A doctor makes a rare house call to visit patients in Florida. While such house calls are uncommon in the US, Steve Weissman explains that in France, where he and his wife live, they are common. (Photo: Gregg Matthews / The New York Times)
Growing up in Florida in the 1940s, I saw many of the doctors my family knew fighting against Harry Truman's effort to enact what they called "Socialized Medicine." Their immediate target was Sen. Claude Pepper, a New Deal Democrat who supported universal health care. Our doctor friends dubbed him "Red Pepper" and helped defeat him in the elections of 1950. Yet, for all this early "fight for freedom," I now find myself in France enjoying single-payer, socialized medicine, which I would heartily recommend to all Americans.
The system here is surprisingly nonbureaucratic, at least for the patient. My wife Anna and I picked our own general practitioners (GPs), specialists and hospital care, with no insurance company restricting us to their list of doctors or hospitals. In fact, we found only two restrictions. The GPs could turn us down if they already had too many patients and they had to be within our geographical area so they would not have to travel too far when making a house call. Yes, under socialized medicine here in France, doctors still make house calls, even here in the boondocks where we live.
Nurses also make house calls to give shots or take blood for testing. Test results usually arrive in the next day's mail.
For each visit to the GP, we write a check for 22 euros. The system then reimburses us for 70 percent with a direct deposit to our bank account. For some particularly debilitating conditions, the government system pays the full 100 percent. To pay whatever the government doesn't, most people here have private top-up insurance, which is very reasonably priced. So, the single-payer system has more than a single payer, but the insurance companies exercise none of the control they would back home.
At the pharmacy, we don't pay at all. We simply present our health service cards: the government and top-up insurance then pay the pharmacist directly. The system excludes certain nonnecessary medicines and requires that we use generic medicine when available.
For most visits to specialists, test facilities or hospitals, the GP acts as a gatekeeper, writing prescriptions and often a letter explaining particular problems. He or she does all this on the spot during office visits, and there's none of the paper shuffling one sees in doctors' offices everywhere in America.
Most specialists and test-givers also write up their reports on the spot and hand them directly to the patient, though x-rays and other test results will soon be transmitted to the GP by computer. Again, we've seen very little bureaucracy and no interference by either the government or insurance companies.
None of this is free, of course. Everyone in the workforce pays a percentage of their taxable income to cover this, their pensions, and other social charges. For Anna and me, the costs are covered by our British pensions from the time we lived and worked in England.
How good is the French medical care? Surveys by the World Health Organization rate the French system as the best in the world, and far better than average health care in the United States. Life expectancy and most other relevant rankings are also higher in France than in the United States.
From our own experience, we would agree that French medicine is much better and far cheaper than in the United States. When we lived in Florida, my very expensive heart specialist seemed content for me to have a bit of high blood pressure, which he saw as natural for a person of my age. Not so here in France, where the doctors kept changing my pills until they got me down to the normal 120 over 80. The French doctors also found a way to end a long-standing enlargement of my heart that never bothered my American doctors.
To be fair, not all doctors here are as good as the ones who've treated us, and we've heard the same kind of horror stories we heard in the States about doctors who buried their mistakes. We also hear threats to cut back funding, which is already far less per head than spending on medical care in the United States. But, so far, we've gotten the best of care, as do all our neighbors, including workmen, farmers and retirees on limited budgets.
Why, then, can't Americans have the same kind of socialized medicine? Mostly, because of the health maintenance organizations and insurance companies, who take such a big slice off the top. So strong is their influence that almost no one of any clout in American politics dares to talk of a single-payer system that would simply do away with private medical insurance, except perhaps as the kind of top-up they have here.
Hopefully, if enough Americans get to know what exists here in France, the debate will open up. Something like the French system would certainly save Americans a great deal of money and provide much better care.
But, for Anna and me, it's already too late. We've become so enslaved by the great medical care we now have that we cannot see ever moving back to the United States or anywhere else. That, I suppose, is the true horror of socialized medicine that all those Florida doctors warned about back in the 1940s.