Health care à la française

I moved to France just in time.  In 2000, I was 46 years old--just about halfway through what I hope to be my lifespan.  And just on the brink of a series of annoying, degenerative health problems of the sort that begin to plague us in our deuxième âge, as the French so elegantly designate middle age.  Within a bit more than a year of my arrival, I had surgery on my arthrotic right foot.  The operation took place in a private clinic and I was kept there for about 5 days.  I learned that I should have brought my own towel, as none was supplied by the clinic.  And that's about the worst thing I've experienced in French health care.

Since then, I've had countless hours of physical therapy and massage, many CAT scans,  MRIs, and ultrasounds, another surgery--this time on my hip, and several cortisone injections under X-ray.  We paid for that first surgery on my foot out of pocket, as I was not yet insured.  The total bill came to around €1200 (I remember the surgeon's fee was €400.   When he learned I wasn't insured, he waived his fee.)  But shortly afterwards, Denis officially declared me as his concubine (not exactly the same sense as in English) which, along with my visa, made me eligible for French national health insurance.  With that came my lively green carte vitale (photo above), a smartcard containing all my personal data which entitles me to free medications and free or nearly free medical services.  And I'm not even French!

How does this lovely little card work?  Well, when I present it at the pharmacy, it gets swiped, the pharmacist swipes the barcode on the meds, and that's that.  I don't pay, and the pharmacy gets paid on my account by l'Assurance Maladie, our national health insurance.  When I visit the doctor, I receive a feuille de soins (care sheet) with the doctor's info and the care I received, along with its cost, already filled out.  I pay out of pocket, spend 1 minute filling out the care sheet with my name, send it in and get reimbursed directly to my bank account.

For hospital and clinic visits, only non-reimbursed amounts are payable out-of-pocket.  French health insurance reimburses a fixed amount for every imaginable procedure--kind of like Medicare in the US, except that the amount is quite generous.  Some doctors and luxury clinics charge over that amount.  You get the picture, I think.

But let's just imagine that I didn't have that magic little green credit card-like thing.  What would I be paying for health care; that is, just what are the costs like here?  Well, right off the bat I can say the most striking thing is that the identical medication--identical right down to the brand--here costs about 20% of its price in an American pharmacy.  Yet--lo and behold--the pharmaceutical companies are still able to make money at those prices.  I'll leave unsaid what they are making at U.S. prices.  Fees for medical services are dramatically lower than in the U.S.--by just how much I can't accurately say.  I can tell you, though, the number of times Denis (a radiologist specialized in brain and spinal cord radiology) has wistfully pointed it out how wealthy he'd be if he'd lived in the U. S.  But then his wistfulness beats an abrupt retreat as he always follows that remark by "But I'd rather live here."

The quality of the care I've received in France has been outstanding.  It's not unusual for a doctor to spend half an hour or longer on a consultation.  I can see any doctor I please.  I've never had to wait more than a couple of weeks to get an appointment, and as for scheduling surgeries, the delays of a month or two were due to my wanting to be able to plan ahead for downtime rather than to the admission schedule.  Techniques and equipment are state-of-the-art.  Facilities range from somewhat spartan to very luxurious, depending on the surroundings.  And ironically, some private clinics are more spartan than public hospitals.

Now, what do you suppose contains costs of such excellent care (the best in the world according to a WHO survey; the U.S. ranks something like #22)?  Okay, cover your ears, get out your braid of garlic and your silver cross:  socialized medicine!  The arch-bogeyman himself!  (Now, ask yourself, just what is Medicare, other than just about the only good thing about getting older in the U.S.?)

Like many American expatriates, I've been watching the health care debate in the U.S. with a mixture of dismay, disbelief and horror.  "People!"  I've wanted to scream, "what is wrong with you?!"  I've felt like shaking the American public as you would feel like shaking a hysterical child.  Are you going to let the "public option" be Swift-boated into oblivion?  Are you going to let yourselves be manipulated once again by Big Money?  I thought we'd been there, done that--during those 8 excruciatingly long pre-Obama years.  I thought you'd come to your senses, Americans!  Health care should be socialized, as it is a fundamentally social  issue.

So here are the main points as I've experienced them in my adopted socialist country:

1.  The quality of socialized medicine is excellent.
2.  There have been no waits for care.
3.  Costs are a fraction of what they are in the U.S.
4.  The time one spends pushing paper is almost zero.
5.  There are no death panels.  In fact, euthanasia is forbidden in France.
6.  You might have to bring your own towels.

Now, let me tell you about a woman I'll call Pauline.  She is a tall, willowy woman of about my age, with a shock of wiry gray and blond hair that she wears short.  Pauline is single, and she lives down the road about half a mile from our house in Provence, in a dilapidated old stone house.  It is to Pauline that I entrust my garden when I am not there.  She comes over to water and to do a bit of weeding and just generally check on things.  She moved down to our area from Picardie in the north of France a few years ago.  Pauline has never been married, and she has a slightly goofy air about her.  But I don't let that fool me, because she is the most meticulous weeder I've ever come across.  I wish I could show you how she telescopes that long body of hers down to the plants' level.   Pauline for me is nothing less than a rough-hewn diamond.  Yet she's someone content to just be able to get by.

It's taken me a while to get accustomed to Pauline's thick Picardie accent to the point where I can carry on a detailed conversation with her.  One searingly hot day last month, when she'd finished working in the garden, I invited her on to the terrace to have a glass of cold juice with Denis and me.  We asked her discreetly about her past.  She worked as a carpenter up until a few years ago, she said, until "this happened."  And she flapped the fingers of her right hand back and forth like a screen door swinging in the breeze.  Suddenly I realized there were only three of them (plus a thumb).  Her index was so perfectly shorn off at the knuckle of her hand that you had to blink to make sure it wasn't there.  It had been mangled beyond any hope of repair in a table say, she explained, unable even now to repress a slight shudder.  But then, with typical Pauline sang froid humor, she remarked at my amazement, "Oui, ça a été drôlement bien opéré, hein?  (They did a crazy good job, hunh?)  For indeed, I had never even noticed that the finger was missing, even after months of seeing her.  The surgeon had tapered the edge of her hand somehow to make it almost imperceptible that there should have been one more finger there.  Plus, she had adapted magnificently, thanks to long and ongoing physical therapy.

She left Picardie, Pauline explained, because of the intolerance of the people there.  When we looked quizzical, she clarified, with a bit of hesitation, that she was epileptic and that she felt stigmatized by that up north.  Denis' ears perked up, as here was a subject he knows very well.  "Where are you followed?" he asked (meaning what clinic or doctor takes care of you, and wondering if he should verify her diagnosis).  She named a clinic in Marseilles and Denis pushed back from the table, relaxed.  He assured her she was in the best of hands and proceeded to ask her more about her type of epilepsy, how she was being treated, and most of all, how she felt. 

Pretty good, all things considered, she said.  She began enumerating all the tests she'd undergone.  They included countless CATs, MRIs, PET scans, and even scintigraphy (gamma camera).  Every so often, she has to go check herself into the clinic for a series of tests and monitoring.

Why am I telling you this story?  Because, Pauline--a middle-aged woman with no steady job, essentially no resources, and no family network--is receiving the absolutely best medical care that the country has to offer--for free.  And that's as it should be.

Now, contrast Pauline's story with this one.  Last January, the daughter of a very dear friend of mine came to visit.  Lana, as I'll call her, is 40 years old and unemployed because of the events I'm going to tell you about.  She used to work as a wine merchant.  Then, about three years ago, she suffered an attack of severe, disabling back pain for which she eventually underwent surgery.  The operation was "pre-authorized" by her insurance company.  Can you guess what's coming next?  That's right.  On the basis of a fabricated technicality, her insurance company then refused to pay for her medical expenses.  Meanwhile, Lana's pain got worse, not better, and she suffered through another surgery, without insurance.  Today, Lana still suffers incapacitating pain each and every day of her life.  In fact, she is now on lifetime disability and had to declare bankruptcy because of her medical bills.  She can't drive a car because of the medications she has to take.  While she stayed with us, I had the heart-stopping experience of waking up in the middle of the night hearing her shouting with pain.  She came to France because Denis offered to look (via CAT and MRI) at her back gratis, and hook her up with a specialist surgeon to see if anything could be done to improve her condition.

So, Lana crossed the Atlantic to seek crucially needed healthcare she was excluded from back home.  Sadly, the specialist here couldn't offer any better solution than a medullary stimulator--a device which is implanted in the spine and saturateds the pain's neural pathways with a mild electric current.  This would have been a very expensive affair even in France, so Lana went back home to await being granted Medicare. 

Of course, I didn't even bother to tell you that Lana's surgery shouldn't have been done in the first place, as a complicating condition--a conjoined nerve root diagnosed preoperatively--made its likelihood for success feeble, and its risk of complications very high.  I'll leave you to ponder the implications of that on your own.

The point is, of course, that Lana, and everyone like her as well as everyone different from her has a right to the kind of treatment that Pauline received.  I would like to know that, even if my children were out of a job, they would still receive medical treatment equal to those who have jobs.  Isn't that only fair?  Isn't health care a fundamental human right, to be fulfilled to the best of the ability of our social contract?  Anything less is barbaric.

Feel like supporting the public option after reading this story?  Click here.

Share