Wednesday, March 17, 2010

Something's (Always) Wrong With This Picture

"I recently had the opportunity to speak at a conference in Paris, France. Surprisingly, based upon Michael Moore's glowing reports of the French health care system in his movie, Sicko, I discovered that few French citizens or physicians like their health care either, though some told me that it was a French trait to criticize everything, regardless. My French colleagues said the ambulance takes too long to appear from when it is called, it sometimes takes people to the furthest hospital instead of the closest. They said that doctors are rude, arrogant, and spend too little time. Some are drunks, or so says the media.

Within the ranks, physicians themselves told me of the cut-throat competition for the coveted hospital jobs in Paris and elsewhere. They described doctors attempting to discredit each other and tear one another down in order to climb to the top of the mountain and stay there. One opthalmologist cried as she told me about a colleague of hers who was a good surgeon and was being falsely accused of making errors by the doctor who wanted his position as head of opthalmology and Professor at a medical school.

In the USA, we are too focused on how we will be paid and on how much. Medicine is driven by profit-loss statements. France has apparently similar problems. Doctors may compete for status and income to the detriment of their patients.

The basic coverage pays about 23 Euros to the doctor, which amounts to about $35 US, regardless of how long the patient is seen. This, of course, provides the incentive for doctors to see as many patients as possible per hour because that's how they make the most money. Doctors are allowed to bill 30% over top of Basic Coverage, which the state pays for the poor or for refugees, private insurance sometimes pays, or the patient pays. My medical colleagues told me the system was breaking down because of the large numbers of poor, immigrants, or refugees. For doctors on salary at a hospital, the pay is substantially less than the U.S., though teaching as a Professor doubles one's salary, so long as a position can be found in the hospital. Becoming a Professor is apparently a very political process and some Professors don't teach, but just take the money after they become Professors. One of my colleagues, the opthalmologist, makes 60 Euros for a half day of work. That's about $100. Not many American opthalmologists would work for that fee. Pay is not increased for the complexity of the patient, but there are conditions in which the state pays the extra 30%, including cancer, psychotic disorders, COPD, coronary artery disease, and other serious illnesses. Only physicians who have been chief residents or served as hospital doctors for two years are able to bill private insurance which still has a maximum on what it will pay. Doctors lose one Euro (about $1.35) for writing a prescription. One other health care sector exists-- fully private doctors who bill whatever the patient will pay. Anyone can do this if they think they will succeed. Not all do. Insurance sometimes covers some of their bills. Finally in the French system, students start medical school at age 18 or 19 and go for 6 years. Then they do four to five years of residency and may serve as a chief resident for 2-3 years. They write a thesis somewhere in this process, though I was told that not many take it seriously."
-- Lewis Mehl-Madrona, an American Indian NewAge quack (and author of Coyote Healing) discovering Michael Moore and France are as big a pair of liars as I've always said - and that the grass isn't always greener on the other side - in this case, on the other side of the ocean, or wherever else quacks pretend they're producing Futurehealth.

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