September 21, 2009

• A Socialist Healthcare Horror Story

  You’ll probably want to read this one to the very end for the surprise finale.  It’s actually an e-mail that was sent to a friend of mine in 2007, from a gentleman in France.  Every word is true; nothing is made up or altered.

  Socialist healthcare horror story
  by Jerome a Paris
  Fri Apr 20, 2007 at 09:15:40 AM PDT

  As the next exam for my son gets near (next week), I though I’d provide
  a short summary of my family’s dealings with a socialist, centralised,
  single-payer healthcare system.

  As a reminder, my (then 4 years old) son was diagnosed 2 and a half
  years ago with a brain tumor. He underwent surgery, then chemotherapy
  for a year and a half. Early last year, he appeared to have been cured,
  but the tumor reappeared last autumn, and he underwent radiotherapy
  this winter.

  Next week we’ll know how that is working.

  In the meantime, as a consequence of surgery, he is handicapped and only very partial use of one arm.

  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 chemotherapy, 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.

  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.

  An interesting twist to that story is that we do have private
  healthcare insurance in France. Basic healthcare is covered by social
  security, but only partly: except for the poor (under a certain income
  level), there are co-payments for most expenses like medecine and
  doctor visits, and doctors are also allowed to charge you more than the
  official tariff (and you have to pay the difference, in addition to the
  co-payment on the official price). Thus many people buy private (or
  mutual) insurance to cover that difference partly or fully. Such
  insurance is often provided by your employer. But whenever you have
  “major” expenses, you switch to 100% coverage of expenses by the public
  system – except that, if you had a private insurer, it has to pay to
  the public entity a portion of the costs. In my case, as I had a good
  insurance via my bank, this is what’s happening, and thus the private
  sector bears a portion of “catastrophic risk.” (And they have no say in
  what care is provided. They just pay an agreed fraction of it.)

  Thus there is solidarity across the system.

  This is not to say that all is well in French healthcare. As in other
  countries, costs are barely under control, spending increases every
  year, and there are many ways the system could be improved for doctors,
  nurses and patients. But the fact remains that if you are badly ill,
  you will be taken care of; you will not need to give up your job (or if
  you do, you’re helped); you will not need to sell your house; and you
  will not be denied healthcare (see my second comment below).

  It’s been tough enough to deal with a sick child; I simply do not want
  to imagine what it would have been like if I had to beg for care or to
  scurry around for money in addition.

  It’s just inconceivable. And thus, I was happy to pay taxes before, and
  I’m really, really happy to pay taxes now to provide that level of care
  for those who really need it.

  • 8:07 am
  • 7 Comments