The struggle to access and afford quality health care has become a quintessentially American horror story. As politicians fear monger about how we’re going to pay for policies like Medicare-for-All, there are countless accounts of people turning to crowdfunding platforms in order to cover their medical bills. In emergency situations, it’s not uncommon for people to make calculations about whether or not they can afford to take an ambulance .

The country’s expensive and broken health care system is one that is only more burdensome for women. The average cost of childbirth in the country is $32,093 according to one study—and that’s if there are no complications. Even women who are insured will still likely have to pay thousands of dollars just to give birth. Yet despite its high cost, the United States has one of the highest maternal mortality rates among wealthy nations, which disproportionately affects Black mothers . Women also disproportionately shoulder the costs of elder care . And while the Affordable Care Act expanded coverage for contraceptives, Donald Trump’s administration has been diligently working to dismantle those regulations.

It doesn’t have to be this way. We talked to women in five countries with universal health care systems—Canada, Iceland, Taiwan, Australia, and the UK—about their daily interactions with their country’s medical systems. While conditions varied, and there were certainly shortcomings, most of the women that ELLE interviewed could agree on one thing: at least they didn’t have to deal with the health care system in America.

The interviews have been edited and condensed for clarity.

Her biggest unexpected medical cost was $150 for the dermatologist.

Íris Gunnarsdóttir

Reykjavik, Iceland

Age: 32

Job: Pharmacist

Children: 3 months pregnant

In your own words, describe how your health care generally works.

We don’t really have health insurance, it’s just the government. You just pay taxes, we pay around 37 percent of our wages to taxes. [Ed Note: By comparison, marginal income tax rates in America range from 10 percent to 37 percent, with the average effective federal income tax rate at 14 percent.] It gets up to around 45 percent if you make more than a certain amount of income. We do have to pay up to a certain amount per year for health care. If I want to see my general practitioner, then I just have to pay $10 to visit him and I don’t pay anything else, that’s just for the appointment. But if I have to see a specialist, then the first appointment I have to pay around $100 to $250, it depends, but then as you pay more, the more the government pays for you. If I have to see more doctors, then I pay less.

How much do you pay a month?

It just depends on what you need to do. Before getting pregnant I almost didn’t pay anything, maybe at maximum $100 a year. But it was usually even less, just like $10 to $20 per year.

Has it changed since you’ve been pregnant?

I don’t really have to pay, but if I want to have an extra ultrasound I have to pay $100 for that and for extra check ups. If you want to do some extra tests then you have to pay for it. But for just the normal services you don’t have to pay anything.

How was your experience being pregnant with the medical system?

It’s just great. You can call a nurse anytime for free if something comes up, which hasn’t happened with me, but I’ve heard other women talk about it. You can always have free check ups. It’s really nice.

What about other reproductive health services?

Birth control is really easy, you just have to pay $10 to see the general practitioner and then you have to pay for your own birth control here. For me, for three months it’s $30, maybe $10 per month. It depends what type you have because some are more expensive and some are less expensive.

Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

No.

What’s the biggest unexpected medical expense you’ve ever gotten?

Probably nothing. When I was in Guatemala I got a worm in my foot so I had to pay for the visit to the dermatologist and then I had to pay for medicine. It wasn’t paid for by the government because it’s something that doesn’t really happen in Iceland. The visit to doctor was probably around $150, and then another $150 for medicine. That’s probably the biggest one.

Is there anything that you think might be overrated about your health care system?

Right now we have a problem with the lack of general practitioners, so you have to wait. But it depends on where you live. Maybe if you live in a neighborhood where many people are sick then you have to wait for a longer time than if you live in a neighborhood where not as many people are sick. It depends, you can always get a doctor by just paying a little more, you go to private practice and then you pay $50 for a visit instead of $10. Then most often you can get a visit to a doctor in just one day. But if you can wait, and if you don’t have to have an appointment immediately, then you can wait maybe a week or two for an appointment.

What do you think about the US system?

I don’t think it’s great. Actually I think it’s quite funny when my US friends are really upset about having to pay for someone else’s health care because that’s just my usual way of seeing life, you pay for the ones that are less fortunate. I think it’s quite crazy that you can get denied from getting into a hospital because you don’t have insurance. That’s just insane to me. It’s crazy that you can be unemployed and not be able to go to hospital even if you get sick because you have to pay for everything.

She pays nothing, and can see the doctor for free.

Laura Goldhopf

Toronto, Canada

Age: 32

Job: Currently unemployed (previously a research coordinator)

Children: One (10-months-old)

In your own words, describe how your health care generally works.

If I’m sick, from a basic point of view, I just call my doctor’s office in the morning, they have walk-in hours in the afternoon and then I go to the doctor. For my baby, he goes to see the doctor more frequently than me, those are just check-ins that don’t cost anything. He just gets vaccines and gets weighed and the doctor asks us questions to make sure everything’s okay. He hasn’t had to get any prescriptions yet and not all prescriptions are free for kids, but a lot are free under the age of 25. That’s a newer thing in Ontario the past few years.

How much do you pay a month?

Before I was on a contract and the grant was coming to an end—it was a 7-year study at the Hospital for Sick Children—and then I got pregnant before it ended. That’s all to say I had insurance until August, that’s when my contract was up, so I still had to pay a little bit of money for that insurance just through my employer. I don’t pay any money anymore and I don’t have any side coverage. I don’t have an insurance plan, but I’m still able to go to the doctor for free. It’s just for drugs and dental.





So that’s the big difference between being covered under your employer or not?

With my employer I had dental and also if I wanted to go to a psychologist. Therapy was covered up to a certain amount and other benefits, but those are the main ones.

Another thing, during my pregnancy I developed depression and I was referred to psychiatrist in a clinic there. I saw them up until October, after my insurance coverage was up, but since it’s a psychiatrist it was covered under the Ontario Health Insurance Plan (OHIP). I was still able to see them without paying any money.

How was your experience being pregnant with the medical system?

Being pregnant was fine, I didn’t really like it. I don’t know what it’s like in the States, but you can either have a family physician obstetrician or a midwife, those are all covered. I had family physician OB, they were good. Sometimes it just feels a little bit quick, they just check boxes to make sure you’re okay.

That being said, when I developed depression I found the program that I wanted to be referred to and told my doctor. She was like, sounds good, and referred me to that program. I did have to wait a while to get seen but I think it’s because they triage you. So they called me and found I wasn’t in any immediate danger, but by the time I saw someone I was no longer in the depressive episode, so it was quite a while. It felt like a while at the time, but I just wanted to be in the program because I had anxiety about developing postpartum depression, so that way I was able to be seen afterwards. It was nice in that sense that I didn’t have anxiety about having to find someone without having any supports in place.

Another thing about the insurance, when I gave birth I had to pay a little extra to get a private room, just $40 (CAD), after he was born. I don’t know how much it costs if you don’t have insurance.

What about other reproductive health services?

I used to be on the pill for many years. It’s funny because I went to NYU for grad school so I had to pay for birth control and I was like, “But I have insurance.” And they were like, “This is the price with insurance” and I was like “What?” It’s insane. It was something like over $20 (USD) a pack. At the time when I had insurance before, I would get three packs for $4 in Canada.

What do you think people overestimate about the Canadian health care system?

Living in the city it’s really easy for me to access a lot of different services. Where the problem would lie would probably be for people in rural areas. I know there are things like telehealth, where you can be called in and speak with people who are in the city. Living in city and having access to so many different people, it’s hard for me to complain.

What do you think about the US system?

I felt like the cost was a lot. A lot of people at the time that I knew at NYU had never had pap smears and stuff before and I think they were more scared of the medical system. Whereas I was taught—and also because it didn’t cost any money—to go get a pap smear done right when you start having sex or you get to a certain age.

Her husband's chemotherapy was practically free.

Yupu Du

Taipei, Taiwan

Age: 61

Job: Retired

Children: Two (26-years-old, 30-years-old)

In your own words, describe how your health care generally works.

The current health care system in Taiwan is known as the national health insurance. It’s a government program administered by the ministry of health and welfare—the insurance is a compulsory social insurance plan everyone has to join. The system promises equal access to healthcare for all citizens. If you are an employee, the company will share some of the cost.

How much do you pay a month?

I used to pay about $100, but now only $25 after retirement. It’s quite fair and affordable.

How was your experience being pregnant within the medical system?

The health insurance program covers everything from prenatal examination to childbirth. We are lucky, we can choose any hospital we want to go to. When I was six months pregnant with my first daughter they found early contractions in a routine checkup and I had to be hospitalized for fetal stabilization for about a month. The program helped me a lot. My second baby was born by cesarean operation. That I had to pay my own expense, it was not included by the national health insurance program because my doctor deemed it medically unnecessary. The personal payment was about $2,000 for the operation and I stayed at hospital for about four days. Everything else was included. If you just follow the normal process and a normal examination, you don’t have to pay any fees.

You mentioned in your email that your husband has cancer. How has it been taking care of him?

All legal residents of Taiwan are eligible for national health insurance, but my family just joined this insurance program, which is a self-paid program provided by a private insurance company. My husband did it, I think for an annual fee it’s about $3,000 per year. The national health insurance has a wide range of coverage, but patients are still required to pay a small portion of the cost. Some special cancer treatments are not included, such as gene therapy, targeted therapy, and immunotherapy. Other than those programs, they pay for everything. When my husband got cancer in 2007, the NHIP covered almost all the treatment. He was proceeding with both chemo and radiology, he didn’t take gene therapy so we didn’t pay anything except for in-patient costs and some of the registration fees. It was less than $1,000.

So you decided to go on private insurance for speciality therapies?

Yes. Basically NHIP covered everything for chemo and radiology. But the NHIP doesn’t include special treatments.

Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

No. It’s not the main reason but it would help for cost-sharing. If you are an employee for a company, the company will share 60 to 80 percent of the costs.

What’s the biggest unexpected medical expense you’ve ever gotten?

Actually, I had a little dental issue, my teeth were bloody. After they cured that, they ask me to pay $100 myself. I thought, “Oh, that’s not included?”

Do you have any opinions on the US system?

When I studied in the US for a master’s program I got a cold and a sore throat and I didn’t get well for about more than two weeks. I went to the hospital, but at that time I had student insurance, so I only paid about $40—that was around 35 years ago. At the time I thought it was so expensive, but I could afford it. We are lucky in Taiwan, we have a very good health insurance program.

She paid extra to see the same OBGYN for every appointment.

Anna Burns

Sydney, Australia

Age: 38

Job: Manages a university lecture series program

Children: One (2-years-old)

In your own words, describe how your health care generally works.

I’ve lived a pretty privileged life in terms of health care. I do have private health insurance, but that’s because the government encourages you to have private health insurance otherwise you pay a levy in your tax at end of financial year. [Ed. Note: The Australian government implements an extra surcharge for people who earn above a certain amount of income and do not have private coverage.]

But I have the lowest grade of it and it’s just because I have bad eyesight and I get glasses and contact lenses.

I think because I live in the inner city—the services in Australia on the whole are very good, but that it depends on where you live, which is a concern in broader sense.



How much do you pay a month?

My health care and my husband’s health care are combined. So we pay around $350 (AUD) month for both of us. That’s for private health insurance. I actually think the public system is better than private system. If it comes down to it and there’s an emergency, you want to be in the public system. I don’t know if private system stacks up for us, we’re looking into it and are like, what do we pay all this money for? I am happy to pay my taxes, I believe in them as a moral and ethical thing you should do to contribute.

Tell me what it was like being pregnant?

I went through public system but as a private patient, so I could go to the same obstetrician for every appointment. I did it for pragmatic reasons in that I was caring for my mother who had a really terrible terminal illness and my doctor was like, you don’t want to have to explain every time you go to an appointment what your situation is. I was in a really fragile and vulnerable place. I wanted to know I had my team and they knew who I was, and that I didn’t have to explain myself over and over again because she was dying. She died six weeks after my daughter was born. It was pretty full on.

But no matter what system you go through, if there are any complications—like you have to have cesarean or those kind of things—they don’t go, “Hey what’s your level of health care funding, are you eligible for this, or by the way could you sign this disclaimer that it might cost you X about of dollars?” That’s not a consideration, not if you go through the public system.

So as a private patient in public system, you were just paying more?

Yes, it was a little more than $6,200. Which, over nine months, you’ve got time to prepare for. It certainly is a chunk of money, but it was an optional thing, I didn’t have to do that. It wasn’t like you have to find that money to have a child.

How has care for your child been?

Amazing. When we had Isabelle, the midwife came out to our house probably once a week. Partially because my mum was sick and then died, I was having trouble breastfeeding so they came out a lot more than they might have for other people. But again that was free. Every time I take my daughter to the doctor it’s bulk billed, meaning it’s a Medicare covered thing, so I don’t have to pay for it.

Children cost money, but not on that front for us. The early childhood center, those services are amazing, the midwives who are out in the community working with mothers on challenges around breastfeeding. They also check in on your mental health in the the first six months to a year after. They’re very caring and I felt very supported. I felt amazed and grateful that I lived in Australia.

Tell me about what it was like taking care of your mother?

My mum got diagnosed with motor neuron disease. She was going through system in Adelaide, but for a bunch of reasons she came to Sydney.

When they were trying to figure out what the problem was, we were sitting in clinic getting all these CAT scans, getting really big tests done in one of the big hospitals here in the city. I was totally freaking out because I was sitting next to the counter where people were coming in and leaving and I was hearing that they were being charged $900 for that scan, $1,500 for this thing, and I was thinking, I don’t have that kind of money in my bank account. I was having a mild panic, like how the hell am I going to pay for these scans? And my mum doesn’t have private health insurance. Then we got to the counter and because she didn’t have private health insurance it cost us nothing, where it was costing other people between $900 to $1,200 per scan for people. I just remember thinking, Oh my god, thank god.

That kind of happened to us over and over again. She got referred to a clinic that was attached to Sydney University—it’s a teaching university so it has research that’s also combined with the hospital—with one of the world leaders of motor neuron disease research. And everything was free. Again, that’s absolutely the privilege of living in the city. If she had been living where she was previously, some of those things would have been free and some of those things would be charged. But everything we had to do was largely covered by Medicare. I felt extraordinarily grateful and lucky that we lived in Australia, because it could have cost us tens of thousands of dollars. It could have been a financially crippling experience.

Navigating the system and figuring out how stuff works—it was a lot of work. I was very lucky that I’m well educated and I have family and friends who work in health services, and I could figure out how to find out what was available and make it work for my mum, but you really have to be an advocate. I think of what happens if you don’t have English as first language, or if you have a job where you don’t have the same flexibility I had. It has the capacity to move more towards the American system.

Have you ever felt like you needed to get a job or be with a partner for medical insurance reasons?

No, that’s not a thing here.

What do you think about the US system?

It’s really frightening. When I was younger I did an internship at NPR and I was living in New York. It was winter and I got sick and I remember thinking, maybe I’ll go home to Australia rather than go to the doctor [laughs].

Going to the doctor costs nothing, but she has to pay for prescriptions.

Tiffany Philippou

London, UK

Age: 30

Job: Freelance brand consultant

Children: None

In your own words, describe how your health care generally works.

I use the National Health Service (NHS). I lived in America for a couple of years, so I’m quite aware of the difference. It’s definitely less of a service I suppose in England. When I went to doctor in US for example, you maybe felt a little more bit listened to, they test for things. But obviously because our health care system is free, it’s a bit more formulaic feeling. It feels like they very much have a set of rules.

How much do you pay a month?

Nothing. You just pay for prescriptions as and when you need them. I do see a dermatologist privately and also therapy and because I don’t have health insurance or anything like that, I just pay full price for those things. I spend quite a lot of money on those two things, even though I get free health care generally. If you had health insurance you’d have that subsidized. Those two things it’s maybe 400 to 500 pounds. I’m fortunate because I can afford those things. When I have friends who need mental health therapy and go through the NHS it’s really difficult and takes ages.

What about other reproductive health services?

I’ve actually recently had quite a bad experience. I was on the pill, I was originally put on it for acne twelve or so years ago. There was no warning about any side effects, they just want young people on it because they’re scared of pregnancies, that’s the culture. I went on the pill for many years, came off it, and I felt a lot better physically and mentally not being on it.

I decided to get an IUD put in, the hormonal one and the information they gave me beforehand, there’s literally this video on this site that’s like, “I went straight back to work it was really great.” I’m not dramatic in that kind of context, I’m quite stoic, but it was the most painful thing I ever experienced when they put it in. After a few days I was in loads of pain. I felt really angry that they hadn’t communicated what it was like. There’s no follow up appointment either, there’s no come back in six weeks, which I think is standard in the States. You can’t make an appointment so you have to show up and wait all day. And I just haven’t done anything about it.

So you have your general practitioner and then the sexual health center is a different place. It was all free to go get the IUD, but you can’t make appointments. Even if you go to sexual health center for like a sexual screening or something, you have to sit for hours and hours. You can see why people don’t go. I haven’t gone, I’m like, I’m sure it’s fine. I mean it probably is fine, but it’s just not great.

You’re freelance—have you ever been on employer insurance and does it change how you interact with the health care system?

I’ve never had employer insurance. But I know people who do have it, and they mostly use it for physiotherapy, people don’t use it in same way you use your healthcare. People use NHS for main stuff, and then it’ll be something like physiotherapists and nutritionists and other stuff.

So you don’t feel like you need a job to get employer health insurance to cover things?

Yes. That’s obviously amazing, that’s a stress that I don’t have. Because I work in an insecure world, basically everyone I know at some point has been fired. But it’s not a stress about health care, it’s fine. I actually was without health care for two months in New York and it was really stressful because if anything happened to me, it would be a disaster. I freelance now so it just doesn’t matter. It does make you more free I suppose.

What’s the biggest unexpected medical expense you’ve ever gotten?

Nothing, that doesn’t really happen.

What do you think about the US system?

My experience was that it’s great if you have access to it and you’ve got a good health insurance provider. I’ve had two different jobs and I could tell the difference when I had a cheaper insurance deal. But saying that, as a culture in England we’re really judgmental of the US system, the NHS is one of the very few values that bind the British people together. It’s the only thing that everybody agrees on. I think people are a bit overly simplistic about it but it’s something people are very proud of and are very shocked about how the US system works. Because I’ve experienced it, as an individual it’s better in some ways if you can afford it but because a lot of people can’t, it’s not great.



Clio Chang Clio Chang is a freelance politics writer based in Brooklyn, NY.

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