The French way of cancer treatment; it’s entirely humane

I’m still switching to climate writing, and have two strong piece in the works. One details the inevitable death of South Florida (yep), and the other, the coming ice age in Europe (yep). For the first, think “salt water.” For the second, think “Atlantic Gulf Stream.”

But I couldn’t resist taking time off to post this. Anya Schiffrin is the daughter of the late writer André Schiffrin and the wife of Nobel-prize-winning economist Joseph Stiglitz. She’s also quite the writer and editor herself. A few weeks ago, she wrote an article for Reuters about her father’s struggle with cancer last year, and about the relative cancer care he received in the U.S. and in France. (Her father was born in France, but he and his family fled the Vichy government for the United States during World War II.)

What Anya Schiffrin found was that there was no comparison at all. All of the indignities you take for granted in the U.S., the French take away. To read this account, the French system for human health care is … well, humane.

So I consider this piece a must-read. It’s clear and stunning.

It’s not just that single-payer done-right is a terrific system. You have no idea how terrific it is, done the way the French do it. You have to read it all to get that. Every paragraph, it’s one more thing done right. Wait-time for chemo treatments? Eight hours at Sloan Kettering, a big-deal hospital. And only ninety minutes in a French hospital, the one down the street. And there’s much more like that.

Anya Schiffrin

Anya Schiffrin

Before you read, a word or two of clarification:

▪ “Single payer” refers to a system where the government is the insurance company, while the health care providers can be either public or private, as they choose. Medicare and Medicaid are “single payer” systems. (Schiffrin says the French system is most like Medicaid in structure.)

▪ “Nationalized medicine” refers to a system where the government is the health care provider itself, and doctors and hospitals are government-controlled. The British health system is nationalized medicine. The closest we have in the a nationalized medical system is the VA.

▪ Under “single payer” it’s critical that the government regulate cost. They do that in France, and most other countries with good health care. We try hard not to do that in the U.S. (because, jobs, or profits, or something to do with CEO compensation). If we actually regulated cost — for example, by letting Medicare use its size to negotiate drug prices — you’d pay cost + a small profit for your medicine, not cost + a CEO salary bump.

That said, here’s Anya Schiffrin (some paragraphing mine):

When my father, the editor and writer Andre Schiffrin, was diagnosed with stage four pancreatic cancer last spring, my family assumed we would care for him in New York. But my parents always spent part of each year in Paris, where my father was born, and soon after he began palliative chemotherapy at Memorial Sloan Kettering my father announced he wanted to stick to his normal schedule — and spend the summer in France.

I humored him — though my sister and I didn’t want him to go. We felt he should stay in New York City, in the apartment where we grew up. I could visit him daily there, bringing takeout from his favorite Chinese restaurant and helping my mother.

I also didn’t know what the French healthcare system would be like. I’d read it was excellent, but assumed that meant there was better access for the poor and strong primary care. Not better cancer specialists. How could a public hospital in Paris possibly improve on Sloan Kettering’s cancer treatment? …

But my dad got what he wanted, as usual. After just one cycle of chemo in New York, my parents flew to Paris, to stay in their apartment there. The first heathcare steps were reassuring: my parents found an English-speaking pancreatic cancer specialist and my dad resumed his weekly gemcitabine infusions.

My parents were pleasantly surprised by his new routine. In New York, my father, my mother and I would go to Sloan Kettering every Tuesday around 9:30 a.m. and wind up spending the entire day. They’d take my dad’s blood and we’d wait for the results. The doctor always ran late. We never knew how long it would take before my dad’s name would be called, so we’d sit in the waiting room and, well, wait. …

Eventually, we’d see the doctor for a few minutes and my dad would get his chemo. Then, after fighting New York crowds for a cab at rush hour, as my dad stood on the corner of Lexington Avenue feeling woozy, we’d get home by about 5:30 p.m.

And in France?

So imagine my surprise when my parents reported from Paris that their chemo visits couldn’t be more different. A nurse would come to the house two days before my dad’s treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting.

Total time at the Paris hospital each week: 90 minutes.

There were other surprises. At the hospital, the doctors all came to see Schiffrin’s father, in a group. That meant they would talk to each other about his care and nutrition. If they kept him extra long, he got breakfast and lunch, on them. He got replacement drugs when the original drugs stopped working — drugs that his U.S. insurance wouldn’t pay for. Even his taxi home was taken care of. 

The list of differences is amazing. You really do have to read this piece. And then there’s this:

In 2011, France’s expenditure on health per capita was $4,086, compared to $8,608 in the United States, according to the World Health Organization. Spending as a percentage of gross domestic product was 11.6 percent in France while in the United States it was a far higher 17.9 percent.

That’s half the per-capita cost, but you knew that, right? The end of the essay is quite touching, by the way. It’s about time spent with billing departments vs. time spent with her father.

The ACA is as close as you’ll get to a good thing from triangulating, profit-protecting Democrat. Ready for another to take his place? If you’re not, the time is now to clear space for a real progressive in 2016 — literally now. The longer the good ones don’t plan to enter, the less likely they’ll come in later, even if a slot opens up.

But you knew that too, right?


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Gaius Publius is a professional writer living on the West Coast of the United States.

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