Today the Washington Post reported that the Senate Finance Committee's health care reform bill, if passed, "would require people to buy insurance or face penalties ranging up to $1,900, to be assessed on their income tax returns."
I laughed when I read that, and not in a gleeful way. Coming from France, or any country in the European Union, the very idea of forcing citizens to purchase their own basic health care or pay a fine of $1,900 is absurd. I would like to remind you that, in Paris, my private, comprehensive health insurance, which I must pay for because I am not a French citizen, costs €696 per year. That's $1,016.46 per year at the current exchange rate. And my coverage is terrific: 70% of regular doctor's visits, 100% of major medical. But you can read all about that in Getting Sick Part One, and all about how much French citizens pay in taxes to support the world's top-rated health care system in Part Three.
Today, for Part Four, I'd like to focus on what the French get in exchange for their income taxes. We already know what Americans get: public education through Grade 12, Medicare after age 65, and Medicaid for those below the poverty line (in 2009, a single citizen must make less than $10,830 a year to qualify).
By contrast, this is a short list of what French citizens get, and it bears mentioning that they get it whether they are rich or poor, employed or unemployed, young or old:
HEALTH CARE COVERAGE
- 70% of doctor's visits (generalists and specialists, including psychiatric care).
- 100% of doctor's visits for children age two and younger.
- 100% of prenatal care.
- 65% of vaccinations (70% if the vaccination is given during regular doctor's appointments and 100% if the patient is deemed "at risk" due to age or health problems).
- 70% of dental visits (this includes cavity treatments, tooth pulling, crowns, and bridges).
- 100% of orthodontic treatment for kids younger than 16.
- 65% of eyeglass costs, limited to one pair per year.
- 100% of major medical (health problems that last more than six months — HIV, Alzheimer's disease, Parkinson's disease, diabetes, hemophilia, cirrhosis of the liver, etc. — are covered completely).
- 80% of hospital charges for elective surgeries (70% of anesthesia treatments).
- 100% of hospital charges for those who must be hospitalized longer than 30 days.
- 100% of hospital charges for women with birth complications, before and after delivery.
- 80% of home hospitalization; 100% for those with long-term illnesses.
- 100% of cures thermales, or spa hydrotherapy, for those with such debilitating long-term illnesses as neuropathy and inflammatory polyarthritis (this includes spa lodging up to €150.01 per night and a round-trip, second-class ticket on a SNCF train, as most French spas are on the coasts).
As I stated earlier, that is the short list of what is covered by the French national health care system. Now let's look at a few of the other benefits the French receive in exchange for their "high" taxes:
AFFORDABLE CHILD CARE
- 16 weeks of pregnancy leave for women who do not have any complications (those who have complications, of course, get more time off).
- "Welfare" checks for low-income parents (for example, a couple earning less than €39,376 a year who already have two children will receive €889.72 for the birth of their third child).
- Affordable, government-run day care. (The amount parents pay for day care depends on their household income; those who make less pay less. A couple earning €3,000 per month with one child will pay €288 per month for group day care. Household nannies are also available under the government-run system for roughly the same amount.)
AFFORDABLE EDUCATION
- Public education is basically free from école maternelle (preschool, which starts at age three) through lycée (high school).
- Affordable public universities. Fees for the 2009-2010 school year at all public universities are as follows: €171 for those earning bachelor's degrees, €231 for students in master's programs, €350 for those earning doctoral degrees.
EARLY RETIREMENT
- Retirement age varies in France but, for those who work physical jobs, it can start as early as age 55.
Are you reeling yet?
I am — especially when I think of that single American who lives in California and earns $25,000 a year from two part-time jobs with no health insurance, who doesn't qualify for Medicare or Medicaid, and who pays $5,833 of his salary in taxes and might soon pay an additional $1,900 because he can't afford his own health insurance. With $17,267 left, and studio apartments in Los Angeles ranging from $635 to $2235 a month (I just checked Craig's List), how is he to pay his rent? How is he to eat? And why don't Americans care enough to fix this?
Sources: l'Assurance Maladie, www.ameli.fr; Allocations Familiales, www.caf.fr.
This series was excellent and should be read by every American.
Posted by: Diogenes | October 12, 2009 at 10:36 PM
As long as we Yanks put sooo much into our "defense" (?)...
You left out all the wonderful public transportation that you enjoy.
Once, while working in Paris, I compared my tax situation with someone who did the same job at about the same level. After I added on my self-employment taxes, and he took all his legitimate deductions, we were at the same place. I am paying $750 a month for health insurance, with a $2,500 deductible for doctors and $500 for medicine. Living in Los Angeles, I have to have a car, for the transportation situation is famously non-comprehensive.But the pride I feel at all my intelligent fellow-countrymen bellowing "We're number 1!" over and over, is priceless.
Posted by: Peter (the other) | October 13, 2009 at 10:13 AM
... and with the $17,267 left, the single American living in California might also have to:
- save to pay potential deductible fees in case of health problem
- save for health-related issues in case of unemployment
- have additional savings to be able to survive few months in case of unemployment
- reimburse the college loan
- start saving to be able to send his kids to college in 15 years
None of this is to worry about in France. And that's a huge amount of money taken away from US salaries (e.g. $10,000 to $50,000+ per year for college education...). Those costs are taken care of by French taxes, while they must individually be paid for by US citizens/residents, at prices that are often way too high.
All together, given those additional costs in the US, it is reasonable to say that even if taxes are a little higher in France, at the end Americans must end up paying way more (wayyyyy more) than the French in order to get similar benefits.
Posted by: Herve | November 11, 2009 at 12:35 AM