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Thursday, June 12, 2014

How to be Uninsured in France

Well, this is a fine situation.  I'm not sure how it happened but I apparently have no health insurance here right now.

Just before we left for Canada I received an urgent note from the cancer clinic saying that they needed an attestation, a piece of paper that confirms that I am indeed covered by the French national health insurance.  I found that odd because in 2012 I was  accorded something called the 100% which covers my care through my cancer treatment (five years).

My spouse was in the neighborhood of the social security center so he went and asked for the document and they replied that we should just go into ameli (a website for the insured where you can do basic stuff like payment info and address changes) and download it.  Well, we tried and the darn system said, "Sorry, no can do.  Come down and see us."


So on the way back from church and my weekly visit with Madame G I stopped by to see what was up.

After giving the lady at the counter my insurance card and the note from the clinic,  she consulted my account.

"You have no rights!" she said.  And I said, "What?

And then we tried to figure out what happened.  Do you work?  said she.  No, I replied.  Are you getting unemployment?  No.  What are you doing then?  Uh, living?

I swear that the woman was more upset than I was.  At one point I said, "C'est pas grave." (It's not a big deal) and she shot back, "Oh, yes it is, Madame."

Here's the deal.  I was covered for two years after I took myself off unemployment at which point I should have gone down and had myself added under my spouse's social security number.  I didn't know, there wasn't any notification and so they just cut me off.

All fixable.  She gave me a form (isn't there always a form?) and a list of documents to gather and bring back to them and then they'll work their magic so I will be insured again.  I thanked her profusely for her kindness and went home and had coffee on my back porch.

Another bit of business to add to the already very heavy load of paperwork to be done this month.  For those of you not in the know June 15 is the date for Americans abroad to either file their US taxes or ask for an extension.  June 30, of course, is the date to file those loathsome FBAR's (Foreign Bank Account Reports).

The French taxes have already been filed.  All on-line and the few questions we had were ably answered by a nice gentleman at the local tax office.

Looking at all this I find it interesting that on the French side none of this administrative stuff stresses me out.  Systems and procedures are not always well-designed but there is access to real live competent human beings when there is an issue.  Above all, is the sense that they are on my side.  They want me to be insured and they want me to pay my taxes (and, yes, I do see the connection between the two).  And there are people available to help to make both of those things happen.

On the American side is, well, not much trust at all.  Just a lot of stress when I look at the arcane language of the documents designed to "help"; a certain frustration with systems that don't work very well (I had to contact tech support via email last year for the on-line FBAR);  and above all precious few human beings to talk to if something does go wrong.  Not the fault of the US government agencies, by the way, but of their political overlords who seem to think that handing them major legislation to implement and then starving them for funds will have some sort of beneficial outcome.  How they think they can square that circle is beyond me.

I don't like to make comparisons between my home and host country - it is unfair because different doesn't mean better.  It's entirely possible to have divergent means to reach similar objectives.  But I have this uneasy feeling that efficient delivery of public services by dedicated, independent, and competent people (folks mandated to do their very best to help their fellow citizens navigate the systems that lawmakers have made) has been under attack for some time now and we are now in a vicious circle where because there are limited funds, service is poor; and so the average American is left wondering why he should pay taxes at all.

I find it rather ironic that here I am in France - a legal resident but not a citizen - and I have more faith and trust in the French bureaucracy then I do in that of my native country.  Yes, I have had bad experiences with bureaucrats here but overall it's been rather good and yesterday's experience was one exemplary example.

Ronald Reagan once said, "The most terrifying words in the English language are: I'm from the government and I'm here to help."  A rather broad indictment that is subject to diverse interpretations.  Let me be very unkind here and note that he said "English language" which implies that it is Anglo-Saxons who are simply incompetent (or have evil motives) when it comes to government.

Rubbish, I say.


Inaka Nezumi said...

Glad to hear your insurance issues are easily sorted out.

I know what you mean about taxes. Japanese taxes can be done on-line for free, any questions can be quickly resolved by talking to a live human being, and the rules themselves are a lot simpler to understand than the IRS rules. I feel more satisfaction and civic pride getting my Japanese taxes done than my American ones (which just make me feel aggravated and abused), and I'm not even a Japanese citizen.

Bruce B. said...

Maybe it's time to consider getting your French passport? ;)

Christophe said...

What an interesting post.
I am glad your insurance issues are straightened out - or will be soon.
You mention that people in the US don't want to pay taxes because of the poor services they're getting. My feeling from living here is that the reason is different. I came to realize - and as everything, it should not be generalized - that the American society is a lot of more selfish than other societies. They don't want to pay taxes because they don't want to pay for things that they think other people should not get for free. In the case of healthcare, it is different. They don't want to pay for a single payer type system, because they don't want to purchase a product that they don't think they need - which is totally wrong and BS to me, as everyone eventually needs care. Most Americans just don't believe in being social and pay for things that others will use.
It is freedom pushed to the extreme
The things that strikes me though, in the case of healthcare, is that they'd rather get money through fundraising than getting it through the government in the form of health insurance, which is interesting. It goes against another pillar of the American society, which is pride. I see fundraising to help pay someone for money to afford medical care as begging - not much different than a homeless person asking for money at a street light. I find it very diminishing. I honestly rather die than doing it. I have my pride.
On the other hand, they're very good at getting together in responding to catastrophic events.

P. Moore said...

First, I must say I am glad to hear you are able to sort out that insurance hiccup without too much is much too important to lose.

Secondly, I have to say the entire post is quite interesting. I am particularly intrigued by your point that your seem to have more faith in the French government than that of the US. As much as the French live to tax heavily, they seem to deliver some quality services for those taxes. I sure can understand how it is hard for you to do those IRS, Fbar returns each exchange for what?

Catherine said...

It's so good to hear the insurance was sorted out easily. It's a bit more tricky in Canada with the provinces. Oh, but in England - that is quite smooth too, you just need to intend to stay more than 6 months and you are covered. As you say, different doesn't mean better - but it can certainly mean more straightforward.

Victoria FERAUGE said...

@Nezumi-san, Interesting. That certainly jibes with my experience. In Tokyo there was always someone at every metro station who would jump out of his little office to help you if you were having trouble with the ticket machines. It was wonderful.

@Bruce, Yes!

@Christophe, Good point. There are things that Americans don't want to see public. But for older Americans they remember (and expected) things like bridges to be repaired, librairies to be open, schools to have books and local, state and federal agencies to be staffed with efficient helpful people.

And that may be why, according to my father, US social security (In the US that's the government retirement program) still has really good service.

"One of the most efficient, helpful, competent government entities I have ever dealt with (and in my practice I deal with a LOT of different government entities of many kinds) is the U.S. Social Security system
and the related Medicare program. The level of helpfulness and
competence that your mother and I have both experienced with them is amazingly high. Others have given me the same observation.
advice was complete and thoughtful."

@P. Moore, I would say so. For example there is a tax office I can WALK to if I have a question. Same with social security. Or the prefecture. Sure, some stuff is now on-line but you can always find a human being here to help you. Public servants make bureaucracy tolerable. And it's worth the price, I think, that we pay in taxes here. So what if we pay more than in the US. It's worth it. Or so I think.

Sauve said...

I agree with you entirely regarding help in the states compared to help in France when it comes to the taxes and health care,Victoria. I think you are right Christophe. American didn't use to be like that. My parents were not rich they were just simple working class people. But we were taught as children to set aside some of our allowance to send to people in poor countries. The thought was that there were plenty of well paying jobs for people living in the land of the free and the brave. Sure there were a few people who were disabled and they got disability payments. The very poor still had roofs over their heads and could get by, we thought. We never did think that a fellow American who was not a drug addict or an alcoholic could be forced to beg. It simply was not possible in our great country. That all changed with Reagan.

I don't think Americans are good at responding to catastrophic events. Katrina proved that out. America is good at responding to those catastrophic events that effect big businesses and finance, but for the most part the citizens are on their own and being as such they live in fear. What they are thinking is: 'If I give away my security I won't have it when I need it'. The problem is, they are right.

Donna said...

Great to hear that your insurance was sorted out, and with so little drama!

Two days before the deadline, we are still lost in the maze of FBARs, 3520s, and 8938s. We have visited the local IRS office, phoned the "help" lines, and not one IRS representative will help. Never mind "can" help--they will not answer questions, will not let us speak to a supervisor, and direct us to call phone numbers we've already tried. This train wreck in contrast to the UK, which sounds much like France and Japan--a relatively straightforward tax code, real people to whom one can turn for assistance, and no need to hire a "tax professional" who may or may not be competent in this area.

It's understandable why very high net worth individuals renounce, but now I'm beginning to understand why everyday people (for lack of a more elegant term) renounce as well.

Carolyn said...

Well said, I agree with you 100%. I did my French taxes serenely, but doing the US ones put me in a very bad mood. It's funny because France is well known for its bureaucracy (so aptly named "paperasse"!), but I also have great faith in the "system" and feel that, in the end, the system is on my side... In contrast, the IRS makes you feel guilty and it's up to you to prove you're innoncent!

Anonymous said...

A couple of reasons that the US culture of pioneer independence is creating problems. It is to beat one's head against the wall to watch the most economically disadvantaged citizen vote for politicians who want to strip way the services that they require. Promoted by the illusion that they will be robbed of their basic independence if provided with decent retirement and healthcare. The idea that we can make decisions regarding our long term economic future is not playing out well for many. Social Security is a great baseline income but generally, particularly in cities, far from providing a "reasonable" standard of living for most retired people. And cities are where accessible services are clustered for the elderly. If you believe my broker most people retire with less than $80K in their personal retirement accounts. Bringing us to Medicare, boy do most of us need it. ACA,(Obama-care) adds a layer of support to medicare. An important feature of ACA is the ability to buy insurance. previously denied to those of us with chronic illnesses. You know the people who need it the most. So, why do we distrust the providers of the most basic of services and why do we believe that everyone in the government is out to get us - its a puzzle to me but boy does it play to the crowds in the lower ranges of the economic scale in the US. It sucks.

Victoria FERAUGE said...

@Sauve, I remember much better service in my chilhood in the US and I certainly remember very good service at the US consulate in Paris back in 1990. You could go any time and show your passport to get in. There were helpful people to answer questions and provide things like the etat civil for the French authorities. There was even walk-in service at the Paris IRS. A lot of that is gone gone gone.

UPDATE - I went back to the social security offices with the formed filled out and signed. Again the service was impeccable. Yes, I had to take a number and wait but when it was my turn I was treated very well and she took the time to explain things to me. She even promised to try and expedite things. Very nice.