Losers in French health care

Do not assume that just because French health care ranks first in the world, and costs a fraction of what you pay, that everyone is a winner there.

There are many losers.

Consider that while at the Open World Forum in Paris we watched a demonstration of nurses go past the window, seeking a living wage. They wore scrubs and masks. They carried carefully hand-made signs and drew attention from both the police and TV cameras.

Or consider the doctors we met, at their offices. Simple men in short-sleeve white lab coats. Unpretentious and no reason to be otherwise. They have the rank of high civil servants here, an honor to be sure in a society that prizes security. But a medical degree is not a license to get rich.

Or consider the hospitals. We stayed opposite a clinic in Mulhouse (pronounced mill-ooze in French). A simple building, none of the grandeur found in an American hospital. People were led outside by their families, or stood about wearing casts on their feet and single canes ending at the forearm.

Then consider the insurers. Yes, French health care is based on insurance. And they do advertise. But it's on billboards, not TV, and the prices are clearly marked. The market is tightly regulated, there are just enough choices to create competition, no more.

France is a highly centralized country. It has one medical system, to which everyone subscribes. Procedures are prescribed or proscribed centrally. There is limited autonomy for those not direct engaged in research.

But that's how most medicine is. There is no mystery to the setting of a broken leg, or the care of a diabetic or with another chronic condition. Even cancer has protocols.

You get what you pay for, and what you demand of the system. The French government demands sacrifice from everyone in the system – doctors, nurses, insurers, hospitals, patients too. Patients must sometimes be very patient, as any American critic of the French system will quickly tell you.

Seeing how doctors in France aren't gods and don't have a license to get rich, while insurance providers are highly regulated and can't wiggle out of their contracts, it's easy to see why many in the American industry fought health reform to the end, and are still fighting.

This post was originally published on Smartplanet.com