The French Way Of Cancer Treatment

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Above photo: Cochin Hospital in Paris, France.

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, theFrench 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) andadmiring 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.

Staff note: The French health system treats health care as a public good rather than a profit. It is a stark contrast to the US health care system that treats health care as a commodity so that patients only get the health care they can afford rather than what they need. It is up to us to change this because we have everything we need in the US to change to a health system that is about health and healing except the movement to demand it.

  • Millicent B Accardi

    I am sorry for your loss and am deeply appreciative you posted your story. Having been through the US medical care system numerous times with family members I can attest to its lack of humane treatment.
    A few years ago when I was in Lisbon, I had a bad cough and went to urgent care; they saw me immediately.
    In the US, the examination and subsequent tests would have cost over $1,500 (with my co-pay), plus they would have been stretched out over, perhaps weeks.
    In Lisbon the results were immediate. They gave me an inhaler and medicine on the spot, even demonstrated me how to use the inhaler. All tests performed IN an onsite lab and my assigned doctor (and a nurse) was with me every step of the way. Total cost? $20. Humane, thoughtful treatment? Priceless.

  • NOTgaltHouse

    But, even Hillary Clinton couldn’t find a better system than ours when she searched and searched for one back in the early 90s. But then, she couldn’t find her ass with both hands.
    Single payer Medicare, with no other insurance allowed for those who think that they are “better” than the rest of us.

  • otherjerseyguy

    I sympathize with your loss, I lost my father 20 years ago and miss him every day. Thank you for sharing your father’s French healthcare experience. Perhaps one day we will have an expanded Medicare offering similar compassionate medical care.

  • Jon

    Since expanded Medicare to cover everyone has about as much chance of passing in THIS Congress as a snowball in hell, why not invent one ourselves? Think of it as a big medical cooperative where all people hired are paid a fair salary, but the cooperative decides who to hire for managers (at a fair but never exorbitant salary), along with the medical staff, accountants, attorneys etc.

  • Patricia A McKnight

    You might check out Kaiser Permanente — of the Mayo Clinic —

  • R. Millis

    I’m very sorry for your loss. May your memories of him fill you with love.
    The American health care system is ALL profit-based. Approximately 30% or Americans with or without insurance refuse treatment simply because the cost and the care is criminal. Immense profits go to Big Pharma, and to overly paid specialists as well as administrators. Eventually, the system will treat only the wealthy, and that will not sustain the voracious appetite of $$$$.

  • B Craig

    I need to balance this story. I’m sorry for this loss, and glad the family was happy with Mr. Schiffrin’s care. In June of 2011 I was diagnosed with pancreatic cancer with indication it had metastasized to my liver. (If you know anything about pancreatic cancer, you know this is not good news.) To make a very long story short, I received excellent care at Mt. Sinai Medical Center in New York City, both from the medical standpoint and the human one. I cannot over-emphasize the gentle and sensitive care I received from everyone at Mt. Sinai, my being a regular guy, not a famous author. And, I’m here, almost 3 years later, continuing in complete remission, to tell the story – unlike others. I am grateful for that, for the team at Mt. Sinai, for my faith and for my friends and family who were and are essential to my health.

  • Margaret Flowers

    B Craig – thank you for sharing your story and it is wonderful news that you are doing so well because pancreatic cancer is very serious. That said, I do not consider that your story provides balance because in the French system every person is provided with the treatment that they need in a humane way and in the US, because we treat healthcare as a commodity, millions of people go without, go bankrupt or make choices to either not receive treatment or commit suicide in order to leave their family with something instead of losing everything. It is estimated that 2 million people in the US go without necessary cancer treatment each year due to cost. Last year,80 million people went without necessary care and in the last 2 years, 4 million families went bankrupt due to medical costs.

    It’s easy to feel like things are good when you experience or hear stories that turn out well. But it is important to step back and look at the big picture to see what is really going on.

    The US spends 2.5 times as much as the average OECD nation on health care per person per year. And the other countries provide universal care and have better health outcomes. If we treated health care as a public good, with this amount of spending, we could provide excellent lifelong care to every person living in the US. To not due so is criminal and inhumane.

  • B Craig

    The original story implies indifference and mediocracy among the U.S. healthcare system. This was not my experience, and I think my story balances the implication in the original post.

    I’ll be straightforward. I received “caring care” from the team. I did not experience delays nor indifference. And I am alive and in full remission, in contrast (unfortunately) with Mr. Schiffrin. (If I had to pick, I’d pick health.)

    Cost seems to be your main issue, and I would not argue with the fact that the U.S. is far from efficient with our healthcare finances. We can and must do better.

    However, I didn’t take that as the main point in the post from Ms. Schiffrin. Nor do I take it as the main thing of concern to me.

  • kevinzeese

    It is not only cost it is equity. Tens of thousands of Americans do not have access to healthcare at all in the US.

  • Margaret Flowers

    If you are trying to imply that the quality of care in the US is better than France, that is not true. France is the top system in the world and has better health outcomes than the US. In fact, lifespans have been increasing in France while they are in decline in the US. There are excellent medical centers in the US and excellent research, but it is not available equally to all who need it. Great that you were able to get care. But I think of the many I know and hear from who suffer terribly in the US.

  • jelun

    Thank you so much for sharing your story with us. I would like to share it with others.
    Care is always better when it is not for profit.

  • CALynnie

    One of the major issues with the uniquely American health “care” system is the large concentration of money held and not utilized to help those that need care. Memorial Sloan Kettering rakes in over $2 billion a year. According to its most recent Form 990 it has over $3.5 billion in cash and Wall Street investments – more than a year’s worth of operating costs. But if you look further, beyond the outrageous compensation packages, perks, bonuses, to a select few at the top, we see the top 5 largest independent contractors are construction entities who were paid $70 million (for comparison, they spent $17 million on charity care). MSK is a business which pays no income, property, or sales taxes which means they are subsidized by the taxpayers. So we pay insurance premiums and we pay for

  • Malka Margolies

    Thank you for sharing this important, albeit sad, story. Your father was legendary. I had the privilege of meeting him once when I sought him out at the annual booksellers convention. I was working at Random House and he had recently started his own publishing company. When I introduced myself, he was gracious, kind and wise and took the time to talk to me despite the crowds waiting to meet with him. It was the highlight of the convention for me.

  • David

    B Craig – Congratulations on your remission. My father passed from PC after an almost 3 year battle. Of course his physicians initially told us to expect 4-6 months. His fight for life was strong – Unfortunately, I don’t believe his medical experience was nearly as good as yours. He was treated at Danbury Hospital in Connecticut. At one appointment, my Dad asked his doctor (the head of oncology) about a treatment he heard about. His doctor’s reply: “You’re always finding new angles, aren’t you, Ken?” He just put the suggestion aside – we then quickly moved on to a different doctor. I think the article is terrific and offers a great viewpoint of the European vs US Healthcare systems. Again – I wish you the best of luck with your treatments, and continued good health. As for Ms. Flowers – Mr. Craig is having a positive experience with his treatment. Can’t you acknowledge that? Wish him good well?

  • Margaret Flowers

    David – If you read my first post – you will see that I did wish him good will. His story is wonderful, but it is not the norm in the US. Too many people in the US hear great stories like this and believe all is well. It’s a myth, as is upward mobility in the US. Because we are so isolated, we rarely recognize health injustice. The important point of Anna’s story is that her father’s treatment is the norm in France. We could have the same here if we understand that health care is a public good and not a commodity as it is treated right now.

  • Ethan

    Your experience was not the norm.

  • Anna Raccoon

    A commendable article. I am a British citizen, who has been resident in France for the past seven years. Three of which have been blighted by Cancer.
    As a French resident, I am entitled to ‘cent percent’ (100%) free care for a life threatening illness. I pay nothing, and have no need of auxiliary health insurance.
    My care has been nothing less than Gold standard. So speedy it takes your breath away; so dignified I am humbled; so empathetic it reduces me to tears at times.
    I have a rare cancer with an appalling ‘life expectancy’ – no one would have predicted that I would be replying to this post three years on, nor even three months on. That I can do so is testament to everything you have said about French health care.
    The question is – why do other countries, the UK with its ‘envy of the world NHS’ included, find it so difficult to emulate the French system?
    ‘Political Ideology’ seems a pathetic pigmy of an excuse from my stand point.

  • kevinzeese

    Thanks for your report. Well said.

    Why? Because too many people profit from the status quo and pay-off politicians to protect their profits and to profit even more from something people have no choice but to buy. When you need healthcare you will go into debt to get . I know I have a big healthcare bill over my head for recent emergency surgery. The corruption that turns what should be a public good into a profit center for the wealthy makes me angry — and gets me to push forward organizing and mobilizing people.

  • Not trying to “blame” the physicians here in the US – but many people, including physicians have a very strong financial stake in the status quo.

    http://theincidentaleconomist.com/wordpress/physician-fees-and-salaries-in-the-us-and-other-countries/

  • kevinzeese

    Two-thirds of physicians support a single payer system, so most are with us. Many physicians are leaving practice because they can no longer stand insurance companies being in charge of how they practice medicine. Insurance-based healthcare for profit is making US healthcare worse.

  • Margaret Flowers

    Yes. And many of us physicians left practice and are working to create a single payer health system in the US that is universal, non-profit and has the health of our population as the bottom line. The greatest problems are the industries that make billions off of our broken system and pay off politicians to keep it that way. That is why we ended up with a health law that further privatizes health care and gives hundreds of billions to these industries while tens of millions of people still go without needed care.

  • Roberta Faulhaber

    I’m very sorry for your loss, and couldn’t agree more as to the quality of health care in France (I’m American and have been living in France for many years). However, I’d like to point out that health care is not free. Every working man and woman in France pays into the system. Freelancers like myself pay even more into the system. So it’s based on sharing and solidarity and not a free ride for all… I’ve noticed many Americans in Europe believe the health care system is free. It is not!

  • The US has some great doctors and medical scientists, but its funding system can only be described as fundamentally broken. Families of cancer victims are commonly left not just bereft, but bankrupt. I’m in the UK, we have to wait a bit. But we don’t pay for treatment, and the care is sometimes awe inspiring. When my sister died the ITU nurses cried, then they laid her out in a side room, cleaned up, dressed in white, with candles. You cannot buy that kind of commitment.

  • Valerie Finnigan

    Dealing with state as well as private insurance has been a nightmare while I’m recovering from a car crash. The problem in the US is that health care coverage seems to be handled more by insurance adjusters – people who try to get out of providing coverage- than health care providers, and I’m being made to wait for people who aren’t even health care providers to make health care decisions for me.

  • ConcernForHumanRights

    Neither Kaiser Permanente nor the Mayo Clinic are cooperatives. Check out Group Health Cooperative of Puget Sound — a real cooperative. For more info re cooperatives and what defines a real cooperative, check out http://www.ica.coop.

  • ConcernForHumanRights

    Better than Medicare-for-All (Medicare requiring that the patient pay 20% if one doesn’t have supplemental insurance) would be Medicaid-for-All.

  • Cpt_Justice

    I am sorry for your loss, and commend you for using it to try to make at least some part of the world a better place.

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