"The evolving Francophile..."

My husband Jack has always wanted to live in Paris and learn French. I thought it would be good for him to achieve his life time dream. Hence, we moved to Paris in 2008. My first year was difficult. I started "missives" to relieve some stress and chronicle my life so friends back in the US could read what I am experiencing. I currently write about my food and travel experiences, which is my passion.

It is definitely a challenge to live here, but each year it gets easier, and quite enjoyable, in large part because I value friendships over locale. I have a love/hate relationship with Paris as do most Parisians, mais La vie est belle (but life is good)!

Monday, November 8, 2010

Sick in France, no worries. Health-care in France...

Health-care in France

There's been much debate about health-care in the US. I have experienced both and can only give you my opinion as I experienced them.

To understand health-care in France, I need to first go back when I retired from corporate America in 2002. When I worked, I had great health-care coverage. The problem began when I retired.  I went on Cobra, but had to secure coverage before it expired in 18-months. I retired at a relatively young age and was not eligible for medicare. I thought since I was relatively young,  healthy and only had two pre-existing conditions, high blood pressure and gout, and that the record showed that I maintained these conditions with medication, I should have no problem getting health insurance: I was so wrong on so many levels.  I saw several advertisements saying e.g., "A Blue Company" offered coverage as a low as $80 a month. I checked into it and was ineligible because of my pre-existing conditions. The low teaser rates were just that, teaser rates. The only ones eligible for those rates are 18-year olds with no history of any medical problems and probably lived in a bubble!  And, the coverage is basic, high deductible, high copay, catastrophic coverage.

As I was nearing the expiration of my cobra, I was getting frantic, I only had a month to get insurance, so I went to an insurance broker. I told him that I went to several major health insurers and was denied. He was concerned because he says the insurance companies share files, and now they all see that I've been denied a number of times and considered high risk. We looked at some options, and one option was for me to join a farmer's group, but I told him I'm not a farmer, but he said it was OK? we'll make believe you are a farmer.  If any one knows me, I'm about as far removed from a farmer as can be. I did mention to him that I had a cousin who owned a real estate brokerage company, and he suggested as a last alternative that I could be listed as an employee at my cousin's company and I could pay the employee cost and his cost for insurance. The insurance broker recommended I take this later option. So, in 2002, I finally got insurance, but through my cousin. Here's the catch, I had to pretend to be an employee. Also, since I got insurance through an HMO (the only plan he offered), the problem was that HMO only covered certain regions of California; therefore, I have to technically live in one of those regions. Since I was living outside of that region, I could not be covered. How did I get around this restriction? I used a friend's mailing address in central California, imagine that. I also had to drive an hour and half whenever I had a doctor's appointment, for me a small price to pay for coverage.

This is what I felt analyzing health-care options in US

All was well, but the premiums went up every year anywhere from 5% to as high as 10%. At the beginning I paid less than $300 a month, close to the end (2009) I was paying over $800 a month and had no pharmaceuticals.

In 2008, we decided to move to Paris and make this our primary home. I kept my US insurance since we still lived in the US several months out of the year and the travel policy we got for Europe did not cover the US. This is where the trouble began. In 2008, the market crashed, my cousins company couldn't survive the down-turn, and in summary I lost my health-care coverage. I tried to renew it through the same HMO in June 2008, but was denied. I thought since I was already a "customer" surely they can see that I was not abusing their system; hence, I could easily get continued coverage, WRONG again! I was denied. To make a long story short I complained until I ran out of steam. Finally, they conceded and said I could continue my coverage, but at a higher premium, over $800 a month, $50 co-pay and no pharmaceuticals. I had no choice so I accepted it. My medication sky rocketed. I had one prescription cream that I used that I had to pay $225 for 8-ounces, but what choice did I have.

In 2008, while in Paris, my partner had an issue with his high blood pressure. So, we went to the local hospital's emergency room. When we went to emergency, at the check-in they did not ask him how he was going to pay or if he had insurance, all they wanted was ID. NOTE: when I went to emergency in the US, the first question they asked me was not "what is your problem?" but "do you have insurance, and how will you pay for it?" Anyway, within 5-minutes he was rushed in and he had a battery of tests performed, including a cat-scan. As I waited in the waiting room, I saw a diverse group of people go to emergency. What impressed me the most was that low income, e.g., bums, as well as the wealthy were all treated equally and with respect.  After 8-hours in observation, the doctors determined he was fine and just needed to follow-up with a cardiologist. As we were leaving, we had to actually ask how do we pay? They told us not to worry and we would get a bill in the mail. We were concerned that since Jack had a battery of tests our bill would be in the thousands! Oh well, we'll wait and see.  In a few months we got the bill, much to our pleasant surprise and shock, the bill came to an equivalent to 150€ about $225 (that amount included the cat scan and all the other charges) and this is full cost.  If we were in the French health care system it would have been greatly reduced.  Of course our travel insurance's deductible was more than this amount so our insurance covered nothing.

Later that year, Jack discovered a little cyst in his nose and it was recommended it be removed. So, Jack went to a nose specialist and also a anesthesiologist in preparation for the removal. A date was made for the operation. We went to the hospital, it was extremely clean, orderly and Jack was given a private room, which he would also use later for recovery. But at this time we were in the French health care system. We were pleasantly SHOCKED, that the total patient pay part of the bill came to just 16€ or $25. Imagine having this operation in the US even with good insurance. At this point I'm thinking at these prices, maybe I should get "emergency" liposuction.

In 2009, we made the biggest decision concerning our health-care, we decided to get rid of our costly American insurance. Together we paid over $1,100 a month just for the premiums, paid costly co-pays for visits, high deductibles and we did not have any pharmaceuticals. Here's a few observations about French health-care:
  • Eligibility: Since the US does not provide universal health care, and if you are a legal resident of France, carte-de-sejour card holder, you are eligible for enrollment into the French health-care system. In fact, if you are a legal resident of France, it is required that you show proof of health-care coverage. If you are a citizen of a European union country, you are not eligible for enrollment in the French health care system, since your native country already provides you with health-care.  If you are a non-working French resident (but not French citizen) you must pay directly to be in the health care system (i.e., premiums) if you wish to join it.
  • Health-care: The government system is called, "Assurance Maladie".  However, you do not have to go into the government French health-care system, you can obtain private health insurance. Several are available through private companies. These premiums are still much more affordable than in the US. (check on-line)
  • Supplement: You still must pay some out of pocket expenses; however, you can get supplemental health coverage to cover all costs known as a police complémentaire or mutuelle. NOTE: the destitute French are fully covered.
  • Employed in France: Your employer will automatically deduct for French taxes and 'social charges' (which include the health insurance) and provide you several options for health care supplements.
  • Costs: Premiums are determined by your income, except for the complémentaire or mutuelle which is a free market enterprise. For the two of us, we opted not to get the additional mutuelle insurance. We pay 25% of what we would've paid for disaster only insurance premiums in the US, and we have full coverage and pharmaceutical benefits. With the lowered cost in premiums and with pharmaceuticals cost greatly reduced, we are saving close to 90% of what we would've paid in the US. 
  • Primary doctor: You can select your own primary doctor (you do not have to select only 'plan' doctors). So, you pay for example 22€ for a doctor's visit, and the government will reimburse you 70%. However, if the doctor charges more, or you go to a private doctor not in the government program, you still only get 70% of the 22€. And, of course if you have the complémentaire or mutuelle, the supplemental insurance company pays for the difference. Note: doctor's make house calls.  And many if not most doctors (except of course those at the American Hospital in Paris) are part of, and charge the approved rate, of the government guidelines.  Note: the American Hospital in Paris is extremely expensive. Here's a list of English speaking doctors in Paris. Also, doctors order tests and do procedures they think are needed; they do not need to get pre-approval.
  • Specialists:  If you get a referral from your primary doctor for a specialists, e.g. dermatologist, and they are in the assurance maladie program, the costs are comparable of what you pay for your primary physician. You can select a specialist of your choice not in the assurance maladie program, which I have done, you can submit the paperwork to get reimbursed what the government would've normally paid.  You do not need to have a referral from your primary doctor, but the reimbursement rate is higher if you do.
  • Medication: The French government pays a percentage of your cost for medication with, interestingly enough, higher reimbursement for chronic or medically necessary medicines (65% reimbursement) and lesser reimbursement for 'convenience' medications. Medication costs are government controlled. Even if you weren't under the French health care system and paid full price, full price for brand medication is still about 80% less than the cost in the US, that is because the costs are government controlled. For example, I paid $225 for an 8-oz prescription salve in the US, in France I paid 14€ the equivalent of $18 for 10-oz. Note: over the counter medication can only be purchased at a pharmacy. There are a few generic medications that are cheaper in the US, but non-generics are always higher in the US. Pharmacies are plentiful in France and are distinguished by their green cross. Also, in some instances, e.g., you burn your hand while cooking, pharmacists have the discretion to recommend and prescribe prescription medication.
Common green pharmacy signs

  • Lab work: Based on your health, your doctor can prescribe specific lab work/tests, at extremely reasonable costs without pre-approval. The government also has a data base and will recommend lab tests for certain groups and at no costs. For example, last year I got in the mail a form to get a free screening for colon cancer. The French believe in PREVENTIVE medicine. Note: Test result are often ready the same day. It is up to the patient to pick up their lab work results and bring it to their doctor.
  • Coverage outside of France: Since we also live in the US a couple of months out of the year, we do have a "worldwide traveler's insurance" at a cost of under $150 each per year. Keep in mind that this insurance only pays when outside of your country of residence and you cannot remain outside your country of resident for more than 4 contiguous months; which means, you can leave the US for a few days and come back and the clock is reset.  These type of policies are only available to legal residents of EU countries.  And EU countries recognize each others health care systems so travel in the EU with an EU country's health coverage means you will probably see no difference in coverage/costs and, if you only travel in the EU you would not need to have a travel's insurance policy.  Because health treatment is SO expensive in the US the EU reimbursement rates for care rendered in the US would probably not cover much of the cost thus the necessity of having a travel policy for US coverage.
In summary: There's no denying the US has great health-care, there's one big caveat, you have to be able to obtain and afford it. The biggest worry Americans have and the primary reason they file bankruptcy is for medical expenses  according to a Harvard study.  Health-care in the US is a privilege, whereas health-care in France/Europe is a right! Hence, the quality of life in France is better because of one less thing to worry about.  Not all socialized medicine is equal, but I can only speak from what I have personally experienced between the US and in France. In 2010, France was ranked the country with the worlds best health-care by the world health organization, the US was ranked 37th.

As I was watching the debate about health-care in the US last year, I could not understand why Americans are so afraid of socialized medicine. If you have the money, you're still going to get great health-care; however, for the vast majority like myself, I should have the right to have coverage that I can afford. I don't expect to be given a hand-out, but I also don't mind helping those who are destitute. The fallacy and fear about socialized medicine, anyway as I've experienced in France, there are no death panels, and there are no long waiting lines, no waiting for insurance approvals for lab work or tests, and the French medical health professionals are very, very qualified. Do the names Pasteur or Dr. Luc Montagnier who discovered the HIV virus sound familiar?

In my opinion, if a country does not provide health-care for all, what happens is that health-care becomes reactive rather than preventive.  Logically speaking doesn't it cost more money to have an operation than to have preventive medicine? Currently,most uninsured Americans will only go for health care in an emergency, which costs more and bottom-line the tax-payers are going to have to pay for it anyway.

I have several American friends that come to France for medical vacations. The costs for medical treatment as well as medication without insurance is still much more affordable in France than it is in the US.  And, the French medical establishment is first rate!

For me, this video clip of Senator Dick Durbin says it all.  Take away the "federal" health-care of the Congress, Senators and their families and let them obtain it on their own. I can guarantee you our health care system for all would be greatly improved!

Sadly, in my view, only rich American lives are valued, whereas the poor are dispensable.

Please also refer to my most recent update on "France's Universal Healthcare."   I describe the basic inner workings of their healthcare system.

NOTE:  I did not provide the names of the insurance companies nor specific locations in fear that if I return to the US as a full-time resident, I will be "black-listed" yet again, from the insurance companies!


    1. Great piece Randy.. informative and very clear.
      Think I need a consultation with you & J on how to proceed here for my daughter and I... lol.
      Have my first doctor appointment on Wednesday with a French MD. Am really excited actually...

    2. I have doctor's appointment this afternoon. I love being a hypochondriac in Paris!

    3. RD,
      That was a great piece. On a visit to Paris several years ago we met a couple from the US that came to Paris for the husband to have hand surgery. In the US he would have been hospitalized for surgery, and the prognosis was iffy. In Paris, the Dr. did it as an outpatient, slapped a bandage on it and off they went to sightsee! Cost $225. They had been previously for the procedure on the other hand and it was a total success. My friend's father had the same condition, had surgery by a specialist here in Alabama, was hospitalized, it cost thousands, AND it did almost nothing!

    4. Great post Randy. It's fantastic to read the comparison from someone living in both situations. I definitely agree with your assessments. If all of our elected officials had to live under the same health care as the average American things would likely improve.

    5. Great post and all true, in line with my experience here over the past 9 years. Even in the 10 years I spent in Hungary, the health care there was top notch and cost pennies.

    6. Hahaha... thats not good, if a man goes to clinic for their treatment then he see that there is not any clinic on that place and read the board, that the clinic has been gone to china. I think you should inform that patient before changing your location.