French Health Care

he French national health system, la sécurité sociale, is often cited as one of the best in the world. It served as a model for ObamaCare and Michael Moore gives it ample laudatory footage in his 2007 film “Sicko”. But as with any industry where humans are involved, there is good and there is the not-so-good. And then there is the downright ridiculous, which I wrote about in the Papaya Cure.

As a longtime beneficiary of the health system here I’ve had lots of opportunities to observe and experience some of the terrific--as well as odd--services that make the French national health system one of the most talked-about when we talk about healthcare.

The Good and the Enviable: Cost

 “In France, you pay into the system according to your means. And you take out of the system according to your illness.”

I’m misquoting Karl Marx here, but this is the core philosophy upon which the French system is constructed. Outsiders often think that the French system of socialized medicine is free. Guide books will tell you that should you take ill while vacationing in France, you can walk into any emergency room and be treated “without paying a dime!”. But the reality is that it’s not free—we are taxed heavily (I pay 60% of my gross salary back to the government and they disburse it to several agencies, the healthcare system being but one of them). In that way, paying taxes is a bit like paying an obligatory insurance policy. If you have children, get sick a lot (or have children who get sick a lot), live to be old (and get sick a lot), you’ll be very happy that you and your fellow citizens paid all those taxes all those years. On the other hand if you are childless, in excellent health and age without incident, you’ll never get your money back out of the system. But you are helping the Community (which is, after all, one of the tenets of the French Republic) so that alone will get you in to heaven. (And with that sentence, I just violated another tenet of the French Republic, which is to never mix the sacred and the secular.)

I’ve already amortized my investment. Between birthing one baby on French soil and having a serious accident with a resulting year of physiotherapy, I’d say the French have put about 1.5 million dollars in me at this point. So you’ll never hear me complaining about the system here, unless it’s about the hospital food.

The less-than-stellar and sometimes irritating: Lack of centralized information

Every French parent knows the “Carnet de Santé.” This booklet is given at birth—one for each child—and you take it with you each time you bring your child to the doctor. Some are plain (my daughter who was born in America has a boring white one, given to us by the French consulate in San Francisco), some are fancy (her sister, born in Neuilly, has one whose cover features a sketch of a child going through her developmental stages), and there is an entire industry devoted to making cute protective covers for them. (Not included in your national health plan.) The carnet de santé is sacred.  You must not lose it, for inside is your child’s health history: vaccinations, milestones reached, height, weight, all illness ranging from the common cold to the more-serious. French people like to visit lots of different doctors, often for the same malady, so the carnet de santé is a sort of ambulatory health file. The doctors don’t keep centralized files on you. You do. For adults, this means you keep all your xrays, blood test results, MRI records…all the data you’ve obtained from the different places you’ve been treated. If you are sick a lot, you’d better have a closet dedicated to holding all your different films and paperwork, which you’ll have to carry with you each time you see a doctor.

Another problem with such disparate information is that the doctors in France only know their area of expertise. You cannot ask, say, your orthopedic surgeon, for a referral to a good physiotherapist. A surgeon only knows how to operate. He is not tied in to a larger community of healthcare providers. This is quite different from the States, where all these guys get together at lavish conferences in Hawaii and try to create lucrative networks. I speculate that the isolated nature of healthcare professionals in France may be a result of the lack of impetus in profit-making.

The usually kooky and often ridiculous: Medicine Douce, or alternative treatments

Homeopathic or “kooky” medicine is practiced right alongside allopathic, or “western” medicine in France. You could go to a dermotologist with a hideous rash all over your body and get prescibed cortisone-- a legitimate drug (‘take one every morning”) as well as apis mellifica, a voodoo treatment (“place five granules under your tongue every three hours”). The “real” medication will come in some boring vial or box whereas the “fake” medicine will have some elaborate system of delivery and some extremeley intricate and impossible-to-comply-with method for application. That is so that when the worthless sugar pill fails to live up to its promise, the fault is yours. I was recently told, when I purchased some snail slime, that I “should use it for two weeks. If you don’t see results, it means your body is not receptive to the product.” That makes sense. It’s my body that is not receptive, and not your product which is completely bogus. (I bought it anyway. And no, it did not work.)

Hopefully we will all enjoy good health and limited contact with any health care system, French or not. But if you do find yourself in a French doctor’s office, it’s important to keep your mind open and your mouth shut. The latter I learned first hand when one of my doctors brought out some medieval-looking hook which he wanted to use on me to break up some scar tissue. Fearing leeches next, I exited his office as fast as possible.

At the intersection of expectations and reality

ross-cultural confusion can be the greatest where expectations meet reality. I saw this clearly when reading some comments on one of David Lebovitz's blog posts which focused on Speculoos but also wove in a good chunk of Monoprix insanity. Both Lebovitz and his readers cited the refusal of the Monoprix clerks to provide change (to use the photocopier, or break a large-ish bill when purchasing a small item) as an example of French rudeness.

Yes, it appears to be rude. But the thing is, these folks were looking for change in the wrong place. In America you can ask a supermarket cashier to open her drawer and break a bill for you. In France, you can't. You have to go to the [poorly-named, one must admit] Customer Service desk, situated near the entrance to the supermarket, to get change. That's where you go to get an item refunded or exchanged as well. Not the checkout lady. But because the supermarket setup looks the same as in America, we expect the people working in the French supermarket setup to have the same job functions as back home.

This is always a source of frustration when traveling, and especially so when traveling to Paris because Parisians are by nature not warm and cuddly to Anyone Different, nor are they information-sharers.  So when we (Americans) go to, say, the French hairdresser and expect to have our hair shampooed before it is cut, because that is normal procedure in our country and we find out that that will cost extra (as will the cream rinse and the styling and blow dry after the cut), we think how odd. The place looks the same but the people don't act the same.

When I first moved to Paris, there were a million things that appeared similar to what I knew in America but which tripped me up until I learned the new cultural code of operations. The neighborhood café...I didn't realize, until a waiter told me so, that there was a three-layer price scale in that place: cheapest at the counter, mid-level seated indoors, and most expensive if seated outside. Where I came from, all prices/seats were equal in a coffee shop. So the first time I paid more for my coffee when sitting out in the sun compared with the cost the previous day when I had sipped it at the counter, I complained loudly to the waiter that he had overcharged me. His reaction was not customer-friendly. But it was I, in my cafe-price-scheme cultural ignorance, who was at fault.

One of the most-essential lessons I've learned as an expatriate is never to assume that things will work as they do back home, even if they look the same. From the way the post office functions (you can bank your money there) to how to eat a hamburger (with a fork and knife), it is always prudent to stand back and watch the natives first.

In France they don't serve you water automatically when you sit down.
But they will serve it to you automatically when you order ice cream.

Coquilles Saint Jacques

e have a sweet modest weekend home out in the Norman village of Verneuil-sur-Avre. One of the many architectural highlights of the village is its Gothic church spire which can be seen from as far away as Chartres and is mentioned in one of Proust's stories.

 During the Middle ages, Verneuil-sur-Avre was a stopping point for Christian pilgrims hiking the Saint Jacques de Compostelle trail, and the town remains quite devout today. While that piety was not a drawing point for us--we are more prone to be found at the village bakery than inside the church on Sunday mornings-- I do love this little emblem I spied this weekend embedded quietly into one of the village walkways:

This is a marker showing that this town is a pilgrimage site. In the background is the famous Mont-St-Michel which is an hour and a half away (by car for the non-pilgrims), and which certainly ranks higher than Verneuil on the hierarchy of religious stopping points. The shell and the hooked staff are traditional pilgrim talismans. St Jacques shells were easily collected from the beaches along the route then pocketed and used by pilgrims for sipping water from trailside springs. The shell also holds a metaphorical value: the many grooves coming together at one point symbolize the various ways to get to Santiago de Compostela, the town in northwestern Spain which is the endpoint for the pilgrims' journey. The staff was used as a hiking tool and with its hook, also became a carrier.

There are still people who hike the St Jacques de Compostelle trail today, some as religious pilgrims, others as secular nature lovers. I'm pleased when they come through our little town and I find it incredibly cool that there's this tiny secret marker lighting their path, right there between the bakery and the café.

Something you'd never see in a French election

his, from my absentee ballot for the California primary:

Living in secular France, this language shocks me.

May 1st and kooky rules

t's May 1st, the French Labor Day, which is celebrated  here in diverse fashions.  Some--generally the wealthy-- take a four-day weekend.   Others--generally union activists-- hold noisy protest demonstrations to show their displeasure with Sarkozy.  The Far Right pays hommage to party idol Joan of Arc.  And everybody offers the dainty muguet, or lily of the valley, which can be purchased on any street corner from those people whom the French government euphemistically refer to as "itinerant travelers," the bane of the Right.  It's an odd paradox  (or maybe it's entirely normal) that the only people working on this historically significant holiday are those who hold the lowest ranking in the hierarchy of immigrants.

The French come out with some kooky rules from time to time, and as we sit here five days from the conclusive round of the Presidential elections, this moment is no exception.  An edict has just come down from the RATP, the managing body for the capital's public transport system, instructing ticket-checkers to not check tickets during these "tension-filled days leading up to the election."  During the last election in 2007 some métro riders were caught hopping the turnstile and things turned nasty and riotous.  While the RATP insists this order, which is in place from now until May 6th, has "nothing to do with politics", it seems a bit suspicious.  But what do I care?  FREE RIDES ON THE METRO FOR EVERYBODY!  (Even the itinerant travelers!)  This is almost as good as the parking ticket amnesty that typically follows each presidential election, another kooky decree but one for which I wait eagerly every five years.