Health Care in France—and in America

A journalist’s observations

Welcome back to America, I said to myself after a two-week trip to France. Yes, I did think about health care while I was away—all that rhetoric about the U.S. and its “best” health care in the world, and the French and their “socialistic” system. Traveling abroad always brings up the medical what-ifs—an accident, a sudden illness, the need for a doctor in the middle of the night. In France, though, I was hardly worried. Patient satisfaction with medical care here is among the highest of any western European country. The French have a higher life expectancy, lower infant mortality, and lower costs than we do. In 2000, the World Health Organization ranked the French system the best in the world. The U.S. ranked thirty-seventh.

I have experienced the German and British health care systems on other vacations for trifling ailments that were quickly cured. I didn’t think France would be different. “Don’t worry,” said a German doctor when I presented my Blue Cross card to him thirty-five years ago. “You can’t pay here. The most important thing is that you are well enough to go out and enjoy Oktoberfest.” I never got a bill. Making sure a foreigner got well seemed to be more important than collecting money. In England, I sat on an exam table silently rehearsing all the consumer questions I had to ask the British doctor. Should I tell her to wash her hands? She did that as a matter of course. Should I ask her to read the antibiotic prescription to me so I could tell the pharmacist to give me the right drug? Should I ask about side effects? She handed me a computerized form answering all my questions—no illegible doctor’s scribbles here. Go down the hall to the pharmacy and get this filled, she said. I paid about $12. All this took about an hour, wait and all. I never got a bill.

Luckily, this time I didn’t need health care, but lots of people I met wanted to talk about it. An American journalist who has spent most of his career in France said he and his wife were not interested in moving back to the U.S. largely because of health care. In fact, he didn’t even sign up for Medicare when he became eligible. Some Brits we met at breakfast one morning had trouble comprehending what they considered the silliness of the current debate. The tone of the discourse in the States was unthinkable to them. They talked of their own costly medical experiences while visiting Chicago. They had learned that the first thing American doctors and hospitals ask is whether you can pay, not how they can fix what’s wrong.

France—the land of some of the best pre-and post-natal care in the world! Making sure that babies and children are well cared for, medically speaking, is a tradition dating to the time when the French government wanted to make sure babies grew up to be healthy soldiers. Necessity turned into good public health policy. One thing stood out as I watched families interact with their children and kids playing in the town squares: The kids were not obese, fat, or even slightly chubby. That’s an observation, of course, not a scientifically proven fact. Nevertheless, the comparison with a group of American kids playing in a park was striking. In the U.S., one in three children born in 2000 will develop diabetes during his or her life—a disease linked to obesity, now considered an American epidemic. Although cola creep (bottles of soda getting bigger) was noticeable on this trip, I didn’t see kids or (adults, for that matter) walking down the street carrying venti caramel macchiatos loaded with useless calories.

Then, a column by Garrison Keillor published in the International Herald Tribune drew me back to reality of American health care. “Awaiting the Sausage Mill,” screamed the headline. Uh-oh, I thought. Have I missed the grinding party? I hadn’t. Keillor told of two benefit concerts he had attended recently to help musicians pay their medical bills. He told of another friend who had been injured in England, where doctors didn’t ask for his insurance card before fixing him up. They just did what had to be done. That was exactly the same experience I had in London a few years earlier. “That is just ridiculous,” Keillor wrote. “Why should anyone, least of all a valuable contributing member of society, have to pass the hat to pay the doctor?” In America, it’s done more often than you might think.

Benefits to raise money for health care in France? C’est impossible! Kind of makes you wonder what’s so bad about the French health care system, and all those skinny children who look the way American kids once looked.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.