Originally Published September 1st, 2021

I present to you yet another brow-scrunching word to stumble over. This little jumble of letters sounds roughly like “oh-sah-key-debt-suh” and is the name of the Basque public healthcare system. Like many things in Spanish Basque Country, the Basques have managed to set their own course. The public healthcare system in Basque Country is completely independent of Spain.

As with all worthwhile things in adult life, there is paperwork to be filed to start your coverage in the public system. It was, however, less than I had imagined. To become a card-carrying member of Osakidetza I need to provide: proof of residency in Basque Country, a copy of my Spanish ID, and proof of employment for the past three months. Proof of employment was needed because I am not a citizen, merely a resident.

After validating and dropping those documents off at a local clinic, I was given a short letter that could be used as proof of coverage if I had any medical needs before receiving my card. I was also assigned a doctor at that clinic and given login information to the healthcare portal to set up appointments, check test results, etc. A few weeks later, my medical card arrived in the mail. It is the size of a credit card with a magnetic strip and my ID information embossed on the front.

My medical history and prescriptions are associated with the card so it is easy for everyone involved to have the same view. Any pharmacy can dispense the medication I have been prescribed. I receive periodic reminders about checkups and screens associated with different ages. All-in-all it is quite familiar and boring.

I realize public healthcare is highly political in the US. You can pick and choose metrics to paint any picture you want comparing the vastly different systems. But in the end, how does it feel compared to private healthcare in the US? I would say it is at least as good if not better.

To me, there are two things about it which really make it feel better. The first is that hardly anything is paid out of pocket. Public healthcare is definitely not free. It is paid for with taxes. However, our tax brackets are comparable to back home and once they’re paid, they’re paid. You are never worried that an unexpected medical cost will come along to derail your life.

The second thing is that coverage is not associated with your job. It’s bad enough to be let go but at least you’re not out in the cold health-wise. Changing jobs is also easier to navigate without the “benefits” question hanging overhead.

Basque Country does not have a 100% pure single-payer healthcare system and we choose to additionally pay for private insurance. To put a number on it, it works out to about $80 per month per adult. This is frowned upon by many people here because they fear a slippery slope to more privatization and eroding quality in the public system. I understand the sentiment but many mechanisms are in place to avoid this.

The public system offers wider-ranging coverage. Doctors earn more in the public system. The public system has newer equipment for certain specializations. However, having both public and private gives you some flexibility of facility location, doctor preference, elective scheduling, etc. It is a luxury we are fortunate to be able to afford but it is not essential. Less than 20% of the population here has any form of private insurance.

You may wonder how private insurance can be so cheap here. It’s not that the insurance is so cheap, it’s that there are regulations in place so the medical industry is forced to charge realistic prices. You may have seen that certain operations in the US cost less if you pay cash than if you have insurance? That only makes sense if the prices being charged are completely artificial. An MRI does not cost $1000-2000, that’s just what they can charge your insurance company. We had a completely elective MRI done via private insurance here and it was $22 out of pocket.

Our most expensive public system episode was the birth of our son in 2019. He needed to spend a week in the NICU, was released, then returned after a day to the emergency room with an infection. He stayed another three days in the NICU. Our total cost was about $200 worth of sandwiches, snacks, and parking meters. To me, that’s healthcare. It’s peace of mind.