SOS Healthcare

I remember the first time in happened: my roommate was sick as a dog and the doorbell rang. “It’s the doctor,” she wheezed.

“The who?”

“The doctor.”

“What does he want?” I wondered.

“He’s coming to see me. I’m sick!”

Suddenly, I realized what was happening. Her doctor was making a house call. My jaw dropped. She was sick, but she wasn’t dying, after all. Not that that would make a difference in my country. Back home, if you are dying, you take an ambulance. House calls have gone the way of the Model T. House calls belong to another era, a mystical time when you could get a root beer float at the drug store counter. They are the butt of jokes, an example of something that is so impossible to obtain, you might as well wish you could fly.

When I opened the door for the doctor, my mind flashed on the last time I was sick as a dog and still living in New York. First I had to beg the doctor’s secretary for an appointment the next day. Then I had to drag myself out of bed and take a taxi to the doctor’s office. Then I had to wait for an hour and a half in his office. When I finally got in to see him, he seemed irked. Apparently I was wasting his time because it was “only” the flu. He spent about 10 minutes with me and I left on the verge of tears. I then paid something like $150 for this rewarding experience.

At this moment, the US Congress is gearing up for a fight against the president’s very mild health care reform that would attempt to cure only the most blatantly unhealthy aspects of our health care system, and is a far cry from a single payer system like the one in France. For those who fear “socialized” health care, here is another first-hand report on what a single payer system is “really like.” If house calls aren’t enough to make your hair stand on end, get this:

The other night, my 8-year-old son woke up at 11pm with severe abdominal pain. When it didn’t go away, my husband called SOS Médecins, a public service that sends a doctor to your house in emergencies. True, we had to wait 3 hours for him to show up, but when he did he was pleasant and professional and the whole thing cost 55 euros, which will be reimbursed by the public health system. (By the way, my son was fine – it was just gas, I’m embarrassed to report).

Yes, these are the kinds of things that can happen when the government gives in to those lefty big government types. Tomorrow it could happen to you. You too might get excellent health services delivered right to your door. Anything is possible.

The Claritin Question

Back in 2000, when I first moved here, I had some sinus trouble and went to the pharmacy to buy some Claritin. Sure enough they had the same pill I knew from home, but the price was completely different. I don’t remember how much it was exactly, but I do recall that my jaw dropped significantly. How was it possible that the exact same medicine cost so much less here? I wrote it off to some sort of subsidies from the French health care system and let it go at that. Since then, I have noticed that almost any medicine you buy here costs startlingly less than it does in the States. And from what I've gathered, drugs are not subsidized here, though I think there may be price caps. It would be one thing if these were French versions made by different companies, but often they are not. They are the same medicines with the same names made by the same company. So how is it that the same pharmaceutical companies who insist that they are obliged to charge outrageous sums for their products in order to keep on top of research, etc. still find it profitable to sell their products overseas for a fraction of the price? I mean, Schering Plough does not sell Claritin in France for charity. If it were not profitable to sell Claritin here, they wouldn’t do it.

What kind of price difference are we talking here? Today I went to the pharmacy to see what Claritin sells for these days. A package of 15 pills containing 10 mg of the active ingredient, Loratadine, costs 5.54 euros here in the suburbs of Paris, or 36 euro cents per tablet. A package of 20 of the same pills costs $18.99 at Walgreens online, or $.95 per tablet. That’s almost three times as much (OK, if you want to take the exchange rate into account, it’s about two times as much, but that’s still quite a mark-up and besides, if you live in euros they have the same impact on your wallet as dollars). Interestingly, when I looked around the Internet I stumbled on an article in the New York Times Magazine (“The Claritin Effect, Prescription for Profit,” March 11, 2001), that mentions this international price difference on the first page of an 11-page investigation into the machinations of Schering Plough in its quest to get this expensive, and not particularly effective, pill to market. What’s more, it seems that the price of Claritin has actually dropped in recent years; another NYT article shows that when it went over the counter in 2003 the price fell from $3 to $1 per pill (“Nothing to Sneeze At,” May 7, 2003). The author of the article seemed to think this was a great savings to consumers, which it was, but when you realize that overseas consumers are paying a third of that “low” price, the savings doesn’t seem that great.

So here’s my question: what’s the deal, Schering Plough? How do you justify your prices? Why is it OK to gouge American consumers, when you know you can make a good profit selling at lower prices in Europe? Is it because Americans are so used to sky-high pharmaceutical prices that they just don’t question them?

Let’s hope that new health care bill makes it through the Senate in one piece. It’s time to start questioning.

Heathy Living

Now here’s an addendum for Michael Moore’s film, Sicko: I have a French friend who is very pregnant with her second child. Due to the configuration of her pelvis, her first delivery was by Cesarean. She was all prepared to have another Cesarean, but this time around, the midwives at the hospital are turning themselves inside out to get her to give birth “naturally.” Without her requesting it, she has been treated to acupuncture, homeopathy, and something called sophrology, a touchy feely technique which I had never heard of before I came to France. By the way, she is not paying a Euro cent for any of this. While I am marveling that she gets all this free alternative medicine without her even asking, she keeps telling me that she’d rather just have the Cesarean and be done with it.

I admit, I am a major fan of the French health system. As I have mentioned before, I had brain surgery here at one of the best hospitals in Europe, and the only bill I ever saw was for using the telephone. French doctors love me. "What? You only get 23 Euros for an appointment? You deserve more than that!" They don’t get to hear that very often. In fact, there are French people who complain that 23 Euros is too much. Never mind that those 23 Euros are reimbursed by Social Security, so they don't even really pay anything. True, there are plenty of specialists who cost a lot more, and not all of their fees are covered. But most employers offer supplemental health insurance, so in the end, almost everything is covered. Even when it's not, it's a fraction of what it would cost in the US. Naturally, the system is outrageously expensive for the government, so there is constant talk of reform and then shrieks of horror from those same French people who were complaining (grumbling is sort of a national pastime here). So things change at a snail's pace, and at every tiny change, people start to say that now France is on the slippery slope and soon the health system will be like that in America. When this happens, I say "relax, you have no idea how much your system will have to change to reach that point..."

That said, the current proposed reforms regarding hospitals make my hair stand on end. I keep thinking about what happened to American hospitals a decade or so ago when our brilliant bureaucrats decided that it would be just too cool to run the public hospitals like for-profit businesses. I believe that was the beginning of the end, or perhaps the beginning of a new era of hospitals that have so little regard for patients that you don’t dare stay in one without an advocate (family or friend) to fend for you.

In France, access to good health care is considered a right, right up there with Liberté, Egalité and Fraternité. There was a mini revolution here in 1936, when social security was first established, along with paid vacations and retirement benefits. French people don’t consider themselves lucky to have a social security net, they feel they fought for it, and they deserve it. Maybe when we decide that we deserve it, it will happen in the US too.