Health Care and Holland
Yesterday morning, I went out for bread. Steven was asleep, so I took the keys and walked around the corner to the neighborhood bakery.
Recently I learned to say “Please” in Dutch, (it translates literally to “if it is your belief” or “if you feel like it” or “if you will.” ) I already knew “Thank you.” We needed bread and so I went out to practice a bit, and got myself a latte while I was there. I walked back, with my string bag full of bread and few pastries. It was when I reached the apartment that I discovered I did not know how to make the lock and key work together. Tried it a few times, the door didn’t budge.
So I sat on the stoop, watched the weather go by, had my coffee , got out my phone and emailed Steven for help. He was up there in the apartment and sooner or later he would wake up and notice I was gone. I figured I could be patient. I was there for nearly an hour but it was no hardship. I drank my coffee, watched the clouds sweeping by and thought about life.
Eventually, Steven woke up, saw the email and came downstairs. He showed me how to use the keys (easier than I expected) and we got on with the day.
Part of our plan for the day involved solving a problem. While in NYC before leaving the U.S. I lost a vial of medication I take for my heart. Two days ago, I ran out. So I got on AI and asked about taking a break from that drug, just for a few weeks, until we could get settled and figure something out. AI echoed what Steven said “No way. You need that. Stopping that drug would be dangerous.” But AI (whom we call “Data” in our house, added; “Here’s what you do.”
I was reluctant to give over another day to fixing things that should not have gone wrong but I know common sense when I hear it. I took the advice, took a snap of the directions to the walk-in international clinic to explain the situation since my health care is not yet covered here. And also took Data’s advice to bring my passport and stop at an Apotheek if we saw one along the way. Data said they may not be able to help but being a pharmacist is a more respected and serious profession in the Netherlands than it is in the U.S. It was possible that a pharmacist could offer a solution that would not be available at an American pharmacy.
We saw a neon sign with “Apotheek” on it in blue neon letters, and taking Data’s suggestion, went in, explained the situation and asked for advice.
They helped. The Apothecary took a picture of my passport to explain the change in his inventory to officials, then he sold me three months of the medication. He apologized for how expensive it was. It’s called something different here, and it is one of their most expensive medications. One Hundred and eighty Euros for a three month supply. The whole interaction took ten minutes. It was easy, friendly, and pleasant. In the US, that is about 2/3 of what I would pay for my co-pay on this drug. The Apothecary assured me I was doing the right thing, a big contrast from the way my interactions with pharmacists in the US had often gone.
While in Massachusetts, I was aware that I might run out of this particular drug sooner than would be convenient. So I went to the pharmacy and tried to have my prescriptions filled sooner than they were due. I was told this was possible provided you are willing to explain your absence.
I explained we were leaving the country for an extended period. I explained that I had two refills remaining on this prescription. I explained I would be in the middle of the Atlantic, on an ocean liner, when my prescription was due for renewal. The answer was a flat, “No.” Explaining didn’t help. No solutions were offered except for the opportunity to buy the drug out of pocket. I did this with the other drugs I’ve been prescribed and then got the price for this one. $3,000 for a month’s supply. I bought ten days worth, knowing I had about 30 days supply still at home. It cost a lot.
In the Netherlands, you are obligated to buy health insurance and join the national plan. It’s not a choice, it’s one of the conditions of staying.
You are also charged for the months you were present in the country and uninsured. Ultimately, that could cost us as much as $1,000 each. We have private insurance now but it’s not actually useful most of the time. Eventually, we can’t have private insurance at all.
Using private insurance after you get your visa is a breech of your visa obligations, so I knew we would have to sort out our insurance within a month or two of arriving. But we had so many other things to take care of that it seemed to me that I might be able to just wait the mess out. In New York, before departure, I had 40 of the pills I needed already in my possession. Chances were pretty good that I would be able to make the transition to the new health insurance before I ran out. I felt I had covered any eventuality to the best of my ability.
In America, my health insurance is purchased on the Mass Health ACA exchange, meaning, the government subsidizes the premium because my income is modest. It’s a form of Medicaid but a lot people in MA use it. It’s our version of socialized medicine.
Right now, in Massachusetts, we pay under $50. a month, or thereabouts, for my insurance. It makes a good deal of sense from my side because it’s affordable. It makes sense from Tufts perspective (my insurer) because I haven’t been able to get in to see a GP since COVID so my use of medical resources is minimal. The insurer can dictate which doctors their clients can see and my insurer has created so many restrictions that it’s virtually impossible for me to get care unless it is a continuation of the care I had in 2014.
Since 2021, I’ve had no pap smears, no annual check-ups, nothing. I have referrals to a couple of specialists, most notably a dermatologist, but I’ve been turned away or wait listed since 2021. We offered to pay out of pocket for me to see Steven’s dermatologst but a regular patient needed my spot so I was “rescheduled” out of any possibility of an appointment.
I see my cardiologist twice a year, that is possible because my relationship with a cardiology department continues uninterrupted from my heart operation in 2014 when Massachusetts had a robust and effective health care system.
I fill my prescriptions, see my cardiologist, and, once a year, I get a mammogram. That is the extent of my health care access. All of this means the amount we pay for me more or less balances out to the cost of my annual treatment excluding drugs. In fact, despite my somewhat complex health status. I am telling you all of this to avoid people asking me detailed questions that I would find annoying to answer. Yes, I have researched this thoroughly. You can see the numbers. If you’re still having trouble understanding how this can be, the problem lies with you, okay?
I am actually a good deal for insurers. I use a minimum of resources and I do the work that helps me steer clear of surprises. They get a lot more than the $50 a month I pay in premiums from the government for my care. They charge me $50 a month. My cardiologist charges $300 per appointment. The insurance company pays that and then gets $220 of it reimbursed by the government. But the real money comes from the subsidies they receive from the MA government to pay for the cost of my insurance premiums. That amounts to $500 a month right now. They get more money from insuring me than I cost them in charges. They charge me, they pay for the care I get and they still get a reimbursement for that care.
But in all of this, I get reasonably affordable health care, some of the best in the nation, and, in theory, access to state of the art care if I need it. So it’s a win-win. I have coverage if something crazy goes wrong, they get $600 a year from me, that nothing. The big money comes from what the government provides to the insurer. In my case they get around $10,000 a year from the government and then another $400 from the reimbursements they get from the care I actually use. (I use about $600 a year, excluding drugs which is a whole other, equally complex and shocking equation.)
I always felt I was getting significant help on the cost of medications from my health insurer but it turns out the cost of most of the drugs I take adds up to less than $100 a month, so it’s not actually such a great deal. It is the cost of this one drug that makes the difference. But the cost of this one drug is nowhere near as high in the rest of the world, so what am I to make of that?
There are people who go on vacation to places like Aruba simply to get their prescriptions filled. The cost of the vacation is more than offset by the savings they make on buying their drugs in another country. After seeing all of this, I can understand how that would be a good idea.
Next year, in 2026, due to budget cuts, my health insurance in the U.S. would have cost us $826 per month. That is well in excess of what I cost the system. To explain again; at one time, there was a law that demanded insurers pay back any money they received that gave them a surplus profit. If the cost of care was more than the premiums paid, (not counting subsidies, which the insurance companies got to keep anyway) then they could keep 20% for their profit but they had to give the other 80% back to the person paying. In my case, that would result in something like a $9,000 rebate next year. But they removed that part of the law so the insurance company will pocket $9,000+ for keeping me insured. (unless I have a catastrophic event, which, I suppose, is the point.) There are much larger cuts coming in November of 2027. I can only imagine what health insurance would look like for me then were we to stay in the U.S.
Nevertheless, it seems to me that what this really means is that , most American health insurance is now effectively only insurance for a catastrophe. It’s nearly impossible to get in to a GP and without a GP you’re not seeing a specialist. So most people don’t go to the doctor, instead, they go to the emergency room when something awful happens. Unless you’re on medicare, but that’s a different story for another time.
Hospitals in our area have also been defunded. There have been staff layoffs and, in my own case, when I turned up for my annual echocardiogram the nurse qualified to give me the contrast dye my cardiologist needs in order to read my results, was away. Her replacement was one of the people the hospital cut when they had to find 300 positions to kill off this year. That happened because the Trump administration “paused” all government grants and loans as soon as they took office.
That “pause” was challenged in court and the people challenging it won. The Trump administration is not allowed to withhold the funding that was already allocated during the 2024 fiscal year. But guess what? The Trump administration doesn’t care about doing what the courts say. As of now, they have not lifted the “pause” and as a result, our local hospital lost $9 million. The nurse who was supposed to fill in when the main nurse/tech who is in charge of contrast dye cardiac testing is not available lost her job in those cuts. So there was no one to help me, no one to do the job, so it didn’t get done. The result? My test results are unreadable. That’s wasted money, wasted time and a loss of care for me.
This is just one of a dozen good reasons why we left the USA. I wanted you to know them, yes, but just as important to me that they be communicated is that they be recorded for my own sake. To remind me not to romanticize the US and to remember to keep trying to help, even from here.
I want to be clear, we moved (or are in mid-move) to the Netherlands as much as we moved from the US. We moved to support my husband’s profession and to open a small business. We can’t do those things in the US anymore. We can’t afford them. My husband’s professional life needs time and space that we cannot give to it in America. In America, he took a break, took a job and ended up on a treadmill that he couldn’t dismount.
So we moved to live in a society that recognizes climate change and cares about finding solutions. We moved to do our best to continue to contribute to human society. Our interests and our areas of experience and skill are no longer supported in the U.S. (more on that another time) We can both work as we’ve always worked, me as a writer, analyst and researcher and Steven as a photojournalist in possession of a signifcant, historic archive that revolves around sustainable agriculture, Jimmy Carter’s home town, friends and family, and New York City in the 1980’s including American political life and movements toward sustainability, without fear from here.
So once again, it may seem redundant, but I grew up being absolutely excoriated by my family of origin for doing perfectly reasonable things like going to university and marrying my husband, so, in the interest of keeping my defenses solid, I want to be clear. We moved to the Netherlands. But we also moved away from the U.S.
We moved away partly because the expense of being in the U.S. has become unbearable. It’s paralyzing just to continue to come up with a budget to meet expenses that rise by $800 a month or more, without warning. Health care was only one of those expenses. Utility bills in the Northern U.S. are tied to Canadian resources. We were expecting a 50% rise in the cost of heating and electricity next year. In the U.S. our fixed expenses were set to rise by $25,000 annually at a minimum beginning in Winter 2025 and then again, rise even more when the Trump administration actually gets to enact their reforms.
As for me? Running our rental houses was already taking nearly all my time. Even when all of the upkeep, cleaning, communications work and guest relations is done by me, there are increasing fees and taxes to be paid annually, and expectations seem to rise with every quarter. Hosting platforms expect more of a share of your rental fees and so so cities but guests expect to pay less because there are more options available and they have less money.
Meanwhile the downward pressure on rent continues. No one seems to understand how the cost of maintaining a house has shot through the roof in the last five years while wages have remained stagnant at the same level as the 1990’s. You can’t pay for 2025 expenses on a 1995 salary. (I’m not even exagerrating here, I briefly took a job as a substitute teacher and it paid under $15 an hour. When I left teaching, I spent my last few months as a substitute before returning to school in 1995, wanna know what it paid? $15 an hour.) In the end, it cost us more for me to do that job than I gained in pay.
Then there is the cost of food, the hidden cost of crumbling infrastructure, the strain of living in fear every day, the potential for gun violence, the racism and the unrestrained performative hostility of people who support Trump in our area. I could go on and on but this is already so long, no one will read it. (And that’s fine.) These increases in expenses would have the net effect of locking us into our current home as we made more budget cuts, deferred maintenance, and cut expenses year after year, depleting the value of our assets and draining our savings.
I think we’re pretty typical of an American couple living in the middle of the middle class. And let me tell you, in America, we are drowning. This step, beyond the borders of our national identity, was our chance to get into a lifeboat, so we took it.
This is the first essay in my account of our move from rural New England, to the old world, the Netherlands. Nothing is in any particular order. I’ve spent the last few years being scared and silent. I’m just learning to talk again. And here we are.
