As the "Big Beautiful Bill" Guts American Healthcare, Europe Offers a Lifeline
The truth about the for-profit U.S. system they don't want you to know, and how you can get real, preventative healthcare for a fraction of the cost.
Hello and thank you for being here! I’m Kimberly Anne—a U.S. expat who moved to Portugal solo in 2022, sight unseen and without a safety net. I started this Substack to document my own journey, but these days, I’m here to help you explore your own dreams of moving abroad. Thanks for joining me on the adventure! (Want more of the backstory? Click here.)
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Introduction
I handed my American prescription, which cost me $45 a month, to my new pharmacist in Portugal.
She looked at it, then at me, with genuine concern, “We don't use this one here,” she explained. “It's been linked to cancer in several studies.”
She then sold me a superior, safer alternative for €3. In that moment, I didn't just realize I had overpaid for healthcare in the U.S.; I realized the system I had trusted was fundamentally failing to keep me safe.
This was just my first lesson in the profound differences between American for-profit healthcare and the public-service models common in Europe.
The Truth About Healthcare in Europe
I can’t speak about every country, even in Europe and I don’t know enough about countries outside of Europe (please do your due diligence) but I do know a bit about healthcare in Portugal, Spain, France, Italy and Greece and it’s phenomenal. A quick search shows that almost every European country has a free healthcare system, though the quality of services may vary of course.
I’ve been told by other friends abroad in Europe that the level of care I experience in Portugal is similar elsewhere. And my level of care here far outweighs any care I ever received in the U.S.
Here in Portugal, the system is designed to catch problems early. Upon arrival I was given a battery of preventative tests, from CT scans to ultrasounds, without having to beg. It's a stark contrast to the news from home, where the new “BB” bill is set to strip insurance from 17 million people over the next decade. This will eliminate access not just to advanced screenings, but even to the most basic care, leading to sicker patients and more strained emergency rooms, as experts have warned.
I paid $1500 a month in the U.S. for the lowest tier of healthcare. It included one fifteen minute (to the minute) consult with my doctor and a mammogram every two years even though I’m in the high risk category and was recommended to have one a year. My co-pay was $80 if I wanted to see another doctor or if I had to go to my family practitioner twice in a year.
In Portugal (and many other European countries, and countries elsewhere) there is a country funded plan that is free. You can also get private health insurance. I have both, the free Serviço Nacional de Saúde and private.
My private insurance here costs €130 a month, a fraction of the $1500 I paid in the U.S. for inferior coverage. Meanwhile, the BB Bill just passed by the House will not only cut Medicaid by $930 billion but also eliminate subsidies for the Affordable Care Act, making insurance impossibly expensive for millions more.
Most everything in Portugal is covered, unlike the U.S. Here my tests are either free or very low cost. I was even able to get an MRI by just asking once. In the U.S. I begged for one for years but was always denied. In Portugal my MRI was €50, in the U.S. with insurance it’s over $2,500.
I also had significant surgery here for two broken fingers. This included an overnight stay at a private hospital that rivaled some of the nicer hotels I’ve stayed in. I had my own room and bathroom. I was served four meals, given medication + the surgery including general anesthesia; all for €200. And my doctor was the top hand surgeon in Portugal.
Contrast that to a friend’s daughter who went to urgent care in the U.S. for a sprained ankle and was charged $5,000 for an ACE bandage and no X-ray. Or my sister who was charged over $200,000 for a single emergency room visit—with insurance.
I’ve also lost several friends to the abysmal healthcare (or lack thereof) system in the U.S. A co-worker who couldn’t afford an asthma inhaler died from an asthma attack in her 30s. The inhaler costs run from $350 to over $600 without insurance in the U.S. In Portugal the full retail price is €4 to €5.
I can list many other cases but if you live there; you already know.
Tests
As mentioned above, I’ve been given a slew of preventative tests in Portugal that they either refuse to do in the U.S. or only allow people in high-risk categories to get. I’m given all these tests regularly. CT scans, a stress test, ultrasounds on every organ, a colonoscopy, a DEXA scan and the list goes on. There are so many tests they give me that I’ve never even heard of and they were appalled to find out most of them simply aren’t done in the U.S.
This is because healthcare in the U.S. is a for profit system based on alleviating symptoms. It’s not preventative. I’ve come to learn there is no true preventative care in the U.S. And why would there be? That doesn’t make money. Keeping people sick and on pharmaceuticals or machines (ie: dialysis) does.
Pharmaceuticals
This also blew me away. As mentioned in my introduction, I took my $45 prescription from the U.S. to my pharmacy and found out it was an inferior product compared to what they prescribe here. But not only inferior, dangerous, shown to cause cancer in multiple studies. My pharmacist, who I’ve come to trust with my life over the past three years, offered me something else. She assured me it’s much better and sent pages of studies to my WhatsApp on both the other drug and the new one she recommended. Plus, this one costs €5 without insurance and €3 with insurance. I had paid for and brought over five tubes of the old prescription. She told me to throw them all out, though she took them and disposed of them properly. I don’t have to drive for an hour to find a place that does this like I had to do in the U.S. because the pharmacies here dispose of old medication properly and there are pharmacies every few blocks.
Whenever I have anything wrong, I go to my pharmacist first. When she can, she recommends something natural but regardless of whether it’s a natural remedy or not, everything I’ve taken here has been 1,000 times more effective at a fraction of the cost. Everything.
Doctors
When I go to see my doctors, they spend as much time as I need. Not fifteen minutes. My doctor in the U.S. was always looking at her watch and apologizing.
“Sorry, I can’t spend more than fifteen minutes per patient,” she would say.
The doctors here don’t do that. Granted, it sometimes means you may have to wait a little longer to see them because they’re truly helping someone else. But that’s a trade-off I’m willing to endure.
Remember: healthcare in many countries is “cradle to grave” which means you’re completely covered from the time you’re born until you die.
Of course, no system is perfect. European healthcare is not a utopia, and it faces significant challenges. Many countries are grappling with workforce shortages, aging populations that require more care, and rising costs that threaten sustainability. In France, for example, some rural hospitals have had to reduce services due to staff shortages. In Spain, the public mental health system is notably underfunded compared to the EU average, and a high percentage of health workers are on temporary contracts. These systems are constantly navigating the difficult balance of cost, access, and quality. The key difference, however, is the foundational philosophy: they are wrestling with how to best provide universal care, not whether they should provide it at all.
Plus, the quality of care can be country dependent. I know someone who had to go to Greece for surgery because the healthcare system in Albania is sub-par. But she didn’t have to go back to the U.S. to get the surgery and going to Greece for it didn’t bankrupt her!
Medical issues are widely considered the #1 cause of personal bankruptcy in the United States.
The “BB New Bill”
The following information is taken from the three articles listed in the resources section.
“This isn't a distant, future problem. The consequences of these policies are already being felt. In Curtis, Nebraska, a community Hospital is closing its doors, explicitly blaming the anticipated federal budget cuts to Medicaid. In San Diego, two of the largest healthcare providers have announced hundreds of layoffs, citing 'mounting financial pressures' from federal policy changes. This is what a 'fiscal pandemic,' as one New York healthcare leader called it, looks like: not just numbers on a spreadsheet, but jobs lost and clinics shuttered in communities that need them most.”
“The Congressional Budget Office estimates that 11.8 million people will lose Medicaid coverage between now and 2034, but the bill also abolishes other subsidies for the Affordable Care Act that the CBO estimates will dump another 4.2 million people.”
“Another 1 million on top of that will lose their coverage because of other health provisions in the bill, bringing the grand total to somewhere around 17 million people over the next decade.”
“The bill imposes work and reporting requirements for the first time on Medicaid recipients whose income is from 100 percent to 138 percent of the federal poverty level (roughly $32,000 to $44,000 for a family of four). Able-bodied adults between 19 and 64 years old will have to prove they are working, volunteering, or going to school at least 80 hours a month.6 Medicaid recipients will have to submit paperwork, such as pay stubs, proving they are meeting the work requirements. Even those who are exempt will have to demonstrate they are still eligible.”
“The bottom line for patients, according to an accounting from the Congressional Budget Office, is that 11.8 million additional Americans would become uninsured by 2034 because of the healthcare provisions.1 Notably, few of those dropped from Medicaid coverage would have access to job-based health insurance, according to a Congressional Budget Office report about the House version of the package.”
“The impact of the bill on the healthcare system is expected to be profound, with corners of the sector, like rural hospitals, set to be most directly impacted. As Sen. Catherine Cortez Masto, a Democrat from Nevada, pointed out during a virtual roundtable this week, these cuts will “devastate health care in Nevada,” and people will go to the ER after they get sick enough.”
Other Life and Death Concerns
These are from Heather Cox Richardson’s Newsletter on July 6th, 2025…
“On June 30, the medical journal The Lancet published an analysis of the impact of the United States Agency for International Development (USAID) and consequences of its dismantling. The study concluded that from 2001 through 2021, programs funded by USAID prevented nearly 92 million deaths in 133 countries. It estimates that the cuts the Trump administration has made to USAID will result in more than 14 million deaths in the next five years. About 4.5 million will be children under 5.”
And there are a lot more… read about them here.
Conclusion
My journey from the American healthcare maze to the Portuguese system has been eye-opening. While I have access to affordable, preventative, and high-quality care, I watch from afar as the U.S. moves to dismantle what little security its citizens have. The “BBB” is projected to leave 17 million people without insurance, adding immense strain to a system already at its breaking point. The closure of a rural hospital and layoffs in Southern California are not abstract policy outcomes; they are the first tremors of a seismic shift that will harm the most vulnerable.
European systems have their own issues, from wait times to budget pressures, but their goal remains fixed on universal care.
The U.S. is unique among developed nations not for its challenges, but for its willingness to treat healthcare as a commodity, leaving millions to fend for themselves in a for-profit wilderness.
The question Americans must ask is not whether a better system is possible, it clearly is, but people are stuck in this seemingly never-ending spiral of not having the option to change it.
So if your fear of moving abroad is a lack of healthcare, I challenge you to look at what you’re receiving now and think about what you may need in the future. Do your research. Join groups. Ask questions. Do you want to be taken care of for the rest of your life? To not worry about how you will cover insurmountable medical expenses or lose Medicaid? Please consider all your options and plan accordingly!
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Resources
Gizmodo BBB Article
Washington Post BBB Medicaid
NY Times Opinion Piece on BBB (gift article)
My last article on healthcare
Interviewed yesterday on Karen’s Podcast!
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I offer consults and a DIY move abroad class.
—If you want to learn another language before you embark (or after) on your new adventure, I highly recommend the platform Preply! It’s what I use to learn Portuguese and it’s also the platform I teach on. Please use my referral code for $17 off your first lesson!
—I use Wise to transfer money internationally between bank accounts and they also offer a free ATM card that can be used worldwide without fees. Please use my referral code for a free transfer of up to $600.
—I’ve started using Kindred Home Exchange in order to secure affordable accommodations! If you’re interested and want to sign up, you will get five nights with my referral code!
—I use SafetyWing for my travel medical insurance abroad. You can check them out here.
—For travel hacking, I use my Chase Sapphire Preferred credit card. I earn enough points by using the card regularly (with no foreign transaction fees) to get a “free” RT ticket from Europe to the US at least once a year.
—I use the eSim Nomad. I’ve tried several others, and Nomad is the only one that’s ever worked for me.
—If you’re traveling or moving to a new country, I highly recommend choosing ExpressVPN. It’s the VPN service that I use. Click here for more information and get three extra months on an affordable twelve month subscription.
If you’re interested in my “Why I Left the US and Won’t Ever Return” Series, please check out..
Cost of living: Article here
Healthcare (or lack thereof) here.
Safety—article here.
Polarization—too much hate and anger
If you’re interested in moving abroad, check out my free Expat on a Budget pub or podcast on Substack
The How to Live Abroad Publication is here.
Part 1—Want to move abroad? Start here!
Part 2—Conquer your fears about moving abroad!
Part 3—12 Minimizing Mistakes Part 1
Part 4—12 Minimizing Mistakes Part 2
Part 5—A Personal Case study (re: Minimizing)
Part 6—Your Move Abroad: The Ultimate Checklist
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—Expat on a Budget (AKA) Living Abroad on a Budget and My Unknown Adventure by Kimberly Anne
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***Disclaimer: My writing, and podcasts are based on personal experience and are for informational purposes only. I am not a lawyer. Please seek professional advice before making decisions about moving abroad. I am not responsible for any outcomes resulting from the use of this information.
We just moved to Lisbon and found your latest post most reassuring. Thanks for sharing this information.
This is all substantially true, and there’s more: here in San Francisco over one third of the National Institutes for Health contracts have been summarily impounded- think AIDS, Hep C, and drug resistant TB. I have a friend in New York who is now no longer able to access her life- saving cancer immunotherapy trials due to “funding uncertainties” and is forced to spend money flying to Mexico repeatedly. This government simply does not understand how public health works.