Sicko !

No, I didn't not have an unpleasant bump-in with someone on the subway this morning (I'm still Velib'ing so actually I don't take the subway that much anymore) and no, I am not coming down with the flu....

Sicko! is the new Micheal Moore movie we went to see last night. It's basically a hollywood documentary about the health care system in the US and how bad it is compared to health care systems in other counties (Canada, England, Cuba and .... France!)...

Now, if you've seen a Michael Moore movie already (Farhenheit, Bowling....) you probably know that Sicko! is not going to be a very politically correct documentary.... and that's not a bad thing actually... usually you go see a Michael Moore movie expecting it to be politically incorrect.... but when you realize it is also factually incorrect.... well.... then it's worth a post in Fned's Blog.

I'm not going to go into the movie's details or even post my personal opinion about it but I do want to mention some incorrect information that is in the movie and that as a resident in France I feel it is important to point out.

First and foremost, MM states that the average revenue of a couple in France is 7,000 € per month (+/- 10,000 USD).... as an example he shows an Engineer and his wife who's an assistant..... well.... André is an Engineer and I'm an assistant..... and in no way do we earn that kind of money per month ..... (and I'd say we're well above the average)

Ok, had to get that off my chest....

MM claims that health care in France is simple, free and accesible to everyone.... ok for it being accesible and undecided about it being free.... but it is absolutely in no way close to being simple. In fact, I've been living in this country for over 5 years now and I still don't fully understand how it works ! Still, I'm going to try and explain it and André will probably correct me where I'm wrong.....

The health care system is based on a reimboursement system. In most cases, first you pay, then you get reimboursed.

When you go see a doctor he will write out a feuille des soins which is a pre-formated document that states who you went to see, what he prescribed and how much he charged you for the appointment. In order to get reimboursed you must then send out the feuille de soins to your CPAM (Caisse Primaire d'Assurance Maladie) which would be the equivalent of an HMO. The CPAM has a gouverment issued list of every treatment for every illness known and what is the percentage of reimboursement applied to what is called a "plafond" which is the top amount for which you will be reimboursed.... Lets say you go see your MD for a general check up and he charges you 60€... you send your feuille des soins to the CPAM and they reply stating that the plafond for general check ups is 43€ and the percentage of reimboursement is 60% .... that means that you will be reimboursed 25.80€ (60% of 43€) out of the 60€ you payed initially.....

So what about the other 34.20 € ? In this case, you must also have a Mutuelle. A mutuelle is a privately owned insurance company that is supposed to reimbourse the complementary part of what the CPAM wont reimbourse.... only they too have a plafond and a percentage rate based on the amount reimboursed by the CPAM !!!! Getting all this? Basically, after you receive the reimboursement from the CPAM you must then send your feuille des soins again to the Mutuelle in order to get reimboursed for the complementary amount !!!

An a similar process also applies to buying your meds at the pharmacy.... The boxes of the medecine come with little stickers that you must stick to your feuille des soins to prove you bought them for a prescribed treatment (I am not kidding.... stickers!!!!!) and the whole "percentage-of-a-plafond-of-the-CPAM-issued-list + mutuelle" works in the same manner. I recently discovered this and realized that for 4 years I had not been refunded for a single med 'cause I kept throwing the boxes away without noticing the stickers !!! )

This "system" has supposedly been made easier with the appearance of the Carte Vitale, which is baiscally a "green credit card" which you are supposed to present to your practician and/or pharmacist and everything (CPAM and Mutuelle) is done electronically.... problem is I have yet to go to a Doctor's office that actually owns the terminal device to swipe the Carte Vitale !!! So in the meantime I buy a lot of stamps and carry my carte vitale in my wallet to keep my Visa company.

Then there is the fact that in order to go see a specialist you must first go and see a general practician !!!! Say you want to see a cardiologist because you feel strange chest pains..... tough luck.... first you must make an appointment with your general MD which will then instruct you go see a cardiologist and then and only then can you go see one.... If you skip the MD because, say you're afraid you'll have a heart attack by the time you get the MD appointment, take a day off work and spend 2 hours waiting at the Dr's office only to have to do it all over again when you actually do see the cardiologist.... well... guess what ? You'll be charged an extra fee..... Sounds logic ??? Ehmmmm...... no comment.....

So, yeah.... health is accessible to all and yeah.... it's relatively free (if you don't count the stamps of all those sent feuille des soins) but it is in NO WAY simple !

Ok, ok.....so some information in his movie is incorrect.... it can happen.... what is dissapointing though is that some important information is .... not in the movie !

MM doesn't explain the two main problems of the French health care system which I think in order to make a valid comparaison should be mentioned !

First : The "Secu" as they normally call the health system is a major financial disaster for the goverment... it even has a name : le trou de la Sécu (the hole in the health system).... basically the goverment can no longer continue to finance this system and each year the deficit grows and grows.... everybody is aware of this and knows that at one point it will explode without nobody really knowing the economical, social and health consequences this will bring ... but no one dares to make any changes because that would just completely bring chaos (!!!) upon the country.....

Second : Because it is so accessible, free and "simple"... people abuse the system.... I've heard of 300€ designer glasses, breast implants or spa treatments (to name a few) being fully reimboursed !!!!

And plus, we do pay for the health system.... it's just in our taxes.... Ok, I know, that's the whole point of a social system, right ?

Well... I guess so...... only that when you work from the 1st of January to the 30th of June to pay your taxes and only start actually earning money from the 1st of July .... well.... honestly .... who wouldn't be sick ????

F.