levels were still abnormally low. Shortly thereafter, I got a call from the doctor. She seemed concerned. She asked me if I was a vegetarian or a vegan; and when I said no, whether I suffered from stomach pain or diarrhea. When I said no again, she told me that I would have to do an additional blood test and, more upsetting, bring in a stool sample.

This is when I began to panic. I had blithely assumed that my low iron levels were due to overtraining for the marathon, but the doctor seemed to think it could indicate something far more serious. I will spare you the details, but the stool sample was brought, and the blood test done, with no progress. There was no blood in my stool nor was I positive for celiac disease.

The doctor called me again, and told me that I would have to go get an ultrasound. This is when I realized that they were looking for lumps in my digestive tract—ulcers, cysts, or even tumors. A letter came in the mail, telling me how to make the appointment. Within a month, my belly was smothered in sticky goo and the nurse was passing her baton over it, as if I were pregnant. I expected her to say something but she didn’t, so I just wiped off the goo and left. The report came a few days later, again through the health portal: no irregularities found.

I thought that this might be the end of it, but I got another call from the public doctor. She said that, to be absolutely sure, I would have to get a colonoscopy (of my intestines) and an endoscopy (of my stomach). This is when panic really started to set in. You see, both stomach and colon cancer can cause iron deficiency, often without noticeable symptoms—until it’s too late, that is. And while colon cancer has a relatively good outlook, stomach cancer decidedly does not.

The appointment for the procedure was set for the beginning of April. This left me about two months to stew in anxiety. My mind was not soothed when a story was published in the New York Times, just a week before the appointment, that colon and rectal cancer rates are growing among young people. It seemed like an ominous sign.

For an endoscopy, a tube is inserted down your throat; and for a colonoscopy, up the other end. You’re spit-roasted, in other words. Thankfully, they sedate you for the procedure. It is the leadup to the colonoscopy that is the really unpleasant part. As the day nears, you must increasingly restrict your diet, cutting out foods with lots of fiber or strong colors, and finally cutting out food altogether. The final step is taking a powerful laxative. It’s not a fun way to pass the day.

Since you’re put under sedation, which takes a while to wear off, you can’t go to a colonoscopy alone. There has to be someone to help get you back home. Thankfully, I had Rebe. She arrived home from work and it was time to go. Strangely, at that moment, I didn’t feel a lot of anxiety about the results. I was so tired from not eating that I just wanted to get it over with.

I waited for just about five minutes before I was ushered in. The next thing I knew, I was on a stretcher with a needle in my arm. “You’re going to sleep,” the doctor said, and I was out. I came to, as many anesthetized patients do, wondering when they were going to start, and was astounded to learn that it was already over. I felt groggy and hungover. After waiting for fifteen minutes, I was handed the report: they hadn’t found anything—no tumors, no cysts, no ulcers, just a mild gastritis. It turns out that, as I originally thought, I had just over-trained for the marathon and used up my iron reserves.

You would think that I would be ecstatic at the news. But in my groggy state, I only felt annoyed that I had gone through so much trouble just to be told I was fine. I had pizza that night and drifted off into sleep.

I wanted to relate this health scare simply because it was shocking to me that, after so many tests, and speaking to so many doctors and nurses, I was never once asked to pay. No bill came in the mail. I walked out of the hospital a free (and healthy) man. What’s more, though I had to wait a couple months for the procedure, I never felt like the wait times were excessive—a common argument against public healthcare in America. As far as the doctors went, though they couldn’t spend a lot of time with me, they were highly professional, and arguably did a better job than their private counterpart, who only prescribed me iron supplements for a potential symptom of cancer.

To be absolutely fair, I should mention that the public system in Spain seems to do a very bad job when it comes to dentistry. I’ve never heard a good word about the public dental system, and the vast majority of the people I know don’t even bother trying to use it. As a result, like many people, I have private health insurance, paying a measly four euros a month. With those four euros, I get a cleaning and a checkup twice a year, with no co-pay—though, if I need anything beyond that, I have to pay out of pocket.

However, I should also mention that dental procedures are incomparably cheaper here than in the US. A single cavity drilling and filling costs between 40 and 50 euros, for example, and a root canal is about 200—prices that would seem almost free to many Americans. Even so, this doesn’t excuse the lack of good public dental care in Spain. For the life of me, I can’t understand why teeth are deemed categorically different from the rest of the body when it comes to insurance.

Even with that lack, however, I think that the healthcare system here in Spain is far superior to what Americans have to suffer through. It is cheaper both individually and collectively, and achieves better outcomes, as evidenced by Spain’s significantly higher lifespan. Going bankrupt due to a health problem is unheard of; people are not afraid of going to the doctor or the hospital or to call an ambulance. Not everyone is satisfied, for sure, but there certainly isn’t the deep hatred on display in my country.

Unfortunately, here the public system is continually in danger of privatization by right-wing parties. But if more Spaniards understood what Americans had to deal with, they would cherish their system, with all of its faults.

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Cover photo by Israel Hergón – Flickr: IMG659, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=32799310