Healthcare Costs

Sometime in the spring of last year, I started waking up every single day with a headache.  It kept me in a fog all day and made me irritable all the time.  

After a couple of months, I went to the doctor, who checked my ears and said they were fine.  She recommended physical therapy for my jaw.  So I went to the physical therapist and after several weeks of adjustments and training, my headache was finally better.  

Alongside the physical therapy, I started going to get regular massages.  The headache issue was clearly caused by a neck strain I'd gotten at the beginning of the year that affected my jaw in such a way that my whole head suffered.

Long story short(ish), I started really trying to take better care of myself last year.  Some of it started in 2024 with some gender-affirming care, but last year was when I really started pushing away all of the other obligations and zoomed in on myself.

And it's really gotten me thinking - I am spending a whole lot of money on myself.  When I started getting massages (one every 3 weeks), I wrestled with myself until I could categorize this expense as general healthcare, especially for my specific body.  I feel like I am swimming in healthcare luxury right now because all of these "basics", as I've now accepted they are, were considered extras in the US.

Let me break it down by cost.

In the US in 2022, my employer spent approximately $600 on my medical + dental insurance per month.  To cover the rest of my family's medical + dental insurance, I had approximately $1,100 deducted from my paycheck per month.

Cost of just medical + dental insurance in the US for family of 4 in 2022 = $20,400 per year.

In the Netherlands in 2026, insurance is not tied to the employer and is also legally required for you to get on your own.  My employer gives me a €35 per month reimbursement to help cover insurance costs.  Nic and I pay a combined €3,700 per year for our medical + dental insurance and the kids' insurance is covered by the government, free for us.

Cost of just medical + dental insurance in NL for family of 4 in 2026 = €3,700 per year.

Now, what about all of the luxurious extras I have been spending on myself?  As of January 2026, I am currently spending the following out of pocket (annualized):

• Mental health therapy = €2,600
• Personal training and nutrition coaching = €3,600
• Massage therapy = €1,800

Including the medical + dental insurance costs applied just to me, I am currently spending a total of €9,850 per year on a broad definition of healthcare just for myself.  

Cost of medical + dental insurance for a family of 4 + bundle of healthcare extras for just me in NL in 2026 = €11,700.

Shall we include the 2024 gender affirming care (non-surgical) that I mentioned earlier?  €1,720.  Please note, the doctor and physical therapy for my jaw in 2025 were covered by insurance.

Any Dutch readers will remind us that the Dutch healthcare system is by no means perfect.  I'm paying for therapy out of pocket because of waitlists, which are so long for some things (food allergy test and child therapy, so far) that the provider has refused to add us.  A colleague of mine is having surgery today because her doctor wanted her to try minimal treatment for a finger injury that now has become too bad to continue without surgical intervention.  A friend of mine struggles to get any kind of relief for perimenopause.  An acquaintance from Germany keeps a general practice doctor in Germany and just goes back for medical needs because they find the Dutch system so ineffective.

A further caveat is that while costs here are lower, so are earnings.  We also have quite a chunk taken out of our checks as taxes that go towards the healthcare system.  It still feels insanely cheap to me, proportional to the service especially when compared to service/cost in the US, but it doesn't feel cheap to many Dutch people.  

So no, it's not perfect.  But it is a world different from life in the US in ways that feel like slipping into a warm bath (odd but accurate simile).  People don't have to have the same level of privilege to access medical care in the first place.  People don't have to fear losing their job specifically because their job is tied to their healthcare.  Perhaps this is a different post, but this simple security has allowed me to explore being a different person at work than I felt was ever safe to be in the US.

Other Americans with more specialized needs who have moved here may also have different feedback, of course.  For us, healthcare has been one of the biggest aspects of our move that has made us feel safer.