Rwanda meets America via France

I am publishing this piece because I was asked to write about my personal experiences with the health care systems in the United States and France by a blogger with the tag J.O.B. I get the impression that a lot of his readers are a little right of center, to say the least. In some ways, this is a continuation of the ideas I was writing about in my earlier piece on the fledgling Rwuandan Health care System. I might have thought twice about doing this, but, I like the guy, his desire to ask questions and listen and his honesty. To me, that goes a long way...so I wrote this and he will put it on his blog. Perhaps you might check out the reactions and want to take part in the discussion that is being conducted on a blog from Crestwood, IL:

J.O.B. asked me to write a little about my personal experience and impressions of the differences between American Health care and French Health care. I am an American citizen, and an ex Toledo resident, married to a naturalized French Citizen. I have the equivalent of a "Green Card" here, a Carte Du Sejour. I pay taxes in America and also in France. I am a property owner her. I earn money in America and in France and have never been a recipient of "welfare", except for a few months on unemployment in the USA over a 35 year working period.

I worked for a railroad in Toledo in the 1970's and was a Union Member. I did have health care benefits, but I never had to take advantage of them. Later, I moved to NYC and worked for a small company as a graphic designer. The company had a good small business health insurance provider and in the early 90's, I was hospitalized for a week and thank my lucky stars for the coverage.

When I saw the bills that the insurance had covered for hospital, treatment and subsequent tests, I was floored by the astronomical amount that my insurance covered for a relatively minor illness. As a child, I grew up in a family that was literally destroyed by illness. My mother died of multiple sclerosis after a 6 year decline. My father worked for Chrysler and had insurance at the time, but he still was saddled with bills that remained unpaid at the time of his death a few years later. We were an average white collar middle class family impoverished by catastrophic illness.

Subsequently, I always held the viewpoint that the best way to stay healthy was to stay away from doctors. When I left my full time design job in New York, I became a self employed free lancer. I was offered a co pay insurance from old insurer. It would have cost about 300 bucks a month. This was the period about 12 years ago that I first started to live between the USA and France.

Luckily, I was in pretty good health. I really could not afford the 300 dollar a month insurance. From what I gather from my friends and relatives, that amount isn't very steep. My brother in law in California seems to be very proud that he is only paying 1000 bucks a month.

This reflects the basically out of control health care system in America. Over billing, the profit on drugs, the doctors charges, at the cost of administration of the system itself as well as the salaries of the insurance CEO's, the advertising and of course the political lobbying are all charges that are passed on to you, the consumer.

The problem is that to reform a system as embedded and corrupt as America's would entail destroying it and rebuilding it. When I first moved here, I saw a doctor for simple things like getting tetanus shots after I was treated for physical injury. I live in a very rural location and tetanus is big concern!

I was first amazed that my visits to my local doctor were 20 Euros cash...I was not covered by any system at the time. I was given a prescription for a tetanus shot dose, which entailed me going to my local pharmacy and buying the vial there, which I brought back to the doctor and he gave me the shot.

I have had a life long asthma condition which flares up from time to time. I ended up having to see a doctor for it a few years ago and again the office visit was 20 Euros and the cost of the prescriptions run me about 250 Euros a year. When I had the problem which caused me to seek treatment, I had an emergency visit from a doctor at my house on a Sunday afternoon which cost me 40 Euros!

Presently, I am enrolled in the French Medical System. Now that I am an official resident, I have a Carte Vitale which has a computer chip in it. When I go to thedoctors, the card get swiped and I pay, but I get reimbursed by the government for 18 Euros. So now, my doctors visits cost me 2 Euros. The same with prescription drugs. I pay up front, the card get swiped, the bill go to the Medical Administration which approves the transaction and I get reimbursed and end up paying 2 Euros for each prescription filled. I payed around 250 Euros a year before I was enrolled in the system, now I pay perhaps 10.

But, I do have "insurance" instead of insurance companies here, we have what are called Mutuals...when you go to hospital, you are guaranteed treatment, no matter who you are. The Mutual covers anything above the basic level. The Mutual also reimburses the 2 dollar fee which you pay on prescriptions and doctor visits. My Mutual de Perigord policy costs me 18 Euros a month.

The government cover most basic dental work as well. I have a great dentist in a town called Vergt. Before I was covered by the government, most basic procedures cost me about 20 Euros a visit. My dentist has a state of the art clinic and is a swell guy to boot. Before I was covered in fact, he once took payment in a few bottles of Wine from the Chateau Vieux Chevrol, where i work. I am also covered by agricultural workers insurance when I work at Vieux Chevrol. The amount of coverage guaranteed by the French System is based on income. If you are unemployed and have no income, you cannot be denied medical treatment. Because of the administrative system and the basic difference in approach to medical treatment, the over all costs of the system per person is much lower than in America. I would say the basic difference is emphasis on the philosophy of prevention and the regional organization of treatment. No matter how you cut it, the over all health here is much better statistically than much of the rest of the world. You have the right to free screening. All senior citizens are notified to come in if they want for a full range of diagnostic tests. This is why France has the lowest infant mortality rate in the world. There is prenatal and post natal care. Parents are guaranteed maternity leave. Senior citizens have a wide range of services provided to keep them independent and out of care centers. Of course the basic responsibility for health rests with the individual,  but recognizing that health care and access to health care services is a human right and not a privilege goes a long way to insuring a population stays healthy and productive.