Health Care in the Netherlands vs. Health Care in the US

When you think about the entire globe, the cultural differences between people in North America and Europe aren’t huge. But the one thing that separates specifically the United States from say, the rest of the developed world, is lack of affordable health care. I can not emphasize enough how huge of a deal this is, but I’ll try by way of example.

Back in October 2006, I moved to NYC from Paris. A few weeks later I accidentally cut my finger pretty badly while I was at home in Brooklyn. I was working full time, but I didn’t have health care, which is entirely normal. I bandaged it up myself, but later in the evening the wound opened up again while I was out at a bar. It looked worse than it was, honestly, but blood always freaks everyone out. I was shuffled outside, and a nice Scottish girl demanded that I go to the hospital right away for stitches. It was pretty obvious that’s what I needed – again, the cut wasn’t going to kill me or anything, it just was too deep for a simple band-aid. The thing is, I didn’t have health insurance. So I couldn’t go to the hospital. That was that, there was no “well maybe I should anyway….,” the fact was that there was no way I was willing to pay hundred and hundreds (if not thousands) of dollars to get stitches in my finger – and also wait for hours in the emergency room until someone could see me. I just couldn’t afford that. Every single one of my (American) friends that I was with understood that, but the Scottish girl just kept saying “but this is crazy, you need stitches, then you’ll be fine, why won’t you go to the hospital?” as though I was trying to prove something about how tough I was being. It wasn’t about being tough, it was about reality. In the US, just because you happen to live there and work full time and pay taxes, that doesn’t mean you have the right to get stitches if you cut yourself. This is the way I was raised, this is what my society taught me. This seems normal to me.

Anyway, I bought a huge pile of supplies from a pharmacy, bandaged myself up properly, and my finger healed slowly – there’s still a scar, and the inside knuckle of my left pointer finger is still incredibly sensitive, but that’s all fine. I don’t have a big, scary story about getting hit by a car or breaking my leg without health insurance, because honestly, if something like that happened, there’s no way I would be in Europe right now. I would be in debt for the rest of my life, like millions of Americans are right now.

A few weeks ago in this blog that I fell off my bike after getting my tire caught in the tram tracks, which is apparently a right of passage here. I was pretty banged up, but it didn’t occur to me to go see a doctor, even though a couple different people told me I should just get myself checked out. First, I thought “it’s nothing, I just scraped up my leg.” Second, I still have this American mentality in me that says “you can’t afford it, and you don’t deserve it” – even though I know both of those things aren’t true. So I didn’t do anything about my cuts and scrapes, I just tried to keep everything clean and bandaged. Then, a few days ago, I noticed that shit, my right ankle was still swollen, it had been over two weeks, and it seemed to just be getting worse. The wound on the top of my foot wasn’t scabbing up the way it should have been (which meant it wasn’t healing), and this was becoming not only painful, but annoying. I haven’t been able to wear heels in over two weeks, and I’ve avoiding running after a frisbee being thrown my way. Not good. So I finally freaked out and went to talk to a pharmacist in my neighborhood this past Saturday.

The pharmacist took one look at my foot and told me to go see a doctor right away, because I had an infection. Since it was a Saturday, I had to make arrangements to go to the hospital, rather than just go see my doctor (I actually haven’t picked a doctor yet). Just the words “go to the hospital” scared me to death, though I kept telling myself, “okay, this won’t be like it is in the states, it won’t be like it is in the states,” but I still took 200 Euros out of the ATM machine. The thing is, I do have Dutch health insurance, but I just literally signed up for my plan and I don’t think I’m in the system yet, so I had to do the whole thing as if I’m not insured. This wasn’t a problem, and I kept getting assured that I would be reimbursed by my insurance company.

When I got to the hospital, the American in me expected to be there all day, which was a bummer, since I had been planning on enjoying my Saturday. Instead I waited about 3 minutes before someone called my name. I wasn’t asked to fill out forms or show ID. The doctor took a look at my foot, said “yup, you have an infection, but it appears to just be local and you simply need to treat it 3 times a day with antibiotics.” The entire process took no more than ten minutes, he wrote me a prescription, shook my hand, and sent me on my way. And that’s… it? Does anyone need to see my passport? Anyone want to charge me 50 Euros just for walking in the room? No?

The pharmacy was just down the hall from where I saw my doctor. I handed the woman my slip, give her my phone number, and waited for it to be filled. Ok, my brain is thinking, this is where I get charged. This is the scary part. Five minutes later, my prescription was ready. “That will be 9.70 Euros please. And keep this receipt, be sure to use it to get reimbursed from your insurance company.” And that was that. Less than ten Euros. That’s what the entire process cost me, and if I feel like it, I can get that 9.70 reimbursed.  At no point was I ever given a different type of treatment because I’m a foreigner who doesn’t speak Dutch. It’s very simple, very obvious – but so incredibly foreign to me – health care being a basic human right.

I’ve been using these antibiotics for just a couple days and my foot is almost totally fine. After 24 hours, the wound started shrinking and the swelling went down significantly. If I had just done this when I fell off the bike, I would probably would be walking around in heels right now.

I’m sure that somehow, in the US, there are clinics and doctors and special programs that would provide something somewhat similar to what I described above. But I’ll tell you something: I wouldn’t really have any idea where to find them, and I have tried. I went to a public clinic once in New York for an exam – the type of place that exists specifically for people who don’t have health insurance. It took me about 30 minutes to fill out all the forms, I had to provide my ID, social security card, pay stubs, and some other paperwork. Then they charged me $175 USD and required me to pay up front (before I even saw the doctor) and in cash. When I told them I only had $100 on me, they gave me directions to the nearest ATM machine. I had to leave the office, walk down the street, get more money, and hand it over before anyone would see me… and this was, again, a “public health clinic.” The actual exam took about 10 minutes, and I was in the office for over 2 hours. I spent most of my time looking at advertisements for different drugs, which were hanging all over the walls.

It’s not about the language, or the food, the religion, the time we eat dinner, or even the legal drugs and prostitution that really create such huge differences between the Dutch and Americans. It’s not a Dutch vs. US thing at all, it’s a US vs. The Rest Of The Developed World type thing. And I’ve got to say, I just don’t see myself ever being able to give this up – this amazing privilege of being treated like a human being if I’m sick. There will always be a part of me that sees this as really special, and not just the way everyone else is doing it. I hope so much that Europeans fight against the privatization of health care, which is slowly starting to happen (but is nowhere near what it’s like in the US), and pressure their governments to keep health care affordable for everyone.


The logistics of living and working in Amsterdam

In the past few weeks, I have been many places. It hasn’t all been cafes and bars and picnics in the park. In chronological order, this is where I’ve been since the 9th of June 2008:

1. To the main IND office in Rijswijk. This is where I applied for permission to get a work permit, basically. After deciding to hire me, my employer gave me a 1-year job contract and made the appointment for me at the IND office. The outcome of this appointment was getting a sticker in my passport that proves I reported myself to the authorities and my visa is in process. I had to bring my contract, passport, and 1 official Dutch-size passport picture, and application forms (which were prepared for me by my employer, again). This was a really simple appointment – I was in and out of the building in ten minutes.

2. To the bank (ABN) to set up an account. In order to get paid, I need a bank account – practically everything here is done with bank transfers and direct deposit. Normally you have to provide a BSN number (which was called a SOFI number, or a dutch social security number). However! My employer has an agreement with this bank that allows employees to set up bank accounts before getting a BSN number (though I need to give them one within a certain time period). I needed to provide a letter from my employer and a copy of my job contract, along with my passport and an address.

3. To the main branch of the DienstPersoonsGegevens (DPG) in Amsterdam, on Stadhouderskade 85. This is where I had to register myself to the city with a legal address. See, in order to get a BSN number, I need a legal address in Amsterdam (keep in mind, everything about this process is different if you have an EU passport, which I do not have). And since you need a BSN number to do just about anything, this is a really important step. I’m fortunate enough to have friends that own their own apartment here in Amsterdam and said “sure, you can use our address to register.” I want to emphasize this is a really big deal here – I needed a copy of their mortgage agreement, a letter saying that I could stay, and a copy of my friends passport. And from here on in, all my mail goes to their place, which is also a huge deal. Everything is communicated through the post – my bank account number, my BSN number, etc. Anyway, everything went fine at the DPG (I was there for about an hour or so) and now I’m officially in the system.

There’s one weird thing that I needed to provide that I don’t have, which is a birth certificate with an apostle stamp. I have never been asked for something like this before and I really have no idea why the Netherlands needs it. I do have my original birth certificate, and the people at the DPG seemed really understanding about this whole lack-of-apostle-stamp thing. They said I had six months to get it, which means requesting a copy from the state of New York, where I was born. So, okay, I’ll start figuring out how to get that sometime soon.

I want to emphasize that because I have a job with a proper contract, my whole integration process into Amsterdam has become absurdly simple. Everything I’m doing right now is based on the fact that I have a job… and everything I do, I do with the help of the HR department at my company. I’ve had one or two very minor problems/inconveniences along the way, but honestly nothing even worth detailing in this blog. Every time I go anywhere, whether it’s to the bank or the immigration office, I just simply bring everything with me. Everything. My passport, photos, birth certificate, job contract, housing contract, etc., and of course I have multiple copies of each one of these things.

So, what’s next? Finding an apartment. I know, my housing situation must sound a little confusing. Here’s what’s going on, in the simplest terms.

-I’m registering at my friends’ apartment, in Bos en Lommer. This is where Amsterdam believes I live, where all my mail goes, etc.
-I’m actually living in a different apartment, south of Vondelpark, in the Oud Zuid. It is not possible for me to register there, since I’m “illegally subletting.”
-Therefore I’m looking for my own place, something nice and legal, someplace that allows me to register which…
-Is incredibly difficult to find here in Amsterdam for a million different reasons but…
-I found one anyway.

This is incredible! I’m going to move into my new place on the 1st of July. It’s located near the Weesperplein, which is technically in the center, but it’s actually more east of the the center (just across the Amstel). Anytime you change addresses in Amsterdam, you need to re-register. So – yes, I just went through this whole process of registering in Bos en Lommer and getting my mail sent there and everything, and now I’ll have to change all that stuff. The thing is, I just really needed that BSN number and couldn’t wait to register myself (and honestly, I didn’t expect to find an apartment so quickly). The good news is that there are DPG offices all over Amsterdam and I can change my address at any of them (think about them like little City or Town Halls), I don’t have to go back to the main branch.

So, just in case there’s anyone reading who might be embarking on something similar – honestly – none of this stuff was hard. Since every other person who moves to Amsterdam seems intent on emphasizing how hard it is to live here, how it’s impossible for Americans to find jobs, how dealing with Dutch bureaucracy is a total nightmare… I just wanted to be that one person on the internet who says that hey, in my particular case, it’s all working out fine. And even though it was raining while I biked to work this morning, I still thought, man, I am so happy to be here.

Legally residing in Amsterdam – victory!

I recently celebrated my 29th birthday, and the best birthday present was putting my signature on the (ten-page!) contract that will allow me to live and work here in Amsterdam. Once I was done meeting with the HR people, I went out to meet up with some new friends and celebrate.

Now, I’ve been planning this move for about 7 months and put in a lot of effort, work, etc., into making this all happen. But I want to acknowledge that yes, I’m really, really lucky to have everything work out the way it has. Way back in October 2007, I found a company that has offices both in the US and Amsterdam, and I met with them in person in NY and Oregon. Once I got to Amsterdam I had about four meetings with the folks here, and was then finally offered the job (to make a long story short). So while a lot of people say “wow, you’ve been here for just over a month, that sure was quick!” it doesn’t quite seem that way to me. Then again, now that I actually have the contract and my start date is coming up soon, it does seem to be rushing up!

Because the company is now sponsoring me to stay here, they made the appointment for me at the IND (the Dutch immigration office). the purpose of this appointment will be to hand in my residence/work permit paperwork and getting a sticker in my passport that proves I’ve reported myself to the authorities and my visa is in process. I need to bring:

1. My signed employment contract
2. the application forms (which are being prepared for me by my employers)
3. My passport, obviously
4. a Dutch official passport picture

The differences between starting a job here in the Netherlands and starting a job in the US are drastically different. I have twenty-five vacation days, and if you’re American, I don’t need to explain how unbelievable that is. When I got to the part in the contract that explained sick leave, I asked “so how many sick days do I get?” and the woman looked at me like she didn’t understand the question. If you’re sick, you’re sick, she said. Basically, there is no “number of sick days.” Sick days are totally different from vacation time.  I thought about my previous full-time job in NYC, where during my first year of employment, I was granted exactly 3 personal days, 5 sick days, and no health coverage at all. And you know what, that’s absolutely not uncommon or weird. Here, I’ll have health care and a pension plan (if I want it), just like everyone else who lives and works (legally) in the Netherlands. They even offer free Dutch classes!

Having the past two months to just kind of relax, travel around a bit, and explore Amsterdam was perfect… now it’s time to really develop a life here.