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An Impromptu Experiment in Social Democracy

Universal Images Group via Getty Images

Keflavík Airport, Reykjavik, Iceland, 2021

Universal Images Group via Getty Images

Keflavík Airport, Reykjavik, Iceland, 2021

Less than a month before the pandemic began, on the morning of February 17, 2020, my brother called me from New York. He said that our mother had fallen while on vacation in Iceland and was at that moment in an ambulance headed to a local hospital in Reykjavik. Because I was living in Paris—closer to Iceland than he was—could I fly there as soon as possible to help her?

So I bid goodbye to my husband and children, packed my laptop and my warmest clothes, and boarded a flight. It was my first trip to Iceland, so as my plane headed north, I summoned the few facts I knew about the country: it had had a banking crisis, grew hydroponic lettuce, and (for reasons I couldn’t remember) had miniature trees and horses.

I’ll admit, as well, that I felt a bit of relief. I was the selfish daughter who had—for no good reason except that I’d wanted to—left my aging parents behind in America, to make a life in Europe. My mother had long ago stopped trying to persuade me to move back home. This was my chance to swoop in and do something, if not heroic then at least dutiful.

Yet I also couldn’t help thinking “I told you so.” My divorcée mother had spent her retirement elaborately planning, and then taking, a series of foreign trips, usually with her younger boyfriend or with her sorority of close friends (this visit to Iceland was a rare journey without them). Some years earlier, for her seventieth birthday, I’d written a musical tribute in which the character who plays her sings:

Kids you’ve got no inheritance, here are the reasons,
I used it to pay my bills at the Four Seasons.

But at seventy-eight, she was increasingly unsteady on her feet, and I’d warned her not to take this trip. Despite her determination to see Iceland’s Northern Lights, I couldn’t picture her walking across the country’s uneven volcanic terrain. As it happened, she didn’t get the chance: her accident occurred almost immediately upon arrival, when she was jostled by a luggage cart in the baggage claim of the Reykjavik airport and lost her balance.

At least this had happened in a Nordic country that probably had excellent medical care. Indeed, as I looked up later, according to The Lancet’s 2015 Healthcare Access and Quality Index, Iceland ranked second out of the top fifty or so world’s wealthiest countries. (The US came thirty-fifth.)

It also struck me that, for exactly this reason, the accident might be politically instructive to us both. After many years living in France, I’ve often found myself lecturing fellow Americans about how European health care—though far from perfect—achieves better outcomes while being much cheaper than ours, almost always with less bureaucracy, and often with more choices.

To anyone who would listen, I’d also raved about the many other government services that we Americans lack but that the French and most other Europeans take for granted: paid sick and maternity leave (EU countries will soon have to offer paid leave to a second parent); subsidized day care; free preschool; and universities that are affordable or even free. (Middle-class Europeans don’t start “college funds” for their toddlers because it doesn’t take them twenty years to save for their kids’ higher education.)

From my American perspective, it was remarkable that such measures are largely uncontroversial in Europe, including among center-right and even far-right politicians. Surveys show that many Americans, too, would like to have European-style public services. And since the pandemic and the election of Joe Biden as president, centrist Democrats in Congress have been increasingly willing to support such measures.

Yet for right-wing politicians in America, these are an anathema. Not a single Republican in Congress voted for Build Back Better, the once potentially historic—though now possibly doomed—social-policy bill that would have subsidized childcare, funded preschool for three- and four-year-olds, sent monthly payments to most parents with children under eighteen, and expanded health insurance coverage. Instead, Republican legislators—with an assist from two moderate Democratic senators—muddied the debate over the bill with scare-tactic phrases, invoking government bureaucracy, higher taxes, and “freedom.”

They rarely discussed the merits of individual provisions. Instead, GOP leaders conflated Europe’s social democracies with Soviet-style socialism, in which the state owns and runs everything, and even with totalitarian rule.

I’d long thought that doubting Americans would dismiss the fearmongering and drop their lingering reservations, if only they could see the advantages of European health care and other social services for themselves. Then, I reasoned, they would realize that the additional help doesn’t represent a malevolent government takeover of their lives, any more than do public schools or their municipal fire departments.

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I couldn’t bring all Americans to Europe. But as my plane landed at Reykjavik, I hoped that at least my own mother—herself a centrist Democrat already—would be won over by the Icelandic system. (Iceland isn’t a member in the European Union, but it’s closely affiliated, and its social policies place it in the EU mainstream.) Granted, my mother was a well-off senior, not the average American voter. And obviously, I’d have preferred that she didn’t need to injure herself in order to experience European-style health care.

But given that her accident had happened, I reasoned that this trip presented a double opportunity. I’d finally get to show some filial piety—while conducting a one-woman test of whether Americans were ready for social democracy.

*

In my taxi to Landspítali Hospital, the driver explained—in serviceable English—that she and practically all Icelanders had been born there (a country of some 350,000 people doesn’t need many maternity wards). She also assured me that the new coronavirus we were hearing about, which had spread from China to Italy and, just days earlier, to Seattle in the US, hadn’t arrived here.

We pulled up to a white concrete building surrounded by snowdrifts, and I headed upstairs to the orthopedic ward. I found my mother in a clean and modern private room, where she was attached to an IV and unable to move her left leg.

“Can you believe this,” she asked, gesturing around the room, phone in hand.

My mother and I are close, but we sometimes regard each other with a kind of mutual bewilderment. In high school terms, I’m introspective and bookish; she’s popular and magnetic. She didn’t understand why I spoiled vacations by working, ruminated on past mistakes, and obsessed over our family’s depressing immigrant history. For my part, I marveled at her optimism and exuberance, her many close friends, and the fact that she’d remained stylish and attractive into her seventies. I didn’t even seriously begrudge her the expensive holidays, because she’d return from each one saying, “We had the best time.”

And although I was in my late forties, she had remained cheerfully parental and protective toward me. In our frequent phone calls, she’d forget to mention any bad news, about who had fallen ill or died. She hardly ever mentioned her own health or moaned about aging.

In Iceland, however, she was for the first time openly vulnerable, terrified, and furious.

It was clear that she did not view the experience as a fascinating cultural adventure or social science experiment. Nor did she appear at all relieved that she had injured herself in a country with world-class medicine. Instead, she was highly suspicious of the care she’d get in a foreign country and had been texting with the sorority back home in Miami who thought she should get “airlifted” there for treatment.

I was taking this in, and trying to figure out what “airlifted” might actually mean (and whether the extra travel insurance she’d wisely bought would cover it) when a young Icelandic doctor walked in. He showed us an X-ray of the V-shaped crack that ran all the way across the upper section of her femur.

Despite my mother’s determination to remain youthful, she had a fractured hip, the quintessential injury of old age. This meant that there would be no medevac flight back to America. The doctor pulled out a femur-shaped pen, to demonstrate, and then explained, in flawless English, that she required surgery to insert a steel rod into the bone. To travel before her leg had been fixed up that much, and then healed a bit, was out of the question.

When he left, my mother described what had happened: one moment she was walking toward the airport’s exit to board a bus, the next she was on the floor in agony. Her small triumph was that she hadn’t allowed the paramedics to take scissors to her favorite jeans.

In the hospital bed, she was obviously upset, so a nurse brought her a pill called “sopi,” for anxiety. There was no excess of positivity now: on a WhatsApp group named “Adventures in Iceland,” I updated my mother’s many well-wishers in the US with her new catchphrase: “I’m never coming back to this fucking country.”

*

When she emerged from surgery the next day, the nurses put her in a pleasant double room with sliding-glass doors overlooking what I guessed was a fjord. The other occupant was a tiny, elderly, black-haired Icelandic woman who alternated between snoring, scowling at us, and knitting—the latter apparently a national sport. (A clan of middle-aged knitters would later surround her bed for hours.)

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As far as I could tell, my mother was the only foreigner on the ward. With the exception of the tiny roommate, the other patients were all so tall and strapping, it was painful to see them shuffling around in their diminished states. It was as if we’d landed in a home for broken Vikings.

They seemed to feel this acutely, too. A rugged man named Magnus, who was hunched over a walker, cornered me in the hallway and explained that he used to own 250 sheep. “I had the biggest of all the farms around,” he said.

My mother’s surgery had been a success, but we were failing the first test of whether she might rally behind social democracy. It didn’t help that she’d emerged from the operation dressed identically to every other patient on the ward, in white cotton shorts and T-shirt both stamped with “Landspítali.”

She also wasn’t used to the democratic, no-frills efficiency of European public hospitals, where the treatment is competent and humane but no one gets preferential care. After a night of listening to her roommate’s snoring, she dispatched me to plead for her private room back. But the nurse on duty—blessed with a Nordic absence of urgency or charisma—said that someone far sicker had taken it. I had to go back and tell my mother that she’d entered a world without advantages and upgrades.

It was hard to distinguish between her critique of Icelandic health care and her generalized railing against decrepitude and loss of control. In any case, we were stuck in Iceland until she was mobile enough to fly home. Over the long days that followed, I learned the Icelandic word for toilet (it’s snyrting) and got to know the carers: Svandís was best at finding a vein; Ingibjörg was good at rustling up the endless paperwork demanded by my mother’s American insurers.

I was finally able to take stock of the many ailments that previously, in her upbeat, minimizing way, my mother had only mentioned in passing, if at all: arthritic fingers (I realized that, at some point, she’d stopped wearing rings), an injured shoulder, and myriad issues with her feet.

“If I fixed everything that was wrong, I’d be in the hospital all the time,” she said, with an apologetic smile.

I still held out hope that her political thinking might be shifting. I pointed out that, on the Icelandic end, there had been barely any paperwork. This was typical for Europe, where a state insurance plan usually covers everyone, and there’s far less bureaucratic hassle. In the US, where some doctors have teams of clerks just to handle insurance, we spend about 1.2 percent of GDP just on the administrative costs of health care. The French and Germans spend about half that amount, and the Swedes, Danes, and Norwegians spend only around a tenth of 1 percent on admin.

In France, I usually just handed over the green, government-issued credit card–sized Carte Vitale I carried around, attesting to my membership. Only occasionally did I need to mail in a simple form. A French friend who’d had open heart surgery told me that, after he showed his Carte Vitale at the hospital, he never saw a single bill.

The total cost of health care is far lower in Europe, too. The US spends nearly 17 percent of annual GDP on health care, or an average of about $11,000 per person. In Iceland—which is relatively expensive by European standards—those figures are just 8.5 percent or about $5,000 per person.

And despite Republican rhetoric about “freedom” and “choice,” in America I’d been bound to certain networks of doctors based on my insurance, whereas in France, when it came to the care itself, I actually had more choice of physicians. Most French doctors were in private practice, and I could generally see whichever one I wanted. Even fancy specialists whose fees surpassed what the state insurance covered were far less expensive than their American equivalents. As for hospital treatment, I once took my son to a French eye clinic and later got a bill for about thirty dollars in total—less than the usual co-pay on even a good US health insurance policy.

The fundamental dignity of European health care impressed me, too. For inpatient stays, public hospitals like the one in Iceland offered world-class basic care for everyone. And in France and many other countries, you could still opt to pay extra for a more luxurious private hospital or clinic. Thanks in part to all this, Europeans live longer, too: to age eighty-three, on average, in France and Iceland, versus seventy-nine in the US.

All the extra help that governments in social-democratic Europe give their citizens brings another real if intangible benefit. When you know that you don’t have to fret alone about how to pay for early childcare and college education, serious illness, and old-age services, a good part of the ambient stress to which Americans have had to grow accustomed—and probably don’t even notice—simply isn’t there. Despite conservative American lawmakers who insist that such benefits pave the road to serfdom, it’s actually liberating.

Sitting in her hospital bed, watching Curb Your Enthusiasm subtitled in Icelandic, my mother was not persuaded. Bernie Sanders had just won the Nevada presidential primary, in part by campaigning on a platform of European-style benefits, including health insurance that would cover everyone. (He didn’t, in fact, envision anything as extensive as the system in Iceland, where the state also provides most medical services.) But my mother feared this would mean paying higher taxes, and perhaps lead to getting stuck in shared hospital rooms, like the one she was in now—an egalitarian system without upgrades.

“I hope I won’t have to vote for Bernie,” she said.

“Why not?” I asked.

“Because of health care,” she said.

*

It had been years since I’d gone out alone for a drink. But after spending all day in the hospital, I needed to affirm my mobility and my relative youth. I began heading out to bars in downtown Reykjavik each night.

This often became an exercise in international mansplaining. A Swede on his way home from an American software conference tried to show me the video of his presentation. A former US serviceman, himself touring Iceland with his mother, bragged about his supposed career in espionage and urged me to visit some hot springs.

I was glad to meet the Icelanders who lurked at the edges of the tourist scene. At an upscale beer hall, a youngish man in a trench coat who said he worked in fisheries recommended a local punk museum that is housed in a former public toilet. Then he told me a joke: “What should you do if you get lost in an Icelandic forest?… Stand up.”

I didn’t mention these outings to my mother (or to my husband), but I began arriving later and later at the hospital, nursing hangovers and muttering about having to work. In my absence, my mother had realized that the only way out of Iceland was to apply herself to daily sessions with a Croatian physical therapist. Once I finally arrived, she’d demonstrate her progress and—in a parent–child role reversal—I’d cheer her on as she sat up, then stood, then eventually walked a few steps.

A few days after surgery, she was able to shuffle down the hall with a walker (I sent a triumphant video of this to “Adventures in Iceland”). At the end of the hall, where I’d never been, we discovered that the orthopedic ward had its own lounge and a dining area, for patients who were strong enough to get there. It was like discovering that there was a nightclub in the back of your house, except all the patrons were elderly and wearing matching “Landspítali” short sets.

At the sight of the lounge, and the chance to socialize, my mother’s latent extrovert nature kicked in. The other patients recounted the household accidents that had landed them here. Laura, a handsome woman in her seventies, explained how she’d fallen in her upstairs bathroom and was on the floor there for more than a day until one of her daughters found her.

Visitors seemed to bound into the lounge with extra vigor, to affirm their vitality. A dapper older man who dashed around in a three-piece suit explained that his wife had broken an arm and a leg while getting back into bed in the middle of the night. “She put her hand on the quilt instead of on the bed,” he said, explaining her fall.

“At least you were there,” I replied.

“No, I wasn’t there,” he said mysteriously, and left it at that.

My mother stopped complaining about the snoring roommate. She began taking meals with her new friends, and looking forward to sessions with the Croatian therapist. When the doctor told us that she could probably be discharged on the coming Sunday, she deferred her departure, saying, “I’d like to be stronger when I travel; maybe Monday.”

She was finally warming up to the Icelandic system—not because her intellectual convictions had changed, but out of habit, the fact that her hip was healing, and because her new friends were part of it, too. “It’s definitely been a good experience—as good as this experience can be,” she conceded.

Her extra travel insurance entitled her to a business-class ticket home, accompanied by a nurse. The company sent a strapping, tattooed RN from Texas who flies around the world retrieving wounded Americans. He and my mother immediately hit it off and posed together for the “Adventures in Iceland” group.

I hadn’t managed to visit the punk museum, the hot springs, or really any place besides a couple of bars. We bid goodbye to Laura and the others and headed for the airport, where my mother would fly to Miami, and I would go home to Paris. At the airport, the employee who’d been the first to reach my mother after her fall came rushing over to see how she was doing. Even sprawled on the floor, she’d managed to make a friend.

Later that same day, in the US, the Centers for Disease Control and Prevention would announce that Covid-19 was headed toward becoming a pandemic. My mother and I didn’t know it then, but we wouldn’t be seeing each other again for more than a year.

“You’re such a good daughter,” she told me—a statement that, despite her tears of gratitude, I still wasn’t sure was true.

I doubt she’ll ever see the Northern Lights. I might not either. President Biden now says he wants to strip off constituent parts of the Build Back Better omnibus bill, and try to pass them as separate measures. With the midterm elections just nine months away, time is running short for the Democrats, with their slender majorities in Congress. But having seen another way, I’m holding out hope. Maybe, just maybe, we’ll manage to bring a little bit of Iceland to the US.

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