Space: the final frontier. These are the voyages of theStarship Enterprise. Its five-year mission: to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no man has gone before.
Growing up in the USA and watching the transition to a more formal European Union (EU), I often thought of the EU, like I did the Starship Enterprise. Peaceably bringing together nations that had been squabbling amongst themselves (to put it mildly) for hundreds of years, if not millennia, is an amazing feat. Creating a common monetary union, even more amazing.
Living in France, I will admit that I still have a very romantic view of the EU. The EU represents progress and peace. Open borders, freedom of movement. This is the world we would all like to live in. At the same time, there are sacrifices to be made. Outside of a common monetary system, the nations of the EU do not share political systems, economic systems, systems of health care or do they even have standardized accounting systems. Each nation is unique and relatively independent. Certain countries have stronger economies. Others have better health care. Some have higher wages. Not even road signs are universal between countries.
Who Lives In France?
Today, over 10% of the French population is foreign born, overall unemployment is near 10% and unemployment for young adults is near 25%. France also has a higher average income than all but a handful of EU countries. Open borders in the EU, mean that anyone from an EU country can come to France and access both the health care system and legally work. Once you have met certain basic requires for legal work in France, and you become unemployed, you are eligible for unemployment. Unlike the US, there is not a cap on how long one can pull unemployment and it is not uncommon for individuals to work a 6-month contract and then take unemployment for 6 months, before taking a new contract. Affordable health care, housing assistance, and other social programs make such a life much more easily attained than in the United States.
Social Security, Health Care & Unemployment in France
Work in France is generally salary work and contractual. Most blue collar and even your average white collar workers have CODs or (contracts with a duration) of 3 or 6 months. After a certain number of renewals of a COD, companies must either offer employees a CDI (basically a permanent contract of an indeterminate length) or they must let the employee go (often onto welfare until the next contract is obtained).
Individuals who work for themselves (artisans, painters, writers, yoga teachers, etc.) must pay both their employment taxes, their income taxes and a hefty obligatory contribution to participate in the healthcare system. For self-employed individuals, participation in the health care and social security system is generally about 40% of one's income. It is not uncommon for a self-employed person to pay 60% of their income in taxes and social security. Think about this, when you think that the French healthcare system is "free," because it is anything but FREE. Unless of course, you are a clandestine immigrant or a refugee.
How do French Participate in the French Health System?
And, even if you are a French citizen that is self-employed, you are not immediately eligible for social security. You must first pay into the system for at least one year, and pay must pay a minimum into the RSI (regime social des independants). If you don't you are not eligible to be part of the system and you must pay for your own healthcare. If you are a handicap senior citizen, you get a small pension, but you still have to pay into the health care system. Nothing is FREE.
Healthcare is Affordable Out of Pocket
Of course, health care costs in France are regulated. A basic visit to your primary care physician is 25 Euros for an adult (28 for a child under 5). If you participate in the health care system, depending on the reason for your visit, 60% to 80% to 100% of this visit will be reimbursed. If you are not part of the system say a visiting American, you just pay the flat fee, with no reimbursement. If you fall into certain categories, such as that of a refugee, your care is free.
On the other hand, not all aspects of health care are well regulated. Dental work and glasses can be quite expensive. Not all providers work with government contracts and sometimes to get access to newer methods or better care, one must pay out of pocket. Generally, this health care still costs less than the US, but then, many French live with much less than Americans. SMIC (or minimum wage) is a 9,61 Euro an hour in France as of 2015. Keep in mind that French only work 35 hours per week. And pay high taxes. Renters even pay an annual tax for their rental. (Homeowners pay a double tax, one for owning a property, and one for living in said residence.) The average pension for the retired population in France is 1,300 Euros. One could argue that the French are just well enough fed and housed not to complain, but at the same time not to be happy.
The State of French Employment Taxes
In the US, we like to complain about rising costs and stagnant wages. About the low minimum wage, but Americans on average actually make more than the average French person. And, French pay higher taxes. The biggest difference is that health care overall costs less, but that doesn't mean long-term illness or disability don't ruin French lives because they do. What is more, is that the French are actually on the higher end of European pay scales, with the bottom ⅓ of EU countries actually having average monthly salaries of 1000 Euros or LESS. Can you imagine living on 500 Euros a month? In Romania that is perfectly average.
At the same time that Americans question the salary and health benefits of the US Congress, many French (and other Europeans) question the salaries of EU civil servants, who often make significantly more than they ever would in their home country. Imagine that a Romanian EU parliamentarian probably makes about 80,000 Euros a year compared to his or her fellow citizens at 500 Euros per year. I am not even going to get into the number of multinational corporations in the world that are fiscally more powerful than many countries, including a good portion of the EU.
I still like the idea of the EU and globalization is here to stay. At the same time, I think that citizens (and politicians) need a reality check. In the United States, we have a huge problem with a health care system that is a "for-profit system." Healthcare should be a basic right in the USA just as it is in Europe. At the same time, Europe is challenged by the unequal economic footing of its participant countries. Some countries have better health care. Some countries of cheaper healthcare. Some countries, like France, have managed both - better and cheaper care, but at what cost?
IS IT THE RESPONSIBILITY OF FRANCE TO PROVIDE HEALTHCARE TO THE CITIZENS OF OTHER COUNTRIES?
Is it really the responsibility of the French, for example, to prop up the economies of Romania and Greece? Is it fair that Spanish may live and pay taxes in Spain, yet pop over the border to have a surgery? Is it ethical for Americans or Australians to move to France on visitor Visas, but then use the health care system like locals? It may be neat, ideal, and romantic, that EU citizens or World citizens have freedom of movement, employment, and healthcare, but how do we balance the strains on certain systems?
No such thing as "FREE"
Sure, pregnancy after 7 months may be covered at 100%. Delivery may be "free." Most prescribed medicines may be "free" at the pharmacy when you are part of the social security system, but is it really free? French workers pay huge "membership" fees with their salaries and taxes. They may not pay at the doctor, but they do pay before their paycheck ever reaches the bank.At its current trajectory, the French healthcare system continues to be the most expensive in Europe and it is a huge drain on the French economy. And average French citizens are paying for it. It was estimated earlier last year that Parisian hospitals had a debt of 120 million euros from caring for foreigners in 2014. And, every year the debt of the French health care system increases.
Ethical versus Pragmatic
The average French citizen benefits from their own health care system, but the average French citizen also pays for non-paying citizens of other countries to use the French system. For example, it was estimated earlier last year that Parisian hospitals had a debt of 120 million euros from caring for foreigners in 2014. And, every year the debt of the French health care system increases. What happens when the debt of the French health care system becomes too great? How will the system continue to function?
Is it the responsibility of France to provide healthcare to the citizens of other countries?As an immigrant to France (the spouse of a French citizen), I am well aware of how I personally have benefited from French health care. I was able to partake in the "free" system about 90 days after my arrival in France. And before I was on my husband's insurance, I was still able to buy inexpensive prescriptions and pay inexpensive health care costs. Lower than anything I had ever paid in the USA.
Even for a visitor, a standard primary care visit in France costs 25 Euros for adults and 28 Euros for kids under age 5. If you are part of the system, 80% of your feel will be refunded. My American friends, can you imagine that? And, so, when outside looking in, think twice before getting up in arms at French citizens for questioning immigration or their participation in the EU. They see people from around the world, and particularly from around Europe, who have figured out how to partake in the French system, without putting back in their fair share. These expenses to the French system or documented and visible, they are not theoretical. And so I ask you, is it really the responsibility of France to provide healthcare to the citizens of other countries?
