Urgences

We are a little too well-acquainted with the emergency rooms. The most recent visit comes after much time spent in U.S. hospitals last year (as visitor). The differences are striking.

U.S.: imposing marble lobby, with a volunteer playing a grand piano. Food court. Gourmet coffee stand emitting good smells. Carpeted halls. Rooms that look a bit like hotels if not for the high-tech control panels and machinery. Heated blankets. A sofa in the room that turns into a kind of bed for a family member keeping watch. Another hospital went for an earthy, natural décor, with lots of warm wood, and tiles and wallpaper that had grass or leaf designs. Very zen.

France: sun-filled linoleum lobby. Linoleum, in fact, is the most prevalent material. Wall-to-wall carpet is considered a germ trap in Europe. Plastic seats–no upholstery. No attempt at décor (white walls with a green accent wall, pale gray floors) except in the pediatric wing, which had animal decals on yellow walls. The emergency room at one private hospital did, however, have as decoration framed x-rays of unusual objects, which provided a distraction. It also had wood paneling. In the patient’s room: a small table, a rigid plastic chair, a very ugly lump of an armless chair that unfolded into a surprisingly comfortable bed for a family member keeping watch. A sheet but no blanket (certainly not heated) nor pillow for said family member. No food court, and the lobby vending machines are locked up after hours (i.e., after 6 p.m.).

Carcassonne’s new 496-bed hospital opened in the summer of 2014.

So far, it sounds like the U.S. is better, BUT marble lobbies don’t make a person well. And they might make one sick when the bill arrives.

On the other hand, the bill for an x-ray of a possibly (but thank goodness not) broken shoulder? Zero.

And the bill for an overnight after our kid passed out on a school outing (why breakfast shouldn’t be skipped…lesson learned)? Minors who lose consciousness are required to be kept for 24 hours of observation. Zero.

And the latest–meningitis, which turned out to be the viral kind, not the deadly bacterial kind? Until the blood test confirmed that, our kid was treated with a speed that was amazing. And kept overnight for observation. Again zero.

This isn’t to say that we don’t pay for health care. There are mandatory social charges in the form of a 6.5% tax on income of self-employed workers; salaried workers pay 0.75% and their employers 12.8% of their wages, for a total of 13.55%.

According to the Bureau of Labor Statistics, the average cost of health insurance benefits to employers was 7.6% of total compensation, but that ranged from 12.6% for union workers to 6.9% for nonunion workers. On average, employers of higher-paid workers cover a bigger share; lower-paid workers get less.

It’s hard to get an average percentage for the employee contribution in the U.S. The Kaiser Family Foundation found that average annual family coverage premium is $17,545, with employees paying $4,955 of it. And the average deductible for a single (they didn’t give family figures) is $1,077.

There are no deductibles in France.

There are co-pays, however. The full price of a doctor’s visit in France is €23, of which the government reimburses 2/3, or about €15. I suspect it’s set up that way–patients have to fork over the €23 and wait for reimbursement–to set the bar just a little higher for whether one really needs to see the doctor. You can buy supplemental insurance to cover the co-pays.

In the U.S., the average copayment is $24 for primary care and $37 for specialty care, for in-network providers, according to the Kaiser report.

In France, all providers are in-network. You get to pick your doctor, from any of the doctors in France, not from a list provided by your insurer. And no surprises coming out of anesthesia to discover a bill bigger than your annual salary because most of the doctors who touched you were out of network. Obamacare has put a cap on out-of-pocket expenses (the sky used to be the limit): $6,850 for an individual and $13,700 for a family. However, medical bills are still causing personal bankruptcies in the U.S.

Note the covered sidewalk. The old hospital had one as well. A brilliant idea, in rain or sun.

Two people I know in France have hereditary kidney diseases. One just got a transplant; the other has been hospitalized a lot but isn’t yet at the transplant stage. One thing they don’t worry about is the cost of treatment. Ditto with friends who have cancer. One quit her job–but she didn’t lose health coverage because that has nothing to do with where or whether one works.

It seems logical to separate health care from employment. And to pay for it with a tax so that those with more money pay more and so that your health expenses aren’t at the mercy of your job or the genetic lottery. For those unfamiliar with the U.S. system, the New York Times a couple of years ago ran an excellent series titled “Paying Till It Hurts.”