The Sick American And The Ailing Spanish Health Care System

This summer an American friend, an old college buddy, came to visit us in Barcelona with his family. Unexpectedly, someone in his family fell ill. We ended up in the emergency room of a local hospital. It turned out to be nothing serious, but his kid had to spend the night, just for observation. The next morning when we picked him up, my friend asked a nurse at a window where he should pay.

“But it is Sunday,” said the nurse from behind the glass screen.

“Yes,” my friend said.

“The payment office is closed on Sundays.”

“We’re screwed,” my friend said to me anxiously.

“Why?” I asked.

“Because we can’t just leave without paying,” he said. “What are we supposed to do?”

I translated his concern to the nurse.

“Why can’t he just come back tomorrow,” she said, looking bewildered. “What’s the problem?”

I explained to my friend that he could pay the following morning, and we walked out of the hospital. He was shaking his head in disbelief.

“Come back tomorrow?” he said. “Try that in America. ‘Hey, I don’t have any insurance, or cash on me. I’ll come back to pay my $4,000 hospital bill tomorrow.'”

He was right. It hadn’t struck me how absurd that would have sounded back home. Yeah, the check’s in the mail. No problem. Except stateside that’d be a big problem. One that would likely end with your bank account getting embargoed.

The real shocker for my friend came the next morning. We got up early, drove back to the hospital, and found the payments office. I handed over the bill for the emergency room care and overnight stay. My friend pulled out a credit card.

The clerk looked at me. “Doesn’t he have cash? It’d be a lot easier.”

“He’s asking if you’ve got cash.”

“Yeah,” my friend said, “I’ve got a suitcase full of twenties in the trunk of my car.”

“How much is it?” I asked the clerk.

“30 euros,” he said.

“It’s 30 euros,” I told my friend. “I’ve got a 10. If you’ve got 20 euros on you we’re good.”

If my friend had been shaking his head the day before, now, as we walked to my car again, it was positively spinning.

“That would have been thousands of dollars back home!” he exclaimed. “How can they do it?”

“Well,” I said, “it’s not really so cheap. People pay for the healthcare system in part through a special healthcare tax. Like the medical version of our Social Security.”

“But I don’t pay that,” my friend said. “I’m just a tourist. And yet they only charged me 30 euros.”

“Yeah, well, it’s a pretty good system.”

My friend flew home, impressed.

I am too. But after a few more visits to hospitals of late, interviewing doctors and patients and administrators, I’m seeing first-hand how that pretty good system is getting gutted. Spanish tax rolls are down as unemployment soars to over 21 percent.

So the Spanish government is slashing spending. More than any other sector, healthcare has its head on the chopping block.

I’m afraid we’re witnessing the dismantling of the European welfare system. Unless economic growth returns soon, the budget cuts will keep coming.

This morning at a city hospital a nurse named Encarna said to me that she really hoped Spain didn’t end up like America, “with so many poor people who can’t get healthcare.” Shame on you, she said, turning away the poor at hospitals.

The poor and any tourist without a suitcase full of $20s, I thought. Viva España.