Invest in public healthcare, do not privatize it
In 2013, my father got pancreatic cancer and insisted on leaving Memorial Sloan Kettering, the high-profile cancer hospital in New York City, to return to Paris for treatment. He had been born there and wanted to go back for the summer as he always did. Terrified though I was of his being far from home in New York, I went along and learned about all the ways that French public healthcare beats US care.
This summer I learned the lesson again. My husband had a procedure at Mount Sinai Hospital in New York City in February and came home bleeding and in pain. Soon a scary rash and swelling started. For weeks we messaged the doctors to tell them but no one seemed to take it seriously as we did. The original doctor said it wasn’t his area and sent us to a specialist. Our regular specialist sent us to another specialist and a dermatologist. Our GP told us to try cream for diaper rash. Over a three-month period, my husband’s specialist doctor sent us to two dermatologists, two more experts, then tried four rounds of antibiotics and a PET scan. They tested for cancer (negative) and noticed my husband had developed anemia, so his new hematologist gave him injections into the bone marrow. Rarely did they examine him. Mostly they asked questions and entered replies onto their screens.
Coordinating all of this during a busy spring at work was a huge burden. I estimated that I was spending at least 10 hours a week scheduling my husband’s care and accompanying him to the medical appointments. Every Tuesday we would go to a doctor at Union Square, another one on 60th st and then take a taxi to the University to teach our classes. We canceled nearly all of our work travel, instead going to doctor after doctor hoping for an answer as to what ailed him.
Finally, a long trip was coming up and my husband was still in pain. Before flying, we went to see two of our New York doctors and they cleared him for travel, took a last look and said: "Maybe it will go away on its own."
I was skeptical but not sure what else to do, and so just in case, I gathered a list of doctors we could call on as needed. I also looked up the best hospital near where we would be in Spain and asked a nurse I knew to check on him as soon as we arrived. We thought maybe traveling and a new set of doctors’ eyes would make a difference. Did it ever!
Soon after arriving in Catalunya, the swelling got worse, so we called the nurse and he took a look and immediately told us to go to the emergency room of Hospital Joseph Trueta in Girona. We also saw a doctor in Girona who said the same thing. In other words, every level of Spanish healthcare worked.
On arrival at the urgencias door of Trueta, we were taken seriously. They pored through the medical notes we had brought with us from New York, asked detailed questions and took a history of what happened. They quickly told us that my husband had a serious infection, did a scan, found the evidence (no idea why the NY doctors missed it in their scan) and admitted him immediately. At some point the doctor said: "I know who you are", since my husband is Joseph Stiglitz, a Nobel laureate in Economics, "but here we treat everyone equally". They put him on a strong antibiotic drip and then came to work on a Sunday in order to operate to clear out the collections. I think they saved his life.
"It’s the serendipity of life. You think you have the best doctors in New York, and then you come to a regional hospital in Spain and they are actually giving me healthcare", my husband said.
He stayed for 18 days and we could not believe the quality of nursing and the kindness and the attention he got. Coming from New York City, it was shocking. Our US friends were amazed when we described how the Trueta doctors worked together and coordinated with each other. Our friends came to visit and saw for themselves the way the nurses showed their humanity.
One hot afternoon I was sitting in a chair with my eyes closed, exhausted by all the anxiety and drama of the previous weeks. A nurse saw me resting, pulled down the blinds, offered me a juice and said: “Take care of yourself. I’m looking after my dad too. It’s exhausting” .
“Girona hospital has spoiled you. Stay there,” my college buddy visiting from New York said. She had just waited three hours in New York with her 93-year old mother for a 10-minute appointment for mom’s glaucoma checkup.
I’m sure medical errors and misdiagnoses happen in Spain. But the whole character of our experience in Girona here has been different than at home. In New York we have famous doctors who have written the textbooks used in medical schools, but they don’t look at and listen to patients anymore. They’re too busy filling out forms online, ruling out possible illnesses and ordering scans.
We got so accustomed to Trueta that I worried about leaving the hospital and not sure what kind of care we’d be able to arrange. It was interesting to learn about the primary care system in Catalunya and how outpatient care is done after a hospital visit. In the US, hospitals try and get patients out the door as quickly as possible, partly for health reasons and largely to save money. As I stressed about where we would go and what date my husband would leave, I was impressed when the surgeon explained to us: “We’re a public hospital", he said, taking pride. "We don’t throw you out on the street.”
Spending so much time in Girona, I got to love the city. Some 40 years ago I had written a travel piece about Girona’s Call and it has been terrific getting to know Girona again. I have had many conversations with cab drivers, hotel clerks and others about the terrible housing shortage and how the city has changed. But one thing I noticed immediately: how many people love Trueta hospital. Inevitably, people told me “it’s an old building but it’s a wonderful hospital.” I heard many stories about people who had been born there or treated there. In the late afternoons when the patients would practice walking in the hallways, we’d talk to others and inevitably people were happy to be in Trueta.
In the US, the first thing that happens when you seek medical care is a conversation with the billing department. People without insurance (or even those with) avoid the hospital and avoid calling an ambulance because it’s easy to get a bill for hundreds of thousands of dollars from the hospital. In fact, medical debt is the leading cause of personal bankruptcies in the US. I recently became a Spanish citizen, but we’re not part of the healthcare system in Europe yet so, naturally, the first thing I did on arrival was present my credit card and discuss how we would pay for my husband’s care. I met the billing office in person to discuss payments. It’s been seamless. I’ve been able to talk to a real person, email them and get an answer. When I needed medical records, I just popped up to the records floor and filled out a form.
By contrast, calling Mount Sinai Hospital in New York is an experience in “voice mail hell” as we call it in the US. When I messaged the New York doctor to tell him my husband had been hospitalized, it took several days for him to answer. When I called his office, I was told that in emergencies it takes 48 hours for the nurse to respond. In the US now, there is a something called “concierge medicine” and Mount Sinai hospital charges $15,000 a year per person to join. When they tried to sell me this service, they said one of the benefits of signing up is the doctors reply to phone calls from patients. I thought I had misunderstood but it was for real. In order to get a phone call from the doctor at Mount Sinai, you need to pay a supplement of $15,000 a year!
All of these differences between Trueta and New York hospital made me interested in the difference between our systems. In contrast to Spain, where health care is public and paid for by taxes, in the US we have a private system where costs are out of control. Total (public and private) spending on healthcare as a percentage of GDP is close to 17% in the US and about 9% in Spain, according to World Bank data for 2023. Although polls find that most US citizens would love to reform the US health care system it has proven to be impossible and some 9% of US citizens have no health insurance, a number already rising as the Trump administration tries to dismantle the popular Obama care program and other protections.
We will be returning to New York for a second surgery this fall so we’ve been showing the medical records from Trueta to doctors in New York who work at some of the best hospitals. They’ve been impressed. One of them told us we would never have had such good care in a regional US hospital.
So this is just to say thank you to Spanish public healthcare and please cherish it closely. Invest in public health care, don’t privatize it. You don’t know what you’ve got until it’s gone.
