The British author Terry Pratchett, in one of his early books, has a character describe the concept of “insurance” thusly: “It’s like a bet. You’re betting that something bad will happen to you, and the insurance company is betting that it won’t.”
With that in mind, I spoke with a few folks last week while travelling around rural France. It comes to this: They think we’re just bonkers. The average French citizen keeps well-versed with world news, and they are mystified that so much of Obama’s health care reforms are being challenged, skewered and hostilely vilified. “It seems like if you can afford it”, one wine maker told me, “you get good health care. If not, you have a problem.”
That simplistic assessment is about right, and his next guess was too: “If someone who doesn’t have insurance gets really sick or hurt, don’t you basically have to pay for them anyway?” Well, yes, I told him. We have laws that ensure that if you are having a heart attack and get yourself to a hospital, they will stabilize you.
“Yes, but then what?” My wine maker friend asked.
“Well, depending on where you live, and whether you can qualify for a government program, you either get follow up care, or you don’t.”
“And if you don’t, won’t you wind up back in the hospital with maybe another heart attack, and then everyone pays all over again?”
Simplistic, and again, true.
“I have travelled a lot,” said the wine maker, “and have been called a Communist in some places for supporting the French social medicine. I am surely not a Communist, but ours is a good system. The government pays, we are taxed, and that's that. Everyone should have good care, and it’s just our way.”
We talked further, and what was clear to him was that our system is more expensive (true) and not as humanistic. Ouch. The truth can hurt, but it helps remembering why I’m so proud to work in Santa Clara County, which has a great public health and hospital system…thanks to our local political leadership and a supportive community. The dedicated team at VMC is even working to solve the problem described above – to offer all needed preventative and follow-up care to the insured and uninsured alike, which is better for them and cheaper for all of us. For much more on this topic, check out the brilliant blog post by Ezekiel Emanuel called “Saving by the Bundle”. It truly reads like what Valley Medical Center is doing – and speaks to the human element of what we’re on about.
Or, to remember Terry Pratchett’s assessment, the French have decided a better wager is for EVERYONE to bet that something bad will happen to SOMEONE, and that since any of us could be that someone, we should all look after our own.
Anyway, it's good to be home with a head full of memories...and perspective.