The Health Care System I Want Is in France

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 Paul 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.

Mary 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.