BUYING DRUGS IN SPAIN

Possibly you thought this might be an exciting tale involving illicit drug purchases, like in the 1978 movie Midnight Express. It is indeed a narrative involving illicit drug purchases, sort of. Or at least, almost. But you won’t make sense of the story unless I tell you a little something about health care in Spain.

The first thing one must do, when writing about health care in Spain, is determine whether it’s “healthcare” or “health care,” or maybe “health-care.” The consensus seems to be that it is two words if used as a noun (as in, “many Americans cannot afford health care”), and one hyphenated word if used as an adjective (as in, “America’s skyrocketing health-care costs”). But it is a single unhyphenated word if used to describe a system (as in, “America’s increasingly expensive healthcare system”).

Possibly you infer from my examples that I think little of America’s healthcare system. That is not true. The United States clearly offers the very best health care that a whole lot of money can buy. When rich Europeans or Asians come down with a life-threatening illness, what do they do? They get in their private jets and wing their way to New York or Los Angeles or Rochester, Minnesota.

What do average Americans do when they develop a chronic illness? I am sure the answer is as complex and varied as the American population. All I know for sure is that some patriotic Americans will buy an economy ticket on a discount airline and fly out of the country they love to get health care they can afford. How do I know that? Let me explain.

Living in a foreign country, especially a non-English-speaking foreign country, is made much easier by the natural tendency of expats to find each other. Say, for example, we are shopping and hear another customer ask, “How much do y’all charge for that?” We may ask this total stranger, “Hey, where y’all from?” Thence there may be a conversation ending with, “Why don’t all y’all come to our place for beer and tapas?”

The point here is not to explain how a man reared in Iowa came to start saying “y’all,” much less the trickier advanced version, “all y’all.” The point is that Americans living overseas find each other. Soon thereafter they get to know one another with some variation of this question: “Why did you move to Spain?” That is how I came to know that some of my friends moved to Europe because they could not afford health care in the United States.

Health-care costs did not inspire our move to Iberia. However, the difference between Spain and the US became apparent before we left the motherland.

In Colorado, a complex insurance plan – one that reads like a tax code and is riddled with restrictions and exemptions – would have cost us $2,500 per month. We did not buy that policy because we would be covered by Denise’s former employer until we emigrated. However, to get a Spanish residence visa we had to first buy Spanish health insurance. We needed to pay, in advance, for a full year of coverage. Imagine our surprise when we learned that its cost also was $2,500, the same figure named by our Colorado agent. There was, however, one important difference: the Spanish premium was for a full year, not a mere month.

To be fair, the Colorado policy covered prescription drugs. The Spanish policy did not. This was a concern because every day I take a pill that reduces the number of times I curse, which is what happens when I wake from a sound sleep because I have to pee. Swearing is a sin and a vile habit, so for many years before our move I shelled out the substantial copay needed to buy a monthly supply of pills. Add to that expense the periodic doctor visit (another copay) so that he would renew the prescription.

I never understood why dispensation of the drug is so closely monitored. It doesn’t make me high and it is not performance-enhancing. Just ask my wife if you don’t believe me.

Almost immediately after arriving in Spain I made an appointment with Dr. Bueno (his real name!). I explained that I needed a prescription for medication that would limit my nighttime cursing, and showed him the pill bottle I brought from the U.S. Dr. Bueno gave me a prescription for 30 tablets.

I looked at the prescription and objected. I did not want to come back every 30 days for another prescription. Dr. Bueno’s English was no better than my Spanish, but by pooling our talents we were able to not understand each other at all. I surmised that the doctor was milking the system, and me (there was a 20 euro copay). He was, I deduced, assuring himself of a small but reliable monthly income. I did not possess the vocabulary needed to make the accusation, so I simply took the script to a farmacia near our apartment and bought a bottle of thirty pills. The cost was a fraction of my U.S. copay.

In one month I was back at Dr. Bueno’s office. He looked at me like I was an idiot, but I am used to that and, besides, he complied with my demand for another prescription. I presented that small document to a farmacia next to the doctor’s office. The new prescription was identical to the first, but this time the pharmacist asked, “How many bottles do you want?” I was taken aback. Clearly this young druggist was making a rookie mistake.

I thought quickly. How many should I ask for? Too many and he might be inspired to re-check the prescription or consult the older druggist at the neighboring register. I looked around and, as nonchalantly as a teen buying pot for the first time, said “three.” Not only did the young man give me 90 pills on the strength of a script that called for only 30, he compounded the error by forgetting to collect the prescription.

I did not return to Dr. Bueno. After three months I went directly to the farmacia by his office. I waited until the same young pharmacist wasn’t busy and showed him the old prescription. He barely glanced at the paper before asking, “how many?” Again I said “three.” I hurriedly stuffed the bottles – and the prescription! – in my backpack and scurried away before a supervisor learned what the trainee had done.

I was almost out of pills when I visited my Canadian friend, Bob Kodak. During the course of our conversation I learned that Bob used the same anti-cursing medication. I boasted how I had found a farmacia that would continuously refill my thirty day prescription. Bob’s response was in Canadian. I will first reveal what Bob said, verbatim. Then, for those of you who do not understand the Canadian dialect, I will translate into American English:

Bob: You don’t need a prescription for that drug here in Spain, don’t ya know. You just show them a bottle with the label on it and tell them how many you need, eh?

Translation: You f-ing moron.

I was taken aback by Bob’s insult, but grateful for the information. Denise and I later would learn that, as a general rule, prescriptions are required only for drugs that are dangerous or likely to be abused.

As in Midnight Express, a story about drugs ends with the protagonist outside of prison walls. There probably are some important differences between that tale and my own, but it has been well over 40 years since I saw the movie, so I can’t be sure.