How one broken bone can shatter the American Dream

Among European expats and fellow Brits living in New York, Holly Baxter finds the conversation often turns to how bad US healthcare is – and the financial and emotional burden it places on citizens

Rough ride: a trip in a US ambulance can be costly (Getty/iStock)

A couple of nights ago, my flatmates and I were having drinks in our Brooklyn apartment with the multinational bunch of friends we’ve picked up while living in New York. It’s easy to bump into European expats in the city, and we seem to be drawn magnetically to each other – so there are a lot of Germans, French people, and fellow Brits who make up our friendship group. There are, of course, a lot of Americans too. And somehow, the conversations we have over beers always come back to one issue: healthcare.

You don’t appreciate how bad the healthcare system is in America until you live here, though you can read about some of the worst excesses of it from the safety of your British laptop: the parents charged $39 (£30) to hold their own newborn baby, the fact that most cancer patients accrue more than $10,000 in debt because of their treatment. What you don’t realise is the psychological impact that has on the entire country.

After being in the US for just 10 months, I already know someone who broke down in tears when she found out she needed abdominal surgery for a serious condition because she feared her parents would have to sell their house to pay for it. (The fact that she had a grave illness didn’t even factor in to the upset.) I have another who fell out with a family member who called her an ambulance after she slipped and broke her ankle, because the ambulance costs are so high. She would rather have chanced it in a taxi with her bone sticking out of her leg.

These people already have health insurance, which they pay about $300 per month for out of their salaries. But the way the system is set up means that you co-pay alongside your insurer for some conditions, and still have to pay lump sums yourself – usually in the multiple thousands of dollars – before you even reach the threshold where the insurance will pay out.

All of that casts the “American dream” in a very different light. People here are paid much higher salaries than their British counterparts, and they tend to all have well-tended savings accounts from a young age. After student loans were brought in in the UK, I don’t have any British friends who have savings (I have none myself.) Living “paycheque to paycheque” is seen in America as living in poverty.

It’s easy to think of that meaning they’re an affluent country. But the truth is that it takes just one broken leg, one case of appendicitis or one emergency C-section to wipe out savings made for decades by professionals on good salaries. That’s not the same for anyone with an NHS safety net waiting for them back home.

My fiance describes the living situation in Europe as “having the edges shaved off”. Few Europeans believe they’re destined to become billionaires, whereas any American you meet will tell you they think it’s a possibility. And Europe has stringent controls in place where America has few: in European countries, for instance, you have to put your house on a landlord’s mortgage before you can rent it out, whereas in the state of New York, not only are you allowed to rent out your own house but a state law prevents your landlord from stopping you from subletting. In other words, you could potentially build your fortune by renting a load of properties yourself and subletting them to other tenants for a profit; you can have a property empire without ever even owning a property. ‘Murica!!

It’s this lack of red tape which means people regularly make millions in America (especially in New York) but it also means even the wealthy live precariously. Elderly people in their eighties and nineties work in theme parks and pharmacies to top up their healthcare provisions, then move to Florida where inheritance tax doesn’t exist so their children can benefit. Pregnancies are met with anxiety and panic because the baby has to be insured 24 hours after it’s born, to the tune of around $600 per month.

Nobody leaves their job to go freelance after the age of 25, because that’s when you lose the ability to be covered on your parents’ health insurance. People stick with their jobs way past the time when they are miserable because of it. The opioid crisis chugs on because big pharmaceutical companies allowed it to happen for profit.

In other words, injecting “competition” into healthcare is something people need like a hole in the head – and it changes your whole society. And as I watch Brexit unfold from afar, my greatest worry is that the UK will vote a hole in the head into being.