Culture

Living the Good Life in Europe: Ex-Pats Enjoy Better Health, Schools

Universal health care, better public education systems, socially liberal attitudes, a frustration with American politics ... there are many reasons to live in Europe.

Even with the U.S. dollar’s weakness against the euro and the pound, Europe continues to be a major vacation spot for American tourists. But for many other Americans, Europe is more than a place to visit or go on holiday; it is where they live, work, get married and are possibly raising a family. According to the Association of Americans Resident Overseas (AARO), more than 5.08 million Americans (not counting those serving in the U.S. military) are living outside the United States—and roughly 1.2 million of them can be found in different parts of Europe.

But what are the main things that make American expatriates want to live in Europe permanently or indefinitely? Universal health care, better public education systems, lower crime rates, socially liberal attitudes, a frustration with American politics? The reasons why some American expatriates prefer life in Europe over life in the U.S. can vary, but according to Joanna Hubbs (president and senior editor of the expatriate-oriented website TransitionsAbroad.com and author of the book “Mother Russia: The Feminine Myth in Russian Culture”), the main reason why Americans initially decide to move to Europe is because they fall in love with all the cultural beauty that Europe has to offer. And after they have taken the plunge and become situated, things like universal health care, a social safety net, a strong infrastructure and socially liberal attitudes may encourage them to stay.

According to AARO, European countries that have more than 100,000 American expatriates include Germany, France, Spain, the U.K., Italy and Greece. And one of the Americans who has spent many years living in Spain is Angela Carson, a Los Angeles native who specializes in marketing for high-tech start-up companies and has been raising her daughter in the Barcelona area. Carson first moved to Barcelona in 1993; she moved back to Southern California in 1997 but returned to Northeastern Spain in 2003 and has been raising her daughter (who is now 15) there ever since.

Carson said that there is a long list of reasons why she likes raising her teenage daughter in Spain, including universal health care, low rates of violent crime, socially liberal attitudes and Spain’s educational system. Carson asserted that although Spain—with its same-sex marriage (which the Spanish parliament legalized in 2005), topless beaches, legal prostitution, widespread acceptance of erotic entertainment and comprehensive sex education programs—would be considered permissive in the American Bible Belt, she finds that there is less social dysfunction in Spain than in the United States.

“I’ve been living in Spain on and off for 18 years,” Carson said, “and I have never seen a pregnant teenager here like you see in the States. Never. I live in a small village south of Barcelona where everyone talks, and I just don’t hear about pregnant teenagers. There’s just a responsibility level here that’s different than in the States. Sex is a discussion here; you can see nudity on television here in Spain, and families joke around about sex—whereas in the States, you don’t have any of that, but you have high teenage pregnancy rates, high divorce rates, high incest rates, and high molestation rates. Everything is so controlled in the States, much more so than it is here in Spain. And yet, so many social problems are much worse in the States.”

Ask a Europe-based American expatriate what things he/she misses the most about the U.S., and the answer could be anything from baseball games to shopping at Trader Joe’s. American expatriates might choose Florence for its art galleries, pasta and cappuccino or Paris for its museums and architecture, but a part of them might miss the great Mexican food in San Diego or the trips to Yankee Stadium. However, one thing about American life that the expatriates interviewed for this article certainly don’t miss is the American health care system. Of the four Europe-based expatriates interviewed for this article, not one of them believed that they would be better off under the U.S. health care system that they left behind.

Political activist/blogger Avedon Carol, known for her work with the organization Feminists Against Censorship (FAC), is an American expatriate who grew up in Maryland and has lived in London since 1985. Carol has used the U.K.’s National Health Service (NHS) extensively over the years, and she has no major complaints. Comparing the American health care system with socialized medicine in Great Britain, Carol said: “There are many differences, but the only one where the U.S. does better is that doctor's offices have nicer furniture. In every other way, I would say the NHS is superior.”

Carol elaborated: “If I want to see my doctor, who used to be right across the street but moved a couple blocks farther away, I phone and can usually get an appointment for the same afternoon—maybe the next day if it's flu season and I'm not actually in a hurry to see the doc. If it's for my annual blood tests, they might ask me to wait until tomorrow, but even then, they don't usually ask me to wait. I can usually be seen exactly when I want to be seen. Once I get there, I might wait as long as ten minutes to actually see the doctor. If I'm there to see the nurse, I might wait around a bit, but I usually see the doc within a few minutes of my actual appointment time. If my doc thinks I need to see a specialist, he sends the request and I get contacted with an appointment. How long I wait for that appointment depends on how urgent the problem is, but I never have to do anything to ensure that I am seen. I don't have to phone anyone unless I actually need to change the appointment date.”

Carol added: “When I needed surgery, I got great and timely care. No one presents me with a bill. Period.” And Carol said of prescription drug costs under the NHS, “I pay a fixed price for prescriptions—an affordable price I barely notice.”

Angela Carson has high praise for Spain’s universal health care system. “I think the Spanish health care system is great,” Carson asserted. “It’s fantastic. In the States, how many people die each year just from not having health care insurance? That never happens here in Spain. No matter what your status is—whether you are on welfare here or whether you are the richest person—you have great quality health care.”

Carson not only praised the quality of health care she received when she gave birth to her daughter in a Spanish hospital—she even had nice things to say about the hospital food. “My daughter was born in the Clinica Tres Torres, which is a hospital in Barcelona,” Carson recalled. “I remember the food coming, and it was beautiful steaks with mushroom sauces. The food was amazing; it was two different courses, and they brought your dessert. It wasn’t a Jell-O pack.”

In the U.S., there are countless examples of patients who suffered medical bankruptcies even if they had health insurance. But Carson recalled that when her former father-in-law experienced a major illness, he had a much more favorable outcome under Spain’s health care system. Carson said: “My ex-husband’s father had cancer and dealt with it. He’s had great results and is still with us. I think that demonstrates that Spain’s health care system works really well.”

The World Health Organization (WHO), in fact, has said that Spain has the seventh best health care system in the world—and Spain, according to the CIA World Factbook’s estimate for 2010, now has a life expectancy of 81 (factoring in both men and women). But the world’s best health care system, according to WHO, can be found in France. Linda Lee Hopkins, an American R&B/jazz/gospel singer who was born in North Carolina but has lived in Paris for 20 years, said of the French health care system: “I have nothing to say against this health care system because for me, it has supplied every need I have presented. For example, I needed extensive work done on my teeth because I am an entertainer and it is very important that you present yourself in a certain manner. I had about $8000 worth of work done, and it was all paid for by my insurance. I never have to pay for prescriptions, and I am reimbursed a large part of my doctor visits as well as full payment for my glasses. I don't think that this leaves me much room to complain. I am sure that this would never happen with the health care system in the U.S.”

Nancy Falkow, an American singer/songwriter who moved to Dublin from Philadelphia in 2004, described health care in the Republic of Ireland as a mixture of public and private systems; Falkow has private insurance, which she said is much more affordable than private insurance in the United States. Falkow has used the Irish health care system extensively since her arrival; she had a baby in Dublin in 2006. But Ireland has been hit hard by the global economic crisis, and Falkow said that while she “got great care and had a healthy baby” five years ago, she also has her worries about a health care system she described as “overburdened.” Falkow said: “Insurance or no insurance, there's not enough consultants, not enough hospital beds, etc.”

Long-time expatriate Kathleen Peddicord, author of the book “How to Retire Overseas” and publisher of the expatriate-oriented website LiveandInvestOverseas.com, said that American expatriates need to know that in Europe, some health care systems are doing much better than others—and like Falkow, she said that the Republic of Ireland’s health care system has been having problems. “Each country’s system is independent,” explained Peddicord, who moved from Baltimore to Europe but now lives in Panama. “For example, the system in Ireland—a country I know well, as I lived there for seven years and stay in touch with Irish friends still—is collapsing and cannot support the need. France—the other European country with which I have first-hand experience, having lived there for four years—has great health care, probably the world’s best. However, you are eligible for the national health plan only if you work or have worked legally in the country or can transfer credit for social contributions in other EU countries.”

One argument that Republicans in the U.S. often make against Europe’s social welfare model is the amount of taxation, but Carson felt that tax-wise, she was getting her money’s worth in Spain. Carson said that at one point (before the Spanish economy seriously tanked), she was in a high-income tax bracket and was paying a tax rate of about 40%. But those taxes, she said, support a lot of things that she likes about Spain, including infrastructure, universal health care, a quality education system, and a broader social safety net.

“In countries like Denmark,” Carson pointed out, “people are paying a high amount of taxes. But the benefits they receive are nice. They go to the university for free. I wish Americans could see the benefit of that socialized system instead of just seeing the deduction of another $40 from their paychecks.”

Although all of the American expatriates interviewed for this article said that they were enjoying life in their adopted countries, some of them also said they would consider a return to the U.S. under the right circumstances. A few years ago, Falkow was considering moving back to the U.S. with her husband (who is Irish) but decided against it. “We did everything to come home in 2008, but the economy went south,” Falkow remembered. “We couldn't find work, and the last place I wanted to relocate to without health insurance was America. So in 2009, we decided to buy a house here, and without saying I'm here permanently, I've made a commitment to stay awhile.”

Reflecting on her life in the Republic of Ireland, Falkow said that despite its economic woes, “this country is a great place for me to bring up my child.” And she feels somewhat safer in Ireland than she did in Philadelphia. “Crime rates are high in the dodgy parts of the major (Irish) cities,” Falkow observed, “but it's nothing like it is in America. There's rarely a child abduction, and people don't carry guns the way they do in the U.S. But there are drug problems in Ireland. There's major poverty, especially now, leading people to break into homes looking for ‘cash for gold.’”

Carson, meanwhile, said that as much as she enjoys living in Spain, there is one thing that may force her to leave: the Spanish economy, which has been hit especially hard by the global economic downturn. “In general, I would be very happy continuing to live here in Spain for a long time,” emphasized Carson, who has considered possible job opportunities in London and Hong Kong. “And if it wasn’t for the change in the Spanish economy, I would never even think about leaving. Barcelona is so charming. But the economy in Spain has taken such a turn for the worse. Times are just getting really hard here in Spain.”

While one of Peddicord’s areas of expertise has been advising Americans on ways to retire in Europe, Hopkins has considered moving from Paris back to the U.S. when the time comes to retire. “I really am not interested in investing in property in a foreign country,” Hopkins said. “If anything should happen to me here, it would probably be too difficult for my family to take care of my business because of the language barrier.”

And when Avedon Carol was asked if she has considered returning to the U.S., she replied: “I used to think about it a lot, but as the U.S. has become nastier, that's a less attractive prospect than it once was. I also used to try to go back home every year to see friends and family and eat decent pizza, but flying has become horrible—and as more and more things change, it's a lot less like visiting home than it used to be. London is my home now.”

Before Americans become expatriates in Europe, they have to decide if they are really willing to uproot themselves—and initially, Joanna Hubbs said, it is “aesthetic” factors that inspire them to take the plunge. “According to most of the articles we’ve received at Transitions Abroad over the years, the reasons Americans move to Europe are really more aesthetic than ethical or practical,” explained Hubbs, whose late husband Clayton Hubbs founded Transitions Abroad as a printed magazine back in 1977 (these days, it is published online exclusively). “When I say aesthetic, I mean, for example, they fall in love with Italy because of the beautiful landscape, the people, the food and the culture in general. They feel comfortable, and they try to find work to settle there. And those who have the funds to retire are even more likely to move to Europe purely on aesthetic grounds; they love the culture, they love the scenery, they love the ambiance.”

The 71-year-old Hubbs, who now lives in Massachusetts but grew up in various parts of Europe, has had extensive dealings with American expatriates along the way—and she said that once Americans are situated overseas, the sense of community can make them determined to stay. “American expatriates, in our experience, have many different reasons for wishing to stay abroad after they arrive,” Hubbs observed. “But the primary one mentioned is the sense of community, which is the cause and result of the social safety net in most European countries. Of course, the cost of those safety nets is beginning to take its toll in Europe due to the global recession and pressures of the global economy. But if you follow the news, you will see that there is an enormous resistance—a rebellion in England, strikes in France—against any infringement on the social safety net.”

For Americans who want to work in Europe, the greatest obstacle can be European hiring laws. In many European countries, labor laws state that businesses cannot hire someone from outside of Europe for a position that a European can do. Peddicord cautioned: “Americans do not and should not move to Europe for job opportunities. It’s not typically possible and certainly not easy for an American to get a job in Europe.” And Hubbs said: “In the EU and in Europe—especially since the Schengen Agreement, which covers an area of about 25 countries—the primary challenge for Americans is getting a work visa, which usually involves getting sponsored by a European company willing to say you can provide a service that no one in that given country can provide. Regulations for this really differ from country to country, but some European countries do allow (American) applicants to start a business there. A substantial amount of money must be proven to be invested, and Europeans must be employed.”

Some Americans who move to Europe worry about possible language barriers, but that is another thing that can vary considerably from one European country to another. For example, English is much more widely spoken in Greece than it is in Spain. “In England, Scotland, Wales and Ireland, there is obviously much less of a language barrier for Americans aside from different accents,” Hubbs explained. “And in Germany, the Netherlands and the Scandinavian countries, so many people are really fluent in English as a second language. So there’s a minimal language barrier for Americans in those countries. However, one should not take that for granted and not try to learn the language of whatever country one is in. Not learning the language makes you an outsider.”

Carson didn’t want to be an outsider when she moved to Spain; thus, she made a point of increasing her proficiency in Spanish, and she said that having already learned some Spanish back in Southern California (which has a large Hispanic population) made the transition easier. Carol, meanwhile, said that she chose another English-speaking country because she didn’t want to feel like an outsider. “I suppose if I spoke French or German, I might have felt differently,” Carol said, “but since my only other language is sign language, I was never going to move to a place where English wasn't the dominant language.”

The political blogosphere is full of Americans who complain that if Sarah Palin becomes president in 2012, they will seriously consider a move to Europe, Canada, Australia or New Zealand. But whatever happens politically in the United States in the future, it’s safe to say that there will continue to be plenty of Americans who have a strong desire to become a part of Europe.

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