Sunday, July 9, 2017

THREE YEARS IN FRANCE - AN AMERICAN EXPAT'S REFLECTIONS

Have you wondered what it might be like to pick up and move to another country? Americans are lured to retirement havens in Mexico, Costa Rica, or Panama. They say that Eastern Europe is beautiful, safer than the evening news might suggest, and relatively inexpensive. Southeast Asia is hot, but it's cheap. Remember, though. I'm not talking about investigating a vacation home, time share, or other form of shared ownership. I'm talking about a permanent, sell out and ship the furniture sort of  move. For most Americans, the thought has never crossed their minds.

Think about it. Think about moving from one state to another, from one town to another, even from one neighborhood across town. Add the need to learn a new language - if you aren't multilingual already. Add the need to deal in a new currency and the need to learn the ins and outs of currency exchange. Add metric measurements. And a new healthcare system. And a new bureaucracy to navigate.

Daunting? You betcha!

Rewards? You betcha!

We  have moved to the Languedoc in the  south of France, the largest vineyard in the world, producing one-third of all French wine and more wine than is produced in all of the United States. Drive down any road and signs for local wineries abound. In three years, we have not visited one-tenth of the tasting rooms within an hour's drive. Our new favorite rosé comes from a domain just down the road. Sweet and fresh and four euros (about $4.50) a bottle!

Along with the wine comes the food. We eat seasonally, veggies and fruits from local farms as much as possible. Grown for taste, not for the ability to be shipped across a continent. Do you remember the kids licking the wallpaper in Wilder's Willie Wonka? "The snozzberries taste like snozzberries!" I say that a lot. And you haven't really tasted a strawberry until you've had one fresh from Fanny's farm. (Fanny has a stand in our market square every Wednesday and Saturday and only sells her own produce. When strawberries are in season, best stop by early or you'll miss out.)

OK. French beef sucks. Range fed, not from from a feedlot. So almost game meat. But the lamb and the duck and the pork and the poultry...magnifique.

The Impressionists painted here for a reason. The light here seems to emanate from the landscape, not reflect off it. The scenery can be breathtaking. On our ride to the nearest supermarket, on a clear day you can see the Pyrenees over 100 kilometers away. Nearly every geography known to man is at hand...except desert. And North Africa is just a ferry ride away.

It's not all sunshine and lemonade, though. French bureaucracy can be frustrating in the extreme. They've had centuries to refine it. Although the winding, two-lane blacktops between villages are generally well-maintained, they also carry slow-moving tractors, wide-bodied recreational vehicles, and bicyclists in packs. Passing can be a hair-raising experience. And whether you like it or not, you still have to vacuum and do laundry.

But the rewards exceed the inconveniences. Perhaps the greatest reward involves being insulated from what's going on in the United States at this very moment - the seemingly intractable discussion on how to deliver quality healthcare to the greatest number of Americans possible. Viewed from the outside, it is a painful discussion to witness. Viewed from France, the discussion is incomprehensible. What could possibly be the problem with providing universal healthcare? Let's look at the objections that I've heard from my friends in the US.

Americans have the right to decline healthcare coverage. Not if the cost of their care when they do get sick is added to my healthcare bill, they don't. Not if the cost of their absentee days at work is added to the cost of the products that I buy or the services that I need, they don't. It's true that Americans have the right to be stupid. Just not at my expense. I'd rather participate in paying for the health of stupid people than paying for the costs of their illnesses.

Doctors will leave if you control their fees. We live in a rural village of about 1,500 people. We  have a fine GP and there are several GPs practicing in the next village over just a few kilometers away. We have had no trouble making appointments with all sorts of specialists - rheumatologist, ophthalmologist, podiatrist, surgeon. If there's a shortage, we don't see it. And because our GP's fees are controlled, she doesn't employ a receptionist or nurse. She answers the phone and schedules her appointments. Herself. Walks into the waiting room and invites us back to the examination room. Herself. Takes our blood pressure. Herself. Apparently, it's not a big deal. UPDATE: Our doctor has hired a part-time secretary to answer the phone and make appointments. Perhaps the 2€ increase awarded to GPs recently helped.

Healthcare will be rationed. A good friend has been treated for two cancers, her husband has just had two stents placed and is scheduled for coronary valve repair/replacement. Their combined age is over 150 years. We've never had to wait unduly for treatment, never been denied treatment, and we don't know anyone who has been. Insurance companies ration healthcare, not the French. (I know. You've read about Trump and the Pope and the baby on life support. You may disagree with the European Court's decision that keeping an infant of life support when his rare genetic disease offers no hope of a recovery and amounts to cruelty, but the issue was never cost of care.)

Pharmaceutical companies will stop doing R&D if you control prices. Take away their marketing budgets and their lobbying budgets and there's your research money. Nine of the ten top US pharmas spend more annually on marketing than on developing new drugs.

The system is unsustainable financially. Healthcare in France is not free. We pay a percentage of our worldwide income for coverage in the French single-payer system, a fair percentage in my opinion. Each year, our tax returns are used to calculate our payment for the following year. (We pay income taxes to the US and the French get a copy that is submitted along with our French return. By treaty, because we pay the US income tax, we don't pay income tax France. But we do pay the 'social charge' that gets us our healthcare.)

Insurance companies will go out of business. Some of the largest insurers in the world are based in Europe. The French single-payer system takes care of from 60% to 75% of the average cost of care. You can pay the rest out of pocket. But must folks buy supplemental insurance. We have purchased insurance that covers the costs of a hospitalization only and we had many insurers to choose from. UPDATE: Working with our bank - which is more like a credit union because we have to buy shares in order to open an account - we now have more comprehensive 'top up' insurance that will pay for 100% of scripts, doctors, and most other related healthcare items for the same price as our previous hospitalization-only policy. We'll see how well that works.

So I guess that the Constitution really IS a suicide pact. Because the only reason not to go to Medicare For All is to preserve the 'free market' in health care that leads to lower life expectancy, greater infant mortality, and greater child mortality. God forbid that we should value the lives of babies and children over the for-profit healthcare system that costs us twice as much per capita as the French system, shortens our lives, and kills our children.

Let me be clear. We love America. We were fortunate to have been born in such a place and at such a time when plain folks like us could make the decision to live anywhere in the world that suited us. So we chose a place where the weather is kind to our aging bones, where there are new places to explore, new people to meet. Why shouldn't we? Proud Americans can and should live where they choose.

But being proud Americans doesn't mean that our vision isn't clear, that we don't want the best for our country and its people. That's what America does, creates the best way to do things or adopts a better way if shown. That's what has made America strong and that's what can keep America strong.

As a post that falls into a couple of different categories, you can read more about my political views HERE and more about my thoughts about life in France HERE.



8 comments:

  1. A clear and cogent read, Ira. Items that matter! My own light experiences with the medical world in France agree with yours. Imagine, the doctor invites you in HERSELF! (I also experienced this once in Paris, and then again in the Haute Provence.) Looking forward to seeing you and Cathey tomorrow!

    ReplyDelete
    Replies
    1. Thanks for your kind words. I'll enjoy your visit even if you didn't bring Nathan's Hot Dogs...

      Delete
  2. Well done, Ira! Sometimes it's hard for us Americans loving life in France. When we point out advantages of life in the US, we're accused of being disrespectful to our host country. If we have criticisms of almost anything in the US, we're accused of being unpatriotic or even traitors.

    I've lived in France for 17 years, speak the language fluently and even have a French passport...but my heart will always be American. Just last night we went to a concert of some friends' of ours who have a rock group, and they played a new song about the American dream. They each apologized to me afterward, because it was very cynical (though I did agree with most of it), but I just said that it's good to dream. Yes, the country is having a rough time these days, but it's certainly not because of our ability to be optimistic or work hard to make our dreams come true. If anything, that's something our French hosts could use more of...

    ReplyDelete
    Replies
    1. Thanks for the kind words. It's a thin line that we walk, loving our new country while at the same time having a deep and abiding appreciation for the country of our birth. It's not an Either/Or proposition, though some would have it so.

      Delete
  3. Just one question.
    Do you pay taxes in USA? And why does france deduct them.
    Do you mean that you file your tax return, does money go into the us coffers in fact.
    Why would France give you a break on that.
    Something is puzzling.
    So, are you French residents, or USA residents for tax purposes. How do you qualify for French healthcare besides via your health ins. Are you being subsidized by French income taxes as other native residents.

    ReplyDelete
    Replies
    1. Yes, I have declared the US as my tax residence and pay income tax to the US. I then prepare a French tax return and, since the amount of tax that I pay to the IRS is at least equal to what I would have to pay to the French, by treaty between the two governments my income tax liability is resolved. Should I pay less to the US than I would to France on the same income, France would get the difference. Since I have filed my American tax return along with my French, the French know my worldwide income and use that for the basis of billing our 'social charges' that pay for our healthcare. Every legal resident of France is entitled to healthcare as long as they pay. And in order to become a legal resident, you have to demonstrate sufficient income not to become a burden on the state. In theory, the social charges that are over and above income taxes are sufficient to fund the system...in theory. I know it's complicated. I hope this helps.

      Delete
  4. Great article Ira! We're in the early stage of a possible move to France and your articles have been most helpful and informative. Thanks from Paula in Seattle

    ReplyDelete
    Replies
    1. Thanks for the kind words. Let me know if you have any questions. Glad to help.

      Delete