The Health Care System I Want Is in France

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The Health Care System I Want Is in France

French Health Care: C'est Magnifique By MARY CLINE

PARIS April 15, 2008 — Shortly after we moved to Paris, my son, Luke,

cut his lip in a fall at school. I rushed him to the emergency room of

a suburban Paris hospital, where a nurse asked my name and address and

a doctor quickly stitched up his cut. When I tried to pay, the cashier

asked me to call the following week because the " computer is slow. " A

bill eventually arrived in the mail for the equivalent of $60.

The same week I took Luke to have his stitches removed at a clinic

where a doctor spent nearly an hour with him first softening a scab on

the cut. This time, the clerk was apologetic as she handed me the

bill, explaining she was sure my American health insurance would

reimburse some of the cost. The total bill: $7.50.

As presidential candidates hammer out proposals to deal with the

increasing millions of uninsured Americans, I know which health plan

I'll choose: the French one.

The World Health Organization has named the French health care system

the best in the world. (The U.S. ranked 37th). It's physician-rich,

boasting one doctor for approximately every 430 people, compared with

a doctor for every1,230 residents in the U.S. (and French docs tend to

charge significantly less). The average life expectancy is two years

longer than the U.S. And while the system is one of the most expensive

in the world, costing $3,500 per person, it's far less than the $6,100

spend per capita in the U.S.

I've had a unique opportunity to see both systems up close and

personal: I had breast cancer in California nine years ago and a

recurrence in Paris this year. I received excellent care in both

places, though looking back now my California oncologist's office was

a bit of a meat market always packed with patients, from the

seemingly not-so-sick to some a step from the grave a time-consuming

disadvantage of living in a much larger country with a lower

doctor-to-patient ratio.

My French doctors and nurses have been sensitive, skillful, caring

and not so harried.

But the biggest difference has been money.

My top-level health insurance paid for most of my U.S. care, but it

was often a struggle to shake loose the money. I was frequently stuck

in the middle of disputes between the company and my hospital and

doctors over " agreed to fees. "

Continually dunned by the hospital for fees and facing multiple

complaining phone calls to my insurance company, I sometimes simply

caved in and wrote checks to cover bills that I knew were the

insurance company's responsibility part of a wearing-down strategy I

was convinced was deliberate.

Here in France I have a green carte vitale literally a " life card " or

social security card that provides entree to the system. It's funded

by worker contributions and other taxes. My husband (and our family)

is covered through his work with a French subsidiary of a U.S.

company, and so is everyone else; coverage is universal. The French

are responsible for co-pays, but some 80% of them have supplemental

private insurance to cover the co-pay. People least able to pay and

those with chronic or serious illnesses often have the best coverage.

Because I'm being treated for cancer, I'm cent pour cent 100%covered.

The effect of a system where hospitals and doctors don't worry about

getting stiffed by a patient or an insurance company seems to be a far

more relaxed, generous system. When my surgeon discussed breast

surgery here, he suggested that I stay in the hospital five days. " Of

course I can do it the American way, kind of an outpatient situation, "

he told me, apparently not wanting to sound unsophisticated. " But I

don't like pain. "

Maternity stays for a normal delivery are a minimum of five days, not

the 48 hours mandated by U.S. federal legislation in 1998 after many

insurance companies insisted stays be even shorter.

I've always had health insurance in the U.S. And yet the few times I'd

had to walk into an American emergency room I've always felt a thief

who seems to be expected to sign over all worldly goods before any

medical care can begin, regardless of the state of agony someone might

be in. French doctors address problems immediately and aren't

constrained by approvals from some medical decision maker in a distant

insurance office.

Years ago, my husband had to wait several hours in Manhattan emergency

room as administrators tracked down someone in our out-of-state

insurance company who would approve (and therefore agree to cover the

bill for) antibiotic treatment for a horrifying infection in his face

that doctors were concerned could have been flesh-eating strep.

There's no question you'll be treated in France. Everyone is. The

nation pays the bills and the hospitals don't get stiffed. It's an

all-encompassing cradle-to-grave system. My fear now is that I won't

be able to even get insurance when and if I return to the states, much

less be able to afford it.

" The French health care system has a lot of lessons for the U.S., "

said Northern Arizona University Professor V. Dutton, who has

studied both extensively for his book " Differential Diagnoses: A

Comparative History of Health Care Problems and Solutions in the U.S.

and France. "

" There seems to be a feeling that Britain's socialized health system

is the only one we can look at because it's English, it's the mother

country. But in fact, the French share many of the same values that

American consumers seek, like choice of physician and freedom from

insurance company authorization of medical decisions. The French

system is already far more similar to the American ideal, " Dutton said.

Except it works.

Cline is a freelance writer and editor in Paris. She's using her

married name for a change because of fears that she won't be able to

obtain U.S. health insurance when she returns to the states if

insurers track down this article.

http://abcnews.go.com/Health/story?id=4647483 & page=1