Worrying that a life-threatening illness will kill you for lack of access to care, or that it will ruin you financially, is a uniquely American condition among citizens of developed nations. It’s also one that we tend to carry far beyond our borders. It’s one which can rear its head unexpectedly, even many years into an expat adventure.
Over the years we’ve spent abroad, I have tried to break myself of healthcare-related bad habits learned over decades spent living in the U.S.: waiting for minor illnesses to resolve on their own, the tinge of worry about what treatment would cost when we’ve been forced to rush to urgent care while traveling, and fearing that despite having the best private insurance available to us in our adopted home, that they would abandon us when the proverbial shit hit the proverbial fan. Until recently, I truly believed that I had changed my mentality and had adopted a more (forgive me) healthy attitude about healthcare.
Everything Sucks Everywhere, All At Once
I can honestly say that I reverted right back to my default settings last year when my wife was diagnosed with stage III breast cancer. My wife, the Ironman triathlete, the ultramarathon runner, the best person I have ever known, with little family history of cancer and no history of breast cancer, got her diagnosis after a mass in her breast grew explosively and terrifyingly over the space of a few months. Her mammograms were always a little complicated, but never really raised alarms until this thing got hungry and gnawed away at her, seemingly overnight.
I write this post from a mostly financial perspective because the story doesn’t belong to me, and I wouldn’t know where to begin to express how hard it has been for her. But, I will say that it sucks, and I have wished every day of the past year that it had been me instead. On the day that my wife was diagnosed, I was the one who received the call from the surgeon who we had seen. The moment that I had to tell my own wife– in broad daylight and in public– that she had cancer will haunt me until the day I die.
Time stopped. All of our plans were put on hold and, due to the relatively advanced nature of her cancer, 100% of our emotional, physical, and financial energies were turned to saving her life. In those early days, we asked ourselves whether she would be getting better treatment if we were still in the US. We– for the briefest of moments– considered whether we should try to make a quick move back to try to seek treatment at a major US cancer center. More than anything, it was the urgency to get her into treatment immediately that led to us remaining right where we are, in a relatively remote city with only two private hospitals.
Yes, we have an excellent private insurance policy, one which we were obliged to have back when we were here on renewable visas. But really, I reasoned, how good could the insurance coverage really be given that we pay annually for the entire family what I used to pay to cover myself in the US with the cheapest available insurance?
Now, a year on, I can safely say that my wife received a standard of care that was on par with the treatment she would have received in the US. That’s not to say that it was always the same— there was sometimes frustratingly little connective tissue in the private system here, which most people use as a supplement to public care. There were no social workers, no recliners in the chemo room, and most of all, there was little communication between entities. Whenever my wife would pass into a new phase of treatment– imaging, chemo, surgery, radiation– it was I who called the next doctor, showed up with a copy of the reports to date, and ensured that things would keep moving forward on time. It’s my understanding that this would never occur in the private system, but it happened and it’s a consideration.
And yet, my wife received exactly the same chemo and radiation, at the same doses, as she would have in the US. That insurance company? They approved every single treatment within 48 hours. I never had to explain a thing to them. Care was needed, and so care was provided.
The (Non-Emotional) Cost
So, was there a financial cost? Yes, but it was by choice, not out of necessity. When the time came for my wife to have surgery, we chose to go back to the surgeon who helped us at the very beginning of this road, despite knowing that he did not accept our insurance. Though the insurance would have covered the medically necessary treatments with one of their in-network surgeons, there would have been the same implications for reconstructive surgery– waits, limitations on which procedure was covered, etc.– that there would have been in the US. In the end, we chose to pay cash for the whole surgical portion of her treatment to be able to choose the best option for her as a whole person.
To maintain the fiction that this a financial post, rather than therapeutic writing, I’ll share here what we were paying for, and what it cost us.
|Hospital Costs||Rental of the operating room, 72 hours of stay in the hospital, blood transfusion, all medical supplies||2564.08 €|
|Oncological Surgeon and Anesthetist||All costs for these physicians, plus one assistant each in the OR||3000 €|
|Plastic Surgeon||All cost for plastic surgeon and assistant, including 4+ months of followups||2000 €|
|Reconstructive supplies||Medical supplies related to plastic surgery||1760 €|
|Nuclear Medicine||Physician cost for nuclear medicine tracer to biopsy lymph nodes||400 €|
|Pathology||Cost for OR immediate pathology, plus postoperative pathology of all tissue excised||425 €|
As near as I can tell, this cash price of this surgical care in the US would be somewhere in the $200,000-300,000 range. In the end, our total treatment cost for this cancer nonsense is the above: around 10,150€, less than our annual family out of pocket max for our terrible plan back in the US.
My wife finished active treatment in February. There is no sign of the cancer. She’ll continue certain treatments for the rest of this year, and taking medication designed to prevent a recurrence for five years. From start to finish, medical staff here have been kind and empathetic, and any differences were more procedural than medical. With any luck, cancer will one day be a distant, distinctly shitty memory.
For the first time since that time-stopping, life-changing moment last year, there is reason to think of a future. My wife is growing stronger again and returning to the things she loves, though the progress is often frustratingly and heartbreakingly uneven. But there is a future, and it began here, in this small city, a million miles from a US cancer center.