
The French way of cancer treatment - MaysonL
http://blogs.reuters.com/anya-schiffrin/2014/02/12/the-french-way-of-cancer-treatment/
======
yoha
As a French, I must say that we are so much used to this system that it seems
obvious. And, French being French, we like to complain about the flaws (well,
there are some). But whenever I read this kind of article, I realize that this
is not obvious at all and that, in the States, you have to pay for your health
like for any groceries.

This is when I understand what people means when they say that France is a
socialist country: we have very strong public service. This means that police,
fire fighters, healthcare, school and so on are mostly public: we have no
militia, prisons have no incentive to get more people jailed by bribing
judges, fires are fought without caring if the flat's owner can pay for it,
people are being taken care of without delay for checking if there private
insurance will accept it, and kids from poor families have a firm chance of
getting a good education.

The amusing part is that having this critical services being managed by the
state seems so obvious to us that we don't think we are specially socialists
(well, the French social party seldom wins the presidential elections). I
guess it would seem odd for the government to nationalize a company, but it
would be nearly impossible for them to try an privatize a critical public
service.

~~~
jessedhillon
I'm no flag-waver, but I think it's important to point out that for 40+ years
after WW2, it was an extensive (and expensive) US military budget which
countered Soviet aggression. So when you talk about all these great social
services, you have them in part because of a very expensive investment we made
in the defense of western Europe, which freed you to spend money on these
things.

~~~
flexie
The first many years after WW2 Europe spent rebuilding itself. America came
out of the war with barely a scratch on its home territory. Although many
American soldiers had died overseas no cities or industries were destroyed and
almost no civilians died. In Europe, two generations had been decimated by the
two consecutive wars, hundreds of major cities were destroyed, infrastructure
was destroyed, businesses - well, entire industries, were destroyed. The iron
curtain meant that trading partners in Eastern Europe were no longer
accessible.

For America WW2 meant opening up it's trade with the war. Let's not forget
that Europe's welfare states were born in hardship.

~~~
wikiburner
_> The first many years after WW2 Europe spent rebuilding itself._

The U.S chipped in quite a bit too. $15 billion, or $148 billion in today's
dollars, which was almost 6% (!) of the U.S. GDP at the time. This was in
addition to a previous $15 billion in aid before the Marshall Plan was
enacted.

[http://en.wikipedia.org/wiki/Marshall_Plan](http://en.wikipedia.org/wiki/Marshall_Plan)

~~~
flexie
While indeed massive, the Marshall plan was handed out over 4 years so it was
around 1.5 percent of US GDP. I dont think it made it impossible for the US to
build public health care.

~~~
smacktoward
Indeed -- in fact at the same time as the Marshall Plan, President Truman
actually was trying to pass a national health plan:

[http://www.trumanlibrary.org/anniversaries/healthprogram.htm](http://www.trumanlibrary.org/anniversaries/healthprogram.htm)

[http://pediatrics.aappublications.org/content/127/3/399.full](http://pediatrics.aappublications.org/content/127/3/399.full)

------
nolok
Interesting bits from one of the linked articles

>In 2000, the World Health Organization ranked the French health system as the
best over all in the world. Do you agree?

>I question the W.H.O. methodology, which has serious problems with data
reliability and the standards of comparison. A study I would take more
seriously is one published last year by Ellen Nolte and Martin McKee in the
journal Health Affairs. They examined avoidable mortality — that is, deaths
whose risk of occurrence would be far lower if the population had access to
appropriate health care interventions. In that study, based on data for the
year 2000, France was also ranked No. 1, with the lowest rate of avoidable
deaths. The United States was last, in 19th place, with the highest rate of
avoidable deaths. That’s a severe indictment of our health care system in my
judgment and calls attention, quite justifiably, to the high performance of
the French health care system.

[http://prescriptions.blogs.nytimes.com/2009/09/11/health-
car...](http://prescriptions.blogs.nytimes.com/2009/09/11/health-care-abroad-
france/#h\[IqtTas,2,3\])

~~~
_pmf_
> The United States was last, in 19th place, with the highest rate of
> avoidable deaths.

Alas, a negligible price to pay for Freedom™.

~~~
swombat
France is a free country, by any sensible definition of the term.

Sure, you can coin a definition of "free" that excludes France, but you can do
that for any country, including (and perhaps especially) the United States.

(or perhaps you were being sarcastic)

~~~
ekianjo
> France is a free country, by any sensible definition of the term.

haha. Funny comment. There are probably a thousands ways the US is more Free
than France. Let's not start by checking all the administrative barriers to do
ANYTHING in France. The US is certainly not an exemplary model for Freedom
anymore, but trying to compare France and US in terms of Freedom is a lost
battle.

~~~
chris_mahan
I am french, and I agree.

~~~
julie1
I am french and I don't think playing the dick contest on who has the biggest
freedom is smart.

Freedom in USA and France is decreasing because citizens are not involving
themselves in the functioning of the Republics we live in.

Quis custodiet ipsos custodes?

------
hartator
Am I the only one who doubt that this is the truth?

I am living in both Paris and the US. It's not what I have experienced.

In Paris, one of my friend has been hit by a motorcycle. The motorcycle run
away. She hits the ground and nobody cares. She was disoriented with weird
bubble on the skull. I call the french 911, they send the firehouse department
who came for finally asking me to go get my car to get her to the hospital.
When she can walk, they don't have to take her. I mean WTF?. I took her to the
hospital, lot of homeless people, cold waiting room. We wait for 2 hours for
her to be taking care of and after that we wait for another 4 hours. The
hospital staff were making fun of her because she can't remember her first
name and a lot of stuff because of the disorientation (She is pretty so maybe
they wanted to take advantage of the situation or something, wtf). Duh? They
finally say the scanner didn't revealed anything and send us home. Actually
she had blood in her skull and suffer from permanent brain damage now. I mean
WTF? Yeah we've paid something like 7 euros I guess, but what's the point if
it's for getting treatments from the middle ages?

In opposite, one of my friend got in a car accident in Austin. They wanted to
run away, they were DUI but finally get caught. He get to the hospital by an
ambulance. Duh? And I finally join him in the hospital. Wahoo, this is day and
night. The hospital have scanners or IRMs in every rooms and he has been take
of right away. Someone was checking on him every 15 minutes or so. Plenty of
devices with computers (duh!) and electronic devices (duh!). And the hospital
food was not that bad (for hospital food I mean)! Everything clean and warm,
people professional. He didn't get to pay anything because of good coverage.

~~~
Luc
Anecdotes. Duh?

~~~
hartator
The original article is an anecdote too.

------
jokoon
Just like chomsky said it in the corporation documentary, some institutions do
a much effective job if they operate at a loss. For the simple reason that
those insitution makes sure the whole country benefits from them. Often profit
will bring more destruction.

Profit driven economy is important for competition, it applies for many
market, like luxury, automobile, housing, furniture, etc, and it's also
important when the government need to make expenses: they will buy from the
company who offer a good service at a fair price.

That's where capitalism fails. Capitalism doesn't directly make the poor
wealthier, but if you make programs that help the poor, it will always have
benefits to the rich. That's what I don't understand when the wealthy wants
the poor to not be given aid: it might increase the wealthy's relative wealth,
but not their absolute wealth.

I think the wealthy don't like socialism not because it doesn't reward their
effort or their wealth, but because it gives them less decision power in
general. Which is stupid, since wealthy people have a career in business, not
in politics. I guess it boils down to an inferiority complex.

Also don't forget france's budget is mostly financed by the valude added tax,
which doesn't exist in the US.

------
pilooch
Both my parents, and my sister have faced life threatening diseases, with
lifetime treatment required. Call it bad luck. They benefit a 100% health
insurance coverage for these diseases, for free. Had it not been the case, our
family would not have been able to cope. This shared insurance system builds
the society I want to live in.

IMO France now needs to rebuild its economy so it continues to support this
gold standard system. Let's not let it degrade.

------
danielhunt
I'll be the first to admit ignorance on the Medicaid fiasco in the US, but
stories like this really drive home the difference between European and US
mentalities to healthcare

Being Irish, I'm used to a public healthcare system that, while slow and
filled with red tape, does actually work. Private health insurance is
expensive and quickly becoming something that can mean the difference between
paying your mortgage or not, but _still_ is seemingly better than whatever is
going on across the pond

Definitely worth a read, if only to highlight the stark difference in
approaches.

~~~
masklinn
And of course US healthcare is no faster and no less filled with red tape,
unless you have significant amount of money (and even then, the red tape of
having to negotiate with and coordinate care actors still falls on the patient
or their family)

~~~
davidw
Oddly enough, here in Italy, regular doctor visits have very little red tape.
They just type your name in their computer, and then get on with asking what
you are there to see them for. If you need a prescription, they print one out
for you, that you can take to the pharmacy.

By and large, Italy is not a stellar example of how to run a country, but the
health care system is less bureaucratic and easier to deal with than the US,
and generally not something you have to worry about much.

That said, it's not perfect, either. When our son was born here, it felt very
much like a factory operation with the pregnant woman as an input and a
woman+child as the output. I felt they were competent in the event that
anything went wrong (in our case, everything was fine), but it was all very
impersonal and felt designed to maximize throughput. I was not allowed to be
with my wife for most of her labor, for instance.

------
tluyben2
As others have said; this is normal in the EU (I'm not aware of exceptions in
the EU). And I have never had to talk about finance at all in relation to
healthcare; I think it's insult to injury to have to navigate insurance
policies, bills etc while you or someone you love is ill, dying or died.
Especially when you have insurance companies wiggling out of their
responsibilities by not paying is a side of this much loved capitalism which I
would not like to see appear here.

------
DanielBMarkham
As an American, I've been reading these kinds of articles for decades: country
X has awesome attribute Y, why can't we have it?

Best I can figure, country X also has these undesirable attributes A, B, and
C. The premise here is that you can pick and choose various best features of
wildly divergent societies and then combine them, like eating at a buffet bar.

I do not believe this premise is valid. If you want socialized French-style
medicine, then you also get national strikes that shut everything down,
Mediterranean time reckoning, really bad enviornments for startups, and so on.

That doesn't make the effort worth abandoning. American healthcare is broken
and it has remained broken through major political turmoil designed,
presumably, to fix it. Just at some point, you have to decide for yourself
whether or not you want to form political opinions based on how emotionally
moved you can be from listening to just part of the story, or whether diving
deeper is worth it for you. I applaud the French system's strengths and the
efforts to improve our own. I'm just not sure how much here is useful. There's
much more to this than "But if we could only just expand Medicaid!"

~~~
michaelochurch
_If you want socialized French-style medicine, then you also get national
strikes that shut everything down, Mediterranean time reckoning, really bad
enviornments for startups, and so on._

That's ridiculous.

All the European countries have healthcare systems that are _far_ more
civilized than ours. Not all of them have those problems.

Also, it's not that Europe is a bad environment for startups. It's that
Silicon Valley (for all its defects) is the best environment for startups in
the world, and there's a power law distribution. (Whatever #2 is, it's not
even close.) The US minus Silicon Valley is no better than Europe in terms of
supporting entrepreneurs.

------
negrit
French living in the US here(California). I had to go to the general
practitioner and I still don't understand how they can come up with prices as
high as $400 when it cost me 22 euros back home for the exact same service.

Also my insurance company in France would rather pay for my flight ticket to
go back home instead of going to the hospital in the US.

I've been in the US for almost 2 years now and it still puzzle me that I had
to pay for STD test(!) and I still don't understand the US healthcare system.

~~~
p4bl0
Paying for STD tests? It means that it is not anonymous either… What a shame.

For non-French people: in France it is standard that STD tests can be done
anonymously and for free by anyone (you are never asked any identification
information, everybody can do it even non-French person).

~~~
arjie
In the US, you can get either confidential testing or anonymous testing. You
have to pay for both, but the former results in your insurance provider being
informed of your test. Some states also have only confidential testing.

I know people who are very careful about this because they don't want premiums
going up. These things all add friction to the process in a time of high
stress. As a user experience, it is of very poor quality.

------
kremlin
French care for mothers giving birth could be better. My wife had to pay for a
private midwife because the standard French treatment is to drug up the
mothers as a matter of course and perform c-sections something like 10 times
as often as necessary. Maternity wards are basically treated like baby drive-
thrus. In and out as quickly as possible.

Which isn't to contradict that French health care is good; just pointing out
an area in need of improvement.

~~~
Jare
In Spain it seems the reverse: public institutions push the natural birth
route much harder, whereas private clinics routinely perform C-sections or
fully medicated or induced birth simply for their own convenience or to
collect the extra money from the insurer. After the baby is born and all is
well, public hospitals will assist moms to breastfeed if needed, whereas
private places just want you out of there ASAP.

If I want convenience and pretty flowers for simple procedures I'll go with
private, but for anything serious public all the way.

------
scotty79
US hospitals created entities to negotiate with the suppliers to get better
deals for them. At some point they stupidly decided that these entities can
finance themselves by taking percentage on transactions (as opposed to being
financed by the hospitals according to entities needs as it was till then).
Then the thing went downhill from there. Entities got free, became for profit,
concentrated, and now they stand in the middle between hospitals and suppliers
taxing the trade between them and punishing everyone that wants to get free by
making deal with other business partners of that hospital/supplier more
expensive.

------
ck2
The US will never have humane health care like France as long as we are locked
into the insurance driven model.

And that fate has pretty much been sealed now for the next few generations,
maybe even hundreds of years.

There are now many millions of people in the US that will never have health
care under the insurance model because of the medicaid gap caused by the
loophole the supreme court made and the states that refused medicaid
expansion.

------
puppetmaster3
In USA, we have legalized corruption to pay more for less:
[http://en.wikipedia.org/wiki/Karen_Ignagni](http://en.wikipedia.org/wiki/Karen_Ignagni)

------
beilabs
My father passed away from cancer, he was given 3 months to live. I often
believe he received a sub-standard level of care and wonder would things have
been different if he lived in a country like France.

Work hard and pay high taxes all your life. Your country should take care of
you when you need it the most.

------
rwissmann
This. All this hate for the European health care systems is just misguided and
ignorant. Health care delivery is one of the few sectors of the economy that
the US is not world class in (despite having the best medical research).

We all have our national pride and there are real philosophical difference on
how to organize societies - and these differences matter. Being smart however
includes the ability to sometimes ignore one's ego, compare solutions based on
their merit, and learn from each other where possible.

~~~
danmaz74
_All this hate for the European health care systems is just misguided and
ignorant_ Not really... a part of it is misguided and ignorant; the other part
is highly informed and very well guided.. towards ever increasing profits.

------
ThePhysicist
I think you could call this article the (North) European way of cancer
treatment, since overall the healthcare systems and standards are pretty
comparable in most of European countries (with the exception of some new
member states and a few southern countries). In fact, as a EU citizen your
public health insurance card will even cover treatment in other member states
in some cases, although "health tourism" is in general not possible
([http://en.m.wikipedia.org/wiki/European_Health_Insurance_Car...](http://en.m.wikipedia.org/wiki/European_Health_Insurance_Card)).
Personally I lived in Paris for three years and always tried to go back to
Germany to see a doctor (which rarely happens) since I perceived the hygienic
standards at hospitals and private practices to be a bit lower than in
Germany, but maybe I'm a bit biased there as a German ;)

------
prestadige
My suspicion is that _both_ health care systems are unsustainable because of
rising geriatric care costs. To counter this we'll be forced to navigate the
minefields of legal euthanasia and life extension technologies.

------
vasilipupkin
[http://www.worldlifeexpectancy.com/cause-of-death/all-
cancer...](http://www.worldlifeexpectancy.com/cause-of-death/all-cancers/by-
country/)

US has better cancer survival rates than France

~~~
agarden
This is getting to the point. The question I had at the end of the article
was, would her father have survived if he had stayed in New York to be
treated?

But I think that chart is ranking cancer deaths per 100,000 people in the
general population. Death rate of people who have been diagnosed with cancer
would be much more informative.

~~~
lilsunnybee
Survival rate for pancreatic cancer, especially stage IV, is very low
regardless of being in the US or elsewhere:
[http://www.cancer.org/cancer/pancreaticcancer/overviewguide/...](http://www.cancer.org/cancer/pancreaticcancer/overviewguide/pancreatic-
cancer-overview-survival-rates)

------
nickpp
One advantage Western Eropean health car has that is not very often talked
about is the brain drain from Eastern Europe.

Countless well prepared doctors from countries like Bulgaria and Romania leave
to work and live in France, UK or Germany.

They are happy with the higher standar of life and better income in the west.
However their education is subsidized by the East with the losses never
recouped.

Without those doctors, the health care in Western Europe would be
significantly worse, kind like how Silicon Valley would be without immigrants.

~~~
DanBC
There is a similar problem with nurses being recruited from other poorer
places.

Another problem is that clinicians make mistakes, and those mistakes kill
people, and the risks of those mistakes rise with Whatever national language
as a second language.

------
mnml_
You also need to understand something about French healthcare : money is where
the risk is. Our Intensive care services are amazing, however basic depts are
not that great.

------
joesmo
A similar system in the US would allow millions to stop being dependent on
their jobs for health insurance and possibly not accept the horrible working
conditions they have here simply to avoid dying uncared for in a hospital.

We can't possibly have that here however. "Capitalism" (meaning oligarchy /
monopoly based market control to Americans) must be applied dogmatically to
everything, regardless of outcome.

------
Fizzadar
I'm glad to see this on the HN homepage, it's about time americans started
questioning why their insurance/healthcare system is focussed on money and not
health.

------
cognivore
This is apples to oranges. The French system is designed to provide medical
care. The American system is designed to make money.

------
duedl0r
welcome to Europe

~~~
scotty79
My life partner got for her brain tumor: brain surgery by one of the two top
neurosurgeons in my city (0.7 mln population), radiotherapy combined with
chemotherapy (linear accelerator lifetime dose, themozolmide 6 weeks),
chemotherapy (themozolmide 6 months), mri checkup every 6 months. Everything
fully covered by her basic state health insurance that costs you 50$ per month
(rougly 10 pizzas) if you are not employed anywhere and you registerd your own
company. Proportionally less if you are employed for less than 60% of average
pay and more if for more. Costs you nothing if you are unemployed and
registerd as unemployed or you have a husband or wife that is covered. You can
also pay it out of your pocket if you don't feel like working or visiting
unemployment office every few months to check there's still no work you could
try. What is more it's nearly in full deductible directly from your tax so it
costs you even less.

It's Poland so neurology ward was overcrowded and begged for renovation and
radiotherapy mask was initially too tight, but we don't care, she was given
two years and counting of full quality life witout any unnecessary burden on
her, us and our families.

~~~
gambiting
I would never ever complain about the Polish healthcare. The oncology clinic
in Warsaw was the one of the pioneers in treating GIST(rare type of stomach
cancer) with then-new Glivec - Initially, my father has been given less than a
year after being diagnosed with GIST. He has been alive and very well for over
8 years now after the diagnosis, having had two operations and taking a box of
Glivec(~$3000 USD box) every month. The hospital even pays for his train
tickets to Warsaw so he can get his medicine every month. He has never paid
anything for his treatment, that's all national healthcare system. And yes,
the waiting rooms get a bit crowded - who cares, he still gets the best cancer
treatment in the country,for free.

As a kid, I always dreamed of living in America - now I wouldn't want to do it
even if someone paid me to. Nope.

------
yread
Even though the article started with saying it's stage 4 I kind of expected he
would survive :(

~~~
michaelochurch
Pancreatic cancer has a terrible prognosis as it is, and Stage IV (metastasis)
makes that worse.

If the cancer makes it into the bloodstream, and isn't wiped out completely by
the chemo (cancer cells have an evolutionary dynamic like antibiotic
resistance; this is why chemo drugs can stop working before they kill all the
cancer) it's very likely that it's a chronic illness and terminal within 5
years: often much less.

------
michaelochurch
_After all, people come from the all over the world for treatment at Sloan
Kettering._

This is one of those claims that has to be attacked. Day after day, I hear
people defend our horrible healthcare system by claiming that people on the
"global rich list" still come "to the US" for healthcare. That was true in the
1980s. Not now.

No one who knows anything thinks highly of our healthcare system in general.
Even if you have insurance, the quality of care is inferior to what many
countries have for free.

What is true is that very wealthy people (for whom money is no issue) travel
_to specific doctors_ for treatment, especially when getting an experimental
procedure. If that doctor's at Sloan Kettering, they go to New York. If she's
in Paris, they go to France. If she's at Hopkins, they go to Baltimore. If
that doctor's in London under NHS, they go to the UK. No one comes "to the
US"; some people come to specific specialists.

Anyway, if you're an average American-- little wealth, no connections, unable
to afford treatments insurance won't cover-- you're probably not going to be
able to get appointments with those specialists no matter what.

The U.S. insurance-dominated healthcare system is a world-class embarrassment.
It's the first sign that we're no longer a first world country.

------
fuckpig
Flogging the old "European socialism is the best" dead horse again, I see.

Comparing radically different countries always yields good results, right?
It's important to also note the French are bankrupt and have massive internal
problems.

It's great they shifted all of their effort into health care. It will make a
nice epitaph.

------
bsaul
All of this is true, but americans have to realize one thing : all the drugs
for cancer are created in the US. Because your system in general is expensive
but that makes it possible to do research. Our doctors are not billionaires,
our private hospitals aren't making an insane amount of money, and the state
is collapsing under its debts. So almost nobody has the money to run research,
and when they do, drug companies look for the american market to cover their
costs.

~~~
steve_barham
Source? If you look at expenditure on pharmaceutical research and development
in the UK vs. the US, you see that 9% of global R&D expenditure is UK based,
and 49% is US based.

This very closely matches the population differences between the UK and US (at
a population of 63M vs. 317M).

Within Europe, the UK represents 23% of all pharmaceutical R&D funding; France
is only slightly lower at 20% of the total.

[http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_...](http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_United_Kingdom#Research_and_development)
[http://en.wikipedia.org/wiki/Demographics_of_the_United_Stat...](http://en.wikipedia.org/wiki/Demographics_of_the_United_States)
[http://en.wikipedia.org/wiki/Demographics_of_the_united_king...](http://en.wikipedia.org/wiki/Demographics_of_the_united_kingdom)

~~~
bsaul
Source is a very close friend of mine who's doing research in biology, and who
knows how things work here vs the US.

He witnessedthe difference in how the interns are paid, how the researcher are
paid, how the labs are funded, gow modern the equipments are, and how much
money the pharma corp are ready to spend todevelop new drugs. And this is a
completely different world.

Now you're perfectely right and the market size is a big factor. I should have
compared europe vs the US. The conclusion would have been the same.

~~~
kalleboo
How people is paid also reflects the cost of education - in Europe higher
education is vastly cheaper than in the US (in many cases free). If American
researchers end up with $200,000 in college debt and a European has $10,000,
they'll be requiring different salaries.

