Single-Payer Health Care: Is That What Makes France So Different? (The French Way of Cancer Care – Part 2)

In “The French Way of Cancer Treatment,”  Anya Schiffrin writes eloquently about the care that her father, Andre Schiffrin, received when he was diagnosed with stage-four-pancreatic cancer, and decided that he wanted to go to France, his birthplace, for treatment. Schiffrin had been undergoing chemotherapy at New York City’s Memorial Sloane Kettering, and his family was concerned: how could a public hospital in Paris compete with a world-class cancer center?

To their amazement, they discovered that “the French way” of caring for a cancer patient was much better suited to Schiffrin’s wants and needs—and this was not because he had been born in France.

At the end of her essay, Schiffrin suggests that “the simplicity of the French system meant that all our energy could be spent on one thing: caring for my father.”  Back in New York, she confides, “every time I sit on hold now with the billing department of my New York doctors and insurance company, I think [of] all the things French healthcare got right.”

                                      A Hybrid Public/Private System

 Many readers might assume this means France has a single-payer system, and that is the key to its simplicity and success. But in fact, France relies on a hybrid system that is not unlike Obamacare. The government picks up the tab for only about three-quarters of the nation’s healthcare bill.

(In 2013 the U.S. government paid for roughly 48% of medical care, though, this year, with the expansion of Medicaid, and millions of uninsured and under-insured Americans joining the Exchanges where the majority will receive government subsidies, Washington will cover more of the bill.  And in the years ahead, as baby- boomers age into Medicare,  government’s share will grow.

In France, “everyone is covered to a certain extent by the government’s Assurance Maladie,” explains Claire Lundberg, a New Yorker now living in Paris where she recently had a baby. “But most people also have private insurance, called a mutuelle that is either offered through their employer or bought on the private market. There’s a thriving private insurance market in France. . .  Private medical insurance is advertised on the sides of buses and alongside movie previews in theaters.”

Ninety-two percent of the French have supplemental private insurance. Many are insured through their employers, as they are here.  Patients pay 7 percent of all health care costs out of pocket.

In France payroll taxes, paid by both the employer and the employee, along with income taxes help finance the 73% of the  bill that the government covers. All told, French workers contribute around 13% of what they earn to the public sector healthcare fund.

Government Regulation Means Lower, Transparent Pricing

 While the French government does not pay all healthcare bills, it does regulate prices. Because it sets fees for medical services, pricing is transparent

This is why, in France, Schiffrin didn’t have to spend hours on the phone talking to her doctors’ and insurers’ billing departments. There was no uncertainty as to what doctors and hospitals would or should be paid.

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Breast Cancer: Catching Up With Amy Berman, a Woman Who Chose Life Over Longevity

HealthBeat readers may remember the two-part post that I wrote about Amy Berman back in October of 2011.

Part 1 began:  “When Amy Berman was diagnosed with Stage IV breast cancer a year ago, she made a courageous choice. Instead of fleeing death, she decided to pursue life.  Rejecting chemotherapy, radiation and surgery, she chose palliative care instead.” 

                                   Our War on Cancer

Berman knew that her stage IV cancer could not be cured. As a nurse, she also knew what women who undergo aggressive treatment endure—and that, despite that treatment, many will never escape the disease.

As Clifton Leaf points out in his new book The Truth in Small Doses, when people talk about the strides that we have has  made in our War On Cancer, they greatly exaggerate our success. When it comes to breast cancer, for example, 30 years after we launched the way, the number of women per 100,000 who die of breast cancer had actually grown from 28.4 per 100,000 in 1970 to 29.2 per 100,000 in 2000.

Over the next 10 years, the death rate fell to 26.2 per 100,000 women. But we know that this was mainly because we have gotten better at detecting breast cancer early, when the tumors are small and easily removed.  By contrast, most of the caustic drugs designed to defeat cancer have disappointed.

Of  “the myriad compounds that have set the research community abuzz, the ones that have already built up billions of sales,” Leaf observes, “there is little evidence” that “they have had more than a modest effect on long-term patient outcomes. Taken together, this multitude of drugs has been responsible for about a quarter of the reduction seen in the standardized death rate.”

Granted five-year-survival rates have improved. But this, too, is largely because we are diagnosing cancer earlier.  In the past, if the disease was detected when a woman was 65 and she died at 67, we would say she died of cancer. Today, if a tumor is detected when she is 62, and she lives a few months past 67, she has made it to the five-year mark and is counted as a “survivor.”  Thus Elizabeth Edwards’ name was added to the roll of victories–even though breast cancer killed her.

By measuring our progress in terms of five-year-survival rates we “transform nearly six hundred thousand annual deaths into a victory-in progress,” Leaf notes. This allows us to hide from what he calls “an unshakable reality: the rising toll from cancer is plain to see, but this method of counting is so firmly established and so commonly used by health care researchers and policymakers, that few remember anymore that it’s a statistical sleight of hand.”

Even If She Could Not Be Cured, Why Didn’t Berman Try to Buy More Time?

After she was diagnosed, Berman secured an appointment a pre-eminent researcher/clinician in the field of inflammatory breast cancer.

He was clear about what she should do: Chemo, radiation and a mastectomy, followed by more chemo. This he told her, is “what I recommend for all of my patients.”

In part 2 of my 2011 post, I quoted her memory of that conversation:

“I pressed him, ‘Why do the mastectomy?’ I asked, puzzled. ‘The cancer has already spread to my spine. You can’t remove it.’

“His brow furrowed: ‘Well, you don’t want to look at the cancer, do you?’

“He made it sound like cosmetic surgery,” she recalled. “Considering that a total mastectomy includes months of pain and rehabilitation, I thought that worrying about the view was secondary.”

She continued to press him.

“But what about the side effects of radiation?’ I asked. ‘I’ve heard they are terrible’.

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