OP-ED

My Return to American Health Care

A year and a half ago, my husband, James Morgan, and I moved back to the U.S. after living 10 years in France.

We returned more or less kicking and screaming. We had been away long enough to lose some of our American culture and to prefer the European way of life, despite our squabbles with it–and every American abroad has some squabbles. I had discovered I was a born expat, something I’d suspected my entire adult life — from my first trip to Europe when I was 19 years old–but hadn’t arranged to test until my younger daughter graduated from high school. Jim and I are both writers, and I’d thought of a book idea for him (Chasing Matisse) that would take us to France, and my intention was for us to stay there.

But there were things we’d left undone for the 10 years we’d been away that needing tending to — life was calling us back. And if the truth be known, I felt France was falling behind in the world, and her inability to change was grating. Paris was stuck in her perpetual stupendous, effervescent beauty, while nothing new happened there at all. This city I love more than any other had long since lost the artistic dynamism that had propelled it forward with Picasso, Matisse, and the other artists that the Lost Generation had adopted and promoted in the early part of the 20th century, when Malcolm Cowley wrote his classic Exile’s Return.

The World Wars had crippled France for a time, and she had gotten back on her feet. But what the French do so very well is the past — not the present or future — and this is even truer in our digital global society. The French refusal to change defines the Gallic nation in every way imaginable, and the centuries-long celebration of their grand culture is what we love about them — and is also placing them in the rear of the international pack.

Except for this — their Number One in the World (as determined by the World Health Organization) health care system.

One of the things I most dreaded about returning to America was having to deal with a health care system that was an embarrassing national wreck.


In the years before I left for France, I had been misdiagnosed with an autoimmune disease that wasn’t that at all, but rather a visceral reaction to the stress of my dear brother Brent’s illness and death from AIDS. But I was punished by being denied insurance, though we eventually found a company that would take me for a much higher price. I’ve always been a healthy person, still am, but this was a constant we had to deal with until we moved to France, and I carried a lot of anger about the abusive nature of American insurance companies.

When we moved abroad, we arranged for international health care policies that proved to be perfectly fine. After a year or two, I quit seeing my American doctors when I was visiting and found French physicians to take their place. Not only that, my experience with French doctors was far superior to the cattle call of my physicians’ offices in Little Rock. I’m not saying the doctors themselves were more knowledgeable or better trained. But in Arkansas, it took me a year to get an appointment with my gynecologist, and I sat in a room with 20 other women who were waiting to see physicians in this group. The nurses weighed, measured, questioned, and instructed me until I was half-naked sitting on the examining table, and the doctor came in to check me out and issue her report, then she was out of there. Don’t get me wrong. I liked my doctor a lot while hating the factory process I was put in.

At my excellent gynecologist’s office in France, I saw another patient only one time. The usual procedure was that I arrived, sat down in the doctor’s salon-ish waiting room, and waited a few minutes until she met me at the door and ushered me into her office. We talked about my history, what was going on with me, what problems I might have, and then she took me to her examining room adjoining her office. I stripped and lay on her table, and she did her work. Then I dressed again and sat back down in front of her desk. She wrote prescriptions. We discussed anything else that I needed, and I left through a different door. The whole experience was humane and personal.

Some of my doctors in France also gave me their cell phone numbers and invited me to call and let them know how I was. Nothing remotely similar had happened to me since I was a child in Batesville, Arkansas, and Dr. Ketz made house calls and Gertie, his nurse, chased me around his office to give me the shots I feared.

In Paris, there are emergency doctors that will come to your house or apartment for a most reasonable price. The only time I used one of these services was when my daughter Bret was bitten by a spider in Greece. The nasty black circle only got worse after we returned to Paris, so I called the Urgences Médicales to treat her. They came to our apartment and took care of her, and I believe their charge was 80 euros. Compare that to what you would pay for a trip to a U.S. emergency room.

Then there’s the price of medications: For almost every prescription we filled, the cost was miniscule compared to the same drug and brand in the U.S. When friends and family visited, we got their prescriptions filled in Paris as well. What is wrong with this pharmacological picture?

While I was having my reasonably priced and pleasant health care experience in France, daughter Bret, then a college student, was in Arkansas having stomach problems that kept getting worse. She was sick all the time. After much pain and many doctors’ visits and tests, she had her gallbladder removed. It was a surgery she’d tried to avoid but couldn’t–and what a relief for her when it was done.

But the next time her student health insurance was due — and even though the company had both her physical and her email addresses — they somehow “failed” to send her a renewal notice. By the time she realized she hadn’t heard from them, the renewal date was past, and it was too late to pay the bill, they told her. The company wouldn’t insure her again — she was now the dreaded Uninsured Person — and no other company would take her either. Bret didn’t have medical insurance for the next two years.

Despite her excellent academic record and internship at the Clinton Foundation, she was one of the young people for whom it took two years to find a job. When she finally did, health insurance was part of her package. But in that two-year interim, there were many times she couldn’t go to the doctor when she was sick. They wouldn’t take her. She was charged absurd amounts of money when she could get in. The cost of not having health insurance often means patients pay more. Her bills were ridiculous. And preventive care for Bret was nonexistent.

During the health care reform debates in 2009, I couldn’t believe how many Americans were set on defeating themselves. They seemed to feel that they didn’t deserve to have health care — and that the mightiest nation in the world shouldn’t help provide affordable health care for its citizens. Many of those shouting the loudest and meanest didn’t seem to understand that they were already on the government dole with their disability, Medicare, Medicaid, and Social Security payments. The new fringe GOP had succeeded in making anti-intellectualism the new ideal — the dumber the leaders the better, the dumber America the better. The more fear these talking heads could inject with loud rants of misinformation, the more power they gained.

The French thought the U.S. had become a nation of crazies, and I agreed with them. I knew one American who couldn’t get insurance if he tried, and yet he vociferously denounced the idea of his countrymen receiving affordable care. He proudly touted his informed opinion on this fraught subject as the result of his habitual watching of Fox News. Another acquaintance condemning affordable health care had had a bout with cancer–would never be insured again–and had coverage only through his spouse’s work policy. But he was dead set against his fellow Americans receiving the health care they needed.

How pervasive is American self-hatred? And how amazing that this cadre of conservative lawmakers and right-wing ideologues want affordable health care for themselves and their families, but have convinced the Common Man that for the good of the country he can’t be insured. Charles and David Koch are backing the anti-Obama group Generation Opportunity, which promotes the idea that young people should remain uninsured when the Affordable Care Act goes into effect next year. The group’s M.O. includes creepy commercials of Uncle Sam doing gynecological and prostate exams.

One might expect that David Koch would want his own three children to be insured, and he himself has had prostate cancer for two decades. What if he were a cancer victim with no money? If he holds no personal compassion toward others, nor any sense of civic duty, he might at least have an understanding of noblesse oblige.

And so it is this cacophony of conservative rants against Americans having affordable health care that we former exiles have come home to. Without any thought or notion that so many of our countrymen have been ruined by catastrophic illness and treatments, and that we in fact deserve to have what every other civilized Western nation takes for granted.

The whole time we were in France, I was afraid that if we ever returned to the U.S. I could never get back into the health care system again — that the insurance companies would find some reason not to take me. And they probably would have, had we not made sure to keep our international health insurance in force.

I do have insurance here now, but that’s after having to sort through a maze of incomprehensible insurance plans and an onerous system. I’ve been to the doctor one time since I returned from France, and this for a colonoscopy. I had been assured that the procedure would be 100 percent paid for by my insurance company since the procedure falls under wellness guidelines. Then the office staff member said, “But if we find something, they may say it’s not wellness after all, and you would be charged.”

I almost threw up my hands and walked out. If U.S. insurance companies don’t gig you one way, they’ll find another. I still wondered if this exile should just fly to France once a year for excellent and affordable health care. But instead — at least for now — I’m going to go to the HealthCare.gov Marketplace and give our new system a shot. As someone who has lived where getting health care isn’t a nightmare, I know that what the Republicans and tea party really fear is that Americans are going to discover how wonderful it is.

Beth Arnold is an award-winning journalist and writer. You can follow her at her personal website or at The Huffington Post, where this post originally appeared.

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CarolDr. Rick LippinPhilip LawrenceBob AndrewsAndy Recent comment authors
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Dr. Rick Lippin
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Dr. Rick Lippin

Leslie- I would personally be for what you propose

Thanks

Rick Lippin

Dr. Rick Lippin
Guest
Dr. Rick Lippin

Thanks so much Beth- Here is where the US must go-soon- Here is my grossly overly simplified US “Healthcare Plan”- – Close 1/3rd of US Hospitals within 5 years. There are too many and too geographically concentrated. Reward efficient ones who don’t horribly gouge/rape the system- Have you checked your hospital bills lately? – Every US citizen DESERVES as painfree and as dignified a death as modern medicine has to offer- Have you checked the medical expenditures in the last 6 months of “life”? – Strong emphasis on both individual (behavioral change) and institutional (public health) prevention. We need both.… Read more »

Leslie Kernisan, MD MPH
Guest

Rick, overall I like your key points.

Wondering whether you think replacing Medicare with ~3 very regulated non-profit insurers should be considered…I think this is what they do in some european countries, and it occurred to me at one point that it might be good for patients and providers if there is more than one game in town.

Bob Andrews
Guest
Bob Andrews

By the way, as far as your ridiculous statement about “this cadre of conservative lawmakers and right-wing ideologues want affordable health care for themselves and their families….”, you might want to be a little more responsible as a “writer” and do a little more research. ALL of Congress and their families are exempt from ObamaCare….Democrats and Republicans alike. So doesn’t this equally apply to liberal lawmakers and left-wing ideologues in our government?

John Ballard
Guest

Mr. Anderson, your comments would be more persuasive if they were heavier on facts and lighter on politics. The old trope about Congress being exempt from Obamacare is a dead giveaway. You might want to do a bit of homework before you repeat that. Meantime, I’m leaving below a link with a string of additional links to other places that you may find interesting. Yes, I’m an old-fashioned Liberals but not all of us are as bound by ideology as you might imagine. I’ve been following health care reform efforts since long before the legislation was crafted, beginning with some… Read more »

Philip Lawrence
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Philip Lawrence

The ACA is way overkill and burdensome to both individuals and businesses. It also strips out individual choice. The government could of accomplished a lot just by limiting billing to individuals without insurance to a set maximum (e.g 200% of medicare rates). In the “old days” before ACA, you had to have insurance just to protect you against outrageous bills in the event you were hospitalized or had to go to the emergency room.

John Ballard
Guest

I’m sorry you didn’t take time to read the links I furnished. The “government” has done nothing more than put into legislation a private sector Rube Goldberg contraption designed never to “limit billing” in any way other than whatever private sector managed competition might yield. MLR was as close as it comes, and even that has no real limitations on billing. As for businesses, there is no reason for employment to be linked with health care. None. Policy wonks on all sides have agreed on that for years but no one has figured out how to uncouple them. The Bush… Read more »

Bob Andrews
Guest
Bob Andrews

What a pile of crap. This is the same b.s. Leftists like you have been spouting for decades…..everything European is SO divine while everything American is so messed up. And you compare the entire U.S. healthcare system to France’s based on your experiences in one tiny Arkansas town? Isn’t that just a bit myopic? Your selective outrage at the “greed” of the insurance companies is revealing. Why do you suppose you have to deal with a “maze of incomprehensible insurance plans and an onerous system”? You’ve never once considered the remote possibility that it’s due to the over-reaching, red-tape-strangled, regulatory… Read more »

Legacy Flyer
Guest
Legacy Flyer

John Ballard, So you would characterize screening as trolling for business? And you think the harm of the false positives outweighs the good from finding real cases earlier? And you think nobody has raised these issues before? If so, you haven’t be paying attention to the lively debate that has been playing out here and in other places about the proper role of Mammography and PSA screening. You have the option of “voting with your feet” and not getting screened. As for me, I will get my Colonoscopy, PSA and recommend to my female friends and relatives that they get… Read more »

Legacy Flyer
Guest
Legacy Flyer

Gnarl,

Thanks for clarifying the data on infant mortality and cancer.

So you will admit that we do better on many types of cancer than the French.

arf
Guest
arf

The French have their version of Medicaid, and French Medicaid recipients have their own trouble accessing healthcare.

http://www.liberation.fr/societe/2009/07/01/trop-de-medecins-refusent-les-patients-pauvres_568006

John Ballard
Guest

Having spent my working life managing the working poor, my guess is that if only one fourth of American doctors refused to see or treat them many would think they had died and gone to heaven. Seventy-five percent participation is better than zero, which is what has been true for millions too poor (until ACA) to afford insurance but not yet destitute enough to qualify for Medicaid.

That’s for basic medical care. For teeth or hearing, fuhgeddaboudit, even now.

arf
Guest
arf

That’s just one article. I’ve seen estimates of 40%. Varies across the specialties, same as here. Also the same complaints about going years to find dentists.

That an American yuppie can access great healthcare in France is not surprising.

Show me what’s it’s like in their baniieue.

David Macfarlane
Guest
David Macfarlane

Wow. All these learned, data-driven folks who experience daily how the American healthcare system is a disaster-on-the-cusp looking for a compelling event, and all it takes to inspire defensive fits is the mention of France. I will sum up the responses to Ms. Arnold in hopes that it can benefit readers who may follow. 1) Yes, our system sucks, but it’s our system, dammit. 2) You’re a liar about that whole gyno exam thing. 3) Go back to France. Note to Beth Arnold: Next time you go abroad and elect to write about your experience after the fact, choose a… Read more »

Malligan
Guest
Malligan

Trying not to add screed to this thread, let me note that France is not at all homogeneous. Walking around Paris, you will see plenty of black, Muslim and Asian residents. But the French government does not keep statistics on race or ethnicity for fear that minorities might face discrimination (which of course they do anyway). So even with a diverse population, France has the No. 1 health care system in the world, according to the WHO. The US ranks No. 1 in one category, though: expense. It ranks No. 38 in overall quality of its health care system. But… Read more »

legacyflyer
Guest
legacyflyer

Malligan, Thanks for your response. I would like to see the vitriol dialed down a bit. It isn’t necessary and it doesn’t help. I have no doubt that the French have a good health care system and I also believe that American health care is too expensive. But I am very skeptical of numerical rankings – whether for “best colleges”, “best hospitals” or “best healthcare systems”. Several points: DVT is rarely fatal, in fact its most serious complication pulmonary embolism is usually not fatal. I have a great deal of confidence that your surgeon friend would be alive had he… Read more »

Andy
Guest
Andy

The cost was not for a splinter. It was for an emergency room visit. People misusing the ER and its resources like that pushes up costs. Why didn’t you go to your own doctor or an urgent care clinic? An infected splinter is not an emergency. That’s why you had to wait a couple hours because people with legitimate emergencies were triaged ahead of you. Anecdotes like this show that though we have real problems, much of the animosity towards US healthcare is contrived. To go to an emergency room with a trivial ailment and expect emediate treatment for little… Read more »

Carol
Guest
Carol

I’m glad you had a good experience with French emergency care, but do you really think the same wouldn’t have happened in NY or LA or Chicago, or most US Metropolitan areas. And, French emergency response killed Princess Diana, so your experience is maybe not the norm?

John Ballard
Guest

This comments thread is as instructive as the post. I’m tempted to jump in but these defensive, ad hominem attacks underscore Ms Arnold’s points better than anything I might add.

Burt
Guest
Burt

I came here BC of your tweet about the vitriol. But it all seems to be yours. You call half of the country dumb, characterise all conservatives as ignorant Fox News watchers and seem to have a personal vendetta against a system that didnt insure your daughter for a mistake she made while mom and dad were playing Euro. Most college kids don’t grow up fast enough to understand how mistakes like that can cost them. Regardless of where the mail is, its your job to pay the bill. What’s ironic is you hit the nail on the head. Health… Read more »

Carol
Guest
Carol

I would add to your point about her daughter – it has been my experience with all my college sons that the school sends an email about the student health insurance each semester, and in most cases, students need to opt out and prove that they have other coverage. So that part of her story does not ring true.

LegacyFlyer
Guest
LegacyFlyer

One other thing. And I don’t have the references for these “factoids”… One of the bases for French medical superiority is their allegedly better neonatal mortality. It is my understanding though that the statistics are not kept the same way and that many cases that are called “neonatal mortality” in the US are called “stillbirth” in France. Hence their alleged superiority is based on apples and oranges statistics. Also, I have heard that US mortality for many cancers is significantly better than French/European rates. I hesitate to present either of these as facts since they may actually be “urban legends”… Read more »

Gnarl
Guest
Gnarl

On the subject of infant mortality/neonatal mortality, it is basically an excuse. Easier to make an excuse than to adress a real problem. The US actually registers more stillbirths than France, as well as having a higher infant mortality. And a higher under-5 mortality, and a higher maternal mortality…There are simply more deaths of mothers and children across the board in the US. Also, the notion that the US performance on infant mortality is based on different measuring criteria fails on several points: -It assumes that infant mortality is some kind of standout in US perfomance. It is not. The… Read more »

John Ballard
Guest

Thanks for this.

I’m glad you mentioned screening. By golly, we get extra points for screening (http://www.cancer.gov/cancertopics/pdq/screening) since every medical specialty under the sun spends small fortunes trolling for business.

We don’t hear much about the consequences of false positives, and even when we do most people blow them off as inconsequential — except for those receiving invasive or other procedures for which they are still expected to pay.

LegacyFlyer
Guest
LegacyFlyer

I will say that I am fairly pleased with the American Health Care system – at least in my interactions with it. I wait very little time to see my Internist. I have his email address. When I sit down to talk he doesn’t seem particularly rushed and has enough time to deal with my problems. (he makes housecalls too, although restricts that to shut ins) I have not needed any major surgery recently, but have had some knee surgeries in the past. They went well. I have had colonoscopies that were quick, efficient and painless. There was a small… Read more »

Carol
Guest
Carol

Excellent points.

Leslie Kernisan, MD MPH
Guest

Crikey. I am really surprised by the tone of these comments and the vitriol aimed at the author and at France.

I liked this post and thought most of it rings true. It IS crazy, the way we manage health insurance in this country, and I’m sure it’s true that the healthcare experience is often much more sensible and pleasant for the average person in France than in the US.

That particular tidbit about the colonoscopy at the end is a priceless example of the inane things that our citizens must contend with. Thank you Beth Arnold for this post.

Peter1
Guest
Peter1

“this loopy anti-American screed”

Typical, cut off discussion/debate with the anti-American grenade.