FRENCH HEALTH CARE, SOME SILLY STUFF, AND IRAN: #25

FRENCH HEALTH CARE

Even though United Health Care sits at the top of the charts when it comes to denying coverage, and even though those denials have most likely caused many avoidable deaths, those denials are no excuse for murder. It's easy to believe that a denial of service led to the murder recently of United Health Care's CEO because for-profit healthcare in this day and age is an abomination, plain and simple. The data on both the ridiculous costs and the poor outcomes of the American for-profit system are clear and compelling.

Around the world, the United States ranks 48th in life expectancy. France is 13th. Of the world's 38 high income countries, the US has the highest infant mortality rate and the highest maternal mortality rate, averaging about three times higher. That's a disgrace. And yet the US spends nearly twice as much per capita for healthcare than France.

So Americans are dumping profit into a healthcare system that provides lousy outcomes while single-payer systems clearly supply the best bang for the buck. That's not to say that there aren't problems with single-payer systems, though. And the problems take two primary forms, funding and regional disparities in the availability of services.

Funding a single-payer system, if the single payer is the government, means taxes. And we are in a world in which rich folks are spending a lot of money, time, and effort to convince poor folks that they - the rich folks - are being taxed too much. So, incrementally, countries like France with vibrant single-payer systems are falling farther and farther into debt. We just have to look across the Channel to see a country whose single-payer healthcare system is almost completely broken, a country in which Thatcher joined Reagan years ago in making government itself villainous. That populist proposition, in France at least, is joined by a leftist philosophy that rejects any cuts in government services of any type while not having the balls to push for the taxes necessary to completely pay for those services. The result in France is a system that's still working quite well but that is in debt, limping along, waiting for the debt shoe to drop.

Two things have to be said. First of all, I'm an American expat with  limited understanding of the long term history of the various political movements in France and a limited familiarity of the thinking of the folks in Paris that shape policy. I'm just sticking my two cents in and my two cents is worth exactly that, two cents. This is simply the way that the situation looks to me today. And secondly, I report that the French system has never failed us. We see specialists when we must, we have scheduled medical procedures when needed in a timely fashion, and throughout we have been treated with comity and respect. We just have the weird habit of being concerned about the future.

About those taxes. The French pay just under 10% of their salary, capital gains, and most other forms of income to the government as what are called their social charges. Employers contribute as well. Public pensions, like Social Security Retirement, are not taxable. In return, the system pays about 70% of all medical and drug bills. And costs are strictly controlled. Our GP charges the mandated 30€ for each of our several annual wellness visits, less than our copay with insurance in the USofA. We get all but about 2€ back from the public system and from our supplemental insurance for each visit. The supplemental insurance is purchased from a for-profit insurance company, costs us under 2000€ annually, and covers most of the costs that the government program does not. The full cost without any insurance at all for a routine surgery, like for cataracts, runs under 2000€. With our public and private insurances, I paid less than 100€ out of pocket for each eye. Cathey had two dental implants, for which coverage is not very comprehensive, and paid just over 1000€ total.

Over ten years ago, before I left the USofA, I paid $6,000 off the top of my paycheck annually to cover Cathey and was paid $6,000 less that I could have been to cover my employer's cost for insuring me. Do the math. $12,000 not counting out-of-pocket expenses, not an insignificant amount if you have a health problem that your insurance doesn't cover fully. In other words, your not being taxed anew. It's that the money you are paying for your health care is being put in a different pocket, a pocket that isn't worried about how much profit can be realized from your illness.

We're fortunate that we live in a rural region that's close to two small cities, Narbonne and Beziers, featuring not one or two but several hospitals and clinics. We have a wealth of choices. The farther into the hinterlands that you live, the fewer services that are readily available and the farther that you have to travel to get more specialized care. Services do tend to congregate in the cities. It makes sense that retirees often do, too.

That's all for now. Happy to take questions.

SILLINESS - IT'S BEEN AWHILE

There are times that I just can't help myself.

It takes a sloth one month to digest one leaf.

Chicle is a tree sap that is used in chewing gum. You guessed it. Chiclets. Not only can't the body break chicle down, but more recently, they have begun replacing chicle with stuff like synthetic polymers that the digestive tract can't handle either. Your Momma was smart when she told you not to swallow your gum. It's almost certainly gonna come out the other end, whether you realize it or not.

Moving to a different vital bodily function, breathing, did you know that trees produce less than half of Earth's oxygen? Phytoplankton is your friend. Don't plant a tree. Save the oceans.

Enough!

IRAN

If you haven't figured out that the war in the Middle East is Israel versus Iran, you haven't figured out the war in the Middle East. Because of Iran, the government of Lebanon has lost control of its southern half. Because of Iran, the Houthis destabilizing Yemen fire missiles at Saudi Arabia, the UAE, and shipping in the Gulf. And Iran and Putin are apparently the last remaining friends of Assad, that beacon of democracy in Syria, and Iran has just decided to skedaddle. EDIT And as I was writing this, Assad skedaddled too.

Many blame Israel for growing instability in the Middle East. And of course, Western meddling is a convenient bogeyman around the world for folks with grievances to air. But if there is one simple way to bring peace to the Middle East, that is to topple the mullahs in Iran and end that country's sponsorship of terrorism in the region. There was a time when the United States would have tried to do that through covert action by the CIA. It was wrong then and would be wrong now. But that doesn't mean that we should not encourage at every opportunity any movement in Iran that encourages Iranian women to live freely as equals with Iranian men and encourage those Iranian men to dance with their women friends and partners in the streets.

RANDOM THOUGHTS #9 - FELONIOUS PARENTING, RACHEL DOLEZAL, OBAMACARE

FELONIOUS PARENTING
I recently read a news story that left me dumbfounded. It seems that an 11-year-old Florida boy came home to a locked house, didn't have a key, and so he spent an hour and a half shooting hoops in the back yard while he waited for his folks. No big deal, right?

Wrong.

A neighbor called police. When the parents arrived, having been delayed on their return from work by traffic, they were arrested for felony neglect. Cuffed and strip searched. As I understand it, the boy and his younger brother (who was in proper day care) were removed from the home in favor of a relative who quickly asked the state to take over their care. The two boys would have ended up in foster care had the eldest not asked to see the judge and begged to be sent back home. The boys were then only allowed back with their parents under strict guidelines.

My parents were felons. I never knew.

There were even aggravating circumstances in my case. My parents let me drink water straight from the garden hose. For years, I walked a quarter-mile by myself to my school bus stop. And after school, if I wanted to go into town to visit friends, I had to walk a mile, part way along a state highway. In fact, the only rules that I can remember regarding after-school and summer playtime was that I "be safe" and make it home in time for dinner. Often, my parents didn't know where I was and who I was with.

My parents were felons. I never knew.

RACHEL DOLEZAL
Makes me crazy. She's black if she says that she is? Really, Whoopi? Really?

I'm sorry, but facts is facts. Snoop is black. Eminem is white. That doesn't say anything about their music or their audience. But two plus two equals four and not some number approximating four.

There may very well come a day when the preponderance of the population is so racially diverse that it would be well nigh impossible to assign such rigid categories as we do today. Indeed, having worked in an agency that collected demographics on thousands of heads of households over many years, I can attest to the fact that the category 'Mixed Race' has grown from a side note to nearly a plurality. But until we are all the color of coffee (light with two sugars, please), there's reality and there's fantasy. Let's not elevate someone whose reality is as confused as Dolezal's to the level of a game changer.

OBAMACARE
I expect that I will be writing more about healthcare after the Supreme Court publishes its decision on the legality of subsidizing the federal exchanges. But there's one thing that's been simmering among some folks that I know that needs to be addressed - the cost of insurance under Obamacare. Many of my friends oppose Obamacare based on those increased costs. I have three quick comments.

First, prior to Obamacare, healthcare costs in the US were increasing at double-digit percentage rates year after year. Healthcare inflation was a primary driver in increases in the cost of living. How quickly we forget.

Secondly, increases in cost to folks already insured was inevitable given the increased numbers of newly insured, particularly since people with pre-existing conditions could no longer be denied coverage. There were simply not enough young, healthy, and uninsured new signups to keep rates low.

Finally, if you want to address the cost of health insurance, it's time that we addressed the cost of healthcare. Why do we spend twice as much per capita on healthcare in the US than they do in just about every other modern industrialized economy? And having done so, why are our outcomes so far down the list? For a country that is supposed to be a meritocracy, why do we tolerate higher infant mortality rates, higher child mortality rates, and lower life expectancies than our European cousins?