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I first wrote this almost two years ago, and reposted it last Christmas as Nataline Sarkisyan was sentenced to death by her heathcare insurance provider. I suppose that, as nyceve keeps on posting yet more healthcare horror stories, it is worth reposting to underline that things can really be different and need not be as broken as they seem to be in the US healthcare system, to the utter incomprehension of the rest of the so-called civilised world.

My (then 4 years old) son was diagnosed 4 and a half years ago with a brain tumor. He underwent surgery, then chemiotherapy for a year and a half. In 2006, he appeared to have been cured, but the tumor reappeared in September that year, and he underwent radiotherapy for several weeks the following winter. Since that, his tumor has not reappeared in the quarterly (now semestrial) check ups.

As a consequence of the initial surgery on the tumor, which was in a very delicate location, he is handicapped and has only very partial use of his right arm.

:: ::

He was first diagnosed by our pediatrician, a private sector doctor, who sent us to the (public) specialised pediatric hospital in Paris for additional exams. We did a scan and a MRI the same day, and that brought the diagnosis we know. He was hospitalised the same day, with surgery immediately scheduled for two days later. At that point, we only had to provide our social security number.

Surgery - an act that the doctor that performed it (one of the world's top specialists in his field) told us he would not have done it five years before - actually took place the next week, because emergency cases came up in the meantime. After a few days at the hospital, we went home. At that point, we had spent no money, and done little more than filling up a simple form with name and social security number.

Meetings with the doctor in charge of his long term treatment, and with a specialised re-education hospital, were immediately set up, and chemiotherapy and physical therapy were scheduled for the next full year.

Physical therapy included a few hours each day in a specialised hospital, with a varied team of specialists (kinesitherapy, ergotherapy, psychologist, orthophonist) and, had we needed it, schooling. As we lived not too far away, we tried to keep our son at his pre-school for half the day, and at the hospital the other half. Again, apart from filling up a few forms, we had nothing to do.

My wife pretty much stopped working to take my son to the hospital every day (either for reeducation or treatment) - and was allocated a stipend by the government as caregiver, for a full year (equal to just under the minimum wage). Had we needed it, transport by ambulance would have been taken care of, free of charge for us (as it were, car commutes to the hospital could also be reimbursed).

During the chemiotherapy, if he had any side effects (his immune system being weakened, any normal children's disease basically required him to be hospitalised to be given full anti-biotic treatment), we'd call up the hospital and just come around. Either of us could spend the night with him as needed. We never spent a dime when we did so.

After a year at the specialised hospital, ongoing re-education was moved to another institution specialised in home and school interventions. In practice, a full team of 5 doctors or specialists come to see him over the week, either at home or at school, to continue his treatment (such follow up, possibly less intense than at the beginning, will be needed until he reaches his adult size). Of course, they manufacture braces and other specialised equipment for him and provide it free of charge to us. This has now been going on for 3 years and pretty much the same team has been taking care of him throughout.

Check up exams take place every 3 months, with all the appropriate exams (usually including a MRI), and we've never had to wait for the appointments. Again, no cost for us, no funds to be fronted.

When he relapsed, our doctors considered all available options. In the end, the most promising technology was in another Paris hospital. Such technology, linked to nuclear research, exists only in 3 places in the world, one in Boston and one in Switzerland, so the "socialist" French system itself was able to provide a cutting edge option. But had we needed to go to Germany, the UK or even the USA for treatment because that's where the best hope was, the costs of that would have been covered fully by French social security.

Since our son has been in first grade (he is now in third grade), he has the right to special help for handicapped children at school, thanks to a fairly recent national law, and he now benefits from part time help - a person who is around about 20 hours per week to help him do his work and catch up when he is absent for his therapy. This is paid by the city of Paris and the ministry of education.

Oh, and as he is officially handicapped, we also benefit from an additional tax break (in France, the taxes you pay are roughly divided by the number of people in the family; the handicap counts as an additional person for that purpose).

So, we did not have to spend a single cent. We got support to be available for him. He gets top notch treatment. We never had to wait for anything. And this is available to absolutely everybody in France, irrespective of job, age or family situation. If you are badly sick or injured, you simply do not have to worry about money at any time, nor about lack of care. You can get substitute basic income if you have to abandon your job for any duration, and lodging near the hospital if required.

An interesting twist to that story is that we do have private healthcare insurance in France. Basic healthcare is covered by social security, but only partly: except for the poor (under a certain income level), there are co-payments for most expenses like medecine and doctor visits, and doctors are also allowed to charge you more than the official tariff (and you have to pay the difference, in addition to the co-payment on the official price, if you go to such doctors). Thus many people buy private (or mutual) insurance to cover that difference partly or fully. Such insurance is often provided by employers. But whenever you have "major" expenses, you switch to 100% coverage of expenses by the public system - except that, if you had a private insurer, it has to pay to the public entity a portion of the costs. In my case, as I had a good insurance via my bank, this is what's happening, and thus the private sector bears a portion of "catastrophic risk." (And they have no say in what care is provided. They just pay an agreed fraction of it.)

Thus there is solidarity across the sytem.

:: ::

This is not to say, of course, that all is well in French healthcare. As in other countries, costs are barely under control, spending increases every year, and there are many ways the system could be improved for doctors, nurses and patients. But the fact remains that if you are badly ill, you will be taken care of; you will not need to give up your job (or if you do, you're helped); you will not need to sell your house; and you will never be denied healthcare.

It's been tough enough to deal with a sick child; I simply do not want to imagine what it would have been like if I had to beg for care or to scurry around for money in addition. It's just inconceivable. And thus, I was happy to pay taxes before, and I'm really, really happy to pay taxes now to provide that level of care for those that really need it.

Originally posted to Jerome a Paris on Thu Dec 25, 2008 at 12:15 PM PST.

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