Affordable Healthcare: Vive la différence

One advantage of living in a foreign country is experiencing cultural differences: new scenery, new language, new cuisine, new ways of looking at the world. I am now living in France for the second time. The first time was 30 years ago when I moved there to marry Laurent, who at the time was in the Armée de l’Air (French Airforce). We lived first in Alsace, then in the Pas de Calais, and finally in Normandy. In those almost two decades, I experienced many joys of French life: diverse landscapes, beautiful architecture spanning centuries, and a wide variety of regional cuisines, to name a few.

After moving back to the States in 2009, I quickly appreciated one facet of French life to which I had never paid too much attention: low-cost universal health care. In all the years I lived in France, I never once worried about getting sick because I knew that no health problem would jeopardize us financially, thanks to the combination of basic state-run health care coupled with our supplemental policy from the military. We returned to the States before the enactment of the Affordable Care Act, and finding coverage was a nightmare. Laurent was covered by French insurance for French people living abroad – comprehensive, but far more expensive than his coverage when he lived in France. As a newly arrived American, the best coverage I could get was a very expensive policy that provided only catastrophic coverage with a very high deductible: I was paying not for health care but to protect myself from bankruptcy in case of serious accident or illness. I got better coverage when the ACA was enacted: less expensive and more comprehensive. I breathed a big sigh of relief when I turned 65 and was covered by Medicare. I received very good care under Medicare, although I had to pay for my own prescriptions, eyeglasses, and visits to the dentist, not covered by my costly supplemental policy.

One of the reasons Laurent and I moved back to France two years ago was its affordable universal health care. We now pay about one-fifth of what we paid for health insurance in the States, a savings of about $8,000 a year, significant for fixed-income retirees. We have better coverage here: we pay little or nothing when we go to the doctor, have an X-ray or bloodwork, and nothing at all out-of-pocket for prescriptions and semi-annual check-ups at the dentist. As an example of how the system works, last week I had blood drawn for an analysis prescribed by my generalist. I didn’t have to go to a clinic: the phlebotomist came to my house, put my healthcare card in her little machine, took the blood, then charged me eight euros and 28 centimes (under $10). I paid her and will soon be reimbursed by direct deposit to my checking account for almost all of it by the state and supplemental plans. The laboratory will send me a bill for the analysis, I’ll pay them by check, and I’ll be almost fully reimbursed by direct deposit. (My bloodwork has averaged about 25 euros here, a small fraction of the cost in the States.) When I see my generalist, she will process my card, I’ll pay her 25 euros for the visit, and I’ll be reimbursed over 22 euros by direct deposit. Due to Covid concerns, I haven’t yet visited an ophthalmologist, but the payment/reimbursement process will be similar; I’ll use my annual allowance for basic frames and lenses but will choose to pay more for the upgrade to stylish glasses and transitional lenses.

From a budgetary standpoint, the U.S.’s primary advantage over France is its more affordable energy costs. In France, fioul (heating oil) is about 0.85 euros per liter, the equivalent of about $4 a gallon; essence (gas for the car) is even more expensive at about 1.5 euros per liter, over $7 a gallon. It costs dearly to fill up the tank, but with Covid restrictions we hardly drive at all these days so haven’t really felt the pinch.

I loved many things about living in the U.S., but the cost of health care was not one of them. The U.S. has miles to go to arrive at reasonable costs for medical insurance, doctors’ fees, hospitalizations, and prescription drugs. It can be done. Food for thought.