Part 1
As we get older, heath care becomes more important and for those who are a bit unlucky, it becomes critical.

A few years ago while traveling in Portugal, Sharon and I stopped in a small town called Alcobaca to see its wonderful cathedral and explore the town. We decided to have lunch in a charming little restaurant across for the church. I had some shrimp and Sharon decided to try their speciality— sardines. As we were finishing, Sharon said to me that I looked rather red and if I was alright. I said I was but she wasn’t sure.

“Your face is awfully red— something is really strange” she said

I said I felt fine but she dragged to to a pharmacy across the street. The pharmacist who spoke little english motioned me to a chair and took my blood pressure. It was 79 / 40. She said “go to hospital right away” and called for a taxi.

Within a few minutes, we were outside of the local hospital in this very small town. It was a very nondescript white concrete building that was a relic from the fifties. Nobody in they place spoke english but after some yelling, and screaming by Sharon, the local administrator came down. He spoke some english and admitted me. We were taken to a small 12 foot x 12 foot concrete room. In it was one gurney, a wheelchair and two wooden chairs. There were three people in this room so I got the remaining wooden chair. Eventually, the guy on the gurney was moved to another room, the person on the wheelchair moved to the bed, the guy next to me moved from the wooden chair to the wheelchair and I stayed on my chair. A nurse eventually came in and tried to take my history but she did not speak english and who the fuck speaks Portuguese except them and 180 million Brazilians. Ten minutes later the woman on the gurney was moved out and I moved to the wheelchair. A nurse came in and took my blood pressure, temperature and listened to my heart. At this time, I was beginning to feel very crappy— my joints began to ache, and I was feeling very uncomfortable. Sharon called for the doctor/resident to look at me. He thought I had had a reaction to the shrimp so he gave me an antihistamine and then left. Twenty minutes later it was my turn to occupy the gurney. (I should mention that the blanket was never changed. I have no idea how many people had occupied this gurney today.

The resident returned and checked my blood pressure again. He shook his head and left the room. (I knew things were not getting better for me). A nurse came in to give me an IV. (She did not wear gloves). My blood pressure was still dropping and was beginning to feel very achey.

I was very uncomfortable and could not find a position to rest that helped me feel any better. No matter how I placed my body on this fucking gurney, I could not get rid of the aching that was spreading to every joint in my body. The worst part for Sharon and I was that we could not communicate with anybody.

In a few minutes the resident returned with another doctor and they discussed my case in Portuguese. The second doctor turned to me and introduced himself. “I am Dr. Alves (in perfect English—He is the guy in the photo) ” I will be looking after you from now on. What medications are you taking?” I told him I was taking Niaspan for my cholesterol and he replied “Has your dosage changed” I told him that they had increased it before I left the US. He went on to say that he was only visiting a friend in this town and that he worked at a hospital in London. He said that he had over 200 patients on this drug and that he had seen this in three cases.
“We will give you an infusion of saline and you will be fine in a few hours.”
The then moved me to another room that was very different from the one that I had spent the past hour in. It was a modern medical emergency facility except it did not have half as many medical toys as the ones in the US. They began the infusion and my blood pressure slowly began to rise. He would come by every twenty minutes or so to see how I was doing. He was not rushed at all and would always spend about five minutes chatting about this and that. I told him that this was a far different place than in Southern Florida and he chuckled. two or three times, the hospital administrator who had admitted me came by to see how I was doing. I thought that was really cool.

Two hours later, Dr. Alves said I was fine and could leave. I thanked him, took his picture and asked him about paying. He laughed.

“In Portugal, emergency medicine is free. For the Portuguese and to all visitors.

Part 2
The following year, while we were in Florida, Sharon told me one morning that her chest felt some pressure and that this had been going on all night. It was my turn to insist that she see somebody. In the US there are walk-in centers for emergencies so we went to one. She was seen vary quickly and when she came out, she told me that they had given her an EKG and that although it seemed fine, there was a small anomaly that they thought should be looked at in the hospital where they had a more sophisticated EKG machine. So off we went to JFK Medical Center—the finest health care facility in Palm Beach County. It was a super modern complex featuring the finest minds, machines, drugs and bullshit that the American health system had to offer. They gave her another EKG and came to the same conclusion. Her EKG was fine but there was a small anomaly that should be investigated. They admitted her. They gave her aspirin and an EKG every hour just to make sure.

While this was going on, I called Blue Cross in Vermont and told them about it. The woman on the phone said that I did not need prior permission for emergencies and they would take care of it. I felt much better since the major concern in American health care is not outcome but cost.

I went to visit Sharon the next morning. Her room was about 24 feet x 24 feet with a private bathroom, a plasma TV and next to her bed was a menu. “Would you care top order lunch” she said. “I’m serious.” I ordered lunch from room service. She said she was fine and that they would be releasing her. Upon her release we were presented with a bill for $17.260.23. (including the aspirin at $6.00 each.)

I thought the process of settling this was a matter between the hospital and the insurance company but insurance companies being what they are did not see it that way. They declined to pay.

“You told me I did not need permission to get emergency care out-of-state” I said

“You don’t” they replied. “You do however need permission to be admitted. We will cover the cost of the emergency visit which was $250.00”


In the end it was eventually settled because insurance companies being what they are know that when they are wrong it is wiser to settle than to face a litigation and raise the attention of the State authorities who regulate them. On the other hand there are always a few poor souls who accept their bullshit without question believing they know what they are doing. And why was the bill $17.260.23? Only because the hospital’s fear of lawsuits forces them into overkill to cover their ass. An individual would have had to pay $17.260.23 but the insurer gets it for far less. Health insurance in America is run by 3 gangs. There are the hospitals, the insurers and the lawyers and they are in charge. The poor schmuck patient is only the vehicle for their avarice, just like the plaintiff in a class-action lawsuit. They are only there to pay the bills.