A Little Confused

I’m a little confused.

I just watched House Calls on CNN.

Everyone agrees there’s a crisis in America, part of it being that 15% of the population is uninsured. But people keep saying they don’t want a system like in France because they didn’t want the government making decisions about their health care.

Except in France, the government doesn’t make decisions about health care; your doctor does.

Presidential candidates on both sides keep talking about changing the system, yet they’re also saying, “We’re not advocating a system like the one in France.”

But if French health care is considered the best in the world, covers everyone, and the average premium per family is less than $150 per month—why not advocate a system like it?

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  • Steve
    February 9, 2008 10:31am

    Why not? Because thoughtfulness and vision are in woefully short supply in today’s political world. It takes only one special interest, wailing like banshees, to derail any new idea in this country. Not that the French are immune! Thank goodness for them that such a program was instituted years ago, as I’ll bet they could never enact it now, just as they seem paralyzed by the thought of making any other significant changes.

    OK, down off my soapbox.

  • Craig
    February 9, 2008 10:57am

    It’s because the current trend in the US is to be anti-French. If you like anything the French do, you’re not American enough. The politicians are simply pandering to the spectacularly dimwitted population.

  • Jocelyn
    February 9, 2008 10:57am

    I think the issue is partly that it comes from *France*. Politicians (especially Conservative ones) are afraid to be associated with anything French since there was such bad blood after the they didn’t support us in the Iraq war. I wonder if there would be more support if it were the German health system?!

  • February 9, 2008 11:04am

    I don’t think that it’s necessarily that it’s ‘French’. Most other countries have nationalized health care that I think is pretty similar. It’s just that here in France, it works very well for some reason.

    If it was tied to another country, I’m not entirely convinced more Americans and politicians would be amenable to it.

  • HenryVIII
    February 9, 2008 11:14am

    It’s like this. We Americans are dumb. We can’t think for ourselves. We let politicians and pundits tell us what to think, what’s right/wrong, and what is important.

  • Andy
    February 9, 2008 11:29am

    Funny that you mention this today, we just watched Michael Moore’s film SiCKO last night and were blown away with his depiction of health care in France compared to the US. From my personal experience, patients and doctors hate health care in the US and the only party who comes out on top are the insurance companies. Doctors need to spend their time taking care of their patients instead of worrying if that patient’s insurance company is going to pay for whatever procedure they need. If we spend half of the money that we spent on the Iraq war on healthcare, everyone could be given the best care. Who deserves our tax dollars more? Defense companies such as Lockeed Martin and General Dynamics who spend billions of dollars developing new and improved techniques to kill people, or doctors who are trying to save lives.

    Bump this country, I’m moving to France.

  • February 9, 2008 11:32am

    It’s simple. So many people (especially politicians) in this country have to feel that “our” way is best, even when it obviously isn’t. So terribly annoying.

  • February 9, 2008 11:39am

    But what if someone spelled it out like this:

    “Look. There’s a system that provides top-quality care, no one gets denied services, and it’ll cost about one-quarter of what you’re paying now. How ’bout it folks?”

    Wouldn’t that get a couple of votes?

  • rorkesdrift
    February 9, 2008 11:41am

    Sorry to burst people’s bubble but the 45 million number that the media throws around is bogus. If you read the government data that that figure is based on (which I’ll bet 99.999% of the public has not done)you will find that if you take out illegal aliens, college students that are too old to be carried on their parents policy, people who refused coverage at work (which includes me since my wife’s company offers a better deal than my employer), people within a waiting period to qualify for their company plan and people that are between jobs then the true number is about 8 – 10 million or less then 3% of the US population. Suddenly this is not such a big problem but people who want the government to run other people’s lives never let facts stand in their way.

  • February 9, 2008 11:52am

    Hi Rorkesdrift: Thanks for your thoughts. Isn’t the purpose of having a government to run certain services for the good of society? Such as the police, military, and fire departments, as well as maintaining our infrastructure?

    In the case of national health care, the government is simply acting in the place of an insurance company, minus any financial incentive. I don’t know how it works elsewhere, but here, they simply process the paperwork. Which, believe me, they’re experts at. : )

    It’s also responsible for keeping costs down and helping doctors and hospitals concentrate on patient care.

  • pf
    February 9, 2008 11:55am

    Do French physicians have the opportunity for earning potential and very comfortable lifestyle that American physicians have?

  • Mark
    February 9, 2008 11:58am

    Math aside…

    The reality is that when you have politicians spending 3 out of every 4 years fundraising to get re-elected, and spending $500million plus just to make the presidential election general election, just how do you think they pay for this? Donations from lobbyists who want the status-quo that are funding by companies that are making a fortune off keeping people spending more on health care and not getting healthier.

    It will take a president and a congress who are willing to not be able to run for the next term to fix this problem since their fundraising efforts will fail them from the point of decision on.

    Don’t be fooled, Hillary will not achieve her lofty goals either if she wins because she is just a career politician and worries about her ‘legacy’ like the rest. What we need is someone like Jimmy Carter again to run, win and not care if he is not elected again.

    Now, back to something tasty…some thoughts about Valentines treats?

  • February 9, 2008 12:33pm

    This issue really gets me steamed. The fact is that most Americans have never been to France, never researched the French (or any other) health care system, have never had a conversation with a French (or Swedish, or Swiss, or Canadian) about the positive and negative aspects of their health care.

    So just like in that glory year of Freedom Fries, 2003, France because a synonym for socialism, government control of one’s personal life, slothful people, and sexual immorality. This gut reaction to anything “socialist” or “French” cancels out any rational argument you might make in the posts on this blog or anywhere else. Grrrrrrrr.

  • Steve
    February 9, 2008 12:56pm

    If over 5% of the U.S. workforce is unemployed, and if many of those unemployed have families, then on those grounds alone I’m skeptical about the 3% uninsured figure. I don’t know the answer, but how much lower would the nation’s health care bill be if we subtracted all healthcare insurance industry profit (but maintained the salaries and other costs associated with the work those firms do)? Not that I know the solution to this problem….

  • February 9, 2008 1:24pm

    Because it’s easier for some people to bury their heads in the sand and believe that either there is no healthcare crisis in the US or that if people just worked harder or made smarter choices there would be no problem. God forbid that we actually look rationally at the solutions that other countries have found instead of just relying on empty rhetoric to manipulate issues.

  • katia
    February 9, 2008 1:58pm

    besides health care think about the 1.2 million kids that go hungry in the us ………

  • February 9, 2008 2:14pm

    On NPR the other day, I someone who called in said that hooooordes of Canadians come to the US to have heart surgeries because they have to wait forever in Canada to get one. I’m not sure about the Canadian system, but I doubt what the caller said is entirely true. However, being a swede living in the US, I can promise you that if you end up in the emergency room at a Swedish hospital with heart issues you’ll get help — even if you’re unemployed, an illegal immigrant or a college student. Are there problems with universal health care? Sure, no system is perfect, but I do believe for a populations peace of mind, a lot is gained by knowing that IF I get, say, cancer, I will get treated.

    It is unfortunate the Americans are in the hands of the insurance companies, especially with all the amazing physicians that are working here.

  • Une franco-americaine
    February 9, 2008 2:22pm

    Although I agree that US health care is in a huge crisis and that we must get everyone covered, as a French-American who has lived in both countries I will say that the French system is not the way to go. The problem is not so much the medical care, which is pretty good, but the unintended consequences of the system, which is bureaucratic and costly. Along with the social security and unemployment systems, this results in very high taxes on businesses and individuals.

    France’s economy is a mess, unemployment is high, and there is very little job creation. Most of my generation (20s and early 30s) are students or are working under CDDs (short term contracts – sometimes very short – my cousin has been signing 4 day contracts every week for the past 2 years, for the same employer). It is just too expensive for employers to hire permanent employees.

    My parent’s generation loves the system – they have job security, medical care, and a great retirement to look forward to – but for the younger generation there is nothing (which is one of the reasons I live in the US and not in France – I love France, but I could never get a job there). If the US wants to emulate a European health care system, I would look to Scandinavia instead.

  • February 9, 2008 3:06pm

    First of all, sorry for my imperfect english.

    Here in Spain we have a public health system like in France and government does not make decisions about our health care. We simply pay some taxes every month and it give us the right of having medical advice, surgery (even the most expensive) and even some medicines for free when your doctor prescribe it.

    I had surgery twice in this public system and it works just fine. You know, is not as comfortable as private hospitals, you have to share your room with other people and sometimes it could be crowded but it is free for everyone. And if you want and can afford it, you can also have your private insurance and choose which one to use. There are some good private hospitals in the country, but some of the best are public hospitals. I think it is great to know you don’t have to worry about it, because if you need it, there will be a doctor or an hospital for you. Even if you are unemployed or don’t pay taxes you have the right to use it.

    I can’t see where is the problem with this system.

  • February 9, 2008 4:02pm

    I’m also Spanish [by the way, Gourmet, I didn’t know you read David]and for all the shortcomings, the Spanish I would never trade our National Health Service for the American system. This last summer I went to San Diego and took a short break to Tijuana. I was really shocked by the sheer amount of senior citizens getting their prescriptions there. If you are retired, you get free meds over here. I’d rather pay more taxes and risk someone abusing the system than have my mother,who’s in her seventies, take a bus to another country to insure her supply. I pay my taxes and vote my government to insure my rights, not, as it’s often perceived Stateside, as a penalty from the government.

  • February 9, 2008 4:07pm

    Une franco-americane: Thanks for your perspective. True, the system here has it’s flaws (among other societal problems), but even though the taxes are high, people don’t have to sell their houses or lose their life savings if they get sick.

    Christina: Yes, there are great doctors and medical care in the US. Unfortunately, when I lived there, 2 of my doctors went out of business and quit practicing medicine because of the low fees paid by HMO’s, and I had two friends who are doctors who quit private practice to work at Kaiser because they were sick of dealing with paperwork and insurance companies and wanted to simply treat patients.

    I know a lot of British people come to France for health care, and a lot of Americans go to Canada too. I wonder why some countries can pull it off better than others? Why France, but not Canada and England?

    (Also, thanks to folks from other countries adding to the conversation. It’s nice to get your perspectives, too.)

  • sk
    February 9, 2008 4:15pm

    On a slightly different note, I have many friends who happen to be from various countries in Latin America. They often lament the closed mindedness of the medical profession in the U.S. as it so rarely considers eastern or holistic or other optional forms of medical treatment as viable resources for patients. What are patients’ options in countries with a public health system like France, for example, when it comes to alternative medicine? Also, how are therapies for people with “grey area” disorders such as autism served/covered?

  • February 9, 2008 7:50pm

    Personally, I think the doctors/hospitals/etc here in the USA make far too much money to ever support a healthcare system like the one in France.
    It’s a darn shame, because when we lived in France, I never could get over how cheap health care was. We did not have insurance, so I paid for my doctor’s visits and RX and it was dirt cheap.
    My daughter had to go to the ER at the children’s hospital one night, and it didn’t cost a dime.
    I do know that dr’s in France promote hypochondria, it seems, as they over prescribe. All my French friends have a crazy amount of things they are supposed to take, JUST IN CASE.

    But I’d still take the French system over what we have now. Like you said, no one over there has to sell off all their property if they get very ill.

    I showed some French friends the movie “John Q” and they couldn’t believe someone would get denied health care when their life was at stake (or not).

  • Charlene
    February 9, 2008 9:46pm

    I used to say that America’s “free market” medical care was good because it led to “competition,” which in medical terms means advances. Unfortunately, I now see that the “advances” our pharma/medical community (with a HEAVY emphasis on the pharmaceutical end of it) cares about most are superficial: Viagra, Botox, Rogaine, etc. . . Drug companies and government are so hand-in-hand here in the US. Drug companies get govt. grants, drug lobbyists own politicians, and few are interested in researching anything that truly helps people, only what’s profitable. Hence, rich old white guys can grow hair, get erections, and heal every other imagineable inconvenient condition, but no one’s curing cancer. Hey, it’s not just because they’re pro-life that Republicans don’t want stem-cell research!
    As for the question of “being like France,” that j@ck@ss Mitt Romney snidely said he did not “want this country to become like France” in his concession speech (buh-BYE!). Why would that be a bad thing???

  • une autre franco-americaine
    February 9, 2008 9:49pm

    I’m also a franco-americaine and have had experience with both systems. France’s system is good, assuming that you have nothing too critical or complex. If I have something complex, I want a second opinion from Sloan Kettering or the Mayo Clinic.

    Main problems are that 1) the culture among French doctors is very different than in the US. In France, they do not feel the need to be on the cutting edge. I have several friends who are doctors in France and I promise that you will never find a medical journal in their homes. In the US in contrast, most doctors I know feel a need to participate in continuing education, and be up to speed on the latest advances; 2) this is partly due to the fact that getting second opinions in the US is commonplace and most doctors suppport this practice. This is not the case in France! Just try to get your medical records to bring to another doctor for a second opinion. It is next to impossible; 3) Even with the best doctors in France, the care would appear inferior to most Americans.

    My brother-in-law in France recently had a very, very rare form of cancer and was operated on by the supposed best surgeon for the procedure in Paris. My husband and I flew to France to spend five days with him after the surgery and I can tell you that the hospital where he spent a month was a post-war relic, with limited nursing support, that Americans would have difficulty tolerating. The doctor also almost never graced him with his presence after the surgery. Furthermore, he was abruptly kicked out, despite the fact that he had been told he needed to be there for a couple of weeks – because they must have needed the bed. (I could go on with many stories about this and other experiences…)

    The main problem with the U.S. system is that because of health insurance provided through employers, most working people have not been sensitized to the cost of healthcare – they’ve only paid co-payments which were very cheap initially. As a result, over the past 20 years, doctor salaries, as well as pharmaceutical company and hospital margins have become grossly inflated. This is very difficult to turn around.

  • February 9, 2008 9:57pm

    Exactly! Time to think about taking Chez Denise et Laudalino over to France!

  • Linda H
    February 9, 2008 10:59pm

    In the past, Americans had such complete health care coverage through their employers that they were ignorant and indifferent to the real cost. Now there are limited or no benefits offered, and the health care industry, being all for-profit, has made care enormously expensive. If, however, complicated, prompt medical care is required, it is at least a possibility. Canadians with enough money definitely do come to the US for treatment. The option is to die waiting. England recently announced also that waiting times are killing people.

  • February 9, 2008 11:41pm

    (sorry for my bad english, i hope this is at least understandable ! :) )

    As i see things, the main difference is that health in france is a right, in US it seems to be a market.

    With a market system, if you’re on the top of the ladder the quality is really high, but you need to win the place on top (money, power, good job, whatever). On the first low steps of the ladder, quality is awfull, but there’s a lot of ways to climb some steps if you can, and also a lot of ways to fall from the ladder back to the first steps.

    => high risks (stressfull), high reward (for those who can :/) .

    With a “health is a right” system, you get average/good care on every step of the ladder, but the quality you can reach at the higher step is not as high than in the market system, because of the lack of competition. “health is a right” system has low steps of the ladder that get treated as higher steps, but you have nearly no way to find better quality if you need some, even with more money, power, or anything.

    => No risk (no stress), no miracles (even if you need some :/).

    I thing that’s the main problem with the french system in US : the ways of thinking are really different. Us guy likes to think that, if he has enough money he can be treated perfectly, and he does not want to say no to some extra quality of care in the system.

    on the contrary the french guy does not pay attention to extra quality, but he does not want to say no to the protection he has at every step of the ladder.

    Every one of them would like to have the good points of the other’s system, without saying no to what he thinks to be the strength of his. But as we say in france : “avoir le beurre et l’argent du beurre, c’est pas possible* !” :D (*you cannot have your cake and eat it too)

    that’s why i think US won’t have a french health system soon.

  • February 9, 2008 11:52pm

    what i find funny by the way, is that the people who constantly say that they do not want french health system “because they didn’t want the government making decisions about their health care“, are the same peope that gave their government ALL the decisision power with the patriot act laws :)

    They agreed even to restrain their human rights, the freedom of the press, the justice and everything…

    For a french eye ( at least a french eye from before the Nasty Princident here), its seems pretty paradoxal :) .

  • tommy
    February 10, 2008 3:04am

    The previous poster who mentioned the trade-offs in the US in terms of care is right on; if you are fortunate enough to have excellent insurance, or enough cash in the bank, you have access to cutting edge treatments that you simply would not in a more “socialized” public system.

    However, is that the case for an increasingly large number of US insured? Of course not…with unreasonable restrictions from HMO’s, cost-containment all around (what difference does it really make if it is a private or a public entity who is trying to squeeze dimes and pennies out of a health care budget?) many people are not getting the care they need in the US…and I have to really challenge Franco-American’s statement that American doctors are somehow all “cutting edge” with up to date medical journals at their fingertips…please, many can barely keep up with their patient loads at the present (imposed by the limited mandatory fees that HMO’s reimburse)…and good luck challenging doctors and getting second opinions reimbursed by the American system…again, if you have great insurance, fine..if you don’t, you are worse off than the average consumer in France.

    Rare types of cancers are always going to be a challenge…and of course, you will want the best, cutting edge treatments, which may well be in the US…but good luck if you do not have the financial resources, through insurance or otherwise, to afford this.

    The fact is, the average consumer makes out better under the French system.
    Too bad the American electorate is too clueless (or believes the junk put out by the insurance/HMO lobby) to believe this…along with statistics that support the fact that government expenditures in “socialized” countries like Canada, France, etc. actually cost LESS per capita than in the US…and the average consumer of health care gets better access.

  • February 10, 2008 3:52am

    Amen, David. I pay an $1,100/month health insurance premium for a family of 3! That is more than my mortgage payment! $150!!! Another thing to look forward to when I retire in Paris.

  • tagine texmex
    February 10, 2008 4:40am

    Well America will have to make a crucial choice especially with this desire that the population is expressing to copy a European health system.
    The thing is, America can simply not afford to take care of its population and maintain its world leader status, it’s just impossible.

    So Americans have to choose what do they want?
    A- Having the biggest number of armored Humvees, F16 and the means to invade any country at anytime,
    B- Instead diverge the money into health care and take care of the ills, and maybe loose the super power status gendarme du monde.
    C- Both at the same time and you get France lost in ratatouille want to keep the people happy and want to share the gendarme status on certain global issues but doesn’t have the full means.

  • Murasaki Shikibu
    February 10, 2008 5:49am

    In Japan everyone is obligated to join a national health insurance if they aren’t employed with a company that has another type of health insurance. Not sure what the percentages are these days but with the national health insurance you end up paying around 4000 dollars a year and pay 30% of all doctor & dental fees & prescriptions.

    The waiting times for a simple visit to the doctor is maddening – maybe 3 hours – but you’ll get to see your doctor in the end. The waiting time for a cancer operation may take a few months. My friend’s husband had such an operation recently but they operated on him at the National Cancer Centre and he seems to be recovering. Basically there are no frills but you will be given good medical care there.

    *No frills: It’s not a private business so not all doctors will be cheerful & nice. Some are really nasty – but you can change doctors unlike the UK system as much as you wish. There is no need to register for a GP. If the closest clinic isn’t to your liking you can go anywhere you please.

    For dental care – you can get things that aren’t covered by the insurance but you’ll have to pay in full for these (100%).

    Wealthier people will get better healthcare in the end under this system but poor people aren’t denied healthcare. I guess the latter bit is the important part.

    Should you lose your job or lose your spouse (who was the one with the job) etc, you don’t end up on the streets as far as medicare goes.

    In the 1960s America had an excellent healthcare system as far as I know. My father worked for an international institute and our American health insurance was excellent and covered everything. In fact, a lot of things worked much better back then…

    What has happened to America? :(

  • Christina
    February 10, 2008 6:39am

    Hi David – First off, I just wanted to let you know that I love your blog and I’ve been following it ever since I moved to France about two years ago. I look forward to it everyday and I hope our paths will cross one day in Paris!

    I think this is an important topic and coming from a long line of doctors in my family in the U.S., I’ve done some extensive research on the French system. I agree with the franco-americaines that if I ever had a serious form of cancer or any rare disease, I’d want to be on the first flight back to the U.S.

    That being said, I do think that on a macro-level, the French have access to better care and money is never the question or issue. In the U.S., I think its appalling that women are told to leave the hospital a day after giving birth and that my friend in her 50’s is having the hardest time trying to get single health insurance just because she had a minor medical condition last year. She is willing and capable to pay the exorbitant premiums, but NO ONE will take her. When I once explained this to my French friends, they were appalled and even more appalled when I described how pharmaceutical companies operate with their marketing and their pharma reps “paying” off doctors to prescribe their drugs. I’ve seen it with my own eyes. I definitely agree that it is TOO MUCH about the money in the U.S. and I’ve read and heard of PLENTY of horror stories about hospital care in the U.S.

    At the same time, the hospitals in France may appear sub-par to an American. I, myself, have never needed hospital care in France, but I have heard of some appalling cases (patients leaving the hospital without a wheelchair) and I do think that you need to be very pro-active and picky when choosing a hospital for outpatient procedures or even non-emergency hospital treatment in France. I was surprised to learn that NOT every hospital in France has a NICU (so you need to very careful about where you want to have your baby) and my fiance himself had to wait several weeks for a MRI (yes, it was not an emergency nor urgent). But from the research I’ve done and having spoken to many people, most people (even Americans in France) are pretty satisfied with the level of hospital care in France and even more happier that they are not stuck with a exorbitant hospital bill in the end. It seems to be the price you pay and from my experience, there is no waiting period for important urgent care (like in the UK) and I like that you CAN go to any doctor you want….you’ll just have to pay more for it.

    I’ve had both good and appalling doctors in France. I think its important to weed out the bad ones (especially those who just dont even care) and shell out the extra money for the doctors that are not conventionee. I’ve found that I usually love the “medecins remplacants”, the ones who fill in for doctors who are away. For women, FIND a woman doctor you are comfortable with…I dont think I’ll get used to a male doctor asking me to strip right in front of him without a sheet or a robe (no nurses in the room with you).

    Again its all about being pro-active on healthcare, especially in France. Insist on all treatments, make sure the doctor knows of ALL of your prescription drugs (trust me, a lot don’t even bother to ask in France), and be on top of everything. Keep yourself educated, read health articles and researches, and get a second opinion, which I do think is quite easy in France since YOU get to keep all of your x-rays and medical records. That is one of the great aspects of the French system. Just dont leave everything in the hands of the French system…which is what I think happens too often in France…or maybe I’m just a hypochondriac!

    And last, I think the best way to beat both systems (in the U.S. and France) to is lead a healthy lifestyle…eat right, exercise, and of course, don’t smoke and limit your alcohol intake. It doesn’t seem like much, but it can do a world of difference when you are older.

  • February 10, 2008 8:09am

    Christina: Don’t forget—stay out of the sun, or wear good sunscreen, too!

  • Janice
    February 10, 2008 10:14am

    I’m an American expat in the UK and I really don’t like the medical system over here. I have been trying for months to see someone with regards to mental health, and the level of care they are able to offer me is appalling.

    I had good health insurance in the US and was able to get the help I needed, but here I get nothing. All my GP has been willing to do is toss Prozac my way and sign me off work. I know I’m not depressed and need to see a therapist. That help isn’t available for me unless I’m willing to pay 125GBP an hour to see a shrink. Great system.

    Maybe I need to work on my French and hop the Eurostar!

  • February 10, 2008 2:53pm

    All of this health care debate just makes me want to scream: “It’s the food system, stupid!” to all the politicians, pundits, etc. Let’s look at the symptoms, here, people. Bad diet = bad health.

  • noromdiam
    February 10, 2008 3:25pm

    Because they b h8rz.

  • elarael
    February 10, 2008 3:58pm

    Wouldn’t 3% nearly account for restaurant workers alone in this country? Hardly anyone I know has health insurance and if they do have it, it is so basic as to be virtually worthless.

    A decent health-care plan here costs about $300 a month which is simply outrageous, considering I can’t use it for any preventative practitioners, like bodywork, ie: massage, accupuncture, homeopathy, etc. Although, oddly, my hypnotist is able to be covered by insurance, so I need to ask her which company allows for that, I suppose, but I don’t want to pay $300 a month period.

  • Terrie
    February 10, 2008 10:35pm

    David, thanks for the Business Week link. Interesting read. Our health care system clearly isn’t working. What a shame to let fear and ignorance stop us from exploring some of the options that have worked for France. Pity. So much talk about how things need to change, so few results.

  • mb
    February 11, 2008 9:09am

    Why? Because no one wants to pay the kind of taxes we pay, and those that make money off your current system aren’t going to give up that easily.

  • Connie
    February 11, 2008 12:07pm

    wow I hope your blog is not burning ! Just so you know all Americans are not anti French , in our household we consider the French much smarter than America . At least American politics …help…….

  • February 11, 2008 2:51pm

    Don’t even get me started….

  • February 11, 2008 4:00pm

    When I got a massive ear infection in France, 10 years ago, I was stunned and amazed at the care I got. I walked into a doctor’s office in Beaune, without an appointment, and was seen in less than an hour. I paid the equivalent of $40 for the visit — this as an uninsured foreigner — and another $20 or so for the 4 prescriptions I needed.

    Contrast with the past 3 weeks, when I have also had a massive ear infection. I have ‘good’ private insurance, for which I pay a healthy premium, and yet my doctor is chronically overbooked due to the constraints that so-called managed care puts on her practice.

    As a result of her inability to see me promptly, I’ve ended up in the ER once, the university’s ambulatory clinic twice, and four trips to the pharmacy for a total of 12 prescriptions. The co-pays alone are closing in on $1K now, and I am still not well. (I finally have an appointment with my GP this afternoon, a full three weeks after my first attempt.)

    Trust me: I would be elated to have a system like the French do.

  • Lesley
    February 11, 2008 8:57pm

    I’m currently expecting baby #3. Husband is self employed, I’m part time employed teaching French at university..no benefits.
    Our “high deductible insurance” doesn’t cover maternity. SO guess what, I get to go to the Residents Clinic. No choice in doctor, no choice in anything…and it will cost me $2600 out of pocket.
    My first two babies cost a total of $15 each.
    People with fancy copays like that don’t get it.

  • Alexa
    February 13, 2008 2:47pm

    This is just a belated answer to Christina. I am Canadian and my mother had some heart trouble nine years ago. She took herself to her doctor and the guy sent her that instant to the hospital. The next day she was transferred to the university hospital 60 miles away and she had an angioplasty about 48 hours after she presented herself with some innocuous symptoms and no prior heart trouble. I find it hard to believe that Canadians would willingly go to the US, pay out of pocket in the tens of thousands for procedures they can get here for $0.00 (I’m factoring in the exchange rate of course).

  • Debbie
    February 16, 2008 4:48pm

    Wow. So much knee-jerk anti-American sentiment.

    “Personally, I think the doctors/hospitals/etc here in the USA make far too much money to ever support a healthcare system like the one in France.”

    One of the advantages of being a French physician is that you can AFFORD not to care how much you’re being reimbursed. Medical school education in France (and much of Europe) is VERY cheap.

    Compare that to the US, where the average medical student leaves med school with a debt of $250,000. (I’m very well aware of this, seeing as I am one of them.) If you defer your loans through residency (which most do, seeing as how residents get paid $40,000 for 3-7 years), you will be WELL over half a million in debt. And you wonder why physicians worry about reimbursement? As much as we all like caring for sick people, I’d like to help send my kids to college too.

    Much of the reason why American healthcare costs so much is because of the extraneous costs. Malpractice insurance for an ob/gyn in the NE (NY and PA) is [b]$125,000[/b] PER YEAR. Cutting down on malpractice insurance premiums would certainly help…but how many people out there in the US would be willing to give up your unlimited right to sue any doctor that you felt made a “mistake”?

    Cutting down malpractice premiums would ALSO cut down on healthcare costs. If you come into the ER with “chest pain,” the hospital almost always will offer to keep you overnight for “observation.” Not because it increases the amount of money that they make (TRUST ME, IT DOES NOT!), but because they’re so afraid that you’ll sue them for “sub-par care during an evolving heart attack,” that few hospitals would be willing to take the risk.

    This is all skimming over the OTHER huge issue that, here in the US, we have some weird idea that physicians ought to be able to cure incurable problems. I’m sorry, sir, that you have trouble sleeping. And I suppose that that VERY EXPENSIVE CPAP machine would help. But, you know, losing 50 lbs. would probably help more…. And yes ma’am, I understand that giving you 5 different types of meds would help your poor kidney function. But if you hadn’t gotten Type 2 diabetes (because you drank a 6-pack of Pepsi everyday for “breakfast”), then your kidneys would be fine now.

    It isn’t always the government’s fault. And it isn’t always the conservatives’ fault either.

  • February 17, 2008 6:58pm

    Hi Debbie: Thanks for your thoughts. To me, the biggest problem I had when in the US was that my doctor (who I’d like to think knew what was best for me) was being stymied by my HMO. Not only was he racing around his office trying to see as many patients as possible. But when he’d order tests or prescriptions for me, my HMO would refuse to pay for them.

    As you know more than anyone, doctors work really hard and spend a lot of time learning to practice medicine. It just seems like the system is breaking down; as you pointed out, many doctors are being hit by skyrocketing costs and patients aren’t getting the proper care.

    I mentioned a bit earlier on in the comments, several of my doctors either quit practicing medicine or went to work for Kaiser since they simply got tired of dealing with all the extraneous stuff and just wanted help patients.

    As you pointed out, the system seems to be failing, and getting worse every year for everyone. (This was a pretty interesting article in The New Yorker about the cost of having so many uninsured people.) So I’m unclear why few want to explore options for making it better.

    It would seem to benefit both doctors and patients to improve it.

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