À AIMER: Getting Sick, Part One

When you are an American living in France, getting sick has a silver lining.  That silver lining is: you're in France!  You're in France, the country that the World Health Organization rates the top on Earth for quality of health care and affordability. You're in France, where you know that, whatever you have, you will be taken care of.  All you need to worry about is getting better.

Don't believe me?  I do not doubt it, after reading the latest headlines on "the health care debate" from American news organizations.  There is a lot of conflicting information out there, a lot of misinformation, too.  So what's the truth?  Does socialized medicine, also known as "a public system of national health care," really work?  Do people in "those" countries really have to wait years in order to get reading glasses?  Do the rich have to pay insane taxes in order to cover the poor?  (If you're a European reading this, or if you are Japanese or Australian or Brazilian or Costa Rican or a person from any of the other countries that have socialized medicine, I apologize for what is probably, to you, a banal post.  Or maybe you find it funny.  I hope it's the latter.)  But back to you, my fellow Americans. Universal health care does work, and it works all over the world.  In a series of posts that I am calling "À AIMER: Getting Sick," I'll explain how it works in France and why it is something to cherish.

For today, Part One, I'd like to discuss the elephant in the room, the beast that is most responsible for driving the cost of American health care to unsustainable levels, and the beast that can be most easily trained: the American health insurance industry.  

As you know, all French citizens are entitled to health care paid for by their government.  It doesn't cover everything, but it covers a lot.  I, though, as an American living in France under a visitor's visa, am not entitled to French government health care.  So what do I do?  I buy my own, private medical insurance from an insurance company that is regulated under French law.

This is what I pay for my private French medical insurance: €696 per year.  

This is what I get: 

- 100% of surgeries and hospitalizations paid beyond €50*, up to €30,000.  

- 80% of hospitalizations without surgery paid.

- 100% of medical prescriptions paid.

- 70% of visits to medical doctors, both generalists and specialists, paid.

- 60% of laboratory analyses paid.

I am too lazy to write down everything for which my private insurance will reimburse me, but I can assure you that the list goes on.  Oh, and that asterisk*?  That's for the additional amount I must pay for my hospital room — €16 per night, more if I want a television.  So let's say I get hit by a Vélib and end up in the hospital, where the staff realizes that I need an emergency appendectomy.  And let's say I stay there three nights.  I would pay €98.  

"Ha," you say, "that can't be possible!"  What about the cost of the surgery and the doctor's fees and the anesthesiologist's bill and the cotton balls?  In the U.S., those fees would add up fast (in fact, they would add up to at least $10,400 and in some cases as much as $19,000).  In France, a laparoscopic appendectomy costs, drum roll please, €284.09.  And I would pay €50 of it, plus the €48 for my three-night hospital stay. Even if I had three surgeries in a year, I would not come close to hitting my insurance company's €30,000 ceiling.

Now do you see why I sometimes smile when I fall ill in France?  

When I lived in the U.S., I never smiled when I got sick.  The only silver lining I found stemmed, ironically, from the fear of financial ruin — it was so great, it sometimes made me forget my physical pain.  

I wonder, now, if things have changed.  So tonight, just for kicks, I am looking up the cost of private health insurance with one of my former insurers, Kaiser Permanente, which, back in the day, I referred to as Kaiser Soze.  Is Kaiser Permanente still Kaiser Soze?  Let's see.

Using my old zip code, I endeavor to find the cheapest Kaiser plan available.  

And here it is: $136 per month, or $1,632 per year.  It covers: 

- 30% of my hospital expenses . . . 

 after I pay a $5,000 deductible.

For readers living in countries with socialized medicine, let me explain that: Kaiser Permanente will not cover a dime of my expenses until I pay them $5,000.  Add that to my monthly dues for a total cost of $6,632 per year.  

Are you, my American readers, shocked that Kaiser will cover just 30% of my hospital expenses after I pay them $6,632 when my French insurance company covers nearly 100% of my hospital expenses for just €696?  If you are not, perhaps this will get you: in France, there is no deductible.  I think that statement deserves capital letters: IN FRANCE, THERE IS NO DEDUCTIBLE!

I hope that President Obama and everyone in the House of Representatives and the United States Senate hears that, because it is the single law they can adopt that will immediately improve health care for all Americans: nix the deductible!  Make it illegal.  Start now, this week, and take care of the rest after your August vacations.  

In the meantime, I'll be renewing my private health insurance — in France.

Note: The Kaiser plan also offers me one hearing test and one eye exam per year.  Both paid by me, for $50 apiece.

Comments

[isabella]

Granted, the cost of most procedures and surgeries in France is less than in the US, but I had the misfortune of staying in the Hôpital Européen Georges-Pompidou in Paris for a few days. Each day I was charged €900, which (with the current exchange) is higher than my Michigan hospital charges per diem ($1043).

The care in both places was comparable...although in the US the nurses smile ;-)

May I ask the name of your French insurance company?

[FB @ FabulouslyBroke.com]

Interesting. But I am not sure it is such a sustainable plan, as I've heard from other people who've lived in France, that they pay a HELL Of a lot more money for this program but don't really take advantage of it as they don't get sick every year.

And I've known others who've bragged about being parasites on the French health system, calling the doctor for any and every little, stupid ailment, costing in indirect dollars, a lot of money.

Whatever the case may be, it sounds too good to be true, in my opinion, as I know how much hospitals really cost to run and handle. Doctors are not cheap. Medicine is not cheap. Nurses are not cheap. This is not a solution whatsoever.

SOMEONE somewhere is paying the rest of your universal healthcare advantages.

It is only a PERCENTAGE of what you earn that you pay in your healthcare, right? So someone earns 7x the amount of you, they pay 7x as much. And that was the case with someone who left France because he was getting taxed 8000 EUR a year for a healthcare program he wasn't even using. HE was paying for you.

I know, that's the case here in Canada where we also have universal healthcare, and it SUCKS from my perspective.

I get taxed at 40% - 60% to pay for other people who mooch off the system, but I rarely go see a doctor. Once a year to get a refill on pills. And I PAY for those pills.

I am not going in for every little cough and sneeze but other people are, and are taxing the health system with their BS "Canada is so great with their universal healthcare".

Can't say I totally agree with either healthcare system - universal or private.

There has to be a better solution.

[Bill McKinley]

I think the Canadian has a point. And I disagree with our American living in Paris on deductables. Deductables place the burden of initial cost in the right place to prevent abuse. In the US, 50% of healthcare dollars fit into a $5000 deductable. So a system that would employ deductables as a method of controling abuse seems appropriate. They could work on a sliding scale based on income similar to tax rates.
I do agree with our American in Paris that the Health industry is bilking Americans while leaving far to many without care and that disposing of insurance companies that cash in on the discrepency between premium and care is a good move. I support a single payer system in the US. Our tax phobia is blinding us to an obvious solution and the lobbyists seem to be more visible and persuasive than the voters. Citizens need to write their representatives and let them know where they stand and what they want. Healthcare in the US cost twice as much as other developed countries because providers get to threaten Americans with the old line "your money or your life". That needs to stop.

[Peter (the other)]

As long as the USA finds it agreeable to pay as much for "defense" as almost the rest of the world combined, we will not have the resources to pay for proper care. As the old way of thinking went, "Guns OR Butter". Neither will our herds of programmed, as opposed to educated, sheeple allow for it. Having lived under both systems, the superiority of the French (and even the British whose, much gutted, NHS I fell under for a year) is such as to not even be in the same ball park, or league. To be sick in the USA is to be a cash piñata, everyone taking their wack at you until the last penny has fallen on the floor.

[Your buddy Kent]

Keep in mind that the writer's healthcare costs were paid as a foreigner visiting France with a fixed date of validity on their visa.

I'm an American, living in France and married to a French citizen, and my healthcare costs are far lower than the writer's and the treatment that I get is far better than anything than I've ever received in the U.S. where I lived for 30 years as a "natural born 'Merican".

The Obama administration has made a serious mistake in not inviting other allied countries into the HC discussion. Why not invite Bernard Kouchner (current French Foreign Minister & founder of Doctors Without Borders) or representatives from DE, CH or anywhere but the U.K. into the discussion? Probably Americans are dumb enough to knee-jerk react to talk of "Lefty Euro-Socialist Healthcare Reform Baby-Fur-Seal Commies". Which is to our further loss.

Also, it is disingenuous for the Anti-Reform lobbyists to constantly mention the worst examples of HC in Canada (which still seems better than US HC) and to even mention the U.K. at all. Margaret Thatcher gutted the U.K. HC System during the same time that Reagan went on a crusade to turn all things that were in the Public Commons (Hospitals, Universities, etc) into private, for-profit, enterprises in order to line the pockets of his fat-cat benefactors & to silence those that disagreed with his policies. It seems like the Anti-Reformers also choose to discuss the U.K. since they also speak English over there (go figger...). It's pretty lazy. Why aren't we discussing the best of other systems? Isn't that what we deserve for We The People? In a government by of and for us?

BTW, a $5000 deductible is far too high for the vast majority of Americans. Think of our large poor population. How are they going to pay for themselves and their kids. Plus, abuse by consumers of the HC system is a super-rare anomaly and is usually perpetrated by the mentally ill that needed help in the 1st place. The low cost of HC in France does not induce rampant abuse. Besides, how many normal people actually LIKE going to the doctor's office?
I don't understand how one can think that having a $5000 (or even $500) deductible placed upon ALL Americans makes any sense when abuse & fraud is so rare and so trivial. There are systems in place to catch that kind of stuff. If not, create or fine-tune them... but 5 grand? I'm certainly not rich, but if I had to go to hospital twice in one year, I could hack it, but WTF and I'm paying for here? Also, the VAST majority of Americans are now living paycheck to paycheck. They are saving money in the negative percentages. 2 kids with an emergency each within 3-5 years will wipe out a family. Hell, RIGHT NOW 60% of all bankruptcies in America are caused by medical bills.

Universal Healthcare seems guaranteed in The Constitution to some degree. Or at least protection from the way in which the insurance companies run things currently. "Life, Liberty & The Pursuit of Happiness". It's pretty clear to me.

Another thing in my long-winded venting: I have 2 types of coverage. One is the Socialized (a.k.a. "Civilized") HC I receive with my residency in France. The other is additional coverage for extra things like Spiffy Reading Glasses, Private Hospital Insurance which is an upgrade from the Public Hospitals, Cosmetic Dentistry, etc. The insurance companies in the U.S. should be legally barred from fundamental HC insurance, as they are in France. Let 'We The People' take care of ourselves with a system that is administered by people that are responsible to We The People. After all, what is a for-profit corporations primary directive? It's to Maximize & Internalize Profits and to Externalize Costs. This is why 30% of all HC money spent in the U.S. is used strictly to employ people to deny coverage for whatever reason can be dreamed up.

Haven't we had enough of the Private Healthcare Denial System's Bureaucrats?

P.S. Fabulously Broke: I'm all for rolling back the tax rate to where it was when Reagan was in office... I'd even go to where Kennedy had it. The U.S. is in the top 10 of largest gap in income inequality in the world.

[David Hardman]

I agree with the french having a wonderful healthcare system, as I was in the hospital for two nights, but we have to remember that france is the size of texas and I find it easier to control a system that is the size of a single state than the entire United States. It is hard to believe that the abuse of our healthcare problem will go away with a universal healthcare system. I do agree what we need a healthcare reform, but I'm not sure that a government control healthcare system in the United States is the answer.

[Your buddy Kent]

It absolutely is the answer. A well-funded & single-payer system that is based upon the successes shown in other countries will work. The 'brain' work has mostly been done by others long ago.

Is the United States able to organize local police & national militia to 'keep America safe' from enemies foreign and domestic?
Was America able to rise to the challenge, during a depression, of defeating the Japanese & the Nazis in two different theaters of war?
Is the U.S. currently paying to have ≈600 military bases OUTSIDE of the U.S.? Do these bases ever face massive budget crunches?
Is the U.S. capable of extending our influence to every country on the face of the earth?
Is Medicare successfully covering millions of Americans nationwide?
Is America incapable of leading the world in Healthcare (not HC technology; which we are no longer a leader in at the moment).

Yet, people declare that we can't create and sustain a not-for-profit system of health insurance? What is going on here?

I suspect that the truth is that the corporate interests use their power of the purse & control of the airwaves to disseminate a message of doubt & despair so that Healthcare CEOs like Bill McGuire can continue to take home 1.8 BILLION dollar paychecks.

Why do so many Americans have such little faith in us as a people? I'll never understand it. It's the chest-beating 'America First' crowd that is the 1st to declare that 'America can't possibly accomplish that!' Oh, ye of little faith indeed!

I'm reminded of something that I heard come up in the 'Evolution vs Creationism' debate (which is another uniquely American phenomenon incidentally):
"Never have I experienced something wherein those that knew so little regarding a matter were so vehemently against it."

I think that this is where the root of our national problems resides. We The People are driven by emotion and flash more so than logic & reason. We are an easily manipulated folk. We buy into marketing with very little hesitation or questioning of motive. I still have great faith in We The People, but it's a going to be a long-term decline before the turnaround.

In follow-up to Mr. Hardman; the United States does not have a Health Care abuse problem of any importance. The only abuse is the fraud & thievery being paid for by the American people to the Health Care Insurers. Some things don't need to turn a profit. I always liked my Socialized Police & Fire Departments just fine. Same goes for my Socialized Interstate Highway System. Just give 'em some proper funding and stop subsidizing the corporate welfare system.

[Brent]

To be fair to Kaiser, a plan that pays just thirty percent of expenses on everything would be highly unusual. More typically, such plans pay thirty percent of expenses after the deductible is met, up to the "out of pocket maximum," and one hundred percent after that. It is confusing, but the idea is that there are two cost thresholds to assess, the deductible and the out of pocket maximum.

My current plan, through Blue Cross Blue Shield, is simpler but representative: I pay $179 monthly, plus an out of pocket maximum of $4,000 annually for any medical services. BCBS pays anything beyond that (in a calendar year) at one-hundred percent. A shorthand way to think of this is that my maximum health costs in any given year will be around $6,000, and usually less if I have no medical issues.