The first day I got to Spain, I was more than a little distressed. I had tried to get all of my prescriptions filled, but unfortunately, my doctor failed to send one to the pharmacy before I left for the semester. I was anxious and worried—partially because I was missing the medication that helped my anxiety—but I still figured I would be able to get it filled in Spain. 

Upon arrival, I went to a clinic and asked if they would be able to prescribe me medication, based only on a bottle I had brought from the U.S. The nurse explained that I would have to get a new prescription from a psychiatrist here, but that I could have an appointment that day. I did not have any insurance—the international insurance provided by Case Western Reserve University was for emergencies only and did not cover a trip to the psychiatrist—but even without insurance, the entire cost of the visit was only 45 euros (approximately $48.65). 

Back in the U.S., my copay would have been about the same, but that is with private insurance covering most of the cost. The pharmacy in Spain was able to fill my new prescription, a supply of 60 pills, for 5 euros. In the U.S., I pay $20, with insurance, for the same amount of medication. I was astounded, flabbergasted and awed.

In the U.S., the general prices of medications are decided by the company producing them. This process is largely without limitations or regulations, even for critical medications. Insulin, the life-saving medication for people with diabetes, is the prime example. It costs anywhere from $2 to $7 to produce the medication, but $450 for a monthly supply in the U.S.

However, in Spain, el Ministerio de Sanidad—the Spanish Ministry of Health (MOH)—decides not only which medications are classified as prescription drugs, which is also standard in the U.S., but also which medications are so necessary that the price is capped to remain affordable. 

Sometimes, the MOH will reimburse the drug company that produces these critical medications. In these cases, the MOH pays the pharmaceutical companies for the drugs under different categories of reimbursements: 100% for hospital pharmaceuticals, 90% for medications necessary for the management of chronic illnesses and 60% for the majority of prescription-only medications. Then, the MOH decides the price ceiling for the drugs to enter the market. If the MOH does not decide the drug meets the necessary criteria for reimbursement, the product is then priced by the company, and the MOH cannot intervene except for the protection of public interest. This system explains how medications necessary for the management of chronic diseases in Spain cost only a fraction of the American price. Insulin, for example, costs 5 euros (about $6) for a box of five Treisba pens in Spain, while the same product costs $500 in the U.S. 

In addition to the government’s regulation of medication prices in Spain, there is also a public healthcare system that, while not perfect, is able to provide more accessible and affordable services than the U.S.’ Affordable Care Act, more commonly known as Obamacare. The Spanish system provides public health care to anyone who has a job in Spain, as well as their family. As a result, approximately 99.5% of the Spanish population is provided with free public health care, excluding dental and eye care. 

That being said, public health insurance can only be used at public hospitals, where waiting lists for specialists can be extensive, causing months-long waits for surgeries or office visits. However, there is also the option to visit a private practitioner, and to use private insurance, to quickly see a specialist.

In my experience, I have found that the public health care system in Spain is not half as bad as many make it out to be. A few weeks into my stay, I got some sort of virus that caused me to constantly vomit. I wasn’t even able to keep down water, so I decided to go to see a physician. Once at the public health clinic, I waited 40 minutes to visit a doctor, who was quickly able to diagnose and prescribe me with medications that completely treated my symptoms. Upon trying to pay for the appointment, the receptionist told me that I did not have to pay anything. Once again, I had a major “does not compute” moment, during which the receptionist, thinking I did not understand his Spanish, repeated himself two times before I managed to thank him and leave. 

The disparity between the costs and accessibility of healthcare and prescription medications in the U.S. and Spain is indicative of a systematic issue troubling America. The fact that around 27.5 million people in the U.S. were completely uninsured in 2018 and that approximately 29 percent of the adults with insurance in 2018 were underinsured, shows the desperate need for some kind of universal healthcare system. While it is clear that there is no strong consensus in the U.S. on what that system would look like—just look at the Democratic presidential debates, if you need examples—the private health insurance system and lack of regulation of Big Pharma is damaging the health of many Americans. I should not be shocked when I do not have to choose between food and my medications or hospital bills.