Mercury Rising 鳯女

Politics, life, and other things that matter

US and French Health Care Systems: Two Examples

Posted by Phoenix Woman on December 23, 2007

Over at DailyKos, nyceve tried last week to get CIGNA to OK a liver transplant for a seventeen-year-old girl, Nataline Sarkisyan; the transplant happened, but the girl died anyway, likely because (as a transplant surgeon who wished to remain anonymous stated) the surgery had been deliberately delayed too long:

Insurers always qualify their denial letters with a sentence to the affect that the doctors must provide whatever care is necessary and that the payment is a separate issue. Insurers never deny CARE only the authorization for payment. To stall the actual delivery of care, insurers hold out an insincere promise to authorize payment if only the doctor provides more information. This leads the doctor on indefinitely, while insurers never says absolutely ‘No’ until the patient gives up or dies.

I agonize every day whether to wait one more day for the promised approval, or go ahead with the surgery and potentially damn the patient, their family, and the institution to assuming the insurer’s responsibilities and financial consequences. If I do go ahead without approval, as I have on many occasions, the administrators in my hospital call me in to explain why so many of my patient’s insurers are not paying and why am I performing surgery not approved by the insurer? No one rescues the patient and the family who face huge bills and bankruptcy.


Nataline was killed weeks ago, once the insurer decided to stall.

It didn’t have to be this way, as Jerome a Paris, a French Kossack whose son had a life-threatening brain tumor, can attest:

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, phychologist, 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.

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.

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 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 too by French social security.

Now that our son is in first grade, he has the right to special help for handicapped children at school (a fairly recent 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, I recently discovered that we actually 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 your 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.

8 Responses to “US and French Health Care Systems: Two Examples”

  1. shrimplate said

    You’d have to be insane, or Republican, to prefer our system to the French one.

  2. Michael said

    Wouldn’t mind living in France, I don’t think…

  3. J. R. Taylor said

    I received health care in lots of countries, including in Europe, and I prefer the health care I receive in the U.S.

    The U.S. is not France. You can go live there, or anywhere you like.

    I want control of my and my family’s health care and don’t plan to surrender it to the masses, the government or a government-sponsored system.

    We can greatly improve the way we pay for and receive health care. It’s not rocket science. A government-run system would be worse than what we have now. The whole idea behind national health care in the U.S. is based more on political power than it is on improving treatment options for everyday people.

  4. MEC said

    “I want control of my and my family’s health care and don’t plan to surrender it to the masses, the government or a government-sponsored system.”

    That’s easy to say when you can afford health care. Lots of people in this country don’t have control of their health care because the almight dollar controls who gets medical care and who doesn’t.

    Maybe I take this personally because I had a co-worker who died of uterine cancer because she waited until she got a job and had health insurance to see a doctor about persistent abdominal pain; until my employer hired her, she couldn’t get a doctor appointment because she didn’t have the means to pay for it. There’s something wrong with that.

    How much worse could a government-run system be than a system where people die because whether they get medical care depends on whether they can pay for it?

  5. Charles said

    Over 10,000 Americans every year die to make that very point, MEC.

    What’s really laughable about J. R. Taylor’s assertion is that one can easily get private care in France or any of the other major countries that offer government-funded healthcare. There are ca. twice as many private hospitals as there are public. Indeed, 80% of French have private supplemental insurance. The difference is that no one goes without.

    My guess is that JR Taylor has traveled to France on the jet streams of hot air emanating from the American Enterprise Institute. But who knows? Maybe s/he just doesn’t know how to ask for a private doctor.

  6. In fact, if J.R. Taylor had followed the link back to Jerome’s original post, s/he’d have seen that yes, France does have private health care.

    I notice that JRT knows better than to try to repeat the old “you have to wait six months for treatment in Europe or Canada” scare anecdote. That doesn’t work nowadays, not when most Americans either have a condition that they can’t get treated because it would bankrupt them even with insurance, or know someone in that situation. (The biggest reason for the growth of alternative medicine is the fact that it’s generally much cheaper than conventional medicine; since the insurance companies won’t pony up for either, and since paying for conventional treatments puts you out on the street unless you’re very rich, people rush to see the herbalists and acupuncturists.)

  7. Charles said

    I think shrimplate said it very succinctly, PW.

  8. Michael said

    As someone who has access to both conventional and alternative treatments, there is merit in both for certain conditions. However, people should not be forced to make health care choices on the basis of whether they have access to insurance.

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