French vs. American Healthcare

Advantages of the French Medical System:

• There doesn't seem to be any cost-benefit analysis done.  If there is a risk, even minor, that you could die of a blood clot, they will treat you.  Update: they also do not wait for you to have a life-threatening reaction before prescribing an EpiPen equivalent.  If you have a food allergy that causes respiratory issues, they prescribe it - as the doctor noted, the reactions are often progressive and you could easily die before medical services reached you.
• Even uninsured medical costs are so low that I mistakenly thought they were my post-insurance rate.  Twice.  23 Euro for an uninsured doctor's visit?  88 Euro for DAILY injections at home by a nurse for two weeks?  Oh right - attending university is free here, so they don't need to pay college-educated people crazy high salaries just to afford their student loans . . . that's one way to keep the gap between "rich" and "poor" narrower for sure.  There is a premium paid for college-educated people (you still invest your time after all), but it isn't nearly as large as in the US.  This is also NOT a for-profit system, so every level of the medical industry doesn't need to carve out their profit at levels that satisfy shareholders.
• While I pay A LOT of taxes, the overall percentage for somebody like me is not actually that much different from what I paid in the US, plus my health care premiums, plus the FSA to be certain I could always foot the 20% that my insurance didn't cover, plus the higher amount I needed to save for retirement because health care costs are one of the big spend categories for US retirees . . . basically, the difference in France is that many people pay a little more in taxes, but then everyone is also covered if the worst happens.  You aren't likely to lose your house here because you get sick or injured.
• They prioritize your health.  I could have easily chosen to spend the last 3 weeks off work with nearly full pay.  Except, I didn't really feel it was necessary with my job and it would have hurt my plant to go through close and year-end adjustments without their only local finance person.
• The doctors actually explain stuff to you.  They tell you not only that they've determined you injured a ligament, then later, probably tore the meniscus, but also that it was this particular test where they moved your leg in this or that way which told them what the problem was.  It inspires a certain level of confidence in the diagnosis when the doctor openly tells you how they drew that conclusion.
• If you tell a French person that you're calling on Wednesday for an appointment the following Monday, they will be shocked because you're calling so EARLY.  Apparently, there must be a much better per-capita number of doctors here than the US if a few days notice gives you your choice of appointment times.
• Doctors will make house calls, if necessary.
• If you can't drive, there is an "ambulance" service that is made up of normal cars to provide medical transportation.  I will be using one of these for my trip to Poitiers for the IRM (MRI).  Or not - I decided to take the train and save a few Euro.

There are really no pictures that go with this post, so you get random French food.  This is a super tasty tartiflette

Disadvantages of the French Medical System:

• Daily injections?  Really?  This isn't really a "con" of the system, but I loathe needles and this was a special kind of torture for me.
• While I understand that there can be issues with people abusing painkillers, pain management is kind of important.  When somebody has torn a ligament, a week's worth of narcotics is not that big of an issue.  Especially when it eventually turns out to be a torn ligament and meniscus.
• Even though most French people aren't paying for them, I'm not sure what the point is in prescribing a full box of medication instead of just the number prescribed.  I guess the upside is that I can tally up my prior leftovers before filling a prescription, just to be sure I actually need it!  It also saves time at the pharmacy - they just grab the boxes and send you on your way.
• Again, probably because there is virtually no cost to the individual (and the gov pays either way), you are required to see a doctor if you miss even a single day of work.  Otherwise, you're taking vacation pay for it.  It comes across like your employer doesn't trust you, but actually the government won't reimburse their share without proof you were ill/injured.
• Due to the house call issue, your doctor really needs to be in your town.  You can't just pick the person in a town 20 minutes away who your friend recommended.
• There can be a little wait for certain non-emergency procedures.  Like, my MRI can't be done until February 28.  But, I've had to wait in the US for non-emergency MRIs also . . . and there is certainly a long wait for many specialists in the US.  It was over a month both for a dermatologist and a hand surgeon.

And . . . well, that's about it (other than dealing with CPAM initially).  Honestly, the disadvantages are more just nitpicky stuff and I can see why it is rated one of the best healthcare systems in the world.  Due to the low medical costs, I've still paid more in taxes than my medical treatment has cost, so it's still a net win for France, but I'm feeling pretty happy about the medical side of the experience.  There are certain specialties here with a wait due to too few doctors, but that's true in the US also (see above).

Update on my Knee:
For those who are interested, as mentioned above, it appears that I tore the meniscus.  I was allowed to try walking without the splint if I could tolerate the pain, but unfortunately it took less than two days of trying to walk around at work without it before my whole lower leg and foot swelled back up and every step was painful again . . . so I'm back in the splint until after the MRI and treatment is determined.

Of course, I had my own comedy routine on Monday and there really should have been video.  I had asked the doctor if I could drive with the splint off and she said, "if you can?"  I thought this was like the walking and referred to my pain level, so I was determined to tough it out and have my freedom back!  So, I tried to sit in the car and realized that I had to move the seat back.  I was quite proud of myself when I was in, foot on the gas pedal and ready to go . . . except I was so far back that I couldn't fully clutch.  "Ok, so I'll scoot the seat forward a bit. Yep, I can fully clutch now!"  Pushed the clutch in and went to press the brake to start the car.  And learned the doctor literally meant if I was actually physically CAPABLE of driving when I can only bend my knee unaided to the position shown below.

It's enough to sit my foot on the gas, but I tried, and failed, to bend my knee enough to actually raise it off the gas and onto the brake.  I yanked on my pant leg, moved my leg to the brake by hand and went to start the car before the less-stubborn, more-logical part of my brain suggested that perhaps it was not wise to drive, especially a manual, when I'd just had to use my HAND to transfer my foot from the gas to the brake.  This was proven quite true when an attempt to transfer my foot back over unaided resulted in my foot half on both peddles and a bit wedged between them.

So, there will be no driving for me through Feb 28.  Hopefully, there will be good news then and I'll only need a few weeks of physical therapy!  If not, I'll be facing surgery in a foreign country.  The period of time since I injured my knee is the first extended period when I've wanted to return to the US - at home, I know how to take care of myself.  Here, the forms are in French, the instructions are in French, many of the people only speak French.  Naturally, I'm in France, but it adds a level of complication that is really unpleasant when you're already hurt.

A Serious Injury in France - Part 2 and Great Friends

The differences in France and the US when it comes to healthcare are a little surprising.  I don't think that I've ever heard of somebody with an immobilized limb getting daily injections to prevent blood clots in the US, but PB has asked me multiple times about this and was acting like I was in grave danger of imminent "death by blood clot" because I went the whole first week without the injection (largely due to difficulty finding a nurse).  It's also weird that they just hand you these boxes of injections, so PB had a valid threat when he said if I didn't find a nurse, I would force him to inject them himself.

By the way, if I do die tragically from a blood clot - PB, you were right.  As always.  Postulate #1. 😁

Frankly, I would probably have went ahead and gotten the injections (why take an unnecessary risk, no matter how small?), except for two small problems.  The first is that I tried to register my social number and it wasn't valid - apparently, a "temporary number" is basically useless.  It wasn't until January 30th that I finally received a valid social number . . . which I registered and my information was promptly sent out.  To my old address.  Apparently, my HR folks forgot to update the address with CPAM (although the prefecture has my correct address).  Of course, governmental departments don't really share information in the US either, so this is no different.  Everything seems to be working smoothly now with my certificate of rights, even without the Carte Vitale.

The second problem is that, despite a large British ex-pat community in the area, I have had serious issues finding English-speaking medical care.  The doctor that I saw in the neighboring town won't drive to my town.  Unlike the US, you may not be able to call your doctor when they've, say, given you a prescription that you're allergic to - the doctor is too busy to return calls.  But they'll make a freaking house call . . . as long as you live in the same town basically.  So, no more doctor in the neighboring town (the nurse that was recommended in the same town also won't drive here for my injections).

So, I started the great quest to find more English-speaking medical people.  The next nurse I called also told me that their group is too far away and gave me the number of two groups that are closer.  I postponed calling the new places because I was a little concerned about daily nurse visits without confirmed insurance.  Once it was confirmed, the nurse's group in my area had inconsistent English ability, so PB gave them his number as my contact person.  He was thus able to arrange for my daily torture, which is probably good because I would have quit after the first two!  Check out the bruise from the first one - can you blame me for wanting to skip them!  The second one left a smaller bruise, about the size of a penny . . . and the third looks like it might be the best of all.  Which is good, because I was beginning to wonder how they'd possibly find room for 14 (let alone 21) of these.😱

I have to say that I'm happy I live in an area with a large British ex-pat community at the moment because they really came through on medical suggestions!  I now have the name of an English-speaking doctor and dentist, plus the nurses.  I'm only missing an eye doctor.  My new doctor is great, but sadly leaving the area in July.  She'll at least be able to get me through the rest of my knee treatment - at the one week mark, she determined I'd actually injured TWO ligaments and that the swelling was not down as much as it should have been.  I was lectured on being less active, but persuaded her that I could still work AND be less active.  PB persists in refusing to fetch my coffee though, which really undermines his assertion that he's become my highly-paid assistant.😂

In addition to PB looking after my medical care (and occasional transportation), l'américaine has been super helpful with driving me back and forth to work most days, taking me to get lunch and buying some of my groceries.  I'm super lucky that I picked a place that is close to work, so it's not SUPER inconvenient for people.  It is still a hassle though because they have to consider my schedule, such as me needing to eat in order to take my medication . . . so I have to be home by a certain time.  Another woman, YV, volunteered to drive me to my doctor's appointment, which was also really nice and a third co-worker has offered various forms of help too.  My team takes good care of me during the week, but I was a little concerned about the weekend.  It was pure luck that Alexis' knee had healed up and he'd arrived back in town the weekend before (I was actually getting him from Poitiers when I hurt myself), so he offered to come by on Saturday.  He ended up looking after me nearly the whole day and assembled my shelves, table and chairs for me (and cleaned up the packaging).  Plus, he took me to get groceries, helped unpack some of my stuff, hung my curtains, washed my dishes and cooked us dinner.  Yep, I've been very, very fortunate to meet some really great people in France!!!

A Serious Injury, CPAM and the French Medical System

One of those things that I worried about, but hoped would never happen, came to pass this week.  I have a partial tear of a ligament in my knee, which means I'm in a thigh-to-calf splint for the next 3 weeks (potentially a month and a half . . . or an additional month and a half?  There was a small language difficulty).  The worst part - I live in small rural town and I cannot drive.

Well, the pain may actually be the worst part because it doesn't appear to be customary to prescribe strong painkillers the first visit, even for a serious injury (not even Tramadol, which is what I prefer because it isn't as strong and is an opioid, but non-narcotic).  This would potentially be ok, since I was given a prescription dose of a painkiller similar to Tylenol, a prescription dose of Naproxen Sodium and a pain relieving cream . . . except I'm allergic to soy, which I told the doctor (in French), yet I was prescribed a soy-containing pain cream.  Unlike in the US, you apparently cannot just call your doctor and tell them that there's a problem with your prescription or that your pain is not even remotely well-controlled.  You can try, but you'll be told by the receptionist that the doctor is too busy to return a call and you'll have to make an appointment.  Are. You. Freaking. Kidding. Me?!?!  The doctors here will make a house visit to ensure you have your required note for missing a day of work, even for a cold, but not return a phone call.  Not even to correct their own mistake.  Incredible.

Now that I know that, I've changed my mind about continuing to see a doctor in the town 20 minutes away who speaks the best English because, as I also learned, they won't make a 20 minute drive for the house calls.  I learned this when I tried to contact the recommended nurse for my DAILY injection.  This is another interesting difference from the US.  I've had limbs splinted or immobilized before and never had an injection required.  After having it prescribed in France, I looked up why this might be.  It's because they've studied the risk of a clot and it's near zero if you don't have at least 3 risk factors (I don't), so it's been determined that prophylactic treatment is not recommended.  The French all took it as gospel that I would need this treatment (but of course you need the injection!) and joked that Americans are simply content to let natural selection take its course for the poor tiny percentage of the population that could be impacted by this.

I'm guessing it also has something to do with the fact that a daily house visit from the nurse isn't so objectionable when the combination of your socialized health care and extra mutuelle coverage is footing the bill.  Can you imagine the cost of a nurse coming to your home for three weeks to administer a daily injection in the US? 😨  Not only would people not agree to pay for it, the for-profit insurance in the US would surely refuse.

So, outside of the apparent reluctance to prescribe anything remotely suitable for the pain caused by a torn ligament, French doctors have no qualms about prescribing you the entire remainder of the pharmacy stock.  This is what I left the pharmacy with:

There's also no need for silly bottles.  If you were prescribed 14 pills, they just sell you the full box of 16.  Presumably nobody cares since they're not paying out-of-pocket.  Of course, if you're not French, then you've probably also encountered the most incompetent branch of the French government well before you've needed any medical care.

In direct contrast to my experience of getting my work permit issued in a week and my visa arriving promptly, plus the prefecture finding me an appointment before my visa expiration, CPAM seems to delight in it's ability to be completely dysfunctional.  First, they incorrectly told my human resources department that I was not eligible for a social number (or Carte Vitale) until I'd been in the country for 3 months.  My immigration attorneys assured me that this was not true with the visa type that I have, plus they sent the link to the French government website that proved this.

It's unclear whether the next problem was CPAM or my co-worker, but somehow this issue never progressed further until I complained to PB that I'd been in the country for nearly 3 months, paying high social taxes and for a mutuelle policy that I couldn't use, with no Carte Vitale to show for it.  He followed up with my co-worker, who possibly never tried to clarify with CPAM about my visa type.  My dossier was finally sent over and, several weeks later, PB followed up again.  CPAM informed us that they'd received no such dossier.  My co-worker forwarded the proof that we'd filed.  CPAM then miraculously found my file, which had been assigned to somebody who was out on leave of some sort.  It seems that CPAM was content to leave my file waiting on a desk until whenever the person returned, but they were finally persuaded to do something with it.

PB laughed a bit while telling me that I was having my first experience with TRUE French bureaucracy.  Apparently, the French just accept this as the way things are here, which could be why so many of them are in favor of politicians who want to fire a significant number of civil servants!  Finally, in early January, I was issued my "temporary" social number and told that a bill of rights would be mailed to me.  The mutuelle insisted that my temporary number could not be used for registering with them.  Fine, I'll continue to wait.

Well, this became a problem when I injured my knee.  Even though I should have been covered from the day I arrived, because my human resources folks didn't persist and file until December, I'm told I have coverage as of December 22.  But, without a Carte Vitale, I have to pay upfront and hope that the French government will actually reimburse me.

The cost in France for an uninsured "urgent care" visit to a doctor?  Twenty-three Euro.  Yes, that's the entire cost.  The pharmacy, on the other hand, set me back over two hundred Euro, but that was for the entire stack of medication and the knee splint.

So, financially, the lack of proof of insurance has not been so terrible.  Of course, I have no idea where to send my "factures" or invoices, in order to be reimbursed.  The CPAM has quit responding to my employer when an update is requested as well (I should have pushed for my US HQ to include this in the services that the immigration attorneys were hired for - they seem able to persuade the government to actually do its job).  I will say that PB has made it his personal mission this week to resolve the issue and has our HR staff working on it studiously.  My understanding is that they will help me get reimbursed and to register with the mutuelle, regardless of my lack of Carte Vitale.

My fears before this experience centered more around what I would do if I were seriously injured in a country where I don't have any long-term friendships yet and no family to call on.  As it turns out, I was worried about something that hasn't really happened yet.  Le Américaine has helped a lot with buying my groceries for the week, driving me to the doctor and taking me back and forth to work.  Alexis, who is back in the area, brought me an ice pack and is going to help with my furniture assembly.  Another co-worker has also offered to pick up groceries for me or help with any other errands.  A new friend offered to accompany me if I needed surgery, so I'd have an interpreter.  On the other hand, PB had a brief moment of acting like I'd injured myself during the WORST POSSIBLE TIME (our CEO visited this week) just to inconvenience him, but then he recalled that I just received a large set of knives as my 5 year service gift 😈 . . . er, I mean he recalled that he generally likes me and should be more concerned that I'm injured than about the poor timing of the injury.

I have learned that there are a lot of things that are a bit of a challenge when you can't bend one knee.  Like getting up from any sitting position without something to grab on to.  On the other hand, my left leg is going to have quads of steel and I'll be able to swing my lower body around using my arms like a gymnast!  My poor right quad is having a time of it though as I pulled it trying to swing my sock around and catch my foot in it like a net.  You know, socks are overrated anyway.  As are shoes.  I posed this question on my FB, but fuzzy blue slippers are proper work attire, right?

To my relief (and surely that of PB), I managed to wrangle a sock and (untied) shoe onto my foot prior to our CEO's arrival and have not yet had to wear fuzzy slippers in public.  Which I'm pretty sure a French person would view as sufficient public humiliation to justify a home visit and a doctor's note to skip work.😊