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Exile's Return to American Health Care

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.
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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 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 has been a professional nomad since she returned to the U.S. from France. Currently, her agent is shopping the book 28 days without the internet that Arnold wrote because she was seriously addicted to the worldwide web and needed to get her life back. Since we're ALL addicted to the internet now, she hopes to inspire a movement for each person to take regular breaks from their screens and devices.

Ironically, Arnold has also jumped back into American culture by founding an internet start-up with her sassy daughters. CherryPic'd is coming!

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