Thoughts on Health Care

I have spent more than a year in France over the last 10 years. Inevitably, even though I am really healthy, I have had a few encounters with their system.

The first was in 2002. I got a bad cold which turned into a sinus infection as they always do, and rather than put up with weeks of misery I always make an appointment with the doctor and get a prescription for amoxicillin which gets rid of the infection. I called a friend and got a reference to a doctor and called and made an appointment - he could see me that afternoon. He was an expatriate Brit who had been there long enough that he spoke English with a French accent. As we went through the examination his English began to lose its French accent, I assumed due to the influence of hearing his mother tongue spoken with a non French, albeit American West Coast accent. He seemed to be enjoying talking to another native English speaker, so I engaged him in conversation. Note that he had the time to choose to let me engage him in conversation. I asked him why he had decided to practice in France rather than England. He had a lot to say on that subject, but the net of it was that he didn't like practicing medicine in a socialized system so he moved to France which had a system that was both vastly superior and not socialized. He said that the government involvement that did exist in France created an excellent system that guaranteed superior healthcare for everybody at an acceptable cost and that made the environment for the practice of medicine much more enjoyable than that of England. I asked him why, as long as he was pulling up roots, and since he spoke English he didn't move to the US. He said that as far as he was concerned the only worse place to practice medicine than the UK was the US. He said that we had the highest cost, worst outcome, private insurance company dominated system in the world. He marveled that Americans would put up with it. He only knew that he didn't want to play in that sort of game.

That office call, that I was able to make and execute the same day cost me 35 Euros. That was max cost possible because I didn't have coverage in France. Later I learned something else. I didn't need to see a doctor at all. I had made the appointment because in the US if you need a prescription you have to see a doctor. So you make an appointment wait a few days, see the doctor, beg for the prescription (after all, what do you know about the state of your heath?) and be charged a couple of hundred dollars for your office visit which will be adjudicated by the insurance company, if you have insurance for several months, after which your doctor's practice will get some portion of what was billed. All of that just to get a prescription. In France the pharmacist is the first line of medical services delivery. When I need a trivial prescription such as amoxicillin I go to my local pharmacy talk to the pharmacist and get a prescription. There is no service charge and the pills cost about 4 Euros.

The second encounter I had was an aberration, but worth noting. I had a severe case of stomach flu and after several day of staying in bed I put my raincoat over my pajamas and went down my four flight of stairs and out to the street to the pharmacy next door. I bought some Tylenol and went back into the apartment and was climbing back up the stairs when I woke up with my head down the stairs about two flights up hearing someone saying in French accented English "'Allow, is anyone there?" I answered, got up and then woke up again, head down in roughly the same place as I had awakened the first time. This time there was a man, even older than me, standing over me and helping me up. He and his wife lived one flight down from me and he had heard me fall the first time. I had no memory of anything except starting up the stairs. He was a retired doctor, but he worked every day as a volunteer physician. He took me into his apartment, examined me, told me I was dehydrated and suffering from a bad flu and gave me some medicine and escorted me to my apartment. That was about 1100 in the morning. He said he'd be back at about 4 to check in on me and did I need anything from the store. I could see that I was going to run out of toilet paper. When he came back at 4 he had a huge package of toilet paper. None of this cost me anything unless you count the bottle of cognac I took to him and his wife a few days later when we got together for a glass of wine and some conversation.

The third encounter was two years ago when I got another, milder case of the stomach malady that had felled me on the staircase a couple of years before. This time I just decided to get a doctor to make a house call - they do that in France. So I called and a couple hours later a doctor showed up, examined me and gave me a prescription for whatever it was that I had. I had to go out to the pharmacy, but I was only up one flight this time so I didn't pass out when I returned. That doctor house call cost me 70 Euros, again, the maximum possible due to the fact that I have no health care coverge in France. Once a person becomes some sort of officially resident non French citizen he or she is covered, but I was still a visitor.

So now to what I heard this morning. Actually, I keep hearing it in various forms; it just finally put me over the edge this morning. Some Republican was decrying the possibility of a "public option" because it would be socialized medicine, just like France (remember what my Brit Doctor friend said?). He also said we couldn't afford it (I guess since the current wonderful Insurance Industry controlled option is the most expensive in the world he assumed that any change would cost even more. It might have been useful for him to have been aware that France's system is not only not socialized medicine, it costs way less than ours and provides generally the best or nearly best "outcomes" in the world - the US is somewhere in the thirties in world rankings for outcomes). And even someone who doesn't pay into the French system - me in the examples above - can benefit from superior service (same day appointments, house calls within a few hours of request) and low cost - 105 Euros for my entire medical needs from the system, not counting prescriptions.

But then he really delivered the coup de grace. If we have a public option, he said, it will kill off our great American Market Driven and Provided approach to the requirement. He said that 120 million of us would sign up for the public option. So how stupid are we? If the public option is so bad, why would i20 million of us all sign up for it? What kind of forked tongued rhetoric are the Republicans dishing out? But the lobbies can apparently keep dinosaurs going for years, to the detriment of all of us, including the dinosaurs.