I got an ambulance ride, CT scan and ER care in Brazil. My bill: $0.
PARATY, Brazil - My son had a high fever, so my wife and I decided to cut short our beach vacation and head home, worried about the quality of health care so far from Rio de Janeiro. I packed our bags, took one last look at the calm shoreline and headed out to load up the car.
I popped open the trunk door of our hatchback and commenced with that intricate game of Tetris practiced by all vacation dads.
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I'd noticed weeks before that rust was eating away at one of the hatch door's support beams but hadn't given it much thought - not, at least, until it suddenly snapped and the full weight of the door came slamming down on me.
I stumbled away and grabbed my head, only realizing how badly I'd been hurt when I pulled my hand away and saw it was covered in blood. There was more on my clothes and in the dirt below. I fell to the ground, yelled for my wife and, suddenly woozy, heard muffled voices beginning to holler for someone to call an ambulance.
Even after six years in Brazil as The Washington Post's Rio de Janeiro bureau chief, I confess one of my first thoughts was stubbornly American. Out of the murkiness, it came with sudden clarity: How much is this going to cost me?
Six hours later - after an ambulance ride, CT scan, X-ray cranial imaging and six stitches in my head - I had my answer: $0.
At a time when health care remains one of the most divisive issues in Washington - and the Congressional Budget Office estimates President Donald Trump's signature domestic legislation could leave millions more Americans uninsured - my unexpected admission to a Brazilian public hospital served as an education of sorts on a fundamentally different system.
Health care is a basic right in Brazil, enshrined in the constitution. Every one of its 215 million citizens - in addition to 2 million foreign residents - is entitled to free care in what has become the world's largest public health system.
The government says the Sistema Único de Saúde - known to everyone here as SUS - tallies an astounding 2.8 billion admissions per year. More than 7 in 10 Brazilians rely on it entirely, receiving everything from mundane care to complex surgeries on the public dime.
SUS is far from perfect. Patients wait in long lines for specialized care. Lawmakers leave it underfunded. Workers routinely go on strike. It buckled during the worst days of the coronavirus pandemic and hospitals began turning patients away, leading to scenes of desperation across the country and inflaming political divisions.
Former President Jair Bolsonaro, a hard-line conservative, sought to privatize the system but quickly backed down after public backlash, organized under the banner 'Brazil Needs SUS.' Current President Luiz Inácio Lula da Silva, a leftist who's long championed a robust social safety net, has since vowed to relieve the strain on SUS with a fresh funding package.
'We're not going to let this program fail,' he said. 'Because the poor need to be treated like people.'
Perhaps because I was more comfortable with a system more similar to the United States', my family and I had always opted for Brazil's private health care network, where the best hospitals rival anything in the developed world. Our son was delivered and receives his pediatric care in Rio de Janeiro's private system.
So on that fateful Friday morning, when my son's fever spiked in this seaside village where the only hospital is a public one, we called his pediatrician and decided to drive the four hours home. But the hatch door had a different plan. The first responders took my vital signs, wrapped my head in a thick bandage and helped me into an ambulance that had been dispatched by Hospital Hugo Miranda. Off we went.
The contrast with the American system was immediately apparent - not from what hospital staff asked, but what they didn't. No one inquired about our insurance coverage. No one even jotted down my tax identification number, which is solicited here even when paying parking meters or buying a bottle of toothpaste.
I was pushed by wheelchair from room to room. First a nook where I received a shot of pain medication. Then a cramped room where a doctor injected a local anesthetic and closed my six-centimeter wound with six stitches. Then onward to an imaging suite where X-rays were taken to ensure the injury had been superficial. And finally to an adjoining center where a CT exam was performed to verify there was no bleeding in the brain.
As the hours went by, I saw Brazil's diversity on display in the halls of the hospital. The population of Paraty is only 47,000, but the historic port town serves as the regional anchor for a vast dispersion of shoreline communities. Many people travel by boat across enormous distances to reach the hospital. On Friday, they crowded into waiting areas and exam rooms alongside the urban working class and affluent out-of-towners - all guaranteed the same level of care. For 40 minutes while waiting to be stitched up, I sat wordlessly next to a barefoot man with one eye.
In the early afternoon, I was called back to the see the doctor who'd performed my intake. She counseled rest, prescribed pain medication and antibiotics, and sent me on my way.
But while I was getting better, my son's fever had reached 104 degrees. We sought treatment for him, too. Hugo Miranda immediately admitted him; after an hour of waiting, his name was called.
Ten minutes with a pediatrician was all we needed for a diagnosis: tonsillitis.
The pediatrician prescribed antibiotics and Tylenol to reduce the fever, then called in the next patient on her list.
My son's hospital bill was the same as mine: $0.
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