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Irish-French-American Sasha Piton has travelled widely outside the US but has recently settled in Dublin. In her new series for The Journal, she shares the insights of a new arrival on a country she’s trying to call home.

MOST DAYS THAT I’m in the city centre, I chat with people and get recommendations from women, from their favorite Asian grocery store to their go-to electronics shop. But one interaction with a woman brought me much comfort when it seemed as though we skipped the small talk and headed straight into conversations about life, passing of loved ones, and the medical system between the USA and Ireland.

I felt right at home and she ended up recommending a clinic to visit a general practitioner.

I appreciated the recommendation for a doctor and called their office and booked an appointment within a few days. That seems lucky. Or maybe because I just paid the full cost of the visit? I still don’t understand. I just know that within 72 hours I booked an appointment with a doctor, had bloodwork done, picked up prescriptions, and had the results of my bloodwork back. I was absolutely sticker-shocked that a month’s worth of medication was less than €4.

When I got here, I was very confused by healthcare because I’m an EU citizen and I don’t need private health insurance, but the longer I’ve been here the more I realise many people have private health care.

It’s interesting to see that opinions of the healthcare system and government taxes change drastically based on the age of the woman I’m chatting with. I’ve noticed that older women that I came across feel that Ireland is very poor but the younger generation feels like Ireland is very wealthy. But that wealth is capped for individuals so they want to leave to pursue their opportunity for more, be it income, business opportunities, jobs they were trained for here, etc.

I’m very much a newcomer and, of course, I don’t fully understand it all nor have I spoken to every Irish person. That generational split made me think about my own relationship with healthcare over the years. Because depending on when you asked me, my answer would also be split on how important immediate access to that healthcare is.

I had been living without health insurance in the United States since November 2019. I worked for a company for six years and I had healthcare through them, and even once Obamacare came along, healthcare through my employer was cheaper. And once I reached management level, the company covered the cost of my healthcare (rare and a coveted job perk in corporate America).

I didn’t get acquainted with universal healthcare during its prime in the states. And then once I resigned from my job (because after six years I realised that the corporate ladder truly wasn’t worth the soul-sucking cost), I didn’t sign up for healthcare right away, because that industry was in major flux and I needed time to do research. The healthcare system in America is so much MORE for profit than people realise and it’s built to confuse and disorient people to fall into debt. And poor people lose the will to fight because we’re focused on survival.

You can have an in-network doctor and an in-network hospital for your insurance, follow the process but the lab your doctor uses is out of network so hidden fees show up. The insurance company wants to refer you back to the hospital/doctor, the hospital wants to refer you back to the lab, the lab wants to refer you back to the insurance company and nobody can ever answer these questions.

An ambulance ride when you don’t have insurance CAN be around $1,200 (depends on the city) but when you have insurance and they bill it, the insurance will pay $2,000 and then you’re left with $2,000 bill.

People will ask and beg, don’t bill the insurance and I’ll take the $1,200 bill. But the rule is if you have insurance they WILL bill it.

I’ve seen people fall into life-changing medical debt because of a single diagnosis and that’s even with health insurance.

When I resigned from my job in 2019, I gave myself six months to research healthcare and sign-up the following open enrollment time but the more research I did I found that it was continuously confusing and there was no cost transparency. I called offices that I normally went to, to understand if they had cash pay patients. I found that in general, it was cheaper to just be a cash-paying patient.

That did leave me vulnerable if I were to ever fall and have to take an ambulance or get surgery because I broke my leg or something. That would put me in astounding medical debt. But in general being a healthy person that just goes to annual appointments for updated bloodwork, and check-ups, I was spending far less money by just being a cash-paying patient. They discount their services to be paid the day of, versus going through the process of billing insurance.

Next thing I knew, six and a half years went by. But I learned the hard way that the system fails healthy people who get sick quietly. A story for another column, but I did end up spending $20,000 for a doctor who could help me after years of medical neglect at my annual check-ups. Unless you find a doctor who knows what extra tests to run and which labs to use, even if that lab is 2,000 miles away, most doctors won’t dig deeper.

They’ll let you go until you need a prescription to patch the symptom instead of finding the cause.

So moving here I really didn’t know what to expect or how to navigate the system. I even hired an immigration lawyer for an hour to ask that question and they just told me to find a general practitioner and to sign up and it would just depend on the wait times and then I could choose if I wanted private healthcare or not.

And that is something I didn’t know Ireland had; private health insurance. Depending on the year and the source, I’ve read that 45-47% of Ireland’s population is on private healthcare. I don’t know why that shocked me but it did.

The story we’re told in the States for anyone who is pro-universal healthcare is that it’s a better system and it’s desirable for all people. But here I am living in a country where almost half the population is being taxed for universal healthcare but choosing to spend additional money on private healthcare.

Maybe no country has a perfect system.

But healthcare as assurance… the fact that if some emergency happened, I wouldn’t be left in astronomical medical debt if I fell and had to go to the hospital, has lifted a weight off my shoulders I didn’t realise was there.

Throughout most of my childhood I didn’t have healthcare either. It’s always been complicated but growing up with divorced parents who lived in two different states. I only had healthcare in the state that my dad lived in and my mom couldn’t afford healthcare in the state that we lived in with her. So we drove six hours one way in order to use that healthcare.

The only time I ever actually used it was when I had double knee surgery when I was in high school because of a sports injury. But once I was back in my home state where I went to school and lived life, I didn’t have health insurance which also meant that I didn’t have physical therapy after that summer I spent at my dad’s recovering.

Maybe people here understand that scenario, where the waitlist for physical therapy was too long to get into unless they could afford private pay. But growing up in a small town, there was a football dad who was kind enough to help me rebuild strength for the additional six months that my legs were in braces from my thighs to my ankles. I have no doubt there are people like that here that help in the community just because somebody needs it.

No system is perfect, but between a stranger in the city centre pointing me toward a doctor and a football dad rebuilding my legs one summer, I’m starting to think the real safety net was never the insurance, but the people who show up for you inside whatever system you’re stuck in.

Sasha will be back with more insights into her adopted home and city next week.

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