Socialized Medicine in France: What Comes After the Colon.
Let's face it, it's easy to have contempt for the French. Has there ever been a people so painfully self-unaware? There's no country quite as chauvinistic as France and yet they're first in line to criticize Americans for *gasp* preferring the simplistic American Way of Life. They maintain a political system that, whether oscillating wildly between left-of-center socialism or center-left statism, maintains a fetid core of crony capitalism and corruption. They defend without shame, remorse or UN resolution whatever they perceive as their interests (I actually admire this) all the while chanting "No Blood for Oil" at you-know-who.
All this to say that mocking the French is light and pleasant work, often profitable, always sweet.
And yet--you sensed there was a "yet", right?--and yet, well first, a little back story: In late August 2011 I was diagnosed with chronic constrictive pericarditis, a rare disease, confirmed after a month's worth of tests & scans and one that requires, eventually, intrusive surgery. Namely, cracking open the sternum like a lobster tail, spreading the ribs with the jack from the back of an SUV and cutting away the thickened, scarred and calcified pericardium that was compressing my heart. My cardiologist spent an entire afternoon-into-evening visiting me at the clinic, consulting other specialists, making calls and finally coming up with a surgeon who had not only performed an impressive number of pericardiectomies --chose rare!, but was also the head of the service at St. Joseph's Hospital in Paris.
Shortly thereafter, I met with the surgeon and anesthesiologist. Next week I was on the operating table.
I had been asked if I preferred having the surgery in the US; I thought it over for a few seconds and answered no. I was just simply reassured by these doctors whom I perceived as consummate pros. The hospital was spotless --they hadn't had a case of staph infection in years and were absolutely vigilant about maintaining that record. The doctors, interns, nurses, aids, orderlies were uniformly professional, courteous, pleasant, funny-- I've taken vacations that were more uncomfortable than my hospital stay. And, most important, the operation was a total success and today I have more energy than I've had since High School.
Now, Mark Steyn has some chilling tales of the state of national healthcare in the UK and Canada, but my experience tells me that in France, it actually works. Er, for now. Of course it's unsustainable, even the French know that, and many rural areas are not at all as well served as in Paris, but in the end, France has socialized medicine because the French overwhelmingly want socialized medicine, and are willing to not only pay high taxes for it, but also live with the lower incomes the socialized system engenders. Furthermore it is egalitarian in nature: the rich, who are taxed heavily have an equal right to the services, unlike a heinous progressive plan wherein higher taxes translate to little, if any access to "free" healthcare.
Sadly, I am not rich but for 20 some odd years I have been paying roughly 1/3 of income for social services and supplementary private health insurance, so I have no qualms about saying that stepping out of the hospital after major surgery and a nearly three week stay, I paid out of pocket, nothing. (Except for the standard fee for in-room TV which I hardly used because I was reading Neal Stephenson's REAMDE on the Kindle, the novel which just keeps going, and going... Or maybe that was the morphine. Whatever.) I was, and still am until 2013, covered 100% for any and all medical expenses including prescription drugs relating to this condition.
"Hold up there, dash", I hear you saying, "One minute you're mocking the French with reckless abandon and in the next you're saying you like their national health care? What gives."
To paraphrase Chuck Yeager: I don't advise it, you understand, but it can be done. Not efficiently and probably not for very much longer, but if you want it bad enough, as the French seem to--across the whole political spectrum--then socialized medicine is what you'll have.
As a system it's not exactly stellar: It's widely abused, costly, inefficient, wasteful, clearly unsustainable and as such offers diminishing returns. In practice, except for certain interventions (such as mine), you will need a supplementary private health insurance because the national plan reimburses less each year.
It should be noted also that malpractice judgments are very limited here as compared to those stateside; it would be fiscally imprudent to nationalize healthcare without first reforming tort law. And by imprudent I mean suicidal.
So serve a paper and sue me, sue me shoot bullets through me. I wouldn't do it this way, I don't particularly recommend it, and I certainly wouldn't try to ram it down the throats of an unwilling nation, giant gavel in hand, but it's not a lake of fire either. Call me a squishy RINO if you must; I cannot totally condemn this system, but neither should l I be surprised if some time soon it all comes tumbling down.
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Comments:
Mar '11
Re: Socialized Medicine in France: What Comes After the Colon.
After many years of working in both private and government sectors, and also being a customer of both, I'd venture that saying the private sector does a better job of delivering goods and services than the government sector is like saying that men are physically stronger than women.
It is true in the sense of averages and trends, but says little about specific instances.
Real capitalism has the virtue of providing a stern corrective to poor behaviour. But other social and cultural standards can, in some circumstances and some places, do almost as good a job. Those standards tend to manifest themselves mostly in places where there is a clear, universally agreed goal as raison d'etre of the organisation. For example military, police, NASA and, of course, hospitals.
Once the mission becomes less clear, more watered down, then the cultural standards become weakened. NASA could put a man on the moon, and when that goal was gone it became increasingly aimless.
As hospitals become bureaucratised, perhaps their mission is also weakened.
Could it be that in France the mission of hospitals has not been diluted by law suits and paperwork? Yet?
Oct '10
Re: Socialized Medicine in France: What Comes After the Colon.
A brave and thoughtful post. I have a French friend who also talks about the abuses that go on there, but I think he also approves of it overall, which seems to be your position. Do you think there are obvious reasons---other than outrageous lawsuits--that would sabotage socialized medicine in the U.S.? I mean reasons particular to the U.S.
Putting that kind of power in the hands of Bureaucrats seems like a recipe for disaster. Not to mention stifling the innovative power of the free market. Doesn't France/UK/Canada/Australia profit hugely from U.S. medical/drug breakthroughs?
Dec '11
Re: Socialized Medicine in France: What Comes After the Colon.
You may not be rich, but somebody had to be to pay for your procedure and care which must have cost --pardonnes the ugly American tendency to parler d'argent-- well over $100,000.
May '12
Re: Socialized Medicine in France: What Comes After the Colon.
In the absence of a free market, it's hard to tell how much my procedure really cost, but it should be noted that salaries are much lower here than in the US: A quick google and I find that for example a nurse category B (whatever that means) with 20 years experience has a base salary of $34,600. I would wager that in the US that would be higher. A younger nurse, with only 5 years service makes barely $2k /month, for very long hours.
Similarly, doctors, specialists, surgeons, technicians... all make a good living by French standards but would be considered underpaid stateside.
In any event what you say would still be true if I only had private insurance. Say I had only been insured for 6 months and yet was covered for a procedure costing 100k. Many others subscribers would be paying for it, not my few premiums.
The difference is philosophical: Compulsion vs. free will.
May '12
Re: Socialized Medicine in France: What Comes After the Colon.
For the time being, there don't seem to be "death panels" but when the fiscal crisis deepens I have no doubt there will be debates about limiting care for the elderly, for example. Sorry gramps, just can't afford it anymore, here's a generic brand pain pill.
As for the pharmaceutical industry, I don't believe it has operated in a free market since the early 20th century, alas.
May '12
Re: Socialized Medicine in France: What Comes After the Colon.
Severely Ltd.:
...but I think he also approves of it overall, which seems to be your position.
It's not that I approve: I'm here, that's the system, I'm obliged to pay into it, I use it. My advice for America would be the same as for the VAT: Don't go there.
The hospital* where I stayed was built around a church. Literally. There's a small, lovingly preserved stone church in the center courtyard. But also figuratively: It was once charitable giving through the church that provided healthcare to "the masses" until the church was supplanted by the state in the last century. Now, surprisingly, France which is today a very secular country, has nevertheless preserved a sense of Christian values in many institutions (although most people would probably deny that--it's reason and enlightenment, you see...). I think that is one reason why the system is not too, too awful yet.
*this hospital also seeks and receives charitable gifts from private donors, it is not entirely funded by the state.
Jul '11
Re: Socialized Medicine in France: What Comes After the Colon.
Last fall I sent a man to northern California to have his pericardium stripped for just such a condition. The first case of contrictive pericarditis I'd seen in private practice and the second of my career. The operation has quite a risk. I know the man as one of the worlds leading heart surgeons and would not have sent my patient to France unless he was French and even then would have been curious if he wanted to pay for better care( mortality and morbidity wise) in the US. It's odd you brought this topic up. I am glad you did well and had the best in your country. France does have good medicine for now. Offering easy immigration and full social services to new arrivals leads to a real full roster of AIDS cases and empty public coffers. Your system will collapse as will ours but for now there are miracles to be had in both.
Apr '12
Re: Socialized Medicine in France: What Comes After the Colon.
The US is known to be the best at diagnosis, then in Canada we have the medical care that is free supposedly, but it is collected in our heavy taxes over the years. So the only health care insurance is by the government so no one else can compete. It also means you are spending government money, not your own. For someone like you, who is patriotic and conservative, you would not dream of abusing such a system. But we now have many nationalities who are dual citizens of convenience. There was an article in the paper where Chinese do not want to live in Canada as it is so hard to make money due to taxes, but they retire here because it is safe and there is good health care. Who paid for the safe community and health care with their taxes over their life time? Those Canadians who are taxed. There is no free health care by the government. The abuses by incoming immigrants would shock and amaze but there is no loyalty to Canada the country. Meanwhile, it takes me six months to see my GP. My son waited one year for his operation.
May '10
Re: Socialized Medicine in France: What Comes After the Colon.
Wasn't it France a couple years ago a number of elderly died in a heat wave in August because so many medical personnel were on vacation and couldn't be persuaded to come back?
Jun '10
Re: Socialized Medicine in France: What Comes After the Colon.
Ponzi schemes are fantastic, if you get there early enough.
Re: Socialized Medicine in France: What Comes After the Colon.
Indeed. Socialized medicine works very well for those who are well-connected and know how to work the system. It works far less well for ordinary nobodies.
Mar '11
Re: Socialized Medicine in France: What Comes After the Colon.
Back in 2003, bit of a disaster:
Dec '10
Re: Socialized Medicine in France: What Comes After the Colon.
Paul A. Rahe
Indeed. Socialized medicine works very well for those who are well-connected and know how to work the system. It works far less well for ordinary nobodies. · 0 minutes ago
When I asked my British friend about the horrible wait times, she said, "well, you just travel to another region to get in sooner." Sort of defeats the "equal access" goals of socializing medicine, doesn't it, if the average bloke can't afford the train ticket to his next appointment?
Dec '10
Re: Socialized Medicine in France: What Comes After the Colon.
Western Chauvinist
Paul A. Rahe
Indeed. Socialized medicine works very well for those who are well-connected and know how to work the system. It works far less well for ordinary nobodies. · 0 minutes ago
When I asked my British friend about the horrible wait times, she said, "well, you just travel to another region to get in sooner." Sort of defeats the "equal access" goals of socializing medicine, doesn't it, if the average bloke can't afford the train ticket to his next appointment? · 2 minutes ago
I'm sure they subsidize the rail as well.
Mar '11
Re: Socialized Medicine in France: What Comes After the Colon.
Paul A. Rahe
Indeed. Socialized medicine works very well for those who are well-connected and know how to work the system. It works far less well for ordinary nobodies.
Prof. Rahe, I have experienced government-run healthcare systems personally in France, Switzerland, and Germany, and find this comment off the mark. Say what you will about the faults of socialized medicine, it was much, much easier and quicker to get care in any of those three countries as a "nobody" than it is in the US.
Let's criticize these programs where they deserve it (i.e., their looming bankruptcies) and not start drawing caricatures that end up hurting our side of the argument.
Aug '10
Re: Socialized Medicine in France: What Comes After the Colon.
I'm no expert on the French system, but I understand that it's a "mixed" system, and not fully socialized. This is in stark contrast to Canada's health care system or Britain's National Health Service.
I don't know all the details of how France administers it's system, but here are a few links:
I do know that when Canadian conservatives talk about how they want to reform our system, they often cite places like France and Germany as models, and they are subsequently shouted down for being extremist right-wingers.
Mar '11
Re: Socialized Medicine in France: What Comes After the Colon.
Mendel
Paul A. Rahe
Indeed. Socialized medicine works very well for those who are well-connected and know how to work the system. It works far less well for ordinary nobodies.
Prof. Rahe, I have experienced government-run healthcare systems personally in France, Switzerland, and Germany, and find this comment off the mark. Say what you will about the faults of socialized medicine, it was much, much easier and quicker to get care in any of those three countries as a "nobody" than it is in the US. · 8 minutes ago
Certainly our mess of a health care system is a model for no one but I think 15,000 dead French citizens might disagree with your assessment of "quick" and "easy". The French Parliament's own internal report blamed their health care system for all those deaths in the 2003 heatwave.
Dec '10
Re: Socialized Medicine in France: What Comes After the Colon.
I work for a company that sells Hospital softwear. We run in about 1/4 of US hospitals and about half of Canada so I hear alot of stories like this, good and bad. Here's one of my favoirte cautionary tales!
In 2010, the Newfie Premiere went to the US for a delicate heart operation, not because he couldnt get it there, but because he would have bumped someone else of the queue because of his status. He said something like "Its my body and my money so I'll go where I want". when asked about the decision. Nice to have choices...
http://www.foxnews.com/story/0,2933,584816,00.html
All in all it seems from my stats that Canada and socialist countries as a whole are great places to get hit by a bus(figuratively or literally), not so great to have bad asthma that needs constant management or a complex pregnancy.
Jul '11
Re: Socialized Medicine in France: What Comes After the Colon.
Mendel
Prof. Rahe, I have experienced government-run healthcare systems personally in France, Switzerland, and Germany, and find this comment off the mark...
To be fair, you are both using anecdotes rather than data. I have no doubt that you are both correct, and therein lies the problem. One system, variable outcomes.
One thing I have always read to be true is that socialized systems are quite good at treating outsiders because of the fiscal benefits to the system. To offer and anecdote of my own, a friend hit her head while in France; in spite of being fine she was made to go to hospital. Once there, the doctor told her what she already knew, "You'll be fine." She was then handed a 500 euro bill. So she received prompt fleecing, even if unnecessary service.
Jun '11
Re: Socialized Medicine in France: What Comes After the Colon.
I have to challenge the premise that France, etc. have socialized medicine and we don't. Is there any other industry so dominated by the public sector? IMO, we're different by degree, not kind.