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Hullabaloo


Friday, February 14, 2014

 
The best health care in the world

by digby

I think that most Americans assume that while it may be expensive and it may be unequal, if a person has money and access to the best American health care has to offer, they're getting the best healthcare in the world.

Not always. Not if you have cancer. This article by Anya Schiffrin about her father's cancer treatment in France is a real eye-opener:

In New York, my father, my mother and I would go to Sloan Kettering every Tuesday around 9:30 a.m. and wind up spending the entire day. They’d take my dad’s blood and we’d wait for the results. The doctor always ran late. We never knew how long it would take before my dad’s name would be called, so we’d sit in the waiting room and, well, wait. Around 1 p.m. or 2 p.m. my dad would usually tell me and my mom to go get lunch. (He never seemed to be hungry.) But we were always afraid of having his name called while we were out. So we’d rush across the street, get takeout and come back to the waiting room.

We’d bring books to read. I’d use the Wi-Fi and eat the graham crackers that MSK thoughtfully left out near the coffee maker. We’d talk to each other and to the other patients and families waiting there. Eventually, we’d see the doctor for a few minutes and my dad would get his chemo. Then, after fighting New York crowds for a cab at rush hour, as my dad stood on the corner of Lexington Avenue feeling woozy, we’d get home by about 5:30 p.m.

So imagine my surprise when my parents reported from Paris that their chemo visits couldn’t be more different. A nurse would come to the house two days before my dad’s treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting. Total time at the Paris hospital each week: 90 minutes.

There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, “It turns out there are solutions for the all the things we put up with in New York and accept as normal.”

One day he had to spend a few hours at Cochin. They gave him, free of charge, breakfast and then a hot lunch that included salad and chicken. They also paid for his taxi to and from the hospital each week.

“Can’t you think of anything bad about the French healthcare system?” I asked during one of our daily phone calls. My mom told me about a recent uproar in the hospital: It seems a brusque nurse rushed into the room and forgot to say good morning. “Did you see that?” another nurse said to my mom. “She forgot to say bonjour!”

When the gemcitabine stopped working, the French oncologist said he would put my dad on another drug — one my dad’s U.S. insurance plan had refused to approve in New York.

By this time, I had become a French healthcare bore. Regaling my New York friends with stories of my dad’s superb care in Paris, I found people assumed he was getting VIP treatment or had a fancy private plan. Not at all. He had the plain vanilla French government healthcare.

I had read many articles about the French healthcare system during the long public debate over Obamacare. But I still I hadn’t understood fully, until I read this interview in the New York Times, that the French system is basically like an expanded Medicaid. Pretty much everyone has insurance, it explained, and the French get better primary care and more choice of doctors than we do. It also turns out, as has been much commented on, that despite all this great treatment, the French spend far less on healthcare than Americans.

In 2011, France’s expenditure on health per capita was $4,086, compared to $8,608 in the United States, according to the World Health Organization. Spending as a percentage of gross domestic product was 11.6 percent in France while in the United States it was a far higher 17.9 percent.

There's more. The palliative care was superior as well. And nobody has to deal with bills and waiting on the phone or "shopping" for insurance without having a clue about how to understand how to assess "value" for money in medical care.

Obviously, American health care, at its best, is very good on a scientific basis. Doctors are highly educated and there is access to the latest technology (if you have money.) But it's not structured around patients it's structured around "consumers." And I think that's what makes the difference.



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