Berlin is one of the early inflection points for my travels. Given that it’s centrally located (given the sorts of criss-crossing of Europe I’m anticipating) and has a lot of cheap travel options in and out, I’m considering using it as a hub city. It helps that I could see myself settling here eventually: solid tech scene, strong expat community, plentiful English skills across the general population.

I just spent the week staying with a friend just north of the city, in Havelberg, a ridiculously small town¹ about an hour’s train ride north. My friend is being gracious enough to store the two massive bags of costuming I was traveling with (to my eternal gratitude). So the next major piece which needed sorted was medical treatment.

Thankfully, I am in reasonably good health. I also, thankfully, am covered by medical insurance. But American medical insurance only covers emergency medical care overseas. Broken bone or emergency appendectomy? Sure, no problem. Refills on the chronic medications you don’t strictly speaking need but your doctor frowns and and knits their brow when you point out you’re probably going to be going without them from time to time? Nope.

American prescriptions aren’t valid overseas; in fact, the names and dosages of available medications are frequently different. The usual way around this is to either return often enough to the United States to take medications filled in person, or to have prescriptions filled and shipped to a friend who forwards them over to you on a regular basis. Neither of these is especially appealing to me; I’m not going to be in the States for a while, and I certainly don’t want to be scheduling doctor’s visits for the minimal time I’ll be back. And the doctors I have back there tend to be pretty stingy with prescription renewals, insisting I turn up for an exam physically what feels like every other month to get another couple months of pills.

So finding a local doctor seemed like the best option, and Berlin seemed like the best place to do it. My friend checked her network and got a recommendation for one, and they turned out to be available for walk-in appointments on Monday morning. So in I went.

There’s been gallons of ink spilled on the differences between American health care and European health care. I doubt I have much to add. But here’s my experience:

58€ is, amusingly, just over $65. But the pills in Germany come in sets of 50, not 30. And let’s be clear: I’m covered under pretty decent insurance in the United States. I have no insurance whatsoever in Germany.

To be sure, some of this is apples and oranges. I’m de facto benefiting from the spending of the German government, which is keeping those prices down. All my medications are generics. This isn’t comparing surgical costs, or wait times to see doctors, or difficulties in getting more expensive procedures approved.

But Germany has a similar mix of public and private health insurance to the United States. Health outcomes are roughly comparable. And the German government spends an average of $5,550/person every year for health care, while the United States spends $10,348. If you’re not seeing where that money is going, maybe it’s time to ask yourself why that is.

I believe it’s basically a deep cultural divide between European values and American ones. Americans have always been distrustful of government and taxation.² Often that’s a positive; too much centralized control can stifle innovation and lead to nonsensical decisions.³ But that kind of anti-government sentiment feels like fertile ground for corporations to step in and corrupt the system. I will never understand why so many Americans don’t want faceless government apparatchiks to make decisions about their health care, but they’re perfectly happy having faceless corporate bureaucrats do the same thing; at least the government official isn’t going to get a huge end-of-year bonus for denying you experimental chemotherapy.

In the end, that difference may not matter that much. Creeping corporatism is slowly infecting even Europe. They call it “the American disease.” I don’t think that’s quite right, though. American exceptionalism may have provided a bigger opening, but it’s capitalism driving the bus, here.

From a certain viewpoint, every market effectively served by the government is one less market effectively served by corporations. In many cases, that is a problem; I doubt many people would be very happy with government-designed sneakers or government-designed restaurants.⁴ But take that impulse a little too far, and you end up in a libertarian paradise, which appears a lot like a Mad-Max-style dystopia for anyone who can’t afford the entry ticket.

This is the paradox of “the American disease.” In the best of all possible worlds, it means with hard work and gumption anyone is capable of anything. In the worst, it means you better pray that’s true, because no one else is even going to help you try.

Next: Vienna (VIE) to Ouagadougou (OUA)
Prev: Stockholm (ARN) to Berlin (TXL)

Footnotes

¹ Population ~8,000

² See the Whiskey Rebellion, if the Revolutionary War isn’t enough to convince you.

³ Although in practice these battles never seem to get fought over rational objections. Brexit was far more about the emotional anguish about having to give up some measure of local sovereignty (symbolized by the fury over passport color, of all things) than about any specifics.

Naturally, the joke is that of course you have to give up local sovereignty to gain access to international markets, and the pointy-headed bureaucrats in London are just as obtuse, high-hatted, and unanswerable as those in Brussels. But, hey, blue passports!

⁴ Government cheese, anybody?