Healthcare in Europe vs the US

I am a healthy 60 year old male and rarely get sick. But the few times I have been, I was lucky to have the coverage I did at the time. I’m now an expat living in Spain. For the five years before very recently, I was living in Vienna, Austria. My wife is an Austrian citizen, so in Austria we had public healthcare, even in early retirement. In Spain, we have private coverage for the time being. That said, it is with the same company we were covered with when living and working in Madrid from 2018 to 2020.

OK, so that sets the stage. But let’s go back in time. We lived in the US for 20+ years of our marriage. We had company offered healthcare, and it was good since I worked for HP, Phillips, and Amazon. That means I was always covered but had to pay for my wife and kids. From 2016–2018 at Amazon in Seattle, that meant about $550 out of paycheck each month to cover my wife and one adult child — still under 26 back then. Note: At Amazon Madrid, my wife was covered at about $150 per month, far below the $400 for her share in Seattle.

Deductibles in Seattle were still high ( $2500 per person ) as were co-pays and out-of-pocket maximums. Doctor visit co-pays were between $20-$40. The only big event we ever dealt with was a severely broken arm for our youngest. Surgery, overnight stay, steel rod inserted. That 24 hour visit and surgery, in 2008, ran up a bill of $22,000. Our part was “only” about $4400. Still insane but somehow manageable.

Fast forward to 2023. We’re living in Vienna. I am retired. Paying $150(US) per month for healthcare for each of us. I had an old umbilical hernia issue.

Doctors in the US in 2017 told me I could put it off, that it might not be worth the expense. Cost for the procedure with a one night stay in the hospital might run $20,000-$30,000. That was enough to scare me off. I cycle a lot and hike a good bit, so this type of hernia at the size it was could be ignored, at least for a while.

So when I strained my abdominals in 2023 in Vienna, I went to the doctor, who referred me to an imaging center. They saw that the hernia had gotten slightly larger. Surgery was suggested. I went to the surgeon for a consult. He suggested a mesh insert but urged me to get a second opinion. My research said that the mesh was not necessary for someone with my size injury.

The second opinion came from a hospital that did a lot of outpatient procedures. They didn’t see the need for the mesh, generally only required for tears >2 cm, and scheduled a stitch surgery three weeks out.

The entire process to this point had had a duration of ten days, and my out-of-pocket had been $0. I was feeling pretty good about the situation. I went in for the scheduled pre-op, then surgery a day later. And the surgery went well. I woke up, got fluids, two hours later a meal, and the obligatory “show me you can pee” routine. Cost? $8. For the meatloaf and mashies they served me before I went home.

My wife and I took a cab home and I was pretty darn sore for a few days, but then walking, and within 4–5 weeks I was at full strength. But then things took a bad turn. I screwed up.

We had a massive blizzard. Fourteen inches of wet snow in 24 hours. I saw that our apartment building’s walk and sidewalk needed shoveling. It wasn’t the shoveling as much as the heavy, wet snow. After about a minute I felt a tug. To my credit, I immediately stopped shoveling and went inside.

Things were fine for a week or so. But then I was walking the trash uphill to the corner and suddenly felt very much out of breath. It was bad. I know my body. 4,000 miles a year on the bike. Heart rate monitor tracking every ride. I was a resting heart rate guy of 52. I was now sitting on my couch with my pulse racing at 102.

I was scared.

My wife urged an immediate visit to the GP. I did that and the doc initially thought I had COVID. But as soon as I said that I also had inner thigh throbbing, she knew something worse was going on. She referred me directly to a different imaging center.

Within15 minutes of arriving at the imaging center, I was in and getting an EKG, a thigh ultrasound, and a consult. The news was not good. Deep Vein Thrombosis or DVT. And the labored breathing likely indicated that it had broken up and bits had moved to the lungs. I was sent for another quick ultrasound of my heart. That was clear, but when I returned to the consulting doctor, she notified me that she had already called an ambulance.

There I was, at 58, and the youngest in the room, sitting in a wheelchair and being told NOT to walk. I had originally suggested that I could walk the ten blocks to the main hospital but that was never going to happen under their watch. The ambulance was the only responsible option.

The ambulance arrived within five minutes and I was shuttled to the ER at Vienna’s famed General Hospital. It’s a massive, twin tower complex. They have 1500 beds, a staff of 9,000 and see 1.2 million people per year. This was going to be a long night, or so I thought.

I was wheeled into the ER, swiped my card, and was taken immediately to triage. I had swiped my card four times that day — at the GP, at the imaging center, in the ambulance and now in the ER. The card knew everything about my healthcare history in Austria. Every visit, every image, every prescription.

The ER doc immediately asked “English or German”. He knew I was American from my data from the swipe. I said it didn’t matter and we bounced back and forth between the languages. His English was impeccable. My German was nearly native.

A second doc had all my imaging from the other office I was at up on the screens already, a nurse was taking vitals and then gave me a jab with a blood thinner called Xarelto. The background of being an avid cyclist, the hernia op all noted, and I was being wheeled to get a lung CT. This wasn’t a chronic illness issue. I hadn’t been in the hospital for more than 15 minutes. I was second in line at CT, and within 20 minutes I was back in the ER with the original crew, and they were checking the CT results.

A dozen points of bad news in the lungs. “But it’s good you came in when you did!”. This will be resolved with 90 days of medication.

I was still reeling. I had a deep vein thrombosis and a pulmonary embolism. Very scary terms to hear. What next? Can I ever ride again? What’s the long term prognosis?

The doctors were very thorough in their consult and left me feeling like this might just have been a bullet dodged and not much else long term. Maybe take the blood thinners for a few days before and after a very long flight.

A smile and thanks for coming in. Come back tomorrow for one more jab in the morning and we’ll have your blood thinner pills waiting for you then.

What a day ! But “day” is overstated. My first stop at the GP happened at 1:15pm. It was now 6:00pm and I was being released from the ER to go home. Four stops, all those tests — ultrasounds and CT, five different consults and a ride in an ambulance. It was all done in less than FIVE hours.

In Seattle I once waited more than four hours with my kid in the ER just to be seen for the first time after he wrenched his knee skiing.

But my amazement didn’t stop there. I received no bill. Everything was covered. OK, after the first 10 days of medication from the hospital (free) I would pay about $8 per 30 days for the Xarelto.

It’s been almost two years to the day since that experience in the ER in Vienna. I made a full recovery, have increased my cycling mileage, and haven’t looked back.

As I watch from afar the craziness now happening around healthcare and the ACA in the US, it reminds me to be very thankful for where I am and the systems in place that help keep me healthy.

The EU countries don’t view healthcare as a profit making apparatus. Sure, there are private doctors, private hospitals, and you are welcome to get additional insurance for that. But even that generally runs only about $300 per month ( in Austria).

Healthcare in the EU is viewed as follows: Healthy people who get early and effective treatment tend to have good outcomes and remain healthy and live longer. People who do not live in fear of medical bills, medical bankruptcy, huge monthly premiums and out-of-pocket maximums tend to go to the doctor even when it doesn’t seem all too serious. One just doesn’t know. Doctors tend to know. So I choose to trust the process over here.

We have since moved to Spain and were required to purchase private insurance for the first year. The bill came to $2850. Hold on, that’s for the YEAR. Hold once more, that’s for TWO of us. And a simple third hold on because there are no deductibles, no copays, and no limits. So, $120 per month per person.

I shopped online for healthcare for the two of us in Seattle today (December 2025) and the estimates were around $3,000 per month !

I hope the US Congress can get together and solve the current issue of ACA subsidies and prevent the massive healthcare premium increase likely to affect millions of people starting January 1.

Stay healthy !