Although I’m far away I keep an eye on what’s happening with the health care debate in the U.S. I get so annoyed everytime I see someone say that if the U.S. goes to a European model that healthcare will be rationed. Seriously?
Isn’t it rationed now, so that those with good insurance get more than those with lousy or no insurance? I don’t understand how the media can spin this the way that they do. JM told me about a diary entry recently on DailyKos where someone described cutting up their migraine medication into small pieces (and licking the powder from cutting it up) because they couldn’t get enough medication for all their headaches. Another friend of mine in California is considering taking a preventive medication that could have very bad side effects for her, because she has been having a rash of migraines and doesn’t get enough medication in the month to treat them. Is this not rationing?
My friend R has a terrible condition Polymyalgia Rheumatica and her GP wants her to see a Rheumatologist. But R is uninsured and can’t possibly afford to go to a specialist; even if she could, she couldn’t afford the tests or any treatment that would be prescribed. After a year on Prednisone she is being weaned off of it and now just lives with agonizing pain. Is this not rationing? Oh, and R’s GP also wants her to have a mammogram, but as R says, if she pays for it and they FIND something, she can’t afford to do anything about so why bother?
In France, if you’re a woman over 50, every two years you automatically get a letter in the mail from your insurance “caisse,” which tells you that you are due for a mammogram and gives you a list of radiologists in your department where you can call for an appointment. You don’t need a referral from your doctor or a prescription, you just call, make your appointment and go in with your letter and healthcare card.
I went this week and had mine done. Once the films were developed the radiologist came in to examine me and, more importantly for me, to GIVE ME THE RESULTS. That’s right, they didn’t have to be sent to my GP or GYN, they were given directly to me so that I knew that I was okay before I walked out the door. Although he was busy, the radiologist took time to chat with me and to find out a bit of my family history (my maternal grandmother died of breast cancer) and to find out if I did breast self-exams (I do). He was surprised, because apparently I was the first patient of the day that said she did that, and this was 3 in the afternoon!
Still, what struck me about the experience, as most of my medical experiences here do, was the humanity of it all; I wasn’t just a number but a real person to be treated as if I mattered. The radiologist gave me back my previous mammogram films (you get ALL your x-ray films given to you here; they are YOURS not the hospital’s or clinic’s), but took the time to explain that he had kept the most recent set to use as a comparison for the final report that I would get in the mail in a couple of weeks and also reassured me that ALL the films would be sent to me.
When I left, I was given my healthcare card and I did not pay a centime. I will not be billed either, because this is covered for every woman over 50 at 100%. So, is this rationing?
I truly don’t see how things can be worse than they are for a large number of Americans. I certainly never have felt that our care here was rationed in any way; I go to the doctor when I need to, I get the medications I need, I get any tests or referrals that I need. That’s it. No rationing.
I suppose that there MAY be treatments that aren’t approved here that might be approved in the States, but I know that works in both directions. Certainly if someting is approved here, however, the patient can get it if their doctor prescribes it for them. The Social Security/health care system has no say in the matter; it is between the doctor and the patient.
Some things may SEEM like rationing, but that is because, as in the U.S., there are more specialists in big cities (Paris, Toulouse, Marseille, etc.) and if you live in an underserved area you might have to wait longer for certain appointments or travel longer distances to see a provider. But, as I said, that happens in the States as well and doesn’t have anything to do with the insurance system.
Another issue that is in the news here is whether to more widely authorize shops to remain open on Sundays. While some small, local shops in villages such as ours are open, the large, chain stores are not with certain exceptions that are determined by individual prefectures. The legistature is examining this issue (as it does periodically), because President Sarkozy seems to really want to authorize it everywhere, every Sunday.
What has been interesting is the attitudes of the French to the idea. While some people say they would be happy to work Sundays if they were paid double time and it was purely voluntary, many say that Sundays are “sacred,” not in the religious sense, but in the sense that it is important FAMILY time, and should not be abridged in any way.
It points out that quality of life is a big issue here far more than it is in the U.S. People want money, need money, like to have money, but what they really want is to enjoy their lives. The money is a way for that to happen, not the goal in and of itself. I think it is an important cultural difference and one that deserves quite a bit of reflection.
Ciao for now.