Health in 2023: United States vs France

Bonjour! I’m Anthony, French chef at Pastreez. Our customers usually ask themselves, where can I find macarons near me? Well, our online French bakery solved that problem.

In this new, very personal blog post, I am going to share my very own experience of health in France and in the United States.

I have had an open heart surgery back in 2018, between the US and France. I have a bit of experience in hospitals on both sides.

And lots of family and friends from France have this “cliché” of health in the United States. But is it true? Has it changed? Is France really that great for health? Here is my personal angle on it. This is an opinion piece: please take it with a grain of salt!

Before I go ahead, are you familiar with Camille’s recording of 180 french sentences used during a medical exam in French: it’s entirely free and comes with sentences in French translated in English. If you plan on traveling to France, you may want to check it out!

Back to the subject at hand.

Don’t get sick in the US. Really?

We have this “cliché” in France about being sick in the US. We all saw Michael Moore’s documentary Sicko, where he was comparing the health system in France with the United States.

In the documentary, he was pointing out someone that has lost two fingers in a DIY home accident. And the person was asked $20,000 to re-attached the two fingers.

In France, it’s “free”. But wait, is it?

Let’s get back to our example in Sicko. What they forget to mention, is that the person who’s injured is not insured.

Would you drive a car without insurance? You shouldn’t, because you would be reliable if you’re involved in any accident.

The thing is in the US, at that time in 2007 before Obamacare, health insurance was not mandatory. So people were free to subscribe (or not) to a health insurance.

It means that, to have more money monthly, you could decide not to enrol in health insurance. So you would have to pay in full if anything happens to you. But on the other hand, you don’t have to pay the monthly fees.

That is what happened with that person in the documentary.

That $20,000 bill is the cost of such surgery. It is actually a very similar cost in France!

But the big difference is, in France, we usually don’t see that bill. We don’t see how much a surgery costs, or how much our insurance covers. I would say it’s less “transparent”.

In the US, they are more transparent about money in general. They send you the full bill, with that big number, showing you what is covered, and what you have to pay out of pocket. It’s not always accurate though, I had to call the insurance plenty of times to square things up.

But in my opinion, it’s always good to have options. The freedom “not to enrol” in insurance comes with consequences. We just need to be ready to face it at some point.

But now with Obamacare, since 2010, Americans must enrol in health insurance. If you don’t, you get a fine on your tax bill annually.

Health insurance: How it works

Now, you know that it’s all about being insured. But how does health insurance work in the United States, compared to France?

In France, everybody has the minimum coverage by definition. It’s called “L’Assurance Maladie”.

In fact, you don’t have a choice – It’s automatically debited from your salary.

And that is the key difference to compare both systems. In the US, health insurance is private. You get to shop around, just like grocery.

I like to make an example with car insurance. In France, you can select your plan, and select AXA, Allianz, or any other private company.

It’s the same thing in the US for health. You can select your plan and your insurance.

Quality comparison (my opinion)

I’ve had open heart surgery back in 2018. Since it was transthoracic surgery with valve replacement, that was a big deal.

I was still in France at the time, but I was transitioning into the US. So I had the surgery in France, but monitored in the US throughout the years.

I’d say my French surgeon was really amazing. But the public hospital I was in was… not cool!

I was operated on at the European hospital Georges Pompidou. The air conditioner was not working. The bed was not comfortable. I was transferred a few times because monitoring was not working..

It was a nightmare. Overall, being French and having been in France for 30 years, I don’t think our system should be taken as an example as a whole.

Hospitals in the US are much better in quality. Again, this is my personal experience! I’ll give you a very precise example.

To monitor my heart issue, I have to do an ETO (échographie Trans-Oesophagienne). Basically, the doctor pushes a camera into your throat for about 15 min.

And I’ve done ETOs in both France and the US.

In France: Only local anaesthesia.. It means that I have to swallow a camera, and basically suffocate for 15 min. Not fun, probably the worst medical exam ever.

In the US: Knowing that experience, I was really scared to do it in the US. I even asked the doctor to make sure it is under general anaesthesia.

They thought I was crazy. They told me: “Of course it’s general anaesthesia!”. There is no local anaesthesia for such exams in the US. Well in France, that is what we still do.. ouch.

Is Free health a thing?

Short answer: No. In France, it seems to be free. Because if you go to a public hospital, and you show your “carte vitale” (public insurance card), it’s likely you won’t pay a dime, and you won’t see a bill.

And that’s a good point. But we need to look at the full picture. The “Assurance maladie” is debited from your salary, remember?

You pay more tax in France than in the US. That’s how they make up the difference.

In the US, you have what’s called a “copay”, and a “maximum out of pocket”. The copay is what you pay for a doctor’s visit. The maximum out of pocket is obvious: It’s the maximum amount you can be billed in a full year. This is like the cap to avoid getting a $20,000 bill as mentioned earlier.

When you shop around for health insurance, you can “play” with these two amounts, and it will increase or decrease your monthly payment.

Needless to say, I was completely lost when I arrived in California!

In France, a good thing is that you don’t really have to “worry” about health insurance. Here in the US, you have to select a health plan that suits your needs.

All together, I prefer the US system, because it gives you more freedom and transparency about what you get, and what you pay. It’s not perfect at all, but if I have to choose, I would pick the US system.

Another example to illustrate that, I was in a physical therapy hospital named Corentin Celton in France, after my heart surgery. I spent about a month there.

And to be safe, I took “une mutuelle”, which is extra coverage from your basic “assurance maladie”. That way, I was thinking I was fully covered for that mandatory to heal.

I was wrong: I got a bill from the hospital of nearly 1,000€! Because apparently, the room was not covered. Ouch. It might have been better to talk to me about it first to make sure I acknowledge that fee.

Skills and customer service

Doctors are very skilled in France! For most, becoming a doctor is a vocation to help others.

But the fact that health is financed by the government, public hospitals’ budgets are getting tight. So the level of care is getting lower and lower.

The hospital buildings are not well maintained. I can tell with no A/C after a heart surgery with 80°F in degrees (30°C+)!

In the US, doctors are not necessarily less skilled. But customer service is better, appointments and timelines as well. No need to wait for weeks for a specialist appointment, it’s usually within a week or so.

One thing that surprised my wife and I when we first arrived in California, is that here, you don’t get to see your doctor only when you’re sick.

Our doctor was like a “coach” to make sure we are in good health. For example, every 3 to 6 months, we would get a blood test to see our level of vitamins, cholesterol and such.

Then the doctor would advise us if we needed to change anything in our food, daily routine, etc. We thought it was great to help us keep in good shape!

Overall, I can say it is two very different health systems. I was completely lost when I first had to deal with health here in the US.
Mainly because here, it’s very comparable to car insurance: You get to shop around. In France, you don’t have to “worry” about health, since it is taken care of by the government through “assurance maladie”.

But I would say that quality of health, timelines to get appointments, quality of the hospitals, it is better in the United States.

That’s it! You got my take about health in the US vs France. There is so much more to say about it, and I’m sure you have your own experience with it!