Readers have expressed so much interest in the French health care system I thought I would publish this supplemental.
Throughout this World Tour there has been considerable interest in France. For that reason I am going to publish some e-mails to me from readers in France. (With their permission of course.) I am also publishing segments of another writers blog. It is not that I do not appreciate the comments I have received from Canada, England, Norway and especially Spain but there has just been so much reader interest in France.
John Schoonover has lived in Paris since 1983. He has a son with birth defects who needs fairly constant care. This is what he writes about France:
The payroll tax is indexed to salary, and I’m pretty highly paid (about $100,000 US at current exchange rates. The supplemental is a flat fee that increases to the maximum with three children and spouse (my case) covered. So, I’m pay above, perhaps significantly above the average for my health insurance, $6200 (I’ve converted at last year’s average exchange rate) for a family of five.
My personal basic care physician, a Syrian woman, who’s office is within walking distance of my suburban Paris home, charges the nationally negotiated rate of €23 [$31.50] for a consultation. My ophthalmologist, an American who is a bit above the specialist scale, charges €60 [$82.20], my allergist charges €55[$75.35], my periodontist charges €68 [$93.16] for an annual cleaning and checkup. Since I haven’t formally declared my GP and I was not officially referred to the specialists, I pay €1 [$1.37] for each visit. The sécu [public health insurance] picks up most of the tab, and the mutuelle [private supplemental health insurance he purchased] covers the rest.
The payment method is somewhat incoherent. The GP takes my health insurance card, and all the charges are done on line. I never see a bill or hand over money. The others take a check or cash, and the sécu is automatically reimbursed. However, I have to file a claim with the mutuelle for the part that the sécu doesn’t cover.
A few years back, I had retinal surgery, which left me hospitalized for two nights. Everything was covered between the sécu and the mutuelle. When I went to emergency for an asthma attack and they kept me for three days observation, it cost me nothing.
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As I mentioned, my second kid is multiply handicapped from birth. At about 2 ½ years, we placed him in a facility for small children like him. At eight he went to another facility for older children and adolescents. Just recently he moved to an establishment for adults, which may be his home for the rest of his life. All of this year-round 24/7 care is covered by national health, as are his medications, doctor’s visits and adapted transportation to appointments. When he visits our home for the day, his transportation in an adapted vehicle is subsidized. We pay about €40[$54.80] for a 40-mile round trip.
Waiting and rationing: I have never experienced either, unless you want to call my wife’s surgery rationing. [His wife had plastic surgery which would not have been covered under American insurance either.] I schedule my specialists’ appointments well in advance, so I probably avoid some waiting time their. My GP can usually give me an appointment the same day or the next. When I want to see her.
In under-populated rural areas, there are shortages of medical personnel, and people do have to wait. The government is trying to encourage young doctors to settle in these areas, but the problem is not yet solved. All is not rosy. Not by any means. We have been hit with a series of free market governments of both the left and the right over recent years, and they all try to nibble away at health benefits. Despite the catastrophe that Thatcher wrought on the UK, a significant part of the French population has not clicked to the fact that the people that they elect are out to screw them. One CEO put the matter quite frankly: the strategy is to elect a government on the right and have them whittle away until people get fed up and throw them out. Then, the incoming left government continues whittling until they are thrown out. Rinse and repeat.
Judi Famin is an American living in France for the past 10 years with her French husband. She also has a chronically ill son who requires a great deal of medical care. Read what she has to say about the French system:
My son is doing magnificently, thanks for asking! He's fully integrated in a regular school where he has a full-time, only-for-him aide, which is paid for by the school system. We live in a very small village (pop. 3,000) which could lead one to imagine that resources are harder to come by, but so far this has not been the case.
I haven't seen "Sicko" yet, but I will, I'm sure of it. I just don't know if I can stomach the stories there yet. Life is tough enough with a chronic illness without having to worry about finances. I can quite honestly say that my family has not suffered financially one whit from my son's unpredictable disease. In fact, he receives an allocation of almost $1500/ month to replace my lost salary or to help pay for full-time help, and to help out with the extras he needs, including vacations, miscellaneous things that aren't paid for by the health care system (special clothing, there's a whole laundry list of things but it goes all the way down to paper for a printer!). I am able to stay at home and take care of him instead of having to try to find a competent daycare worker (a large daycare situation is contraindicated for kids with SMA when they're small). This allocation will continue until he's 20 or is out of my care.
When I asked her whether doctors really made house calls?:
Yes. There is a telephone number (15) that people can call to be connected immediately to a service with physicians. If it's deemed necessary, a doctor will come to you. For exaple, my stepmother (American) was seriously ill with the flu at Christmas while visiting about 4 years ago-- on Christmas night, a doctor came to see her. The total cost out-of-pocket was about €50. I imagine that was about the most expensive visit one would have, as it was a night-time house call on a major holiday!
In our small village, the doctors and physical therapists from the whole canton or county (PTs and respi therapists are a vital part of the system here and indispensable during periods of RVS) do a rotation on the weekends and holidays. The goal is to keep minor illnesses out of the ER, and as a regular at the children's hospital ER, I've seen the admissions people ask systematically if the parents have already seen their local GP or pediatrician-- usually the answer is "yes". At any rate, there is ample opportunity to be seen in one's own home, and barring that, at the ER.
As for bad areas, there have been problems with doctors, firemen, EMTs, police etc. being harassed in "bad" parts of large towns. Some of them require police escorts. This has been blown way out of proportion in my opinion, but unfortunately it is tied in with the whole inner city/immigration/disrespecting authority malaise. I don't know of doctors or EMTs ever having refused to go to a bad area, but I admit, I don't know everything!
I also asked her about the now famous "nanny" scene in "Sicko". Does the French government really provide nannies 2 days a week to women who have just delivered babies?
It depends-- I wouldn't say it's typical due to the low birth rate in general, but there are domestic aids (aides menageres) financed through the govt for women who have 3 or more children, for disabled or sick people, for the elderly. There is a salary ceiling as well.
I told her that I get a lot of friends and e-mails telling me that what Michael Moore documented in his film about France was probably a best case scenario and not really representative of the French medical system or their culture. This is how she replied:
I hear this a lot-- that French health care or socialized medicine CAN'T be that good, or cutting edge, or that we're in line waiting for heart surgery or can't choose our doctors. Usually this comes from people who have no experience with any other system than the US one.
I wish those people could come live with me and my family for a year. Yes, taxes are higher in general, take-home pay is lower, blah blah blah, but when we really, really need it, or worse, when our son really needs it? There is no question for us at all of whether or not we can afford to take him to the doctor or hospital. That peace of mind has no price.
One time a few years ago my son was hospitalized for almost a month, in PICU [Pediatric Intensive Care Unit]. We left without even receiving a bill. I don't even know what the total amount would have been. He required respi meds that cost €3,000 [$4110] several months ago. I know what it cost only because I looked at the stickers on the boxes. My husband says that this is a downfall of the system and that people would be more careful if they knew what was being spent. There are measures being put in place by Sarkozy to address this, and a sort of deductible on meds, which is being protested vigorously by patients and doctors alike.
Jerome Guillet , who describes himself as an "arrogant Frenchy", runs his own Daily Kos blog at http://jerome-a-paris.dailykos.com/... He also has a son with a brain tumor and writes on his blog about the care his son received:
My 4-year-old son was himself diagnosed last August with a life-threatening brain tumor. He went through very delicate surgery, and is now undergoing a year-long chemiotherapy. He has been partly paralysed because of the surgery (it could not be avoided due to the location of the tumor) and he is also undergoing gruelling daily reeducation to get back as much as possible his leg and arm moving.
Doctors appear to be reasonably confident that he can be cured and that he will be able to walk and (partially) use his hand, but, as you can understand, we are taking it one day at a time.
My wife has pretty much stopped her work to take care of our son and take him to the hospital almost every day - and manage the fact that he has become a lot more dependent on us again for small things like getting dressed or going to the bathroom. (I could do a diary on the political fact that, thanks to our universal public healthcare coverage, all our expenses are 100% paid for - and we even get a monthly stipend to compensate for my wife's lost income - so we at least do not have to worry about that. I don't know how we would do if we had to worry about the money at the same time like seems to frequently future, and trying to balance the care our son needs with the parallel requirement not to neglect our two daughters (age 6 and 2).
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And as this is a political blog, just one political "exploitation" of my story. Not only is my son fully covered by our national health care system, but my wife actually gets a decent monthly stipend so that she can stop working to take care of him full time. (and our younger 2-year-old daughter is full time in a government funded kindergarden for which we pay 350 [$479.50] euros per months. The older one is going to pre-school for free). It is totally incomprehensible to all Europeans that such care is not available to everybody in the US, and that the lifes of entire families can be wrecked completely by an accident of fate like ours, in having to pay for it in addition to dealing with the pain of it. How can this not be a massively popular campaign issue??
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And finally:
I intended to write this story today in any case, simply to tell the story and get the feedback from you guys that I have grown to appreciate and crave in recent months, and which has helped me go through this period with most of my sanity, but I think it takes an additional dimension in the context of today's tragedy in the south of the USA. We have seen amazing displays of solidarity, kindness and generosity from untold numbers of people, and we have seen the lack of institutional solidarity in the failure of the government to save or to care for the people of New Orleans. We all feel, correctly, that while individual solidarity is a great thing, it cannot be enough in such circumstances. Some of us are weaker, or unlucky, and we need to help them. We need institutions to help them. We need organised institutions to help them. It is not your fault when disease strikes, or when a catastrophe strikes, and it is not only up to the closest friends or family or the random kindness of unknown strangers to step up to the plate, it is up to all of us, and this is what governments are for - to organise solidarity and to provide safety and help to those that need it, without questions, without conditions, and without reticence.
I was lucky to have such institutional solidarity be provided to my son and my family. The families of New Orleans have obviously not benefitted form the same, and that comes, for a large part, from the destructive ideology of the right for the past 30 years, that abhors solidarity and claims that individualism should triumph (without of course having even the consistency to say that personal responsibility and virtue should govern our acts). That ideology has made "government" and "the common good" dirty words, and states that victims deserve what they get. They are not, and they don't. We must denounce its utter cynicism and failure; its corrosive nature for our social fabric, and its total moral bankruptcy. That ideology is gaining ground in Europe as well, and we must fight it together, for my son, for the homeless of Louisiana and Mississippi, and for the future victims of disease or catastrophe - for all of us.
Government can and must protect us from the random miseries of life.
Tomorrow we resume our travels to Scandinavia and then Friday I hope to publish the Initiative and give you the weekend to read it and make comments.
PS: Is anyone able to tell me how to embed a Word or Adobe file in a Kos blog entry?