French health care problematic in U.S.

Byline: Kevin Cape For The Register-Guard

Having lived most of my life in Europe, I am always intrigued by the extent to which "the European health care system" (or "socialized medicine" to its critics) is invoked either as a panacea or a snakeoil remedy for what ails American health care.

While I do prefer the French system to the U.S. one, it is still hard for me to see how what works reasonably well in France can be grafted on to America's very different economic, social and legal traditions. For me, it is a little like my being comfortable with French 16-year-olds legally drinking beer or wine - yet it is not something I would advocate on the other side of the Atlantic.

First, Americans should understand that there is no "European health care system," as such, since medical practices vary considerably from country to country. In Britain or Italy, the general practitioner is generally a government-appointed physician; no money changes hands from patient to physician, as the government pays the doctor directly.

The French system is quite different, in that patients are allowed to choose their own doctors, as long as the doctors have signed an agreement with the state health service to charge a fixed rate, which is about $30 for a typical office call that usually lasts about 15 minutes. At the end of the medical visit, the patient hands the doctor a plastic card with a computer chip, which sends a message to the local health care office that the patient has paid his $30; about two-thirds of that appears a week later in the patient's bank account, with most of the rest paid by mutual insurance jointly funded by contributions from the patient and his employer.

Increasingly, though, patients are being asked to bear a little of the burden themselves - at the moment it is only 1 euro (about $1.38) per visit, but it is certain to rise.

One of the things I like about this system is that there is a refreshing lack of bureaucracy - "socialized medicine" though it may be. Having accompanied a number of sick relatives to the doctor here in the Eugene area, I am dumbfounded by the number of personnel in a typical medical office, a truly bewildering plethora of people in antiseptic white.

When I go to see my doctor in Paris - his name is Maxime - I wander into his waiting room, usually without an appointment, and I take my turn. He is alone in two tiny rooms, one a waiting area and another his consulting room.

It is a folksy and convivial place, and Maxime usually wears a rumpled sport jacket. He is meticulous about taking my blood pressure - the French are very big on blood pressure - even though it rarely varies. As he has known me for 20 years, we have a good doctor-patient relationship, typical of the conspiratorial warmth of the French after they have known you for a decade or two.

Having said this, I do not want to sound like Michael Moore's latest documentary, "Sicko." While most European systems do cost less (as a percentage of gross domestic product, France's costs about 10 percent vs. America's 14 percent), there are important trade-offs.

America is a famously litigious society, and one reason American doctors make twice as much as French doctors is that they need to pay huge insurance premiums, particularly in certain fields such as obstetrics. When doctors in France make mistakes, the government usually compensates the victims of medical malpractice, but at a penurious rate that would make most Americans scream, "Unfair!" (and send their lawyers to the emergency room).

A further legitimate reason for high doctors' incomes here is to pay off the large debts from medical school (an average of about $130,000 by one count). In continental Europe, medical school tuition is largely state-funded.

Another big difference between the two systems is that the price of drugs throughout most of Europe is controlled by the state. While the state health system does reimburse from one-third to two-thirds of the cost of a drug (with the mutual insurance picking up most of the rest), this is only financially viable with strict price controls - an idea guaranteed to provoke the opposition of powerful and politically well-connected U.S. drug companies.

The French, of course, do live longer than Americans, but I doubt that it is due to the health care system. I put it down to all of that red wine and goose liver pate, the latter delicacy now attracting the ire of American animal rights activists.

In fact, the complexity of health care reform is enough to drive one to drink - but alas, I have promised Maxime that I would cut down.

Eugene native Kevin Cape is a writer and teacher living in Paris.