Making the blogosphere rounds this past week was a very interesting article by Anya Schiffrin.
The article compares what it’s like having stage 4 pancreatic cancer in the U.S. healthcare system vs. what it’s like having stage 4 pancreatic cancer in the French healthcare system (for those who always have to think about what cancer stages mean, the higher the stage, the worse the medical condition, so stage 4 pancreatic cancer is the worst stage of one of the worst kinds of cancer).
Ms. Schiffrin knows of what she speaks, because throughout much of 2013, her father, Andre Schiffrin, received chemotherapy treatment for stage 4 pancreatic cancer in both Manhattan and Paris, and, as is the loving baby-boomer-child’s wont, Ms. Schiffrin was directly involved in helping her parents deal with the nuts ‘n bolts and the comings n’ goings and the whatnots ‘n wherefores of that whole thing. So the Schiffrin family was conducting, by happenstance, something akin to a controlled experiment, as seen through the eyes of a terminally ill patient and his family.
Here is a triplet of paragraphs from Ms. Schiffrin’s piece that well-summarizes the jarring differences between the two systems:
In New York, my father, my mother and I would go to Sloan Kettering [i.e., Memorial Sloan Kettering Cancer Center, a very prestigious place for cancer patients to receive treatment] 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.
I urge you to read Ms. Schiffrin’s article; it’s a short and very good read.
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Many of us reading the first two paragraphs of the triplet quoted above recognize Ms. Schiffrin’s situation because it’s rare for us in America to go anywhere in the general vicinity of addressing a healthcare need without also experiencing some sort of complicating factor, be it insurance or inordinate waiting or Kafkaesque processes or something all new and freshly bad. Why, even getting a forevermore prescription re-filled at the neighborhood pharmacy can test our collective patiences, can it not?. So we’ve all come to expect that, except in the most commonplace of situations (and sometimes even then), interfacing with our healthcare system is going to be a royal PITB.
Reading the third paragraph of the triplet, we then find ourselves wistfully mocking-up how nice it would be to have zero aggravations whenever we have any sort of interaction with our healthcare system, as in: I’ll have une baguette et somme tres delicieux fromage from the charcuterie avec mon pere’s chemo, s’il vous plait!
More seriously, those of us who’ve ever dealt with an egregiously ill loved one also think about how nice it would’ve been if, when that serious illness first reared its ugly head, it had proved to be the only trial and tribulation rearing its ugly head, rather than having been accompanied by a battlefield’s-worth of ordeals, brought to us and our loved one courtesy of the Insurance Services Industrial Complex and the Medical Services Industrial Complex (which I abbreviate as the ISIC and the MSIC, respectively, and which I pronounce, disrespectfully, as I’ sick and EM’ sick, with the latter pronunciation bleeding over into AM’ sick to make a nice couplet of I sick and Am sick).
Because many of us have come to know that, in this context more so than any other, we need to gird for battle on behalf of our loved ones — seeing to it that his or her treatment is up to snuff, seeing to it that the healthcare providers are um . . . providing healthcare, and, on top of all that, seeing to it that our loved one is sheltered as much as possible from all the spurious, unwanted ISIC and MSIC overlays having nothing to do with the health of our loved one, but everything to do with our healthcare system and all the players within it.
Talk about value-detract, eh?
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Ms. Schiffrin then brings it on home, nicely:
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.
I would add that the simplicity of that system also meant that the doctors’ and the nurses’ and everyone else’s energy, as well as the family’s, could be focused primarily, if not solely, on caring for the patient, rather than feeding the rapacious MSIC and ISIC within which all of them were equally captive, responding to its bizarre demands and facilitating its generation of useless, roundabout, mostly paper-based data trails, thwarting a smooth-flowing process at every step of the way.
Until we here in the U.S. are able to describe our healthcare system in a way comparable to how Ms. Schiffrin describes the French healthcare system — that is, until our system allows us to devote the bulk of our energy to caring for patients and loved ones — our system will remain vastly inferior. No one in their right mind would ever design a system to be like this; it came about through accident, through willy-nilly accretions, work-arounds and band-aids, and, yes, through the Powers that Be within the MSIC and ISIC deciding that they would have their way with it, consequences be damned, and from all other relevant Ps that B then allowing the whole thing to come about.
That’s not to say that we are not all at least partially to blame: after all, every last one of us was there, in one way or another, when the house burned down. That is: we are Americans, and there is something quite American about our healthcare system. But some of us were far closer to the ignition source than others, and a few up ‘n lit it.
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And, oh yea, then there’s the cost. According to Ms. Schiffrin’s article (citing the World Health Organization as its source), per capita expenditures on healthcare in France were less than half of ours when stated in terms of dollars ($4,086 compared to $8,608) and about a third less than ours when stated in terms of percentages-of-GDP (11.6% of GDP in France and 17.9% of GDP for the U.S.).
All that thwarting of smooth-flowing processes has its consequences, n’est ce pas? The figure you usually see is one-third — i.e., that fully one-third of our healthcare system is made up of the value-detract part, that one-third goes to the paper and to the friction.
It would make sense for us to pay to not have that value-detract part. It does not make sense for us to pay to have it.
It’s quite embarrassing and quite chagrining to know that we have a layer of totally unhelpful stuff (putting it nicely . . . ) larded on top of every medical service we ever need. And the fact that we actually pay for that larding-up makes it all the more horrific.
Sure, the U.S. has done some terrific things in healthcare, e.g. being a leader in treating and even curing disease and the like. And maybe our excess costs have helped to support, in part, in a cross-subsidization sort of way, better healthcare around the globe. I dunno. But I do know that the healthcare system we’ve built up is not one of the terrific things we’ve done in healthcare. It’s a travesty — one that no caring society would ever seek to emulate — and there are no good reasons for it to be this way.
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So thank you Anya Schiffrin. Thank you for pointing out that France’s healthcare system is a shining counter-example of how to do it better and cheaper by doing it simply and patient-focused’ly.
My understanding is that among the other counter-examples are . . . oh . . just about every other developed country everywhere else across the face of the globe.
That makes our system truly exceptional, doesn’t it? Yay us!
Why, it might be enough to make you decide to spend your elder years in the oh-so-wonderful ville known as Paris France, non?