Unplanned

When it rains, it pours.

Back in January, I made up a 30-day plan for self-improvement. It was mostly OK–I definitely made an effort most days. But what really made the difference was the combination of spring and the lockdown.

Most of today’s photos are from my usual route.

Earlier sunrises and gorgeous weather made it easier to get out of bed, even though I had no work waiting for me. I used the free time to walk and run. I read. Snacking was limited to a daily piece of fruit because we cut back on grocery runs, thanks to the pandemic lockdown.Last week, I set off on a high-intensity walk/run. I am not a good runner. My sprints are a normal person’s trot. But it isn’t a competition–or it is, but just with myself. I “sprint” up hills, jog the flats and walk the descents. I was pleased with my first hill, and was just shifting from a jog to a so-called sprint for the next one when I wiped out.

This is where I fell. Hard to appreciate the view from the ground.

I picked myself up and realized my left arm was dangling strangely, with my hand facing the wrong way. I shrieked and was back on the tarmac, yelling bloody murder. It was just  past the last houses of a village, early in the morning, Nobody came. I managed to get my phone out and to call my husband. I kept screaming.

Finally two guys came running; they had been working in a vineyard and at first thought the screams were kids. They called an ambulance and directed the start of rush-hour traffic around me. A bus came within inches of my head. I hadn’t fallen in a good spot.

If it had happened here, nobody would have found me for hours.

I hadn’t called an ambulance because I thought that was  bit much for a broken arm. No spurtin’, no hurtin’, as a friend once put it. Also, in the U.S., an ambulance can cost a fortune, and getting the bill paid can require many phone calls and emails with the insurance company. But I am in France! Such idiocy doesn’t exist here, or in almost any other developed country.

The volunteer firefighters from a neighboring village came. They helped me up, and if the ambulance had been one step farther I would have passed out before getting in. They put a blow-up brace on my arm and got me to the hospital. I was put on an IV for glucose (I ran before breakfast and my blood sugar was very low) and pain meds and put in a room to wait for an opening in the operating room. X-rays and an MRI showed my elbow was dislocated, with a small bit broken off.

 

The charming anesthesiologist with beautiful eyes was shocked I had heard of his hometown,  Timisoara, and told me about his childhood memories of Nicolae Ceausescu and the revolution. He numbed my arm from the bicep down. I expected a tranquilizer; when I had foot surgery, I was awake but the tranquilizer made everything–even the buzz of the saw–just fine. But no tranquilizer was necessary.I looked out the big window with a view of vineyards and the mountains. Do operating rooms usually have windows? The surgeon had gorgeous eyes, too. So did the male nurse who tried but failed to put in the IV. I have never seen such a concentration of beautiful eyes; I suspect they are all good-looking in general, but with masks and identical scrubs, it’s hard to confirm.

In minutes, my arm was back in place and being wrapped in a cast–no need to cut it open to put in a pin. I was surprised by how many people were in the operating room and impressed by how congenial everyone was to each other and how sweet they were to me. It seemed like a nice place to work.Because it was late, I was released the next day. I had the impression that the orthopedic section had only a few patients. Quietude reigned.

My husband had gotten my carte vitale; no need for other questions about how it will be covered. I will share the cost of my clumsiness when I get the paperwork. We have a supplemental insurance for the co-pays.I can’t drive for three months; after the cast comes off in three weeks, I have to wear a brace for two more months. It couldn’t come at a worse time, when so much is in upheaval. And I am disgusted that the past five months of workouts are getting a setback. I increased my average daily steps to 13,000 from 8,500, lowered my resting heart rate to 59 beats per minute from 64 and lost two kilograms (4.5 lbs.). My sleep quality improved. No more. I did some one-handed yard work the other day and it was a mistake–my bad arm and fingers swelled. Forced rest. Yuck.

I don’t know what my point is here. How the January resolutions got derailed? How the French health system is wonderful? How a small slip can turn one’s life upside down? Or just an excuse to whine? Maybe all of the above.

Meanwhile, completely unrelated, in the what-were-they-thinking department:Cropped sweater over longer  T-shirt on top and cut-off jeans over yoga pants (not leggings) on bottom. Please tell me this isn’t a new thing. Also: why would a sweater exist with short sleeves AND a hood? Sweaters/sleeves/hoods are for keeping one warm. If you aren’t cold, you don’t need a sweater, right? So why does this garment exist?I could do a whole post on misspelled signs. Bazard?!?! It’s bazar–a bazaar. Although it also means “mess,” “junk” or “stuff”–C’est le bazar ici = it’s a mess in here; C’est quoi, ce bazar = what is this junk/stuff? I also thought the phrase “la piraterie n’est jamais finie” (pirating is never over) to be a dubious advertisement for a bazaar, but it turns out to be a brand name. Go figure. Showing my age!

Single Payer FAQs in France

I’ve been reading news about “Medicare for all.” For people outside the U.S., it’s a no-brainer. Of course everybody gets health care. Of course the cost isn’t based on how healthy you are. Of course it’s affordable. Of course you choose your doctor.

I can only really tell you about the French system, which, in nearly 15 years of experience, has been excellent.

Helicopter landing at the hospital. Courage to whoever was inside.

Who qualifies?

All French residents get a Carte Vitale, a green chip card with your French social security number (kids under age 16 are on the card of one of their parents). The card itself doesn’t cost anything. Coverage is obligatory. If you are a tourist, however, you aren’t covered and have to pay out of pocket or get your insurance to pay. But the bill won’t be anything like what you’d confront in the U.S.

 

Emergency room waiting area. Efficient. Carcassonne’s hospital is fairly new.

Who pays?

Everybody. The government insurance covers 77% of health expenses. A further 14% is covered by complementary insurance and almost 9% covered by individuals (co-pay, if you like, but not for everything; it’s mostly for glasses and dental work). The government funding comes from employer and employee payroll taxes (50%), income taxes (35%), taxes on tobacco, alcohol, the pharmaceutical industry and voluntary health insurance companies (13%) and state subsidies (2%).

I was talking to someone in the U.S. who was turned off by single payer, saying that he didn’t want to pay in for lazy people who don’t work. Of course, there are some freeloaders in France, but the cost of keeping them healthy is nothing compared to the taxes evaded by the rich using offshore shell companies. They are the real freeloaders. But psychologically, humans pick on those with less status than us and turn a blind eye to those with more.

Also in France, there’s a list of 30 health conditions that are 100% covered–hospitalization, treatment, doctor visits, medication, etc. These include diabetes, Parkinson’s, Alzheimer’s, incapacitating stroke, cystic fibrosis, HIV, malignant cancer, etc.  A friend had a kidney transplant–something stressful enough, and at least she didn’t have to worry about the cost.

Where emergency patients get wheeled in on gurneys for triage. Not fancy.

What is this complementary insurance?

Complementary insurance covers all or most of the fees not covered by the government program. It’s voluntary and paid individually. It’s private mutual insurance, meaning it’s nonprofit. Patients lose if profits win. The average in 2017 was €688 per person annually or about €57.33 a month.

Patient room. The screens are for TV and Internet; you have to buy time.

How high are the taxes?

Employers pay 13% of salary for health care, maternity, disability and death insurance. Self-employed people making under €43,705 a year pay between 1.5% to 6.5%; over that you pay 6.5%.

In the U.S., the average worker contributions are $1,213 a year for a single person and $5,714 for a family. Worker premiums have gone up about 75% over the last 10 years, vs. about 48% for the employer share. About 80% of workers’ employers pay at least half the premium for both single and family coverage. The average cost of insurance for employers is $6,435, with a $6,000 deductible. (Excuse me, I just fainted at that deductible.)

Other view of a room. The brown column is a closet.

How does it work?

If you’re sick, you call your doctor. Around here, we sometimes can get in the same day, sometimes not. If it’s urgent, one of the other doctors in the group will take us. We don’t have many emergencies, so we usually make appointments for a week or two in advance for routine checkups. Our long-time doctor moved away, so we shopped around for a new one, trying a few recommended by different friends before settling on someone we liked a lot. The idea of in-network or out-of-network doesn’t exist because there’s just one network. While people are free to shop for a doctor when thinking about switching, the French system does require picking a primary-care doctor to limit abuse, such as how much people can shop for somebody to write them a prescription they might not need.

If you have to go to the hospital, there are no surprise bills from out-of-network doctors you never met or who worked on you when you were unconscious. Some doctors can demand a surcharge, but it’s usually in the tens of euros.

How is it different from the U.S.?

Everything is less fancy. This might be in part because we are in the sticks and not in Paris, but I saw the same thing in Brussels. It’s all nice, but not luxe. One hospital in my hometown had a grand granite entry with a grand piano, carpeting in the halls, sofas and armchairs in the rooms. Here, the hospital is brand-new, heavy on the linoleum, only one hard plastic chair per patient room.

However, granite (or carpeted–EEEWWW) floors don’t make anybody better. All that matters is that the place can be kept clean and that it’s arranged in a functional manner.

Vintage formica table in one room. Must have come from the old hospital. Or even the hospital before. Waste not.

The doctors’ offices are pretty simple, too. Always nice, but never fancy. One thing that I found unusual was that the office and examining table are in the same room. You go in, sit at the desk across from the doctor, then get undressed (no paper gowns), get examined, get dressed, your Carte Vitale is read, you pay your €25 and leave. No little exam rooms in a line where a nurse charges in for your vitals, then the doctor comes by for two minutes and disappears. I told one doctor about this, and how the little exam rooms would save a lot of the doctor’s time by not waiting for patients to undress/dress, and she was horrified. Especially with the elderly, she said, it’s important to observe how patients move as they’re dressing. She saw the U.S. system as penny-wise, pound-foolish.

French health care is of very high quality despite being lower cost. France has 3.2 doctors per 1,000 people, fewer than some European countries but more than the U.S., which has 2.5 per 1,000.  Maternal deaths per 100,000 live births dropped  to 8 in 2015 from 15 in 1990, whereas in the U.S. they rose to 14 from 12 in the same years. Check out this article about dying mothers. Life expectancy at birth is 82.4 in France, among the highest in the world, compared to 78.6 in the U.S. Infant mortality is 3.7 per 1,000 live births, vs. 5.9 in the U.S.

In addition, a number of preventive campaigns aim to keep costs down by catching problems early, including free mammograms every two years after age 50, as well as free tests for colorectal cancer.

In the lobby, a piano. Not grand. Nor is the lobby.

Isn’t it weird having the government decide what’s covered?

Well, somebody has to do it, and it’s probably better that it’s decided by society at large rather than by your employer, non? Most people don’t realize that larger companies self-insure–in fact 60% of U.S. workers covered by their employers are literally covered by their employers through self insurance. It’s called captive insurance, and it’s a way of using the risk of employee health costs or death benefits (which would be low risk if you have healthy employees) as a hedge against other corporate risks. The company sets aside a pool of money as its own insurance. It contracts with an actual insurance company to administer claims. The employer can decide what to cover or not, although the Affordable Care Act set some standards on that.

That means employers have an interest in whether you’re healthy. A few years ago, AOL CEO Tim Armstrong announced to employees that he was cutting employees’ retirement benefits because of self-insurance payouts for two “distressed” babies.

With single payer like in France, employers help pay in, but risks are spread across the entire country. There are no questions about pre-existing conditions, because participation in the system is obligatory.

While there are certainly cases of people abusing the system (I know a couple who would go for a weeklong “cure” for “arthritis” every year at a spa), for the most part nobody gets surgery for the heck of it, nobody has chemotherapy just because they can get it for free. Health care is one of those things you want to not have to need. It shouldn’t be available only to those who can afford it, certainly not in developed countries.

Angels in Our Midst

Today’s post isn’t about France. It’s about angels. Down-to-earth, in-the-flesh angels.

The French novelist Proust famously had his madeleine, a cookie that, when dipped in tea, brought back memories for his protagonist. Taste and smell are such powerful triggers for memories. But music also can transport us to another place and time.The death of Glen Campbell last week, and the snippets of songs played along with the news and tributes, took me on a memory rollercoaster. Songs like “Wichita Lineman,” “Gentle on my Mind” and “Galveston” had me back in the house where I grew up, happily playing with my siblings and not having many cares beyond whether it really was my turn to do dishes.

But the songs also take me to the hospice where my father spent his last months.

The photos in this post were taken at Cathédrale Saint-Michel de Carcassonne, which dates to the 13th century.

It actually was just a nursing home, and the hospice part related to the kind of care my dad received. But it was a very special place. It was staffed by angels, who, however well paid, were not paid well enough, considering the bodily fluids and solids that they cleaned up, over and over, gently and efficiently. Angels who never lost their patience with the many disoriented residents in the throes of age-related dementia. Angels who, I fear, receive less than a warm welcome outside the nursing home, because they come from a veritable United Nations of farflung homelands. When the wider public sees see them, do they realize they are encountering angels—heroes? Do they realize these angels are making America great? Or do they just see dark skin and hear an accent?

The home was the opposite of an institution. It looked like the other white-siding-and-round-stone supersized “farmhouses” in the suburbs, with a big porch overlooking an impeccable lawn on a cul-de-sac. You’d need a keen eye and experience pushing wheelchairs to notice that the front door was extra wide, that the sidewalks and curb cuts were extra smooth and that there were no steps anywhere. After entering the code in the vestibule, one arrived in a “great room” that looked a lot like a set for a morning talk show. A large stone fireplace dominated the center, with a clutch of armchairs (some with electric lift assist) facing a big-screen TV on one side, and a few dining tables on the other side. And open to it all was a big kitchen, where somebody was always cooking.

Two of the cooks were Dixie and Donna, both with white hair and irrepressible smiles. They greeted everybody who arrived, often with hugs, and seemed to truly enjoy cooking. They were clever about finding ways to turn familiar flavors into forms the residents could chew or swallow (often involving heavy cream; people in a nursing home don’t count calories any more). They told me that it was important for people to enjoy their food, even if it looked like mush. I tasted some purée, and it was delicious.They also baked. The entire building smelled like cake and cookies 24/7. It was on purpose—to make it feel like home and not like “a home,” as in “a nursing home.” The baked goods were out for anybody—residents or visitors. A little sugar therapy.

While Dixie and Donna bustled in the kitchen, like a pair of comedic cooking show hostesses exchanging witty repartee, the greatest easy listening hits of the ‘60s and ‘70s played on a tape recorder on the counter. Yes, cassette tapes.Glen Campbell was a staple, along with Neil Diamond and Andy Williams. (I always had a crush on Andy Williams. That Christmas special!)

Dixie and Donna weren’t unusual there—the entire staff was caring. Loving, even. When my dad first moved in there, the “elder aide,” Sylvester, came into his room to welcome him. Sylvester was built like a professional football player, with a million-watt smile and boundless cheer. His infectious laugh would ring through the cottage. He took my dad’s hand and told him that in his native Cameroon elders are revered and that he was honored to have a career taking care of elders. He called my dad Mr. John and my mom Mrs. John—a charming mix of honorifics and family-style familiarity.  My dad loved Sylvester. My dad also loved Koko, a nurse at the rehab facility where he was discharged after the hospital and while waiting for a place to open at the nursing home cottages. Koko’s family was from Togo, though he had grown up in the U.S.

He treated my dad with as much tenderness as one would give a newborn baby. I have never seen anyone as gentle. He was a big, strong guy, too, and could single-handedly move my dad without causing him too much discomfort, whereas the young nurses, while adorable and cheerful, had a hard time shifting my 200+-pound father, even when there were two of them.Koko also was an extraordinarily conscientious worker, or at least the best-organized. I would sit with my dad for 5-6 hours at a time, even all night, when I was in town (lest anybody think that was special, please know that my siblings were there all the time, all year, for years, whereas I would just fly in for a couple of weeks; they were real heroes). I knew his orders were to be moved every three hours, because he had a very large bedsore. Sometimes it took a long time for anybody to come. But Koko always came in right on time, as if he had set a timer.

When it was time for my dad to move to hospice, he held Koko’s hand and thanked him, and asked him to consider transferring to the hospice with him.He loved Kelly, the hospice nurse. I think my dad was something of a treat for the staff. So many of the nursing home residents—and even the residents at the assisted living residents where he and my mom had been for about a year—were losing or had completely lost their mental faculties. But my dad was sharp as a tack. He loved to joke. He paid attention to the news. As my dad’s condition worsened, Kelly would do her paperwork in his room, to keep him company.

I can’t name all the heroes who treated my parents with love, care and dignity. There were so many, from the specialist doctors (some from countries on travel ban lists) to the housekeepers who spoke little English but who managed to coddle my parents despite the language gap.Glen Campbell is just one of many triggers lately that bring back those months. I’m a podcast junkie and keep stumbling on podcasts about the elderly, dying and related cheerful subjects. On the Fresh Air podcast, Terry Gross (world’s best interviewer) talked to the author of a book about palliative care. I am not so sure about palliative care. When my dad was in the hospital, the palliative doctor pushed hard for all treatment to end. My dad didn’t want treatment to end. He had great confidence in modern medicine, and figured something would give him some more time. When people talk about quality of life, I am leery. Who is to say which life has quality and which doesn’t? Most of us don’t want extreme measures to prolong life in the end stages of a terminal illness, especially if we’re suffering every minute. But if the person isn’t suffering? My dad was told he needed a feeding tube, and he was OK with that. The palliative doctor strenuously argued against it. It gave him a few more months, during which I think he came to grips with the situation. I also think he truly enjoyed every minute of every visit by family, and every conversation and joke with staff. Isn’t that quality of life?

There was an interesting podcast (on Reply All) about the design of nursing homes, including some like the one where my dad was in hospice. There also was a concept called a “Minka,” which is like a little cottage you’d put in your yard, so your aging parent could be nearby and cared for by family. I think it’s a great idea, but at some point, people need 24-hour care and things like medical cranes. It’s an awful lot to put on family (who might not be so young themselves) both physically and emotionally.On Point had a report about the fight over the right to sue nursing homes. It seems that one of the main roles of government is to protect the weak. But that seems to be flipped on its head daily. Not everybody is lucky enough to be in a facility like the one my dad was in.

When my parents needed to move out of their house and into assisted living, one of the main worries was “how are they/we going to pay for this.” Different facilities required different minimums—24 to 36 months—for paying privately, before applying for Medicaid. Medicaid is available only if you’ve exhausted your own money (as it should be). I wonder what will become of nursing home residents if Medicaid is cut. Will families face a choice of taking care of grandma or paying for their kid’s college education? In some ancient cultures, the elderly were banished to the wilderness when they became a burden and would have to wait alone to be attacked and killed by animals. Are we going forward or back?

The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.

—Hubert Humphrey

Purple Day

Today’s post isn’t about France. It’s about something that doesn’t know borders or nationalities. And the photos? I chose paths, a little wild, hard to negotiate, unclear where they lead, though hopefully to a better place.

March 26 is Purple Day, an international day for epilepsy awareness. One in 26 people will have epilepsy, and most of the time the cause is unknown.

My mom died of epilepsy. We don’t know exactly when it might have started, but probably, as for 33% of seniors who develop epilepsy, came after a mini-stroke or strokes. When she started having seizures, we didn’t even know that’s what it was, so it took a while before she got on anti-seizure medication. Even then, she went to a neurologist who couldn’t say for sure that she was having seizures. She had no memory of seizures. She didn’t have dementia, either; she avidly surfed the Internet (she even said it that way) to do genealogy research.

She even had a seizure when I was right next to her, and I didn’t know it. The day after my dad’s funeral, I slept by my mom, spooning and giving her the cuddles I’d withheld in my quest for independence. Children are so hard to their parents. It wasn’t until I became a parent that I understood that parents’ babies will be their babies no matter how old they become.

In the finality of the funeral, she must have felt so alone and adrift. So I held my mom as if she were my baby. I eventually rolled over to sleep on my back and when I awoke in the morning, she was snoring away, so I let her sleep. But when a few hours later she was still sawing logs and we needed to go, I wasn’t able to rouse her.

Even then, it seemed like a seizure, but it wasn’t for sure. There’s no blood test or scan that can say definitively. The intensive care doctor said the only way to be sure was to see it happen. Indeed, my mom had another seizure in the ICU, and the doctor was there to film it. It lasted 13 minutes and still haunts me; I saw her have others, too. There’s nothing you can do during a seizure. The doctor told me not to even touch my mom during the seizure.

Lest this all sound misleading, I was barely around for my parents, living as I do across the Atlantic. My siblings, however, were devoted to them and checked on them nonstop. The real heroes.

Ironically, two years earlier, during a trip home to see my parents, who were still fairly independent and living in their house, I was listening to NPR on the car radio and heard a man talk about living with his wife’s epilepsy. It was so wrenching that I pulled into a parking lot to give it my full attention. The show is The Moth, available as a podcast, and the particular episode was titled “Me & Her & It,” by Peter Aguero.

For Purple Day, check out how you can make a difference on the Epilepsy Foundation’s site. And give your parents lots of cuddles while you can.

 

Urgences

We are a little too well-acquainted with the emergency rooms. The most recent visit comes after much time spent in U.S. hospitals last year (as visitor). The differences are striking.

U.S.: imposing marble lobby, with a volunteer playing a grand piano. Food court. Gourmet coffee stand emitting good smells. Carpeted halls. Rooms that look a bit like hotels if not for the high-tech control panels and machinery. Heated blankets. A sofa in the room that turns into a kind of bed for a family member keeping watch. Another hospital went for an earthy, natural décor, with lots of warm wood, and tiles and wallpaper that had grass or leaf designs. Very zen.

France: sun-filled linoleum lobby. Linoleum, in fact, is the most prevalent material. Wall-to-wall carpet is considered a germ trap in Europe. Plastic seats–no upholstery. No attempt at décor (white walls with a green accent wall, pale gray floors) except in the pediatric wing, which had animal decals on yellow walls. The emergency room at one private hospital did, however, have as decoration framed x-rays of unusual objects, which provided a distraction. It also had wood paneling. In the patient’s room: a small table, a rigid plastic chair, a very ugly lump of an armless chair that unfolded into a surprisingly comfortable bed for a family member keeping watch. A sheet but no blanket (certainly not heated) nor pillow for said family member. No food court, and the lobby vending machines are locked up after hours (i.e., after 6 p.m.).

Carcassonne’s new 496-bed hospital opened in the summer of 2014.

So far, it sounds like the U.S. is better, BUT marble lobbies don’t make a person well. And they might make one sick when the bill arrives.

On the other hand, the bill for an x-ray of a possibly (but thank goodness not) broken shoulder? Zero.

And the bill for an overnight after our kid passed out on a school outing (why breakfast shouldn’t be skipped…lesson learned)? Minors who lose consciousness are required to be kept for 24 hours of observation. Zero.

And the latest–meningitis, which turned out to be the viral kind, not the deadly bacterial kind? Until the blood test confirmed that, our kid was treated with a speed that was amazing. And kept overnight for observation. Again zero.

This isn’t to say that we don’t pay for health care. There are mandatory social charges in the form of a 6.5% tax on income of self-employed workers; salaried workers pay 0.75% and their employers 12.8% of their wages, for a total of 13.55%.

According to the Bureau of Labor Statistics, the average cost of health insurance benefits to employers was 7.6% of total compensation, but that ranged from 12.6% for union workers to 6.9% for nonunion workers. On average, employers of higher-paid workers cover a bigger share; lower-paid workers get less.

It’s hard to get an average percentage for the employee contribution in the U.S. The Kaiser Family Foundation found that average annual family coverage premium is $17,545, with employees paying $4,955 of it. And the average deductible for a single (they didn’t give family figures) is $1,077.

There are no deductibles in France.

There are co-pays, however. The full price of a doctor’s visit in France is €23, of which the government reimburses 2/3, or about €15. I suspect it’s set up that way–patients have to fork over the €23 and wait for reimbursement–to set the bar just a little higher for whether one really needs to see the doctor. You can buy supplemental insurance to cover the co-pays.

In the U.S., the average copayment is $24 for primary care and $37 for specialty care, for in-network providers, according to the Kaiser report.

In France, all providers are in-network. You get to pick your doctor, from any of the doctors in France, not from a list provided by your insurer. And no surprises coming out of anesthesia to discover a bill bigger than your annual salary because most of the doctors who touched you were out of network. Obamacare has put a cap on out-of-pocket expenses (the sky used to be the limit): $6,850 for an individual and $13,700 for a family. However, medical bills are still causing personal bankruptcies in the U.S.

Note the covered sidewalk. The old hospital had one as well. A brilliant idea, in rain or sun.

Two people I know in France have hereditary kidney diseases. One just got a transplant; the other has been hospitalized a lot but isn’t yet at the transplant stage. One thing they don’t worry about is the cost of treatment. Ditto with friends who have cancer. One quit her job–but she didn’t lose health coverage because that has nothing to do with where or whether one works.

It seems logical to separate health care from employment. And to pay for it with a tax so that those with more money pay more and so that your health expenses aren’t at the mercy of your job or the genetic lottery. For those unfamiliar with the U.S. system, the New York Times a couple of years ago ran an excellent series titled “Paying Till It Hurts.”