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The Biggest Difference Between the French Health System and Ours

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February 17, 2018

By SUSAN CALLAHAN, Associate Editor and Featured Columnist


The French are different, as the saying goes. Perhaps nowhere is that more apparent than in how they deliver health care, as I found out on a recent visit.

Sick with an untimely flu, I was directed to a hospital in a little town in the Alsace region. Because I don't have health care in France, I worried about the cost. I was seen within 50 minutes of walking in the "urgence pour pietons" door.  The admitting nurse too my name and address in France, another took my blood pressure and temperature. Soon thereafter, I was screened by a doctor, had blood taken by an nurse, a chest x-ray, and whisked to yet a second examination room.

After about an hour, I was informed of my definitive diagnosis of "la grippe", given a prescription fro medicines. No bill yet, that would be sent later to my friend's address.

When the bill came, the total was 128 euros. The prescriptions at the pharmacy came to another 23 euros, bringing my total out of pocket to 151 euros.

I don't have to wonder what  such a visit would have cost in the United States because my brother went through a similar bought of flu in Texas.  Though he had insurance through his job, which theoretically should have covered the hospital emergency room trip, he needed up owing over $8700 for out-of-pocket expenses that included the cost of using an out-of-network hospital and an out-of-network.


The French Screen You by Identification While the US Screens You By Ability to Pay



















When you are wheeled into or walk into a hospital in the US, there is a wall of people between you and the medical care you eventually will receive. These people include administration staff there to screen you for medical history and, most importantly, there to screen out people who cannot pay.


Contrast that with the French system, which works like an ID system. You present your ID card and you're then treated. Issues of payment come later. If you are French, you simply present your national identity card  and your national insurance card ( la carte vitale). If you are not French, you do as I do and present your passport.

They are not concerned with payment before service. They are concerned with service before payment. For these and other reasons, including the percentage of their population covered by insurance --- which is 100% --- and the outstanding quality of care, France is consistently ranked as the top health care system in the world by  the World Health Organization.


Our system in the US has a lot to  be proud of, including being the world leader in specialized cutting edge care.  US doctors and researchers have garnered more Nobel Prizes in medicine that the rest of the world combined. The US has the most prized teaching hospitals in the world. It didn't go without notice in France that when French singing legend Johnny Halliday, their "Elvis", became very ill, he chose to seek treatment in Los Angeles. 

So for the very rich around the world, who can pay for treatment anywhere in the world, the platinum standard of care is found in the United States.

For the rest of us, the US system is pretty good, especially of you have a job or are covered by Medicare the health care system for the elderly. And most of us do in fact have health care insurance. A recent report by Kaiser found, based on US Census Data, that 93% of the Us population has health care.


But for about 7 to 10% of us, the US health care system just doesn't work very well. These are the under-insured and the poor.

Moreover, even for those of us in the insured 93%, too may times we are faced with bills that do not fit neatly within the small print of the insurance policies that we carry. This is why studies now estimate that American seniors should budget for up to $260,000 in health care costs during retirement.

Mind you, we are not alone in the developed world in having holes in our health care systems. The much-admired Canadian health care system does not cover prescription drugs. A recent "Globe and Mail" reported article found that the average Canadian spends  about $500 per month in prescription drug costs.


There really should be a way to plug some of these holes, in our system, Canada's and those of other developed countries, without bankrupting us all. Surely, some of our better minds can spare a minute from developing the Next Big Tech Thing and work a little on solving the puzzle of designing a sustainable health care system.

Maybe they already have. You may have heard that Warren Buffet, Jeff Bezos and Jamie Dimon have exploited a new law introduced by President Trump that allows health care associations to offer plans across state lines. This new health behemoth will provide one stop health care to the 1 million employees of Amazon, Berkshire Hathaway and JP Morgan Chase. If the idea works with this set of employees, the three may try to roll it out nationally.


















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