Anya Schiffrin: The French way of cancer treatment:
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…. I… didn’t know what… French healthcare… would be like. I… assumed… 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?… My parents flew to Paris… found an English-speaking pancreatic cancer specialist and my dad resumed his weekly gemcitabine infusions…. 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…. The doctor always ran late… so we’d sit in the waiting room and, well, wait… rush across the street, get takeout and come back to the waiting room… bring books to read… use the Wi-Fi and eat the graham crackers… talk to each other and to the other patients and families… 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…. 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… 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… specialists… instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement…. 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…. 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 hadn’t understood… that the French system is basically like an expanded Medicaid. Pretty much everyone has insurance… better primary care and more choice of doctors… spend far less…. 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) and admiring 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…. 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.