Opinion

Anya Schiffrin

The French way of cancer treatment

By Anya Schiffrin
February 12, 2014

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?

After all, people come from the all over the world for treatment at Sloan Kettering. My mother and I don’t even speak French. How could we speak to nurses or doctors and help my father? How would we call a taxi or communicate with a pharmacy?

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. Around 1 p.m. or 2 p.m. my dad would usually tell me and my mom to go get lunch. (He never seemed to be hungry.) But we were always afraid of having his name called while we were out. So we’d rush across the street, get takeout and come back to the waiting room.

We’d bring books to read. I’d use the Wi-Fi and eat the graham crackers that MSK thoughtfully left out near the coffee maker. We’d talk to each other and to the other patients and families waiting there. 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.

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 nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, “It turns out there are solutions for the all the things we put up with in New York and accept as normal.”

One day he had to spend a few hours at Cochin. They gave him, free of charge, breakfast and then a hot lunch that included salad and chicken. They also paid for his taxi to and from the hospital each week.

“Can’t you think of anything bad about the French healthcare system?” I asked during one of our daily phone calls. My mom told me about a recent uproar in the hospital: It seems a brusque nurse rushed into the room and forgot to say good morning. “Did you see that?” another nurse said to my mom. “She forgot to say bonjour!”

When the gemcitabine stopped working, the French oncologist said he would put my dad on another drug — one my dad’s U.S. insurance plan had refused to approve in New York.

By this time, I had become a French healthcare bore. Regaling my New York friends with stories of my dad’s superb care in Paris, I found people assumed he was getting VIP treatment or had a fancy private plan. Not at all. He had the plain vanilla French government healthcare.

I had read many articles about the French healthcare system during the long public debate over Obamacare. But I still I hadn’t understood fully, until I read this  interview in the New York Times, that the French system is basically like an expanded Medicaid. Pretty much everyone has insurance, it explained, and the French get better primary care and more choice of doctors than we do. It also turns out, as has been much commented on, that despite all this great treatment, the French spend far less on healthcare than Americans.

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.

Last fall, my mother asked me to come and see their general practitioner in Paris so we could plan ahead for my father. My mom got an appointment for the next morning and we walked to the office, five minutes from my parents’ apartment. We waited for a half-hour on a comfortable couch, chuckling over the very French selection of magazines on the coffee table (Elle and Vogue) and admiring the lush garden view. The waiting room was quiet. I realized what was missing: There was no billing department.

We spoke with the doctor for about 45 minutes. My mom wanted to know what would happen when my dad was no longer able to walk. “Oh,” said the doctor, speaking in English. “I prescribe a wheelchair and it’s delivered to your house. Shall I do it now?”

When I asked the price, she looked surprised. No charge. She asked if we wanted someone to come to the house every day and it was my turn to look surprised. What would they do? For example, someone could come and give my dad a massage to alleviate his neck pain. Again, no charge.

At the end of the appointment, my mom pulled out her French insurance card. Total cost of the visit? 18 euros.

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.

The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.

Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.

That time was priceless.

 

PHOTO (TOP): A pharmacist selects drugs for chemotherapy treatment in the pharmacy at Antoine-Lacassagne Cancer Center in Nice, October 18, 2012. REUTERS/Eric Gaillard

PHOTO (INSERT 2): An intravenous dose of Lambrolizumab during a promising cancer treatment clinical trial at UCLA Medical Center in Los Angeles, California, August 19, 2013 REUTERS/David McNew

Comments
9 comments so far | RSS Comments RSS

I love your article and i am sorry about your father, but at least he did not have to worry about his health costs.

Posted by ofilha | Report as abusive
 

It is long past time for the USA to wake up and realize that they are being swindled, not out of their money (although that is happening too), but out of their most precious resource: their time on this earth. Profiteers demonize systems that work very well for patients and taxpayers while the person of average means (and in this case above average means) is shortchanged in their most vulnerable years.

I live in Canada where the system is anything but perfect. That said, I wouldn’t swap my situation for that of my brothers and sisters in the USA for a minute. I hope you all come to your senses and begin to see the truth about “free market” healthcare, if not for your grandparents and parents, then for yourselves.

True notions of conservatism such as we each have to pay our fair share, and freeloaders are not to be tolerated, have been thrown by the wayside in a blind attempt to cast out the “unworthy” from being paid for with “my” money. A true conservative would see that this path needlessly increases the burden on society so that some may enjoy a car that is five years newer than their previous one, or their home can be 20% larger, or however various people choose to spend the money they think they are saving by paying as little as possible in taxes.

To the author: Thanks for the wise words on what I know from experience to be a painful topic. I am glad that in your situation things went well for you and your father at the end. I cannot complain too much, and my own family member who died in a very similar manner certainly didn’t, but I know that even he could have been treated better if we put our collective minds to the task. I shudder to think how many of our old people will spend their last years… simply so us younger people can try to pinch a few pennies… and not even successfully.

Posted by Benny27 | Report as abusive
 

Thank you for your story, for it is important to inform individuals of Healthcare around the world. We no longer have investigative journalism, and the only way we can see stories like this is through an “opinion” column.

As we can see, it is the INSURANCE CO’s that dictate our healthcare, with all of the bizarre “billing and administration” and it is the FOR PROFIT Hospitals and “Medical Teams” that send you on the Merry Go Round of the US healthcare system to maximize their returns!! We need to focus on our citizens, and not our shareholders!!

Why do I not have access to all of medical procedures I have had over the last 25 yrs of my adult life? In our modern world of technology, how come google knows of every move I make, yet no tracking for patients to follow their medical journey through life. However when it comes to life insurance pay out, the can research your medical life and know of everything and deny your beneficiaries.

Posted by mmcg | Report as abusive
 

“the French system is basically like an expanded Medicaid” – a perfect hint, thank you Anya!

Posted by UauS | Report as abusive
 

The American healthcare system was so much better when it was mostly not for profit. The notion that for profit business could improve the delivery of healthcare has been soundly proven wrong

Posted by PapaDisco | Report as abusive
 

@PapaDisco – when were those ‘good old days’ was the US healthcare system not for profit?

As a past benefiicary of the french healthcare system, I totally agree with the word “humane” … as in treating the patient like a human and not just a revenue stream as it is in America.

Posted by euro-yank | Report as abusive
 

Does France allow for-profit hospitals?

Posted by Gaius_Baltar | Report as abusive
 

The U.S. does not have the best care in the world, just the most expensive.

Hard facts from the CIA factbook:
U.S. ranks 51st in life expectancy

Posted by QuietThinker | Report as abusive
 

@Gaius_Baltar – profit yes, gouging no.

Posted by euro-yank | Report as abusive
 

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