Anyone who lives with diabetes in the United States knows that affording care, and specifically insulin, is becoming more and more difficult as prices on insulin and essential medications continue to rise. A recent Yale study even showed that 1 in 4 people with diabetes have rationed their insulin due to cost, which can quickly lead to serious complications and even premature death. In our recent study , an overwhelming 44% of respondents reported struggling to afford insulin.

Our lack of a strong social safety net is leaving some patients feeling as though they have no other options for affordable care, and some patients have even resorted to crossing the border into Canada and Mexico to buy cheaper insulin, where federal price caps prevent runaway pricing on essential medications and prescription drugs. In light of all this, some people with diabetes have even daydreamed of completely relocating to another country for better care, where health coverage is centralized, universal for all people, and where medications are more affordable. The United States is the only rich country in the world that doesn’t guarantee healthcare for all its citizens.

Meet Liz Donehue, a comedian, writer, and American expat who has lived with type 1 diabetes for the past ten years. She moved abroad a few years ago to find better diabetes coverage, and I chatted with her about her experience moving to the Czech Republic.

What made you want to leave the United States? 

I left the United States for many reasons, but one of them was that the motion to repeal Obamacare passed in the House in 2017. Most of my employers didn’t provide health insurance, so the enactment of Obamacare in 2013 was a life-saving situation. Healthcare and insulin had never been unaffordable to me, but then again I was fortunate enough to have my parents support me in times of need, especially after I aged out of their insurance at age 26. I have never rationed insulin due to cost, only at times when the pharmacy or my endocrinologist made an error during insulin refills.

Why did you choose the Czech Republic? 

Part of the reason I chose the Czech Republic was that their visa process was relatively easy compared to other countries. I also chose the city I’m in, Brno, because of the cost of living. Having moved from Seattle, my cost of living went down by 66%. Other candidates included Poland, Vietnam, and Cambodia, but I had previously been to CZ and they had the most advanced healthcare system out of the four.

What was the deciding factor that made you move?

I had recently been laid off from my job, and I had just gotten out of a relationship. Essentially there was no true reason that kept me in Seattle, so I started to look at other options, especially where there was available socialized healthcare. I did research for about four months before moving, and I was able to secure an apartment online for myself and my cat who I brought with me. I’m living here permanently and my visa is through my current employer.

Will you become a citizen? 

I’m not a Czech citizen and as a “third country national” (non-EU), I will need to have lived in the country for ten years before I can apply. When I first arrived and waited for my freelance visa to process, I had to get private insurance through an international company for my application.

Typically, how expensive is diabetes care and insulin in your new country? 

During this wait, about five months, I was paying out of pocket for appointments and medications. But because it’s CZ, the costs pale in comparison to what they are in the US. A pack of five Humalog pens costs $18 here as opposed to $556 back home without coverage. When I got hired by my current employer, they took over paying for my healthcare costs, about $98 a month. I paid this for myself while I was self-employed, but everything was covered. There are no prior authorizations and the notion of pre-existing conditions doesn’t exist here.

Additionally, monthly insulin supply costs me nothing. I take Humalog and Tresiba daily and my test strips are also free of charge and included with my health insurance costs paid for by my employer. I get new prescriptions every 90 days whether I ask for them or not, so I now have a surplus of insulin and I don’t need to worry about refills.

Do you miss anything about the US healthcare system? 

I think the major thing I miss about the US healthcare system is the access to current technology. The system in CZ, while affordable and readily accessible, doesn’t have the technology to download glucometer readings, for instance. I also need to provide my own samples of urine for quarterly testing instead of having it done in the office. The medical equipment and tools are often metal and sterilized as opposed to plastic and designed for one-time use, which I’ve heard is a practice left over from the communist era.

Are you ever planning on moving back to the US? 

My move to CZ was an act of self-preservation. In the US, for some reason, health insurance is tied to a person’s employment. As long as that system is in place or there is no enactment of a system like Medicare for All, I can’t move back to the US. The pandemic has increased my concerns, and right now, I could go back to the US to visit, but I would not be let back into the Czech Republic just on the basis that I was IN the United States as the situation is worsening by the day. I feel healthier [living here] but I’ve also been taking extreme precautions due to the pandemic since I’m immunocompromised.

Thank you for your time, Liz. We really appreciate you sharing your story with us!

Have you ever considered moving abroad for better health coverage and diabetes care? Why or why would you not move abroad? Share your thoughts below; we would love to hear from you!

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