This letter may seem a little long, and it won’t make you an expert, but it is factual and true. It is an expanded version of a letter I sent to Paul Krugman a few years ago after an article he wrote about French healthcare. If you follow the news you know that Chardonnay-sipping, Brie-nibbling, East Coast Liberals are enthralled with French health care, (and everything else French, I might add).
I am re-writing this in response to some patently false statements about European healthcare made in the past and recently by Sens. John McCain and Jon Kyl, and Reps. Jeff Flake and John Shadegg. (I currently reside in Arizona).
The Process
My wife and I lived in France as legal residents from June 2002 to April 2005. The collapse of the US dollar forced us to move back to the US.
We were required by law to sign up for French medical insurance even before we received our official French ID card. We were ordered to a clinic in Avignon, where we were interviewed for a few minutes by a harried doctor, and then were sent to his radiologist for chest X-rays. It was obvious that the only concern was TB or some clearly visible communicable disease. The exam was free, but the subsequent French ID cards were about €500 for both of us. The French ID card (Carte de Sejour) was not the health insurance card, but a picture ID indicating that we were legal residents of France.
The French healthcare card (Carte Vitale) was a smart card that carried information in an EPROM. Medical insurance cost about €100 per month ($90.00) for both of us.
Here’s how it worked. When you wanted to see a doctor, you went to his or her office, sat in a waiting room with anywhere from three to a dozen others, and waited, first come first serve, until you got to see the doctor. No one was turned away. There were no receptionists, file clerks, insurance claim clerks, nurses, or assistants. There was only the doctor.
You would tell the doctor your symptoms; he would examine you, ask a few questions, make a diagnosis, and give you a prescription. If lab work was needed, you would go to the nearest lab and, same thing, no appointment needed. When the lab got the results, they would notify you, and send the results to your doctor. There was no charge for lab work.
At the end of the doctor’s visit, he would take your healthcare card and put it into his laptop for a few seconds. You would then give him €20 cash, and leave. A few days later, €14 would be deposited to your bank account by the healthcare system.
We had to renew or coverage each year, and as the dollar fell, and our real income with it, our insurance premiums also went down.
Medication
At the pharmacy, you would give the pharmacist your healthcare card and you scripts. He would call up your account on his computer, and enter the prescription information. 75% of the price was paid by the healthcare system, (it changed to 70% while we were there), and we paid the balance.
Drug prices were cheaper than in the US. Generics were about the same, but brand names were considerably cheaper.
Full Coverage
Anyone paying into the system could opt for private top-off medical insurance, which would result in full reimbursement for all medical expenses.
A Dutch friend of ours who had top-off insurance went to her doctor with severe headaches. She was diagnosed with a brain tumor, and told to go to a hospital in Lyon, France’s second largest city, and about 5 hours away by car. Her husband drove there that day. She was admitted to the hospital, had surgery the next day, and after a week she was released. Charges? 0. And I mean no money paid out at all.
Other Benefits
At one point, I was diagnosed with a bone spur on my Achilles’ tendon. I was given a script for Vioxx[1], and sent to physical therapy.
The physical therapist used stretching, massage, electro-stimulation ultra-sound, heat, and cold, and told me to do exercises and use icepacks at home.[2] I went 2-3 times a week. Every 2 weeks, my therapist (there were three partners in the cabinet,) would ask me for my card, ask for €40, and enter it into his computer. In a few days, 28 would be deposited to my bank account.
Flu vaccines were available at the start of flu season. You would go to your pharmacist and buy the vaccine for €6 a dose, (free if you were over 55 and a resident of the Vaucluse, the Department we lived in.) You took the vaccine to your doctor and he or she would administer it for the OV fee of €20. My wife’s doctor would do us both for the price of one. Again we got the€14 refund.
Back In The USA
Now for the reptilian-brain side of my story, back on the US. Memorial day weekend, 2006, I came down with a sore throat that was so bad, I was unable to swallow. It was by far the most painful sore throat I had ever endured. I carried a cup around so I could spit out my saliva every few minutes.
My wife was out of town, and my doctor’s office was closed for the holiday weekend, so I went to the nearest hospital emergency room.
They did not do a throat culture. They prescribed a three-day miracle antibiotic, which was absolutely not indicated for this ailment and ineffective, plus massive doses of Ibuprofen, which did not relieve the pain at all. I went to my Doctor as soon as he returned, and he treated me with an effective antibiotic, and steroids to reduce the swelling. Meanwhile the massive doses of Ibuprofen cased an acute attack of gout in my right toe. Which took me back to the emergency room, (it occurred on a Friday night, and the pain was crippling.)
I was given two prescriptions for the gout, (neither worked), and one for pain. It didn’t work either. Tuesday I got back to my doctor, and he again fixed me up in a week or so, (even though the gout had traveled to my knee.)
I eventually settled with the ER doctors for about $430.00[3] I still have an overdue bill for ER services for $966.00 sitting here on my desk. I haven’t decided if I will protest on the basis of malpractice, or offer to settle for 1/3, since it is common knowledge E-rooms triple the charges from the git-go, because they know the insurance companies will chisel them down. They hospital never billed me as the doctors did; they just sent a statement to a collection agency. I checked out their website, and I feel honored such a stellar organization would deign to write to me.
I also missed three weeks of work. This is not an unusual horror story; it is simply ordinary, daily healthcare in America for the working class slob.
11/20/2005 frog405
Footnotes:
[1] I told my doctor that Vioxx was quite controversial in the US, and he said not to worry, that the ado was simply competition between two American drug companies.
About two months later, I read in the Paris Herald Tribune that the FDA was going to pull Voixx off the market pending a lawsuit. I went to renew my prescriptions the next day, and when the pharmacist called up my account, he told me that Vioxx was no longer available. He called my doctor, who switched the prescription to Celebrex.
When I went to renew the Celebrex, the pharmacist asked me how well it worked. I told him that Vioxx was a very effective analgesic, but that Celebrex seemed to have no pain-killing properties whatsoever. He asked me if I wanted to renew the prescription, and I declined.
[2] These procedures were virtually identical to those offered in the US. US prices were $40.00 co-pay per visit!
[3] My US insurance for me alone cost me $140.00 per month. It had a $500.00 deductible, and I used that up for my prescriptions for 3 months. My insurance, which was from work, was considered pretty good, except it had no emergency room coverage.
[On one ER visit, I received 5 sutures. The suture kit alone, which consisted of a needle and sutures, some saline solution, and some gauze, was charged out at $100.00!]
UPDATE 8/09/2009:
Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.
In 2004, France introduced a system under which patients must select a "preferred" general practitioner who then sends them onward to specialists when necessary. Under that policy -- similar to one used by many private U.S. health-care plans -- France's national health insurance reimburses only 30% of the bill, instead of the standard 70%, if patients consult a doctor other than the one they chose. - Wall Street Journal 8/07/2009
CMU contributions can now only be paid by French nationals or long-term residents of five years or more, or non-nationals who were already resident in France and affiliated to the CMU at 23 November 2007. All others now must insure privately for healthcare.
