About a month ago, I told y’all that I was traveling to Germany and Denmark with Mrs. Volts. I solicited your suggestions. l promised you some podcasts. So it’s only fair that I share what happened on that trip, from which I returned just a few days ago. Friends: it sucked.
Yikes, what a trip! Glad you're ok. As a physician early in my career, it is depressing how bad our system is in the US, and just hope that reform comes before I retire. Please take any time needed to recover, it sounds like the kind of trip that you need a vacation from afterward!
You're going to hear this from a lot of other commenters, but you have no idea what kind of terrible, horrible, no-good, very bad experience you were spared because your appendix didn't actually explode. Twenty years ago, when I was in college, the exact same progression of symptoms befell me. Except, assuming myself hale and hearty and impervious to any threat to my life, I waited. Surely it was "food poisoning!" (Why do we always think this?)
By the time I finally got myself to the hospital and made it through *12 HOURS* of increasingly excruciating and desperate ER wait-room waiting, my appendix had well and truly burst its membranes. At this point it was clear to the attending doctors that I probably wasn't making up my symptoms or seeking pain meds and they rushed to to the OR. The fact that my appendix had sprayed infection all over my vulnerable insides somehow went undetected by the surgeon, who went about slicing me the laparoscopic way as if nothing had happened. After a few days, my profit-optimizing medical team rushed me out the door of the hospital without as much as a promised CAT scan. My doctor even berated me on the way out for having quite a bad attitude and not leaning into my recovery! "You must BELIEVE in health, Geoffrey!"
Several weeks later, I was on my second hospital stay, down to a skeletal half my body weight, literal hours from death by the post-op infection that the first team hadn't bothered to check on, on my second round of significantly more invasive surgery (I believe it would be more accurate to say I was gutted like a fish), forced to drop out of college on medical leave, and VERY bitter about my mistreatment at the hands of the American medical system. I had about eight months to ruminate on it, as I very slowly learned to eat solid food, breathe with more than 10% lung capacity, and haltingly walk again.
But I'm lucky because I'm alive. I learned afterward that my prognosis was about a 5% chance of survival. I was also lucky that I was still on my parents' insurance, since the bill they sent to the insurer was $85,000. Where I wasn't so lucky is how two-thirds of a year spent trying to not die delayed my graduation enough to land the start of my working life in the middle of the Great Recession. So my in-pocket post-graduate job prospects were gone and years of underemployment awaited, instead. I aged out of my parents' health insurance eventually, and thankfully nothing else too terrible happened to me while I was uninsured. But this emergency and its aftermath did set me on a very different path.
A path that, as fate would have it, brought me now to live in Scandinavia. Here, I have been party to many other medical emergencies within my family, but none of them addressed with such wanton callousness and neglect as I saw in an extremely expensive private American hospital. I often ask apologists for the American medical system whether they, themselves, have actually had a good experience the last time they visited the hospital or had to tangle with their insurer to pay for it. Because it's always awful. An additional, exhausting indignity on top of your already traumatic struggle to claw back to health. Surely we could do better? I mean, I know we could. Everyone else in the developed world somehow does. So why do we put up with it, is the better question!
Thank you for filling us in. It's a sobering reminder of the bodily bedrock that underlies everything we do and think and say. Very humanizing that you included this post, and we're all so glad you pulled through
Any documentation confirming how excellent healthcare is in Germany and how much ours sucks *in the ways you describe* (not an insensitive rant) is more than welcome (no matter how off topic it is).
If only this story gets into the brains of people who need to hear it (instead of the already converted).
😅😅😅and the other side will take care of their wealthy buddies and benefactors. Nothing for middle class or poor people. The other side’s tax cuts for their cronies is highway robbery.
What other side do you mean? It’s us vs “them” - the elites who want to take everything from you. “You’ll own nothing and you’ll be happy”. Sure. Bernie’s a millionaire. Do you see him volunteering to give it all away? Don’t kid yourself. The elites are the political class, whatever their party affiliation and the more they hide under empty virtue signals, the more devious they are.
David, this was a wild read. (Have you considered writing for a living? /j)
By the end, I too was just grateful you're still around, and got that one picture on your one day with Mrs Volts. The pod can absolutely wait. Thanks for being here!
I spent a night in Emergency in the Netherlands once, years ago, and have told the story many times, using almost the exact words you did - they didn't know how to take money! When I set out to pay at discharge they looked around nervously and shooed me out - they REALLY didn't want to deal with a payment!
From certain technical perspectives, the U.S. system is impressive (knowledge, technology, available procedures) but from almost every other perspective it is sufficiently broken that trying to fix it is futile. We need to start from scratch! Insurance - a parasitic enterprise if there ever was one - and medical education (FREE in many places - no giant debt requiring obscene salaries) would be good places to start.
Holy smokes! How awful! But here you are, back to tell the tale. Thank God. Please fully recover; Germany and Copenhagen will still be there. Take care.
That's a hell of a story, David. Glad it all worked out. My appendix got similarly interesting when I was working in Antarctica, just as a five-day stop-everything-stay-inside-no-flights-leaving storm hit. They soaked me in IV antibiotics, with neither the doc or I very interested in doing surgery in his run-down little McMurdo clinic. Eventually got sent out on the first plane to NZ, where they decided I could keep my appendix bc the antibiotics had done their job. Too well, in fact, so don't forget to load up on probiotics for the next few months... Good to have you back. Thanks for the tale.
Wow! What an experience, and as usual for you a great write up. Glad you survived it. Take some time to chill out and recover. You missed a vacation, have one now. The rest of us will handle a further delay waiting for the next podcast. Your survival means there will be a next podcast. Thanks to Mrs. Volts for all the assistance she provided.
I spent the first part of the article thinking "I hope they have medical travel insurance, I hope they have medical travel insurance" but it seems like it was still bearable even out of pocket. So sorry to hear that whole story.
We went to Germany for three weeks this summer, and it was glorious — if we average the two vacations it probably comes in close to a median vacation. I was pretty concerned about medical coverage, as Americans so routinely are bankrupted by this stuff, but our trip was uneventful and the Allianz travel policy we bought was not used.
I've found better options since returning, as our US insurance carriers (USAA and BlueCross) offer travel riders. They're probably reselling some other vendor's travel insurance product, I'll look into it more before we plan a next trip.
When I was serving as a medic in Uncle Sam's Army, I could always get a decent read on my patient's experience of whatever they were dealing with- or what they reported- by leaning into my undergraduate degree in communication and psychology. Basically, if they're talking about X- and completely unable to talk about Y or Z, X is a problem. (It's worth mentioning, my role- and my patients- were all infantry. Not exactly a population that's known for verbalizing their feelings in an eloquent- or, sometimes, even honest- way.)
In reading the write up of your experience- which was interesting to me as I've had my own fair shair of ruined vacations and time in hospitals (though on my own), along with the appendicitis (a dose of intersectionality with one of my early patients)- though it was a really interesting read, most telling to me? Not one mention of power, infrastructure or related politics or policy. Some mention of healthcare, which is to be expected, but not one mention of your passion. (Or, more correctly, what I understand to be one of your passions.)
This really sucked for you Mrs. Volts- but glad you're [both] okay and do hope you get to go back and have a more vacation-y visit in the near future.
One potential upside? You'll never have appendicitis ever again.
Sorry, for what you had to go through and glad that you are ok. As a German reader, let me decode your German health care experience for you:
> "I scheduled an online consultation with a German doctor. (It was absurdly easy and cheap to do so.) That doctor told me: you should probably go to urgent care. Which, as loath as I was to admit it, made sense."
It was easy because you were paying for it out of pocket. The German health care system has two tiers: the statutory-insured and the privately insured. Statutory health insurance is mandatory up to a certain salary cap and medical professionals may charge private insurances around three-times what they can charge the statutory insurances - in short, private insurance is a) for rich people and b) what keeps the system financially solvent. If you pay out of pocket, you are treated like a privately insured patient, hence it is easy and fast to get appointments.
> "So, Mrs. Volts came back and we went to the Hamburg University Hospital ER around 2:00 p.m. We stood in line for six hours (well, she stood, I sat doubled over in a crappy chair) before even speaking to anyone. Then they whisked me to a different waiting room, stuck an IV in my arm, and we waited for 2.5 hours more."
Congratulations, you waited just about exactly the culturally appropriate amount of time to go to the ER. The health care system in Germany is one of the last vestiges of Prussian culture - not for softies and malingerers. You are too polite to mention it, but you were probably wondering about some of the other people at the ER. These days you find all sorts of non-urgent conditions in the ER including - literally - moskito bites. Hence the 6 hour wait. There are a couple of reasons for that. Firstly and less importantly, we have had a lot of immigration from countries where a) the culture around pain and disease is very different and b) hospitals are the premier entry points of the health care system. Not so in Germany! You generally go see your doctor and only end up at the hospital in an emergency or once explicitly referred there.
Secondly and more importantly, the public insurance tier of the health care system has experienced a steep decline in recent years. Specifically, it takes forever to get appointments with specialists. So you might have to wait 3 months to have that weird thing checked out which you fear might be cancer; OR you go to the ER and claim you are in acute pain. Problem solved.
> "Second, I got a roommate, who Mrs. Volts and I took to referring to as Oscar."
At extra cost, you could have upgraded to a private room.
> "There was no curtain or divider, so I would become intimately familiar with the rhythm and odor of Oscar’s various bags being changed."
Yup, what I said earlier about Prussia.
> "somehow the hospital food was even worse than all the clichés about hospital food"
Again, Prussia. How dare you think that you ought to be made comfortable in a hospital? We don't want you staying there one minute more than necessary! Kidding aside, nowadays this has become an embarrassment even to my doctor friends who when pointed to this will blush and mumble something like "yes, we still have to learn to develop more of a service culture...".
> "Our insurance doesn’t cover us when we’re overseas, so we ended up paying out of pocket for all of it."
What you did not have ze travel healz insurance???!!! Germans are crazy about insurances in general and specifically about travel insurance. Most people are ridiculously overinsured and as a consequence, travel health insurance is dirt cheap. My family goes to my wife's native Kenya every year or so and basically every year we get more out of our travel health insurance than we pay in.
> That thought scared me at first, but all told, our bill was, conservatively, about 1/30th what we would have paid out of pocket in the US."
And - as I mentioned above - this is already the premium tier! My son needed tonsill surgery recently and we were faced with a choice to wait until some time in 2025 for an appointment or to pay part of it out of pocket. We ended up paying around 200 Dollar ourselves and got an appointment swiftly (although a one hour drive away).
Generally however, unfortunately the increasingly rapid decline is undeniable. While politicians and doctors will publicly insist that the publicly and privately insured receive the same medical care, the reality is that crazy waiting times for appoinments and hidden rationing force the publicly-insured to pay out of pocket or game the system. And you cannot go private unless you earn above the salary cap!
I am glad to hear that at least you still had a better experience than in the US-healthcare system.
Yikes, what a trip! Glad you're ok. As a physician early in my career, it is depressing how bad our system is in the US, and just hope that reform comes before I retire. Please take any time needed to recover, it sounds like the kind of trip that you need a vacation from afterward!
You're going to hear this from a lot of other commenters, but you have no idea what kind of terrible, horrible, no-good, very bad experience you were spared because your appendix didn't actually explode. Twenty years ago, when I was in college, the exact same progression of symptoms befell me. Except, assuming myself hale and hearty and impervious to any threat to my life, I waited. Surely it was "food poisoning!" (Why do we always think this?)
By the time I finally got myself to the hospital and made it through *12 HOURS* of increasingly excruciating and desperate ER wait-room waiting, my appendix had well and truly burst its membranes. At this point it was clear to the attending doctors that I probably wasn't making up my symptoms or seeking pain meds and they rushed to to the OR. The fact that my appendix had sprayed infection all over my vulnerable insides somehow went undetected by the surgeon, who went about slicing me the laparoscopic way as if nothing had happened. After a few days, my profit-optimizing medical team rushed me out the door of the hospital without as much as a promised CAT scan. My doctor even berated me on the way out for having quite a bad attitude and not leaning into my recovery! "You must BELIEVE in health, Geoffrey!"
Several weeks later, I was on my second hospital stay, down to a skeletal half my body weight, literal hours from death by the post-op infection that the first team hadn't bothered to check on, on my second round of significantly more invasive surgery (I believe it would be more accurate to say I was gutted like a fish), forced to drop out of college on medical leave, and VERY bitter about my mistreatment at the hands of the American medical system. I had about eight months to ruminate on it, as I very slowly learned to eat solid food, breathe with more than 10% lung capacity, and haltingly walk again.
But I'm lucky because I'm alive. I learned afterward that my prognosis was about a 5% chance of survival. I was also lucky that I was still on my parents' insurance, since the bill they sent to the insurer was $85,000. Where I wasn't so lucky is how two-thirds of a year spent trying to not die delayed my graduation enough to land the start of my working life in the middle of the Great Recession. So my in-pocket post-graduate job prospects were gone and years of underemployment awaited, instead. I aged out of my parents' health insurance eventually, and thankfully nothing else too terrible happened to me while I was uninsured. But this emergency and its aftermath did set me on a very different path.
A path that, as fate would have it, brought me now to live in Scandinavia. Here, I have been party to many other medical emergencies within my family, but none of them addressed with such wanton callousness and neglect as I saw in an extremely expensive private American hospital. I often ask apologists for the American medical system whether they, themselves, have actually had a good experience the last time they visited the hospital or had to tangle with their insurer to pay for it. Because it's always awful. An additional, exhausting indignity on top of your already traumatic struggle to claw back to health. Surely we could do better? I mean, I know we could. Everyone else in the developed world somehow does. So why do we put up with it, is the better question!
Thank you for filling us in. It's a sobering reminder of the bodily bedrock that underlies everything we do and think and say. Very humanizing that you included this post, and we're all so glad you pulled through
Any documentation confirming how excellent healthcare is in Germany and how much ours sucks *in the ways you describe* (not an insensitive rant) is more than welcome (no matter how off topic it is).
If only this story gets into the brains of people who need to hear it (instead of the already converted).
🤞🤞🤞Preach, Bernie Sanders & Co.
All Bernie will do is tax you more and give you less.
😅😅😅and the other side will take care of their wealthy buddies and benefactors. Nothing for middle class or poor people. The other side’s tax cuts for their cronies is highway robbery.
What other side do you mean? It’s us vs “them” - the elites who want to take everything from you. “You’ll own nothing and you’ll be happy”. Sure. Bernie’s a millionaire. Do you see him volunteering to give it all away? Don’t kid yourself. The elites are the political class, whatever their party affiliation and the more they hide under empty virtue signals, the more devious they are.
I respect your opinion.
David, this was a wild read. (Have you considered writing for a living? /j)
By the end, I too was just grateful you're still around, and got that one picture on your one day with Mrs Volts. The pod can absolutely wait. Thanks for being here!
I spent a night in Emergency in the Netherlands once, years ago, and have told the story many times, using almost the exact words you did - they didn't know how to take money! When I set out to pay at discharge they looked around nervously and shooed me out - they REALLY didn't want to deal with a payment!
From certain technical perspectives, the U.S. system is impressive (knowledge, technology, available procedures) but from almost every other perspective it is sufficiently broken that trying to fix it is futile. We need to start from scratch! Insurance - a parasitic enterprise if there ever was one - and medical education (FREE in many places - no giant debt requiring obscene salaries) would be good places to start.
Damn!! We’ll all survive if you need to take some time off to catch back up. Sorry you went through it, but glad you got through it!
"Which apparently it may" - that's a lolsob for sure.
So glad you made it through. I feel like a possible "moral" is how important that idyllic little park ended up being?
And thanks to Mrs. Volts for all she did. I'm glad she's also feeling all better.
Good advice from your brother. Happy you had Mrs. Volts with you. Take care!
Holy smokes! How awful! But here you are, back to tell the tale. Thank God. Please fully recover; Germany and Copenhagen will still be there. Take care.
That's a hell of a story, David. Glad it all worked out. My appendix got similarly interesting when I was working in Antarctica, just as a five-day stop-everything-stay-inside-no-flights-leaving storm hit. They soaked me in IV antibiotics, with neither the doc or I very interested in doing surgery in his run-down little McMurdo clinic. Eventually got sent out on the first plane to NZ, where they decided I could keep my appendix bc the antibiotics had done their job. Too well, in fact, so don't forget to load up on probiotics for the next few months... Good to have you back. Thanks for the tale.
Wow! What an experience, and as usual for you a great write up. Glad you survived it. Take some time to chill out and recover. You missed a vacation, have one now. The rest of us will handle a further delay waiting for the next podcast. Your survival means there will be a next podcast. Thanks to Mrs. Volts for all the assistance she provided.
Oh noes!
I spent the first part of the article thinking "I hope they have medical travel insurance, I hope they have medical travel insurance" but it seems like it was still bearable even out of pocket. So sorry to hear that whole story.
We went to Germany for three weeks this summer, and it was glorious — if we average the two vacations it probably comes in close to a median vacation. I was pretty concerned about medical coverage, as Americans so routinely are bankrupted by this stuff, but our trip was uneventful and the Allianz travel policy we bought was not used.
I've found better options since returning, as our US insurance carriers (USAA and BlueCross) offer travel riders. They're probably reselling some other vendor's travel insurance product, I'll look into it more before we plan a next trip.
When I was serving as a medic in Uncle Sam's Army, I could always get a decent read on my patient's experience of whatever they were dealing with- or what they reported- by leaning into my undergraduate degree in communication and psychology. Basically, if they're talking about X- and completely unable to talk about Y or Z, X is a problem. (It's worth mentioning, my role- and my patients- were all infantry. Not exactly a population that's known for verbalizing their feelings in an eloquent- or, sometimes, even honest- way.)
In reading the write up of your experience- which was interesting to me as I've had my own fair shair of ruined vacations and time in hospitals (though on my own), along with the appendicitis (a dose of intersectionality with one of my early patients)- though it was a really interesting read, most telling to me? Not one mention of power, infrastructure or related politics or policy. Some mention of healthcare, which is to be expected, but not one mention of your passion. (Or, more correctly, what I understand to be one of your passions.)
This really sucked for you Mrs. Volts- but glad you're [both] okay and do hope you get to go back and have a more vacation-y visit in the near future.
One potential upside? You'll never have appendicitis ever again.
Oy vey. I will join you in gratitude for Mrs Volts and for a 1st world medical system for this rotten encounter.
Sorry, for what you had to go through and glad that you are ok. As a German reader, let me decode your German health care experience for you:
> "I scheduled an online consultation with a German doctor. (It was absurdly easy and cheap to do so.) That doctor told me: you should probably go to urgent care. Which, as loath as I was to admit it, made sense."
It was easy because you were paying for it out of pocket. The German health care system has two tiers: the statutory-insured and the privately insured. Statutory health insurance is mandatory up to a certain salary cap and medical professionals may charge private insurances around three-times what they can charge the statutory insurances - in short, private insurance is a) for rich people and b) what keeps the system financially solvent. If you pay out of pocket, you are treated like a privately insured patient, hence it is easy and fast to get appointments.
> "So, Mrs. Volts came back and we went to the Hamburg University Hospital ER around 2:00 p.m. We stood in line for six hours (well, she stood, I sat doubled over in a crappy chair) before even speaking to anyone. Then they whisked me to a different waiting room, stuck an IV in my arm, and we waited for 2.5 hours more."
Congratulations, you waited just about exactly the culturally appropriate amount of time to go to the ER. The health care system in Germany is one of the last vestiges of Prussian culture - not for softies and malingerers. You are too polite to mention it, but you were probably wondering about some of the other people at the ER. These days you find all sorts of non-urgent conditions in the ER including - literally - moskito bites. Hence the 6 hour wait. There are a couple of reasons for that. Firstly and less importantly, we have had a lot of immigration from countries where a) the culture around pain and disease is very different and b) hospitals are the premier entry points of the health care system. Not so in Germany! You generally go see your doctor and only end up at the hospital in an emergency or once explicitly referred there.
Secondly and more importantly, the public insurance tier of the health care system has experienced a steep decline in recent years. Specifically, it takes forever to get appointments with specialists. So you might have to wait 3 months to have that weird thing checked out which you fear might be cancer; OR you go to the ER and claim you are in acute pain. Problem solved.
> "Second, I got a roommate, who Mrs. Volts and I took to referring to as Oscar."
At extra cost, you could have upgraded to a private room.
> "There was no curtain or divider, so I would become intimately familiar with the rhythm and odor of Oscar’s various bags being changed."
Yup, what I said earlier about Prussia.
> "somehow the hospital food was even worse than all the clichés about hospital food"
Again, Prussia. How dare you think that you ought to be made comfortable in a hospital? We don't want you staying there one minute more than necessary! Kidding aside, nowadays this has become an embarrassment even to my doctor friends who when pointed to this will blush and mumble something like "yes, we still have to learn to develop more of a service culture...".
> "Our insurance doesn’t cover us when we’re overseas, so we ended up paying out of pocket for all of it."
What you did not have ze travel healz insurance???!!! Germans are crazy about insurances in general and specifically about travel insurance. Most people are ridiculously overinsured and as a consequence, travel health insurance is dirt cheap. My family goes to my wife's native Kenya every year or so and basically every year we get more out of our travel health insurance than we pay in.
> That thought scared me at first, but all told, our bill was, conservatively, about 1/30th what we would have paid out of pocket in the US."
And - as I mentioned above - this is already the premium tier! My son needed tonsill surgery recently and we were faced with a choice to wait until some time in 2025 for an appointment or to pay part of it out of pocket. We ended up paying around 200 Dollar ourselves and got an appointment swiftly (although a one hour drive away).
Generally however, unfortunately the increasingly rapid decline is undeniable. While politicians and doctors will publicly insist that the publicly and privately insured receive the same medical care, the reality is that crazy waiting times for appoinments and hidden rationing force the publicly-insured to pay out of pocket or game the system. And you cannot go private unless you earn above the salary cap!
I am glad to hear that at least you still had a better experience than in the US-healthcare system.