By Anya Schiffrin
Below, the opening of a compelling essay describing what happened when a cancer patient who was being treated at NYC’s Memorial Sloane Kettering went to Paris. (I have included a link that will take you to the rest of the essay, which originally appeared on Reuters.)
For a great many years, we have been told that the U.S. offers the best cancer care anywhere. Anya Schiffrin will make you think about whether that is true—and what we need to do.
At the end of the piece I’ve added a note (MM)
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? (my emphasis–mm)
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!”
You will find the rest of the essay here. Please return to HealthBeat to comment.
Note: As I read Schiffrin’s essay, I couldn’t help but remember a conversation I had with a close friend who married a Frenchman and lived in the Dordogne region of Southwest France, for a number of years. During that time, she was hospitalized and received medical care. When she returned, she explained that in France health care is so different because “The French believe that nothing is too good for another Frenchman.” (This includes poor countrymen as well as illegal aliens who have filed for residency).
If only we felt that way about each other.
In part 2 of the post, I will explain how France finances an extremely egalitarian system that provides high quality, patient-centered care for everyone. The cost of medical care is a problem in France, as it is in every developed nation. But while the U.S. devotes 17.6% of GDP to healthcare, France spends 11.8% of GDP, just a hair more than Canada, which has a single-payer system. In the next post, I’ll explore how they do it.
If you have not, you should read Matt Welch’s ( he is a senior editor at the libertarian Reason online publication) account on how he much prefers French care.
Two problems with Welch’s piece 1) he seems to think that France has a socialist system. It doesn’t.
It is as I explained a hybrid public/private system. The government doesn’t own the system.
2) He seems to think it’s single-payer. It isn’t. 97% of the population has private insurance.
The government pays only 75% of the nation’s health care bill.
But I’m glad he likes health care in France. He talks mainly about convenience, but in terms of quality of care (outcomes)
health care in France is excellent.
He is a libertarian. Their definition of socialism is quite broad. If a government official had any part whatsoever in any part of health care, it is a socialist system in their view. What is telling is that even though he thinks it is socialism, by his definition, he still likes it because it is cheap, high quality and very convenient. All the things socialism shouldnt be able to do.
It’s interesting that libertarians have their own definition of socialism–I didn’t know this, but from their point of view it makes sense.
And, as you point out,it is very interesting that, even though he thinks the French system is “socialist” he likes it. The labels (“socialist,” “hybrid,” “single-payer” etc.) are far, far less important than a patient’s experience in a health care system.
The link for the second part of the story is broken. Please advise.
I just checked it, and it works. Perhaps it repaired itself since you tried it . . .
Let me know if it still doesn’t work.