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Comparing International Health Care To The U.S.


As the Senate continues to struggle over the fate of the health care bill, European health care systems are often cited as both models and cautions. So we thought we'd talk to one of our reporters there. Lauren Frayer covers Europe for us. She's based in Spain. And right now she's in London. Lauren, welcome.


MARTÍNEZ: All right. So you've lived overseas for a dozen years. So how do you get your health care?

FRAYER: Well, when I first moved abroad, I got it through my employer, an American company - sort of an extension of the U.S. system. So we had a network of overseas doctors. But now as a legal resident of Spain, I'm entitled to coverage through a public health system there, taxpayer-funded health care for everyone. You pay a bit for prescriptions. But when I say a bit, I mean $2. No co-pays for doctor visits or specialists or anything. And on top of that public health care, I choose to buy private health insurance, through which I can find, if I want, an English-speaking doctor, get certain preventative care that might not be covered by the public system.

MARTÍNEZ: All right. So in Spain, a little bit of a public and a little bit of a private thing for you there. The public system - what's your experience with it?

FRAYER: So it's no frills. I mean, the hospitals are pretty rudimentary. You might not get a private room. But the care is of very high quality. Spain does, you know, interestingly enough, the most organ transplants of any country in the world.

MARTÍNEZ: Noted. Good, in case I'm in Spain.

FRAYER: I've been fortunate enough not to need an organ transplant. But as an American being in the European health care system, what strikes me as strange - there's no money transactions. You know, there's no cash register in any hospital or doctor office here. This system is a little bit more analog, you could say. Only recently in Spain could you make specialist appointments through - in the public health care system by telephone. I've had to line up in the hospital basement with slips of paper. These are doctor referrals to make appointments with specialists. But you do get the appointments.

MARTÍNEZ: How long is that wait time? Say, like, I've got something bugging me, and I want a doctor to see it in Spain. How long would I have to wait?

FRAYER: So it depends on how urgent it is. I mean, if you have something serious, you can see a doctor the next day. If you want to go to the dermatologist and, you know, have some moles checked out, for example, have some kind of non-urgent preventative care, in the public system, you might have to wait a month or two or even more.

MARTÍNEZ: Now, for the people you go see, the doctors and the health care workers who work in the public system, what's it like for them?

FRAYER: Doctors and nurses in Spain are sort of mid-range civil servants. Keep in mind the average salary in Spain is about $1,800 a month. Doctors make slightly more than that. But they are not millionaires usually. Anecdotally, I know a cardiologist who - you know, her salary is less than mine. I'm a freelance journalist. She recently started doing botox treatments on the side to supplement her income because that's much more lucrative for her. There are a lot of Spanish nurses and doctors who come here to the United Kingdom because the pay is better. And so Britain's National Health Service is a very diverse health service from - you know, there are workers from all over Europe working here.

MARTÍNEZ: Well, good for us, Lauren, you actually brought someone here who can answer some of these nitty-gritty, economic questions about the U.K. system. So let's introduce John Appleby, chief economist at Nuffield Trust. John, welcome.


MARTÍNEZ: All right. So in England, when it comes to doctors and health care workers, what's life like for them there?

APPLEBY: I think pretty good. Lauren was talking about the pay. It sounds like the pay in Spain is quite a lot lower. I mean, the average sort of pay for a specialist, a consultant in a hospital in the UK is something around 112,000 pounds. That's about - what? - $145,000 a year. That puts them in the top 2 percent of salary earners in the U.K.

MARTÍNEZ: So, broadly speaking, how does U.K. pay for all this health care?

APPLEBY: Well, as Lauren was saying about Spain, we pay through our - we call them general taxes - so income tax, VAT - value-added tax - on goods and services, corporation tax and so on. All the money goes into a big pot. And governments will then make a decision about the global budget for the NHS for the coming five years. And that sets the sort of limit on spending broadly. And, of course, you know the electors vote for governments. Because health is so important to people, what parties - political parties - say they will do for the NHS and how much they spend will be a big factor in influencing people's votes.

MARTÍNEZ: So, on a per-person basis, John, how much would you say gets spent on health care?

APPLEBY: Well, as I say, it all comes out of general taxation. The government take about 38 percent of gross domestic product in taxes and excise duties and so on. Of that, about 7 to 8 percent goes on the NHS. And that works out at about 2,000 pounds per person.


APPLEBY: Well, it's interesting because the U.S. spends more public money from taxes and tax breaks as a percentage of GDP than we do - so Medicare, Medicaid, CHIP and so on. And then tax breaks and so on for private medical insurance. It adds up to - I think it must be sort of 10 or 12 percent of GDP. So, interestingly enough, the U.S. spends more public money on health care than the U.K.

MARTÍNEZ: John, what would you say is the biggest problem with the NHS?

APPLEBY: I think at the moment, it is really suffering from a lack of money. And public polls are now starting to swing in favor of a government putting more money into the health service. And, in fact, you can see in terms of government policy a weakening in terms of the sort of focus on reducing the debt and cutting public spending and putting taxes up a bit and so on. So I think that's the biggest issue at the moment. We're simply not spending enough.

MARTÍNEZ: Now, Lauren, you've reported for more than 10 years outside of the U.S. You're married to a Brit. Wondering, what's the question you get most overseas about the American health care system? What are they - what do people ask you about the most?

FRAYER: Yeah. So as an American living abroad, you're sort of an ambassador for all things American...

MARTÍNEZ: You have to be. That's your job, Lauren.

FRAYER: ...Whether you like it or not. And the biggest question I've gotten lately is, why don't Americans want public health care? I mean Europeans think of health care as something so important that it should not be tainted by a profit motive - that it's so important that it should be in the hands of the government only. And a lot of Americans tend to think the opposite. It's something so important that - don't dare let the government touch it. And that's a really fundamental difference that I've seen among, you know, living on two sides of an ocean.

MARTÍNEZ: Lauren Frayer - you've heard her mostly from Madrid. She's in London at the moment. You also heard from John Appleby, chief economist at Nuffield Trust. Lauren, John, thank you very much.

FRAYER: Thanks for having us.

APPLEBY: Thank you. Transcript provided by NPR, Copyright NPR.

Lauren Frayer covers India for NPR News. In June 2018, she opened a new NPR bureau in India's biggest city, its financial center, and the heart of Bollywood—Mumbai.