Cow Cow, Duran Duran, Doctor Doctor
Since my column first appeared on this page, I've received more emails about my hair than anything else. Health care, in second place, is a far more appropriate topic for this column (at least in an election year). Since I've lived in Belgium for nearly a decade, it seems I might have some survival tips for Americans who are concerned that Mitt Romney won't get the chance to repeal the "European socialised medicine" programme known as Obamacare (previously Romneycare). To lend an air of Soviet gloom, these questions often include words like apparatus, as in: "To get treatment from the European health apparatus, do you bribe the doctors in cash, or is livestock better for tax reasons?"
Let's start with my hair, shall we?
The author's bump-concealing haircut [left], and Simon Le Bon in the 80s.
Back in high school I always brought my single of "The Reflex" along to the barbershop and asked for Simon Le Bon's haircut. (This one time, while queuing for tickets to "St. Elmo's Fire," a cute college girl actually told me I looked just like him. I was absolutely ecstatic until she added, "Duran Duran is so gay.")
I kept the haircut long after it went out of style. For almost 20 years. Why? Secret revealed: the Bruce Willis look would have revealed an ugly bump on my head. I figured it was better to look like an ageing pop groupie than an anvil-struck Elmer Fudd.
Bumps like mine, known to doctors as trichilemmal cysts, are usually harmless. Excision involves a quick procedure that requires a surgeon, a nurse, some rust-coloured disinfectant, a local anaesthetic and some stitches. They often grow back, which is unfortunate – unless you want to compare how different health systems work. In Europe and America, I've seen enough doctors about a getting a "bump-ectomy" over the years to write this (speaking of livestock), my own version of the classic "You Have Two Cows" meme:
You have a bump on your head...
Uninsured in America. You are an uninsured waiter. For $200, a specialist tells you it will cost around $10,000 to remove your bump. You cannot afford it.
Underinsured in America. You are an independent consultant. For basic coverage with a $2,000 deductible, you pay $6,000 a year, some of which goes toward paying your insurer's CEO more than $100 million. For a $20 co-payment, you learn that your insurance will cover 80% of the cost after your deductible. So you'd pay $3,600. You cannot afford it.
Fully Insured in America. You are a member of "The 58%"of Americans who enjoy The Best Health Care in the World. You and your employer pay about $2,000 a year in taxes to fund Medicare, which is for old people. For yourself, you pay premiums of $1,200 per year on top of the $7,200 your employer pays – all pre-tax, your personal entitlement from the biggest subsidy in the U.S. budget ($208.6 billion in 2006). You pay a $20 co-payment to see your Primary Care Physician, your gatekeeper to specialists. You then pay a $20 co-payment for the surgeon, whose clerk says your insurance will cover 80% of the $10,000. You pay $500 up front and work out a payment plan for the $1,500. About four months after you called for the first appointment, you are bump-free and all paid up. About a year later, you have a new haircut and a new job in another city. Another year later, a collection agency tracks you down; due to a problem with "the codes," your insurance company didn't pay the doctor in full, and you are being held liable for the difference plus 18% interest – nearly $4,000. Threatened with legal action and a bad credit rating, you hire a lawyer who charges $300 an hour. You can say it's been resolved.
Uninsured in Belgium. You are uninsured because you are an American tourist. A surgeon answers your phone call himself. When you see him the next day, he answers the door. You are told removing the bump will cost €300, including €100 to the hospital for an hour in the operating room. When you volunteer that you have no insurance, you are told sympathetically that none of the €300 will be reimbursed to you – and that if you bail out now, he still expects €40 for the consultation. A week after you called for the first appointment, your bump is removed. About a year later, back in America, you receive an urgent-looking letter, written in Dutch; the only thing you understand are the numbers and name of the hospital. Fearing the worst, you type the text into Google and learn that, because the operation took only half an hour, the hospital wants to wire you a €50 refund.
Insured in Belgium. Employed or not, you are required to pay about €10 a month to the private, not-for-profit insurance company of your choosing. You have a job, so the government also takes about €7,200 of your taxes for health-related costs each year – enough to cover you plus one non-worker (perhaps a child, a retiree or a "lazy welfare queen"). Two days after the excision, your insurance company reimburses all but €67 of your costs.
Is Romneycare/Obamacare changing things? Absolutely. Millions of Americans are being elevated from "uninsured" to "underinsured." Kids are able to stay on their parents' policies until they are 26, and people with pre-existing conditions have the right to pay the same ridiculous premiums for insurance (plus not more than $5,950 out of pocket each year) as everyone else.
The only way America is becoming more like Europe, though, is that a lot of its twentysomethings are moving back home. Still worried? My next column will list 5 Ways Romneycare/Obamacare is not "European" at all.
Until then, whose picture do you think I should bring to the barbershop?
This is the first of two Continental Divide columns on healthcare. The second one appeared on 29 October.