Health care reform controversy in both Europe and the United States

On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of everything while we were in France in celebration of her turning 40.

I did enjoy catching up on Marceau – I still remembering watching La Boum in my high school French class – but I couldn’t help but notice a two-page spread showing a large group of physicians in their white coats standing on the staircase at the Université Paris Descartes – a staircase I remember descending last year after my visit to the Musée d’Histoire de la Médecine.

It was the central image for an article about physicians writing a letter of protest to Sarkozy regarding French health minister Roselyne Bachelot’s healthcare reform bill. Whether it’s in the U.S. or Europe, it seems, health care reform must provoke controversy.

The article discussed the doctors’ objections to the allocation of decision-making power exclusively to hospital chief administrators (CEO’s / CFO’s), to cuts in staffing and services, and to decisions about patient care being made based on financial rather than medical criteria. Their battle cry, “Let’s Save The Public Hospital,” pointed to the increased economic burden that the current bill implied for teaching hospitals carrying the brunt of high-acuity, high-volume patient care.

Physicians weren’t the only professionals openly protesting Bachelot’s bill. Nurse anesthetists blocked train tracks at the Gare Montparnasse last May to protest the bill’s failure to recognize their specialty (France currently has 7500 nurse anesthetists).

Though I am much less familiar with the French system than the American, the article made me think about how my life might be quite different, both as a physician and as a patient, if I were living in France, as I have often fantasized.

If I were a physician in France I’d be making less. Primary care physicians in France get $32 for consultation ($37 if it’s a house call), whereas Americans under Medicare get $92 for the first visit and $125 for a “moderately complex consultation.” French Anesthesiologists make from 4000-7000 euros a month, according to one website.

But …

As a physician in France I wouldn’t have crippling student loans to pay back (the government would have paid for my education), and my malpractice costs would be significantly lower. I’d also be able to make decisions as I please without being muzzled by an insurance company – though as an anesthesiologist in the U.S. I can already do that; it’s usually primary care physicians in American who have to deal with the frustrations of having to adjust medical decisions based on insurance company restrictions.

In France I would, however, have had to have been in a science / medical track for most of my scholastic career, starting in high school, and would probably never have been able to do what I did in the U.S. – major in literature, then switch to medicine after university. I’d have had to do a lot of demanding oral exams – not just the few I got through here in the States. I’d have had my exam results posted publicly and my class rank determine my specialty choice (which does occur to some degree in the U.S., but less stringently).

As a patient in France, I’d be entitled to health care, but I’d perhaps be paying higher taxes, waiting longer to see specialists, and maybe even having to travel out of my home area for access to certain services, such as a labor and delivery ward. In either country, the system is tiered, with people able to pay for additional private insurance getting access to more services.

I don’t think there’s any perfect training system, practice situation, or place to be a patient, but as both a physician and a patient I’d probably want for myself the flexibility of an American education system coupled with the universal access enjoyed by the French. I dream of living in some idyllic little French village without worrying about whether I can get care when I need it; then I watch shows like BostonMed, and the familiarity of the American system wins me over all over again.

The problem neither country seems to be able to solve is the high cost of universal health care; Assurance Maladie, the French state health insurer, has been “in the red” for decades. I’m interested in seeing what both countries come up with in the coming years.

Anesthesioboist T is an anesthesiologist who blogs at Notes of an Anesthesioboist.

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