In late October, I received a letter from “la Sécu.” That’s the clipped form the French use for “la Sécurité sociale,” the French system of social protection that includes health insurance, family services, retirement benefits and services to the handicapped. It was created in 1944 with, as its first task, the putting in place of universal health insurance financed by mandatory contributions based on income level, paid monthly by the working population and their employers.
On September 1, I retired from teaching after 43 years in the profession. I have been working in France since 1987 and during all those years, I made a hefty contribution to “la Sécu,” all the while benefiting from excellent health care, which cost me very little in supplemental costs. Since I retired, I continue to receive the same care but my monthly contribution is significantly less.
For care not covered in full by “la Sécu,” I have supplemental insurance I pay myself, the same plan I had while teaching. There was no need to scramble for a new one and in France there is no such thing as a donut hole, nor is there a deductible for medications. The supplemental insurance covers most costs not met by “la Sécu.” My plan also assures me a new pair of glasses, basically free, once every two years.
Dental care, on the other hand, can become expensive. The basics of cleaning and filling cavities are taken care of, but inlays, crowns, root canal or all those other unpleasant procedures meant to preserve a winning smile, are largely paid for out of the patient’s pocket.
But back to that letter. It was an invitation to go to my local pharmacy and pick up my flu shot. I am over 65, an age group considered at risk. In the pharmacy, I showed my paper to the pharmacist and she placed the shot in my hand. I took it home, put it in the refrigerator and a few days later went to a health center where a nurse vaccinated me, all at no cost.
“La Sécu” defines the groups at risk, extending well beyond seniors, and if a citizen or legal resident of France belongs to one of them, the vaccination is free. Otherwise, the flu shot costs between 6 and 10 euros, an out-of-pocket expense that will be entirely reimbursed, as is the doctor’s visit, but at the rate of 70%. As of 2019 pharmacists who so choose can give the flu shot in the pharmacy at a cost of between 4 and 6 euros and, once again, that out-of-pocket expense will be covered by “la Sécu.”
In France, the costs of a university education are minimal and by American standards, medical school is basically free. As in the US, medical studies are long, thorough, and demanding. French doctors can become family doctors, called “généralistes,” or choose a specialty. All doctors choose between two sectors, one respecting the fees set by la Sécurité sociale, the other allowing doctors to set their own fees.
In Sector 1, in the case of family doctors, either they charge the set fee of 25 euros for an office visit or exceed it in a controlled and reasonable manner. This is exactly the choice my family doctor has made so I can give an example. I pay 37 euros when I go to see him. Of that sum, 16.50€ are reimbursed by “la Sécu” and 8.50€ by my supplemental insurance. The rest, by choice, I pay out of my pocket. My gynecologist, a specialist, belongs to Sector 2 and fixes her own fees. In that case, no matter what she charges for an office visit, “la Sécu” will reimburse only 23€ whereas for a Sector 1 specialist, the visit, costing 30€, is reimbursed in full.
These are dry facts that don’t make for fascinating reading, but I think they are revelatory of the benefits to a nation that chooses a universal healthcare plan. I have been in France now for over 30 years, I have been operated on twice and been to the doctor and dentist multiple times. Only once was I dissatisfied, with a dentist (and I’ll admit I’m picky about my teeth). Otherwise, I have always received excellent medical care and never once have I worried whether I could afford it.
In my village I have two friends, a retired couple, generous and brave, who are not well-off. They often have money problems and when the car breaks down, they don’t have money on hand to fix it. Up against such an expense, the husband picks up work painting a house or repairing a roof; his wife takes in laundry. Once they have the cash in hand, they can repair the car.
At this time, both have cancer. This is a heavy burden but in France, as opposed to the situation of many Americans, my friends have the comfort of knowing their medical bills will be paid. Near my village there is no major hospital. When they must undergo chemotherapy or radiation treatments, what is called a “medical taxi” comes to pick them up and take them to a hospital 50 miles away. They do not pay for medication nor for the nurse who comes to their home to draw blood. They can concentrate on getting better because they are free from worries about how to pay for care.
Many Americans in the difficult position of my friends would have the additional anguish of facing possible economic ruin. A February 26, 2019 NPR report states that Americans undergoing cancer treatment are 2.65 times more likely to apply for bankruptcy than those without cancer. They spend their savings; they risk losing their homes.
How can this be possible in a country as rich and strong as the United States? When I visit, I am often impressed by the kindness of Americans, but I am convinced the health care system is anything but kind. It is downright cruel when you have to decide between losing your life savings or losing your life. This is a choice many Americans have to make.
I’d characterize France’s current president Emmanuel Macron as standing somewhere right of center. He is anything but a socialist. Universal healthcare is not a socialist idea; it is simply humane.
As for me, by American standards, I am clinging, barely, to the middle class. Yet I never have to worry about health care and that makes me rich.
I wish more middle and low income—and even wealthy—Americans could be as rich as me.
