By now I’m accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.
To put it plainly, when free marketers warn that Democratic health care initiatives will make us more “like France,” a big part of me says, “I wish.” It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it’s instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (I’ll conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctor’s office has sent its third payment notice. By the time it’s all sorted out, you’ve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.
In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and you’re done. If you need a doctor, it’s not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe €300 for any one procedure.
And it’s not like the medical professionals in France are chopped liver. In the U.S., my wife had some lumps in her breast dismissed as harmless by a hurried, indifferent doctor at Kaiser Permanente. Eight months later, during our annual Christmas visit in Lyon, one of the best breast surgeons in the country detected that the lumps were growing and removed them.
We know that the horrific amount of third-party gobbledygook in America, the cost insensitivity, and the price randomness are all products of bad policies that market reforms could significantly improve. We know, too, that France’s low retail costs are subsidized by punitively high tax rates that will have to increase unless benefits are cut. If you are rich and sick (or a healthy doctor), you’re likely better off here. But as long as the U.S. remains this ungainly public-private hybrid, with ever-tighter mandates producing ever-fewer consumer choices, the average consumer’s health care experience will probably be more pleasing in France.
What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”
Since 1986 I’ve missed exactly three days of work due to illness. I don’t smoke, I don’t (usually) do drugs or drink to excess, and I eat a pretty healthy diet. I have some back pain now and then from a protruding disc, but nothing too serious. And from 1998 to 2001, when I was a freelancer in the world’s capital of freelancers (Los Angeles), I couldn’t get health insurance.
Kaiser rejected me because I had visited the doctor too many times in the 12 months preceding my application (I filled in the “3-5 times” circle, to reflect the three routine and inexpensive check-ups I’d had in France). Blue Cross rejected me too. There weren’t many other options. Months later, an insurance broker told me I’d ruined my chances by failing to file a written appeal. “You’re basically done in California,” he said. “A rejection is like an arrest—if you don’t contest it, you’re guilty, and it’s on your permanent record.”
It wasn’t as if I wanted or needed to consume much health care then. I was in my early 30s, and I wanted to make sure a catastrophic illness or injury wouldn’t bankrupt my family. When I finally found a freelance-journalist collective that allowed me and my wife to pay $212 a month to hedge against a car accident, it a) refused to cover pregnancies or childbirths at any price and b) hiked the monthly rate up to $357 after a year. One of the main attractions of moving from freelance status to a full-time job was the ability to affix a stable price on my health insurance.
This is the exact opposite of the direction in which we should be traveling in a global just-in-time economy, with its ideal of entrepreneurial workers breaking free of corporate command and zipping creatively from project to project. Don’t even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldn’t have paid if I had controlled my own insurance policy.
I’ve now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? It’s a question I plan to ask my doctor this Christmas. In French.
Matt Welch is reason's editor in chief. This column first appeared at Reason.com.