Destination: Uncategorized

In my last few years of European guidebook research, it’s increasingly impossible to ignore a new power on the block: TripAdvisor. Many guidebook mainstays have faded, and now small hotels and restaurants can be made or broken by their TripAdvisor rankings. While I am still committed to finding, evaluating, and listing the best hotels for my travelers in Europe, I expect that in the future, fewer people will rely on guidebook listings for their hotels and more will use online services.

I never even visited TripAdvisor.com until a few months ago. Considering the power it wields over so many of my hotel and restaurant friends in Europe, I was curious. It is, admittedly, an impressive collection of reviews from travelers. But anyone can submit feedback, and my hunch is that a significant percentage of them are by friends of enemies of the place being reviewed. I find more and more small hotels offering a free breakfast to people who promise to write kindly about them on TripAdvisor. Conversely, several hoteliers have told me that occasionally guests threaten them with a bad review unless the hotel gives them a deep discount.

I also have serious doubts about TripAdvisor’s restaurant rankings, which reflect the tastes of tourist reviewers rather than local foodies — and therefore skew toward glitzy, obvious places rather than good-value, authentic, hidden alternatives. (If you’re not convinced, see how your favorite restaurants in your hometown stack up on TripAdvisor.)

While it can be helpful to look over TripAdvisor’s hotel and restaurant listings, I wouldn’t rely on them blindly. On the other hand, I’ve found the most helpful categories are those listing tours, sightseeing experiences, and entertainment. When in Salzburg, I clicked around the TripAdvisor reviews to survey the many little outfits doing Sound of Music tours. And from TripAdvisor, I learned that the big shot who owns Red Bull (the energy drink) has an ego-boosting space at the Salzburg Airport (called “Hangar-7”) where he displays his hot cars and fancy personal airplanes, viewable by the public for free.

For me, the most interesting dimension is the huge impact TripAdvisor and other Web booking services are having on hotels all around the world. Hoteliers in Europe have told me they see all marketing these days as two branches: publicity (traditional ads) and recommendation (TripAdvisor). They know that a good TripAdvisor ranking can make their business — and a few bad reviews can sink them. They’re awed and terrified by the power of this one website.

As “recommendation marketing” becomes the dominant force, powers in that arena are jockeying for position. The rise of TripAdvisor goes hand-in-hand with the new power of booking services like Booking.com, Venere.com, Hotels.com, and Expedia.com. All of these services pay to have a link on TripAdvisor. That way, when people search hotels on TripAdvisor, they simply click through to reserve — not directly with the hotel, but through the booking agency (which the hotel must pay a commission).

If you own a small hotel needing to rent rooms via the Internet, you now feel like things are out of your control. To be listed by any of these services, hotels are pressured to pay fees, additional fees for good placement and photos, plus even more fees to allow travelers to book rooms directly. A “parity clause” requires hotels not to advertise or sell rooms for less than the price promoted on these booking sites. While a few hotels refuse to be controlled by online booking services (and don’t play the Internet booking service game), most find it’s the only way to stay in business.

I’ve talked to hoteliers who are trying to migrate to Facebook, where they can sell rooms outside of the booking-site commission racket. To get around the “parity clause,” they are creating clubs where members can get “fan rates.” Even if this works for them now, the hotels fear that Facebook is just waiting for them to do the hard innovation work…and then Facebook will come in, co-opt the business, and extort their own charges and fees. (By the way, Europeans trying to get into the social media swing find Facebook viable for reaching American adults, while it attracts a younger clientele in Europe.)

Now Google is getting into the mix and positioning itself to be the default way to book a room. Hotels report that Google is dropping by to film 360-degree views of their places. European hoteliers told me they worry that Google may soon threaten to make everyone play by its rules for placement in searches.

In short, European hoteliers tell me that if you’re an investor, pull out of TripAdvisor and invest in Google and Facebook. That’s where they predict the next power will reside.

So, in a nutshell, as a community of travelers, we are enjoying new recommendation and booking services — but, whether hotels like it or not, we are all paying 20 percent more than before for our accommodations. This money is not going to the hotels, but to Internet companies.

What’s your take on Trip Advisor as a source of information for your European travels? Have you enjoyed good experiences through TripAdvisor, or do you find the rankings biased? When you book a hotel, what do you find the best method?

For over seven years now, we’ve been producing our weekly radio hour, Travel with Rick Steves, for public radio. And periodically we invite travelers to call in, enliven our interviews, ask our guests a question, and be a part of our show.

I’m recording new shows this Friday and next Tuesday with some great guests, including Phil Keoghan (host of The Amazing Race) and Samantha Brown (my favorite Travel Channel host).

I’ll also be interviewing adventure travelers for a close-up look at African wildlife. We’ll explore the Netherlands and Peru, road trip through African American history, and enjoy winter comfort foods with road food gurus Jane and Michael Stern. Or you can just ask me a question about planning your next trip.

We’d love you to join us and become a caller on the show. Visit this page and learn how.

To whet your appetite, here’s a clip from the last time I crossed paths with Samantha Brown:

If you can’t see the video below, watch it on YouTube.

On Wednesday, I posted a story on my blog and facebook from one of my tour guides whose “socialized medicine-phobic” tour members had a surprising wake-up call in France. Rarely has a topic struck such a nerve with my readers. While I was expecting a mixed response, instead we received an overwhelming majority of commenters’ own positive tales about their actual health care experiences in Europe (plus Canada and even Japan, which have similar systems). My first thought: Boy, do I have some accident-prone fans. My second thought: Maybe if more Americans actually experienced universal health care, they’d begin to see its benefits.

I remember the old travelers’ adage: “When you get sick overseas, get on the first plane out and fly home for quality health care.” Those days are long gone. In fact, elites in the Arab world famously fly to Europe to get their serious health needs dealt with. And based on the comments received, it seems that if you’re traveling in Europe and need medical help, you’re generally in good hands.

By the way, people sometimes talk about “free health care” in Europe. Of course it’s not really free. While each country has its own variation, the common denominator is that everyone pays for heath care as a society — intending to minimize the overall expense and spread around the cost and risk so that an unlucky few are not bankrupted by medical costs. This also ensures that poor people can get the care they might not otherwise be able to afford. Europe’s rich can opt out and (like America’s rich) get immediate top-end care if they like. But all citizens help pay in.

Here are a few of the many comments from my readers. First you’ll read some positive stories about European health care, followed by thoughts from those who don’t like Europe’s system.

Having been forced to find a hospital in France for my companion, we found the hospital care very good and amazingly inexpensive. I think we only paid about 20 francs for the care and medication.
-James

I lived in Britain for a year and their health system took great care of me at no cost whenever I got sick. I too tried to pay them and they would not hear of it; they merely said “you are welcome.” It was eye opening. When I see the fights we have here I do not understand it. I have health insurance that me and my work pay a great deal for and when I was hospitalized for a week due to norovirus I paid some more, I am still paying. It is crazy. The last thing I need is dealing with insurance when I have a toddler and a husband and a job and recovering from being sick.
-Tiffany

I got a sinus infection while in Paris. I was prepared to get some OTC meds to take the edge off and suffer through. When I went to the pharmacie, they were able to give me medication that would have been by prescription in the United States and it only cost €5. I’m sure that their system isn’t perfect, but it was very helpful and convenient.
-Melissa

My husband treated me to a trip to Paris for a special milestone and while there he came down with a vicious flu. We went to the American Hospital in Paris and he was diagnosed and treated and we went to an Apothecary and got a ton of medicine for the equivalent of $20. A big difference from what we would have been charged in the US. I think the French people are smart to have taken the stress of breaking the bank medicine out of the equation. Healthcare should not bankrupt families.
-Tamara

During my recent trip thru southern France I needed to go to a clinic. I was seen right away, treated for about four hours and released. With IV fluids, blood samples, lab tests, I was worried about the bill. Would you believe $38? I would gladly pay the extra taxes the French pay to get such great treatment.
-Olivia

Having experienced my own health crisis in Italy 10 years ago, I am not surprised by this story. Any American who thinks Europeans don’t have a better way of doing some things — like healthcare — does not know how wrong they are. We could learn a few things from the people so many Americans look down on! I almost had a heart attack while vacationing in Sorrento, Italy, spent 9 days in Italian hospitals, had an angiogram, was sent home with a CD with the results for my doctor, and paid NOTHING!!! When I got home, my cardiologist was very impressed with the CD and found no need to do another angiogram before my triple bypass surgery. The level of care was outstanding in Italy!
-Kay

I had a mishap and fell while in Paris in ’05. Ended up 6 days in hospital there, had a fractured femur, the care was excellent, surgery and all came to €6,400 (about $8,200 at the time). I was well satisfied with the level of care and concern. Especially when the doctor in the ER said “don’t worry, we will care for you” — so unlike here where the first thing they ask is “do you have insurance?” One has to be open to new experiences and travel is an adventure. Having to argue with my HMO when I returned was another story.
-Susan

While travelling throughout the UK in the late ’90s, my husband and I were in a head-on car accident. I went to their hospital and received wonderful care, and it cost me $30 — I couldn’t believe it! Loved the healthcare system there!
-Carol

I lived in England for three months (studying abroad); I ended up needing a prescription while I was there. It only cost £7 (about $10 at the time), and they kept apologizing that it wasn’t free like it would be for them. I, too, would gladly pay higher taxes if it meant that I got quality care without the worry. I agree with the guide: Americans do seem to pay more for less.
-Chelsea

Our daughter spent four months going to school in Montpelier, France. She got sick during that time so found out firsthand about the health care in France. Not only did she NOT have to pay anything, but the doctor actually made a house call. Tell me that’s wrong! We have nothing on the French in this country. We do pay too much and don’t get enough out of it. The health care industry is calling the shots and doesn’t like that we’re trying to change it. No system is perfect but ours in the US is certainly far less than perfect — even mediocre.
-Candy

In the UK, where I have lived, everyone is covered for everything — no money changes hands ever, all prescriptions cost £7 (but are free for 90% of people in England — the young, the old, those with cancer, the poor — and free for everyone in Scotland and Wales), and doctors are efficient. Waiting times are minimal and you can always find somewhere to go the same day — whether it’s an urgent clinic, your GP or the hospital. There is a LOGIC to the system. Imagine how much time (and money) Americans waste paying bills, worrying about insurance policies, dealing with the idiots on the phone. One has to be insane — or extremely undereducated — to not realize the “rest-of-the-world” approach to health care is vastly preferable to America’s non-system.
-Anthony

I am a doctor who just visited Paris for the first time. I, too, asked my guide extensively about the medical care he has received as a citizen of France. You hit the nail on the head when you say the French pay a lot but expect a lot in return. That degree of government accountability is lacking here in the States. Health care is considered by many to be a right yet it is largely run as a for-profit business by insurance companies. There is something inherently flawed with a system you pay into but then the companies are incentivized to pay OUT as little as possible for fear of alienating their shareholders.
-Avelino

In Canada, we have access to universal health care. Similar to France, our medical system is primarily funded through our tax base, with small copays for non-publicly-insured services. I can never understand why Americans think their system is so great. If you have money (the 1%), well, maybe. However, nearly 1/5 of your population has no insurance. Those who do can be bankrupted by a major illness. Medical decisions are being made by bureaucrats and insurance companies, not doctors. Although the USA spends the highest proportion of GDP per capita on health care, of the top 37 western countries, the USA has the worst mortality rates and access to care by their citizens. These are facts, not opinions. I am a senior healthcare executive who has studied the US and many European health systems. For a country that purports itself to be the greatest in the world — where is your compassion?
-Alan

I live in the Netherlands (moved here from the US 3 years ago) and I really like the Dutch system. Much better care and lower cost compared to what I experienced in the US. Pharmacies in Europe are a good place to start when in need of advice or looking for a doctor, and some medications that are available by prescription only in the US are available here over the counter.
-Gayla

I was seriously injured from a fall that necessitated a trip to a London hospital via ambulance. The care was excellent and I was ready for a huge bill. I pulled out the credit card to pay and was told that all the care was free. The doctor said that the American health care system was the way it was in Europe before WWII — pay or die — but the devastation caused by the war changed everything. Along with rebuilding their cities, the Europeans decided to rebuild their society, leaving behind the old laissez-faire every-man-for-himself systems. People wanted a social contract between government and the citizens — government by the people for the people — like the social security system of the USA. He said that’s when national health care was created. Now no one dies or loses their home for lack of health care.
-Elisa

I’ve accessed health care in Romania, Bulgaria and Greece. In Greece, two prescriptions cost me €7 and no doctor visit. Bulgaria had affordable, competent care for foreigners. Romania, where I had a serious injury, was the worst, but they are still struggling after communism.
-Mary

I got excellent ER and overnight care and observation after a bad fall in the streets of Pisa. Paperless and free. I think what a terrible experience an Italian would have had taking the same fall on the streets of San Francisco!
-Annie

I’ve just returned to the US after working for 3 years in the NHS (National Health Service) of England. No, the people there do NOT feel resentment over your free healthcare. The culture there believes, really believes that healthcare is a right and the obligation of society. The English view the American system as barbaric, a term I heard more than once from a variety of people. What sort of society have we become where we feel justified letting people become ill and possibly bankrupt because of a medical issue? Those high insurance premiums we all pay, isn’t that a form of a passive tax anyway? Now that I’ve worked within the system, I’m a convert. Socialized medicine, although not perfect, is a more fair and equitable system.
-Dean

A couple of years ago while traveling through central Europe my husband was ill, followed by a fall in which I was sure he broke his ankle. We received health care in two different countries and never had a bill. While I don’t agree with the direction America’s health care is going, there could be some positive changes made. On another note, my English friend’s son was not able to get surgery to place tubes in his ears because it was a pre-existing condition!
-Beth

As a Canadian with great health care I was shocked when just last week I had to go to the hospital in Paris for a badly swollen leg and had X-rays, blood work and care from 4 doctors. They asked for no money, no credit card, no insurance, only my passport. I expect I may receive something in the mail but what a relief that I was not put in a financial hardship while travelling.
-Noreen

Years ago my Japanese wife and I took our first trip together to her homeland. In the weeks prior she had not been feeling well, but not so much that she felt it was serious. Rather than seeing a doctor here in the US she wanted to wait until we were in Japan to do so because of her language but also because she felt more comfortable there with medical care (a previous experience here was not a good one). Upon exam by a doctor in Japan we were informed that her condition was due to her being pregnant! We followed up the next day with an exam by an OB/GYN which included an ultrasound. Two hospital visits, doctors and the ultrasound had me sweating over what the tab would come to. It was $26! That news was almost as big a shock to me as the earlier news that I was going to be a father. I was told this was typical healthcare for the Japanese. Say what you will about “socialized” medical care. I call it amazing.
-Eddie

I had a €5 emergency room visit in Greece. I nearly fell over. I thought it would be cheaper than the US, but €5?!
-Victoria

I had need of medical assistance in France. As it was evening my only option was the hospital emergency room. Within a couple of minutes of walking in the door, I was being treated by 4-5 hospital staff members and was missing about a pint of blood which was on its way to the lab. As it turned out the problem was not serious and was easily treatable. About an hour later I was out the door with no bill for the hospital visit other than being told there would be a bill for the lab work which turned out to be €116 (about $150). Anybody want to guess how long it would have taken or what the cost would have been in a US hospital?
-MMR

I recently spent 3 months with my husband in Europe and he had to go through a small emergency surgery in London. With a month left in our trip (we still had 3 cities to go through), we had to look for medical assistance for his wound in London, Paris and Madrid — and we had nothing but helpful doctors and nurses in these three places at a very reduced cost or no cost at all. Only when we arrived home in the States did we have an issue when the wound center said to my husband, “Sorry we can only see you in a week”…for a wound that needed daily care.
-Nora

We had a similar experience while on the GAS tour in Vienna a couple of years ago. My 10-year-old grandson superglued the fingers on both his hands together while trying to repair his broken sunglasses. One of those long and embarrassing for him “family stories”. This happened after 10 pm, but with the help of a sleepy but friendly and happy to help pharmacist who answered the knock on her little wooden window at the pharmacie, some wonderful advice, precise instructions and a small, inexpensive bottle of acetone, problem solved. I can just imagine what hoops we would have had to jumped through here… I would never hesitate to use any of the health facilities in Europe.
-gac

This similar thing happened to us a few years ago in Florence. We were traveling with friends and one of them (quite young) had a lifelong heart condition and needed to have her blood levels checked for a medication she was taking. They walked into the Florence hospital and explained what they needed. They gave her a blood test with her levels. When they asked what the cost was, they were told that they would not charge them. They don’t charge US citizens traveling in Italy. Our friends left their info and were sure for years they would get a bill and never did.
-Judy

One of my college friends married a French man who unfortunately developed a brain tumor. He had a long, horrible death which couldn’t be prevented, but I can’t begin to tell you how grateful my friend was that he was experiencing French health care. She said the doctors and the health care system did everything possible for him and for her and her family as he went through it. She was sooo grateful. She just had to raise her kids and deal with the trauma of losing her husband, without bankruptcy and medical bills she could never even hope to pay on top of that. Raising her kids and becoming a widow has been more than enough challenge.
-Karen

We have a similar story, but needed hospital care and lots of tests. After 3 days in the hospital (private room), multiple doctors and tests the total bill was €550 (about $720). They kept apologizing for having to charge us. We thought it was the best care ever. After returning to the US we followed up and the cost for the same tests without hospital stay was over $5,000 with insurance. Do we have the best system? No is the answer. By the way, for meals in the hospital a waiter comes in and takes your order. They handle the food like a fine dining restaurant. I tell everyone, if you get sick, go to the airport and fly someplace else.
-Diane

Of course, not everybody has had positive experiences. Here’s the other side:

HA! I beg to differ on the health care in France. I got sick and ended up in Caen’s “world class” hospital. If this is where socialized medicine is going, you can have it. I will gladly pay for the health care I receive in the United States. There is no comparison to the quality of care. The thought of having to have surgery in that place makes my skin crawl to this day. It is one nightmare I don’t want to live again. I now make sure we have insurance to get us back to the States in case anything ever happens like that again!
-Connie

I have a friend who is an MD in France. She says that four days each week she is a “government doctor” and rushes patients through as fast as possible because she earns so little with the country’s socialized medicine policy. One day each week she has a private practice and she earns more in her private practice in the one day than she does in four days in the government program. Consequently, the patients she sees in the private practice get as much attention as needed and receive much better care. She says she would love to be able to practice the way doctors in America do but she will not leave her native France.
-Buddy

Many people on here are commenting on the great free care they received as tourists under many of these systems. I have as well been the recipient of treatment for my son while in England at no cost. I cannot however get past the feeling that “someone” is paying for this freebie for me and feel it is inherently unfair to those paying for services rendered to me. I suspect if the payers were questioned about it, that they would agree.
-Ed

When one of our tour members needed surgery in Paris last month, the doctor wouldn’t perform the procedure unless then first gave him $5,000.
-Jolene

National healthcare isn’t all it’s cracked up to be. I’m from England and my sister had gallstones and was on a waiting list for a year before she got surgery. She was on a special diet to keep the pain at bay…seriously, a year???? I much prefer our freedom of choice with medical insurance. England is also taxed to death.
-Suzy

We are Americans living in Spain. After an accident, my husband was taken via ambulance to the free hospital. Our experience was a nightmare, and they came close to killing him. We transferred to the private hospital where we paid cash in hand…excellent care with highly skilled surgeons, plus it was clean, no more ants, and he recovered. No more “free” socialized medicine hospitals for us in Spain — we’ll pay for the private care any time and LIVE.
-Ellen

Ultimately, the health care systems of the various European counties are flawed. No system is perfect. But this informal straw poll suggests that once Americans actually experience the stress-free convenience of the European medical system, they think a bit differently about whether single-payer socialized medicine is really the boogeyman many American politicians make it out to be. I expected health care to become a big issue in this presidential election. However, perhaps because “Obamacare” closely resembles Massachusetts’ “Romneycare,” it hasn’t taken center-stage…which may be a missed opportunity for American voters to tackle this very complex issue.

Do you have any other European health care experiences, pro or con, that you’d like to share?