Arguments

COVID-19, France, and Me

How I learned that it’s cheaper to be uninsured in France than to be insured in America.

By Sophia Crabbe-Field

Tagged Affordable Care ActcoronavirusFranceHealth Care

I left for France on March 5, for a family trip planned several months ago. At the time, the worst of the virus still seemed concentrated in China, although worry was growing in Italy and Iran. On March 7, the only country the CDC was advising against non-essential travel to in Europe was Italy. On March 16, the day I was meant to return home, the advisory was revised to include all of Europe.

In other words, I naively believed that while flying to Geneva, which only had a handful of cases at the time, and travelling from there to a cabin in the French Alps, I could continue to dodge the virus. Like many governments and individuals, I greatly underestimated its inexorable reach. And now, in late April, I’m still here, waiting.

It was a bus ride that I realized, too late, had originated in Genoa—that is, in high-risk Italy—that altered my fate. First came a sore throat, then a mild fever, which eventually climbed to around 101.5 for the next two weeks, along with an increasingly bad cough and shortness of breath. My cousin drove me to the nearest hospital center. It was out-of-network, not one of Blue Cross’s international partners, but the company assured me I’d be reimbursed for an important chunk of the cost. I was seen almost immediately in the small countryside hospital’s new makeshift COVID-19 wing for around 30 minutes, by not one, but three attentive doctors who checked my lungs, oxygen levels, and other stats. They also called in a lab technician to check my blood for signs of a bacterial infection and to check my organ function.

After four years spent living in the United States, I expected a giant bill to be handed to me at the end of the visit. As I waited, I reassured myself I would get a good deal of this money back and that I should just “focus on getting better”—the words I have learned to repeat to myself whenever I’ve gotten sick and have worried about cost, which happens quite often as a patient with a chronic illness. Instead, I was handed this bill; I owed a total of 25 (around $27) out-of-pocket:

Trying to disguise my surprise, I happily paid it. I later told a friend I’d just spent less money uninsured in France than I do insured in the United States. You see, as a patient who consistently reaches her out-of-pocket maximums, I pay $535.21 per month for my premium to avoid deductibles. Despite that, I also pay a $20 co-pay to see my GP and $20 for a regular blood test, meaning I would have paid a total of $40 for a similar visit. Likewise, I recently received a bill from my nephrologist’s office, charging me a $75 “hospital facility” copay, along with another bill charging me $40 for the actual doctor’s visit: grand total for my appointment being $115 (excluding the blood test that also appears on the bill). Without insurance, this one visit to my nephrologist would have cost upward of $1,000 in hospital and doctors’ fees:

    

Canada, my home country, has admittedly higher provider costs than France. Yet when I recently visited my old nephrologist in Canada—despite being a Canadian, as a non-resident, I’m not covered by our universal Medicare plan—I was sent the below bill of $134.10 CAD (around $96). In other words, this was still less than my copay in the United States. (I would like to note that my Canadian doctor felt so uncomfortable at the idea of her patient paying out-of-pocket that she waived her fee. The bill was only accidentally sent by her office.):

According to the French government’s own public services website, the normal fee for a specialist consultation is also only €25, with the exception of cardiologists and psychiatrists. Of course, residing in France, one must automatically become enrolled in public health coverage (nobody is left uninsured!), so I could never truly play out the experiment of being uninsured with a chronic illness in France.

Some on the right, including The Wall Street Journal editorial board, and even some on the center-left, have taken France’s catastrophic experience with the coronavirus as evidence that the much-touted French system isn’t all it’s cracked up to be. Yet the high death rate is mostly attributable to slow government action on social distancing and low levels of testing, among other mistakes by Emmanuel Macron’s government, as well as a dose of bad luck. France’s system, like that of many other countries with universal health care, has admittedly suffered the consequences of years of austerity, but this is not because it’s inherently bad.

Many of the same individuals now criticizing France also reacted in bewilderment and impatience at the supposed self-righteous anger of the Bernie Sanders campaign, unable to conceptualize his visceral distaste for the existing American system. How could this movement be so uncompromising in its agenda for “radical” change? Yet what these critics didn’t get is that many of his supporters weren’t just naïve youth and uncompromising zealots and Twitter trolls; they were simply everyday Americans sick and tired of what this country offers to those who have been dealt a raw deal, particularly when it comes to health. Nowhere is this more evident than in the more than 13,000 replies Sanders received in response to a September tweet asking his supporters: “What’s the most absurd medical bill you have ever received?”

The replies included six-figure numbers and a slew of replies from new mothers who had paid $20,000 to $30,000 to give birth. Of course, in many cases insurance companies had refused to pay or paid too little. But providers, including doctors and hospitals, are also responsible for the absurdly high prices Americans pay. The American Medical Association has long fought tooth and nail against universal health care, as has the hospital lobby. As many people have pointed out, it’s much more difficult to argue that doctors and hospitals are to blame than it is to point the finger at insurance and pharmaceutical companies. For this reason, neither Sanders nor Elizabeth Warren targeted them in their campaigns. Yet bringing down provider costs will eventually be necessary if we are to make Medicare for All a reality.

This is not to say I haven’t experienced genuine kindness from doctors and surgeons who showed real empathy to me since I’ve lived here. This kindness has been at no time on better display than over the past couple of months, as American doctors have put their lives on the line to save COVID-19 patients. Yet as a patient with a long-term chronic illness, regularly in contact with the health-care system, and who previously lived most of her life without ever paying to see a doctor, I cannot help but feel the corrosive effect of such a transactional system on the patient-doctor relationship. And I cannot help but feel that, despite the very best intentions of so many, American doctors would likely have difficulty understanding what compelled a group of Quebec doctors to call for a cancellation of pay raises two years ago, stating that these resources should instead be “better distributed for the good of the healthcare workers and to provide health services worthy to the people of Quebec.”

The protesters now calling for “freedom” from social distancing in the United States may represent but a small sample of Americans. But they also represent a distorted view of freedom too often burned into the American psyche. What many of these protesters, and even those who oppose Medicare for All, fail to grasp is the tremendous sense of freedom that comes from living in a society based not just on individualism, but also on solidarity, something that many of us have experienced in countries with a more robust welfare system and less striking inequalities in pay. And that freedom—the enormous weight of financial insecurity as the punishment for sickness being lifted off my shoulders—is exactly what I felt as I paid my €25 and walked out of that hospital in France.

I’m continuing to recover. I expect to be back home in the next couple of weeks. Meanwhile, my roommates tell me, a small pile of medical bills has been slowly piling up in our mailbox.

Read more about Affordable Care ActcoronavirusFranceHealth Care

Sophia Crabbe-Field is the associate editor of Democracy: A Journal of Ideas.

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