This is the sixth and last of the summer series on cultural differences between France and America and how these differences can potentially affect our health. I have decided to keep “the best” for last, commenting on what I saw here in the states this summer between my dad with his stroke and continued medical care and complications, with the way that the healthcare system works in America and how different this system is to the French healthcare system. I know there are also major concerns with the French socialist healthcare system, including government intervention and the huge debt, but the French system does have major advantages: almost all of the French population is covered by the government-run healthcare system. This can be critical for practicing preventive care and is especially important when you suffer devastating life changing illnesses such as stroke, cancer and heart disease.
My dad has good health insurance, probably one of the best around; but I still was shocked by what I saw happening between the medical system and his health insurance company. In reality there were the extreme costs of medical expenses (luckily most covered by insurance) and mistakes with billing on the health insurance side (denying reimbursement for things that should be reimbursed). I was scared to think about those who were in the same situation as my dad and who weren’t as lucky to have such good health insurance coverage or who don’t have any health insurance. Or those in the middle class who don’t qualify for government help or free health insurance programs. Does medicare cover all these expenses that my dad incurs? I wonder…
Perhaps these observations on the American health system wouldn’t even cross my mind during any other summer if my dad wasn’t sick. Some differences between French and American system that pop out of my head? As I said, most of the French population is covered by the government health plan including a prescription medicines plan. There is the family doctor that comes to the home every week to follow their patients (for those who cannot leave the home), or doctors that visit a child also at home (at 9:30 pm) with a potential case of the flu. Doctors and specialists that cost 22 Euros-40 Euros a consultation. Hospitalization, blood work, scans like MRIs, etc. all covered. But of course, not everything is covered, for example not things like long-term daily home health aides’ salaries. What does this equate for our health? People who can pay for their medicines, who can get scans done, blood work, who can have a doctor visit them when they cannot. People who can see doctors for very little cost because they are covered by the government plan. In other words, more preventive care rather than emergency care.
But, in America? No, the home health aides are not covered either (buy long-term care insurance if you can, paying for aides is a major expense). And, no, doctors don’t come to the home to visit you if you are home bound (although physical therapists, nurses, dietitians, speech pathologists, etc) can be covered for home visits. But, I think some of the other major shocks this summer include looking at the personal direct costs for medical care, for the costs for what the health insurance and the patient pays for medical items such as bandages for example. I went to the pharmacy to buy 5 x9 sterile abdominal bandages for my dad. They cost less than five dollars for 12 bandages. The health insurance company also covers these on my dad’s plan and they are shipped out by the medical supply company for 110 dollars (again that is for 12 bandages). And the patient pays 8 dollars of this cost. Meaning that the insurance company pays 102 dollars and the patient 8 dollars, and yet they cost 5 dollars at the pharmacy for the same thing. I don’t understand this..no wonder monthly health insurance premiums are so high.
And then, there is the prescription medicines. Thankfully my dad has a great prescription pharmacy plan with his health insurance, but still there are medicines that are covered very well (and you pay 3$) and others that you have to pay up to 30$ a month, for example the test strips for diabetes. And 30$ is the balance after the health insurance company pays their share (which is a lot). What do the 18 million diabetic Americans do if some cannot pay the real cost for these test strips? And this doesn’t include the costs of the lancets and the medicines that go with their disease. If a diabetic person doesn’t test their sugar levels and monitor their diabetes properly they could end up with a stroke, heart attack, blindness, kidney disease, foot disease leading to amputation. I cannot imagine that a person in France could question whether they could afford their sugar test strips or their dinner.
Back to the health insurance company. Yes, my parents are lucky to be covered so well. With my dad’s illness there is even a nurse case manager from the health insurance company that calls every week to see how things are going. I tell her how things are…but in the back on my mind, I get scared to say the wrong thing because this same company last summer made economic decisions not to cover certain necessary medical needs due to various erroneous information on my dad’s medical chart. In the back of my mind when I talk to the case manager I ask myself is she trying to help or is she asking these questions to find another reason to deny my father basic medical needs that his doctor ordered? THIS IS SCARY..THIS SHOULDN’T BE LIKE THIS! In talking to her, I wanted to tell her my real thoughts…that these big health insurance companies decide not reimburse the hospitals for patient care that has already happened because they deemed that certain patients could have been sent home earlier, even if their doctors didn’t think so. I want to tell her that because her company has decided not to pay the hospitals for services they have already rendered the hospital staff is cut due to budget reasons, especially the aides, cleaning staff and nursing. When aides and nurses are working under stressful conditions because there is not enough help, patients like my dad who need to be turned every 2 hours or they get pressure sores get pressure sores. These get bigger at home, and in the end that health insurance company has to pay even more out of their pocket, because the pressure sores that began in the hospital require home visits from nurses, wound vacs, surgeons, medicine. It is a vicious cycle. And who suffers the most? The patient and the caregiver….
My basic personal conclusion seeing both the French and American system up close? In America, health insurance companies have too much control over medical decisions. Medical care is too expensive and Americans are having to make difficult choices such as “do I buy food or my medicine?” There is not enough preventive care and too much emergency care. It is stressful to be sick in America, even when you are covered by a good health insurance plan. In France, there are also problems with the healthcare system, but it is mostly equated with the escalating debt for government and not direct patient care. There needs to be a balance between the two systems, but in the meantime…WHAT IS GOING TO HAPPEN IF WE DON’T TAKE MORE CARE OF OURSELVES? IF WE DON’T INVOLVE OURSELVES IN OUR OWN PERSONAL HEALTH REFORM? I can see a bleak future….especially for our children. Am I wrong? Please comment if you think so.