Breaking Up with the USA: Here’s Why I’m Never Going Back: Healthcare (or lack thereof)

#2 in the "Why I Left the US and Will Never Return" Series

Photo in Stockholm by Anders Jildén on Unsplash

Reason #1 was the high cost of living! You can read that article here.

Intro

In 2022, I made the life-changing decision to leave the United States and move to Europe—and I can confidently say it was the best choice I’ve ever made. I have no regrets, and no desire to return. My decision was driven by many factors, each of which played a significant role in shaping my new life abroad. This is #2 in a series of articles where I’ll dive deeper into those reasons and explore how they compare to my experiences living in Europe. My number one reason for leaving the US was the high cost of living and you can read more about that here.

Some Housekeeping: Please skip to the next heading if this part doesn’t interest you!

It pains me to talk about some of this (the issues I found in the US), but it must be done.

And now a disclaimer. Since starting this series, I’ve been getting a lot of hateful comments. They surprised me, though they really shouldn’t have. Thankfully I’ve “been around the block” (I’m almost 60 after all) and don’t take any of it personally because in truth, it’s not about me at all. I want to state (for the record LOL) that I don’t hate the US. I love my country and if I could have stayed, I would have. But I couldn’t, for the reasons I’m delving into in these articles, so I left. It’s quite simple actually. I’m not a hater anyway, it’s not really in my nature. And if others are haters and they derive pleasure from lashing out at strangers, so be it. I simply report all hate speech to Substack (and I have received quite a bit), block and move on. But… I think it’s interesting to note—both for those who deliver this vitriol, and for me… that it’s having the opposite effect. I’ve found that it’s giving me massive amounts of energy and oodles of encouragement to keep writing about this topic. I think the reasons are twofold: 1. If I can elicit so much emotion in a complete stranger, I feel I must be doing something right. 2. People want to know about this topic, even if it’s just to hate on it. So here we go…

Healthcare

I didn’t understand how much I was compromising my health and my health care in the US until I moved to Europe. I thought, like so many of us are taught to believe, that the US had a great (1st world) health care system. I knew things were much less expensive elsewhere, I had researched enough to learn this but I didn’t know how much BETTER healthcare can be elsewhere.

Profit Before People:

We all know that the healthcare system in the US is a for-profit system. The pharmaceutical companies and even the higher-ups in most insurance companies make their billions as long as people stay sick. There’s not just one issue here but several.

Insurance Costs

—In the US I paid $1500 a month for the lowest tier insurance. Every time I wanted to see a doctor I had an $80 co-pay. My coverage actually covered very little, mostly emergencies plus one FIFTEEN MINUTE ONLY visit per year with my primary care physician, a few tests and a mammogram every two years (even though I’m high-risk). That’s it. And—it did not include dental or vision. The math says I was paying $18,000 each year for one fifteen minute doctor visit and half a mammogram!

—In Portugal, healthcare is socialized (as it is in many other countries in Europe): at the bottom of this article I have included a thorough list). You can also pay for private healthcare if you want. Mine is €130 a month and it includes dental and vision. My co-pay is €17.

I have several examples of being treated in Portugal.

The first is preventative healthcare.

When I went in for my first preventative appointment I didn’t even know that’s what it was. My new family doctor here in Portugal (yes you can pick people who speak English) was referred to me by another expat friend. The doctor ordered a huge, long list of tests I’ve never even heard of. She was shocked that, not only had I never heard of them, I’d never had them! Ultrasounds for every organ in your body, a stress test, ECG’s, a DEXA scan, a colonoscopy, (which I was refused in the US even though I was in my mid-50’s), a mammogram and an ultrasound, a full blood panel and the list goes on. Everything total cost me around €100, but I could have used the national system and had it all done for free.

—When my hip was hurting and the pain wasn’t getting better I asked for an MRI. My doctor ordered one immediately. I had begged for an MRI in the US for five years but was always refused. An MRI in the US usually costs thousands of dollars. Here I paid €45.

When I go to see my doctors here in Portugal, they take as much time as I need. If I need longer than fifteen minutes, which is often the case, there is no issue! They also seem much more present. They’re not looking at the clock, speaking rapidly or telling me they can’t order tests or help me.

Surgery and Trauma Care

I have a longer, separate post about this here. But when I broke my fingers my surgery was €200 and I was given a private hospital room (with a private bathroom) that was nicer than many hotel rooms I’ve stayed in. I had three meals a day, nurses buzzing about and pain meds. All for my €200 surgery co-pay.

I have a friend whose daughter sprained her ankle in the US. She went to urgent care and was charged $5,000 to have her ankle wrapped with an ACE bandage. That did not include any Xrays. Here it would have been free in a public hospital or a €17 co-pay at a private one which would include Xrays, an ultrasound and a cast. I know because that’s what happened when I broke my fingers, before I had surgery.

---

—There’s an amazing woman DD Cardinal who also lives here and she made some fantastic videos about her experience (and monetary breakdowns+comparisons) for the cost of her healthcare in Portugal:

• TikTok (watch the TT one, she breaks it down beautifully).

• Her YouTube video about her low medical costs and experience.

Pharmaceutical Companies

In the USA, the cost of life-saving medicines has more than tripled in recent years. Insulin is just one of many examples. It costs $2 to $6 to produce one vial. In the 1990’s a vial cost a patient $25 to purchase. But now a single vial is sold for $300 to $400, a markup exceeding 5,000% of the production cost. In Europe a vial of insulin costs $10 to $25 each. In India it’s sold for $3 to $10 per vial.

And this is just one of many examples, here are a few more:

1. Epinephrine (EpiPens) increased from about $100 in 2007 to over $600 by 2016. Why? Mylan (the manufacturer) raised prices without any significant changes to the product.

2. Daraprim: A decades-old medication used to treat toxoplasmosis, a parasitic infection. In 2015, the price of Daraprim increased overnight from $13.50 per pill to $750 per pill (a 5,000% increase). Why? Turing Pharmaceuticals, led by Martin Shkreli, acquired the drug and exploited its monopoly status, as no generic alternatives were available in the U.S.

3. Albuterol Inhalers for asthma used to cost about $15–$20, but prices have risen to $50–$100 or more per inhaler.

4. Doxycycline the antibiotic: The price for a bottle of 500 tablets rose from $20 in 2013 to over $1,800 in 2014.

---

And the list goes on. But why? (there are several reasons and I’m listing only a few)…

1. In the US there is a lack of price regulations over pharmaceuticals and pharmaceutical companies.

   1. In Canada, the UK and many other countries, governments and centralized health agencies regulate this and have developed strict policies to keep drugs affordable.

2. Lack of Transparency in Pricing.

3. It’s a Profit Driven Industry.

In Portugal most Drugs are Covered

Not 100% covered but significantly covered. Even if you go to a private hospital, when they write you a prescription and you bring it to any pharmacy, as long as your public health number (utente) is on it, you pay a few euros at most. And supplements here are crazy inexpensive too. The vitamin D I take, which is one of the best brands you can get here is €3 for a bottle that lasts me almost two months.

Death

• My best friend committed suicide in 2023 because she couldn’t get the healthcare she so desperately needed in the US. She begged, cried, and begged some more but no one cared. Seriously. They didn’t care or listen or help because she didn’t have money.

• Another good friend died of asthma in her 30’s because she couldn’t afford an inhaler.

• One of my patients, a war veteran, who couldn’t walk because of his time spent in the service, was denied care and help by the VA. He died as a result.

I could go on and on (and on) but I think you understand what I’m saying. The healthcare system in the US is broken, there’s no other way to look at it.

I don’t want to age out in a country that charges me thousands of dollars just to be seen by a doctor and then pushed out the door without any real help. If I were a millionaire or a billionaire, would it be different? Absolutely. But I’m not and I can’t get behind a healthcare system that only caters to the rich and lining the pockets of CEO’s and executives. Like I said… it’s a very broken system and there’s zero incentive (for the rich, who control the country) to fix it.

So yeah, this is just one more reason about why I couldn’t afford to remain the US and chose to leave.

Conclusion

The U.S. healthcare system is completely broken—it prioritizes profit over people, creating impossible barriers to essential care for anyone who can’t afford it. Meanwhile, countries like Portugal (and others like Spain, France, Sweden, and more) prove that healthcare can be both affordable and high-quality under a socialized or regulated model. My experiences here in Portugal have shown me not just the financial relief, but also the dignity and thoroughness of care that’s possible when the system is designed to actually help people. The U.S. desperately needs reform to put patient well-being ahead of corporate profits, because the current system only perpetuates inequality, unnecessary suffering and untimely death.

If you’re interested in my “Why I Left the US and Won’t Ever Return” Series, please check out..

My last article and the ones coming down the pipeline!

These include:

1. Cost of living: Article here

2. Healthcare: The One You Just Read!

3. Safety

4. Community

5. Values

6. Polarization—too much hate and anger

If you’re considering a move out of your home country, please check out my free “Live Abroad” series, as well as my super affordable class.

1. Countries in Europe with Fully Socialized Healthcare Systems

In these countries, healthcare is predominantly provided and funded by the government, often referred to as the Beveridge Model:

• United Kingdom (UK):

  • The National Health Service (NHS) provides healthcare that is free at the point of use, funded through taxation.

  • Most healthcare providers work for the government, though some private options exist.

• Norway:

  • The public healthcare system is funded by taxes and covers nearly all medical expenses.

  • Hospitals and healthcare providers are predominantly owned and operated by the government.

• Sweden:

  • Healthcare is tax-funded and administered by regional authorities, with minimal out-of-pocket costs for patients.

  • Most healthcare services are provided by public institutions.

• Denmark:

  • Healthcare is funded through taxes and provided by publicly-owned hospitals and clinics.

  • Primary care doctors act as gatekeepers for specialized treatment.

• Finland:

  • Healthcare is tax-funded, with services provided by municipalities.

  • Public hospitals dominate the system, and healthcare is free or very low-cost for residents.

• Iceland:

  • Healthcare is funded through taxation, with most services provided by the government.

  • Patients pay minimal fees for prescriptions and some outpatient services.

---

2. Countries with Universal Healthcare Funded by Insurance

These countries have universal healthcare systems funded through compulsory health insurance (a Bismarck Model), heavily regulated by the government to ensure affordability and access:

• Germany:

  • Healthcare is funded through a mix of statutory health insurance (SHI) and private insurance.

  • SHI is mandatory and funded by payroll taxes, covering most residents.

• France:

  • Universal healthcare is funded through a mix of public health insurance and taxes.

  • Most costs are covered by the national system, and private insurance is common for supplemental coverage.

• Belgium:

  • Healthcare is funded through mandatory health insurance, which is subsidized by taxes.

  • Most residents are covered through public health insurance funds.

• Netherlands:

  • Residents are required to purchase health insurance from private companies, but the government regulates prices and provides subsidies.

  • Universal coverage is achieved through this system.

• Austria:

  • Healthcare is funded through social health insurance contributions, which are mandatory for most workers.

  • The government plays a strong regulatory role.

• Switzerland:

  • Similar to the Netherlands, health insurance is mandatory, and the government ensures it is affordable by providing subsidies based on income.

  • Healthcare providers are a mix of public and private entities.

• Luxembourg:

  • Healthcare is funded through mandatory health insurance and government contributions.

  • Patients can access both public and private providers.

---

3. Countries with Mixed Models

Some countries blend socialized medicine and insurance-based systems, ensuring universal coverage while allowing private healthcare options to coexist:

• Italy:

  • The Servizio Sanitario Nazionale (SSN) provides universal healthcare funded through taxes, with minimal or no out-of-pocket costs for most services.

  • Private providers also exist, but most Italians rely on the public system.

• Spain:

  • Healthcare is tax-funded and universal, with services provided primarily by the public sector.

  • Private providers are available for those who choose supplemental insurance.

• Portugal:

  • Healthcare is primarily funded through taxation, with universal access for residents.

  • Private healthcare exists for those who prefer it.

• Greece:

  • The public healthcare system (ESY) provides universal access funded through taxes and social insurance.

  • Private healthcare providers are also common.

• Ireland:

  • Ireland has a public healthcare system funded by taxation, but many residents purchase private insurance to access faster care or private hospitals.

---

4. Eastern European Countries

Most Eastern European countries also provide universal healthcare, though the quality and funding levels can vary. These systems are generally tax-funded, with some out-of-pocket costs or supplementary private insurance:

• Poland: Universal healthcare funded through the National Health Fund (NFZ).

• Czech Republic: Mandatory health insurance ensures universal coverage.

• Hungary: Universal healthcare funded by taxation and social insurance.

• Slovakia: Universal coverage through mandatory health insurance.

• Romania: Universal healthcare funded through taxes, though private insurance is growing.

• Bulgaria: Universal coverage funded by mandatory health insurance and taxes.

*this block (#’s 1 - 4 re: healthcare in Europe information is from ChatGPT

---

My Class: Learning how to live abroad on a budget is currently live!

• For the low fee of $97 you will get unlimited, lifetime access!

I’m open for consultations/coaching. Schedule a video call with me to see if I can help with your move abroad!

• Consulting Information: what I can help you with.

• Work with me! I offer á la carte consults and crazy affordable packages!

• My Class: Walks you through ways to move abroad on a budget!

---

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

• My Class: teaching you how to live abroad on a budget for under $1,000 a month or under $2,000 a month is here!

Other Popular Articles/Podcast Episodes:

• Travel Hacking: What and How!

• Values: Differences Between Portugal and the US—Part Four.

• Inside the Homes: Differences Between Portugal and the US—Part One.

• Sidewalks, Zebra Crossings, Smells and More: Differences Between Portugal and the US—Part Two.

• Safety: Differences Between Portugal and the US—Part Three.

• First Six Months of Living Abroad

• How/Why I Ended up in Portugal

• Living Abroad After Two Years

• Archive of all my Articles and Podcast Episodes

Thank you so much for reading! If you don’t want to become a paid subscriber (my articles are free) but enjoyed this article, please consider a one time donation below.

If you’re on a budget (as am I) please like by clicking on the heart below and share this article with a friend. 

Your support (in all ways) is greatly appreciated! 

—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 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 use Safety Wing 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.

—Expat on a Budget AKA Living Abroad on a Budget and My Unknown Adventure by Kimberly Anne

*** This article contains a few affiliate links. Using my affiliate links is not required and does not cost you anything extra but I greatly appreciate it, if you do. It’s a (free to you) way to help support my writing.