I Will Never Get a Bill: Medical Care Reform

Yesterday we had to take an ambulance to the hospital. All is okay.

I will never get a bill for this.

We were triaged and treated immediately. No bills.

We were given a medication that began to help, then a doctor saw us for a complete examination as soon as was medically appropriate. No bills.

Health care in Spain is not “free,” but for all the basics and then some you will never get a bill.

Today I am writing about medical care. I’m not an expert in this field but I have gotten to know the Spanish and European system very well and I have worked for a group that designed economic models of long term care coverage that saved states money.

The medical care system has and continues to work very, very well here in Spain. Sure, there are problems, and there are waiting times for some procedures. Also, sometimes people will pay about $60-200 for a second opinion outside of the main hospital out of pocket. If you are diagnosed with cancer, this can be well worth your time.

Ohh but the HUGE TAXES. Actually, your tax dollars here go to pay for a whole heck of a lot more than healthcare…some things good, some things bad. Too many? Definitely! Much of the government is far too unnecessary and inefficient. But, healthcare is not the reason that people pay higher taxes here.

For example, the World Bank has a neat chart about healthcare expenditures as a percentage of GDP. For Spain, between 2011-2015 healthcare spending is 9% of GDP.  For the USA it’s 17.1%. In dollar amounts, that’s approximately $9,340 per person in the USA per year, or $2,657 per person in Spain. Yes, salaries are much lower in Spain, but what matters here is the difference in the proportion of the GDP that is being spent. In the USA we pay 90% more per person for the healthcare we receive.

Let that sink in for a minute.

Ohh but those long, socialist waiting lines. It depends on your own particular health administration, but here in Navarra, this is a myth. Also, the facilities are beautiful.


As I see it, we are paying much more money for much less care in the USA, and we are leaving those who can least afford it to be vulnerable to the costs of medical attention. $1000 emergency room visits for a family of 3 that make $50,000? Are you kidding me? Whatever stereotype you have in your mind on this that allows you to blame the victim of a sickness is sheer perversity. Yes, we need to incentivize people to take care of themselves and to understand and listen to their bodies. This is fundamental. But this doesn’t account for the fact that we are spending far too much money for far too little care.

Diagnosis: too much money for too little care.

Prognosis: Rebalance how we spend our medical dollars; redistribute the financial burden for how we pay for this care; redesign key features of our medical system that cause us to pay absurd amounts for care.

Rebalance: Study how to spend money in the most effective ways to provide the best care for the most people and high-quality care for all people. This can be in simple tricks like funding public-private partnerships that allow hospitals to improve care and efficiency. Also, get insurers out of the pharmaceutical business and

Redistribute: Move medical care down to not only a state-level, but a metropolitan statistical area (MSA) level. Allow people within their own area to shape policies on what types of elective (non-emergency) coverage is covered. Allow taxes to follow these areas, and allow rural health care to be funded by the overall system.

Redesign: Create public-private partnerships (improved efficiency, higher quality care, allow for religious institutions to participate fully with their own values) to provide care. Create a national “race-to-the-bottom” for generic drugs, antibiotics, which are produced as cheaply as possible at the highest quality standards. Begin a national pharmacy system, which allows one to pick up their prescriptions anywhere, or at least the closest pharmacy. Allow these drugs to be subsidized based on income.

The European model can teach us a lot. But let’s not let our attachment to what is familiar prevent us from doing the right thing.