A Tour Guide’s Experience with Health Care Phobia in France

I believe that, especially with a good guide, travel can be transformative and richly experiential…both a political act and a spiritual act. It forces people to grow, to deal with others who see things differently, to get out of their comfort zones, and to grapple with their own ethnocentricity and hang-ups. While people don’t generally sign up for a tour thinking they are investing in the growing pains of a broader perspective, I encourage my guides — like a loving parent who works to broaden a child’s palate — to thoughtfully set up experiences that can pry open a little wider the hometown blinders of an American traveler. Recently, one of our guides (who happens to be an American) shared this fascinating experience relating to health care in France. Here’s her report:

When I’m leading a tour in France, I always give a talk on the French tax, education, and health care systems. When speaking to a tour group — many of whom are relatively well-off, middle-aged Americans — these subjects can be a little controversial…even taboo. But I believe these issues are essential for anyone hoping to understand contemporary French society and culture.

The French pay lots of taxes for social programs. These taxes allow for “free” universal health care (not socialized medicine, but rather a quasi-private system overseen by the government — rated #1 in the world by the World Health Organization) and “free” education through the university level for all French citizens. Of course, health care and education are not free — they are paid for collectively by the entire society through taxes.

The French, in general, believe this is a good system. As is the case with other Europeans, they are not eager to pay high taxes (the French pay about 30 percent income tax, plus about 20 percent sales tax). But they have high expectations for the programs their taxes pay for, and they generally embrace the system. The French see their tax dollars at work each time they go to the doctor of their choosing and pay only a small co-pay (about $20); when they don’t have to worry whether they can afford their cancer treatment; and when they don’t have to ask, “How will I pay for higher education for my child?” No one in France is in debt because they have cancer or because they went to school to become a teacher.

When I explain this to my tour members, I let them know that I don’t think the French system is perfect, and neither do the French.  It’s expensive. There is abuse. And some people fall through the cracks. But I believe that when our tax, health care, and education expenses are added together, we Americans end up paying more for less. The French, by their communal nature, prefer the collective approach — life with more taxes and without the economic stress that we treat as normal. I graduated from the University of Washington owing $30,000, and my parents owed even more. My 30-year-old brother, who is self-employed with no insurance, fell off his bike and had to wait more than six hours to be seen in the emergency room. He was billed $7,000 for that visit. My underinsured father had quadruple bypass heart surgery and had to file for bankruptcy because he couldn’t pay his medical bills.

Rick Steves groups are filled with people of all political stripes, but nearly everyone is rational, open-minded, and willing to respect (if not agree with) the opinions of others. But on a recent tour, a few of my tour members were angered that I would “talk positively about socialism” (as they put it). One couple (I’ll call them Jane and John) said they vehemently disagreed with everything I said — not just my opinions, which I could understand, but even the facts and statistics I had cited, and the personal French accounts I’d collected. Jane insisted that no one could be happy living in a system where one is responsible for carrying the weight of their neighbor.

The next morning, when I went down to breakfast, Jane and John weren’t anywhere to be found. Finally
John appeared looking like he’d seen a ghost — like he hadn’t slept all night. Turns out he hadn’t. Jane had suffered a severe medical problem the night before, but she wouldn’t let John come get me to help — she refused to see a doctor in France. I went to see Jane and convinced her to go to the hospital. When we got there, she was seen within two minutes of walking through the door, they were giving her tests within five minutes, and after ten minutes, she felt comfortable enough with the quality of care that she told me I didn’t need to stay.

I went back when it was time for Jane to be discharged. Fortunately, her condition had not caused long-term damage, and with medication she’d be able to return home to follow up with her own doctors. But John was struggling to sort things out with the discharge nurse. I translated the nurse’s explanation that she couldn’t accept their US insurance information — in fact, there was nothing to pay. John turned to me and said, “Do you know how much this overnight stay would cost in the US? This is crazy! Are you sure I don’t have to pay?” Determined to “pay their own way,” John and Jane took out their credit card. After some convincing, I persuaded the nurse to charge them a small “donation” of about $200.

I’m so thankful Jane was able to walk away from the incident. And I also hope that maybe their experience opened their minds a bit. We don’t need to embrace European social ethics. But we should be open to learning about them and respecting people who choose to design caring societies a little differently than ours.

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