Friday, April 18, 2025

A Tale of Two Healthcare Systems

A friend who is an expat living in France.  A health care professional, JJ asked her to compare her experiences with the health care systems of France and America.  

As a seasoned healthcare provider with board certification in healthcare quality, I've spent years lecturing on how the American healthcare system compares globally in terms of quality, efficiency, safety, outcomes, and cost. When I decided to become an expat, this knowledge—paired with my passion for life's finer pleasures: art, food, and culture—guided my decision. Joie de vivre, indeed! So what's it really like to be a patient in France? I'll report, and you decide...

Part I: The Doctor's Office 

Recently, I needed to see my primary care physician. A simple email requesting a rendezvous yielded a same-day response with an appointment for the following afternoon. If appointments aren't your thing, Saturday mornings are appointments-free on a first-come, first-served basis.

My doctor's office sits just a one-minute stroll from my home, housed in what was once a private residence. Upon arrival, I ring the doorbell and let myself into the waiting room. French custom dictates that everyone exchange a polite "Bonjour" with eye contact—a small ritual of mutual acknowledgment. Today, I have the waiting room to myself. Soft jazz floats through the air as art posters adorn the walls. The natural light streams through enormous windows that frame a view of the terrace garden.

What's noticeably absent? The soundtrack of American medical waiting rooms: screaming children, loud cell phone conversations, the rustling of insurance paperwork. There's no receptionist asking me to update forms or verify coverage—just tranquil music and dappled sunlight.

At my designated time—not 60+ minutes later—my doctor appears and greets me with a respectful "Madame." Dressed in business casual attire, we exchange customary pleasantries before walking past a small examination room to his office. He settles behind his executive-style desk while I take my seat opposite him.

I hand over my Carte Vitale insurance card, which he inserts into a chip reader to access my medical record. Our consultation unfolds naturally as we discuss my symptoms and concerns. Throughout our conversation, he documents everything in real-time—point-of-care documentation that keeps his focus on our interaction rather than delayed paperwork. We settle on a treatment plan, and he prints my prescription, providing detailed education about the medication and follow-up care. We've spent twenty uninterrupted minutes together—a luxury in healthcare anywhere.

For the final step—payment—I hand him my debit card. He charges the standard fee of 30 Euros (approximately $33 USD) which recently increased from 26.50 Euros. He then rises from behind his desk to personally escort me out. As he holds the door for me, bidding me a good day, I'm struck again by the dignified efficiency of the entire process.

Within two days, my bank account is credited with 18 Euros from the national health system, bringing my total out-of-pocket cost to less than $20—with no deductible.

This isn't just healthcare; it's healthcare with humanity.

A Tale of Two Systems: France vs. USA

What I experienced firsthand illustrates the dramatic differences between French and American healthcare systems. While the United States spends a staggering $10,739 per capita on healthcare (as of 2017 data)—nearly 17-20% of its GDP—France achieves superior outcomes at less than half the cost, spending only $4,902 per person while allocating just 10-11% of GDP to healthcare.

The French system excels through universal coverage—every resident is insured through the nationally managed health insurance system. Meanwhile, despite improvements, nearly 8.8% of Americans remain uninsured, navigating a complex hybrid system of government programs and private insurers. These structural differences translate directly to patient experience. The average French citizen visits their doctor 6.7 times annually, compared to just 3.9 visits for Americans. With 3.4 doctors per 1,000 residents, France maintains better physician availability than the U.S., enabling the prompt appointments I've come to appreciate.

Beyond accessibility, the outcomes speak volumes. The World Health Organization ranks France's healthcare system in the top 5 and significantly higher than America's 37th-place standing, with France consistently demonstrating lower infant mortality rates and higher life expectancy. My experience in that sunlit waiting room wasn't just pleasant—it was representative of a fundamentally different approach to healthcare. One that emphasizes dignity, efficiency, and universal access over profit margins and administrative complexity.

As my appointment concluded and I walked the brief minute back to my home, prescription in hand and only €12 ($13 USD) poorer, I couldn't help but reflect on what healthcare could be when designed to serve patients rather than shareholders.

This is the reality of French healthcare—not perfect, perhaps, but a system that delivers care with both clinical excellence and human compassion, at a fraction of the American cost.

Charges posted at the doctor’s office, including home visits for 46 Euros:



Part II: The Pharmacy

Prescription in hand and a spring in my step, I make my way to the next chapter in this petite French adventure: the pharmacy.

Now, French pharmacies aren’t just pharmacies—they’re tiny, glowing green-lit temples of wellness, beauty, and a kind of streamlined healthcare efficiency that feels, frankly, magical. Think: less waiting room, more apothecary-meets-Instagram dreamscape. Especially in places like Citypharma in the 6th arrondissement of Paris, where tourists treat shelves of Caudelia, Bioderma, La Mer, and Nuxe like they're rows of Chanel in a hidden outlet. Yes, it's that serious.

But this wasn’t Citypharma. This was my local neighborhood spot—smaller, quieter, and charming in the way that everything in France seems to be, even when it's just a place to buy medicine.

The pharmacist greets me with a warm “Bonjour”, and I return it, asking about her children who I had given English lessons . I slide my Carte Vitale insurance card into the chip reader and hand over my prescription.

No forms. No eye rolls. No exasperated sighs behind the counter. Just smiles.

She disappears for a moment—maybe into a secret back room filled with tiny labeled drawers and magical elves, I don’t know—and returns swiftly with a small box in her hands. My medication, neatly packaged by the manufacturer. No oversized white bag, no branded logo, no label with my name printed in 20pt font. Just… the medicine.

Then, she asks me—with genuine care—if I have any questions. About how to take it, when to take it, what it does. We chat for a minute, and that’s it.

I pay 3 Euros.

Yes, you read that correctly. Three. Euros. For something that would cost me a small fortune in the U.S. (roughly $180 last time I checked). I don’t need to call my insurance. I don’t need to wait hours. I don’t need to plead with anyone behind a counter. I don’t even have to come back hours later.

Three minutes later, I’m out the door, prescription in hand for safekeeping and refills—like a little treasure map of health tucked into my bag.

No frills. No fuss. Just… healthcare, done differently. Done right.

46 comments:

Anonymous said...

Perhaps it is time for someone to take a hard look at America's system from top to bottom. Diet, including what is mandated for school children; Insurance company profit margins and whatever else might need shaking up. Gosh, maybe someday.

Anonymous said...

That’s a great story. I wonder how the physician makes it on $66 an hour? That’s less than American CRNA or travel nurses. Not to mention the general overhead associated with any business (insurance, supplies, rent, etc) What happens if you show up without a card? We’ve seen how difficult it is for everyone to get a voter ID, so I can’t imagine how hard it would be to convince the public to carry a medical card that has or allows access to medical information.

Anonymous said...

Don't let anyone fool you into thinking US healthcare is a "free market".

Anonymous said...

I lived in Europe for about eight years. Don't even get me started on prescription drugs in the U.S. I never paid more than $12 for a medication and I didn't need a Rx from a doctor to obtain the meds. You just go into pharmacy and tell them what you need. You do need a Rx for narcotic drugs.

Anonymous said...

Ahhh… The French!

Anonymous said...

How much is healthcare subsidized by the taxpayers in France? No discussion of any system is complete without acknowledgement of who is paying the behind- the- scenes costs. I could beat about showing a card and getting a prescription for $5 or so, but it wouldn't be the whole story until I shared the what my employer pays so I can get a $5 prescription

Anonymous said...

More: I didn't have a "card." I was paying retail.

Anonymous said...

I can share two horror stories of socialized health care, one in Canada and one in England, both immediate family relatives, that run counter to this wonderful narrative where I promise customary pleasantries were not exchanged.

Anonymous said...

Sacrebleu! A nation of 68 million people has a different healthcare system than a nation nearing 400 million!

Anonymous said...

That story sounds great (and it may BE that good), but I also wonder about the "experience" of needing something more than an antihistamine for a cold? I often hear horror stories from other low-to-no pay countries about the time it takes to get testing on a higher level or the time it takes to actually have a surgery performed. I suspect those items aren't quite as easy as sitting down with a PHP at a community doctor's office. (She also didn't mention the size of the town she is in.) Her experience isn't too different than what you'll find with small town US PHPs. The paperwork associated with insurance, unfortunately, is a different story altogether.

I'd love to believe there really IS a good, fast, hassle-free, low-cost healthcare system somewhere in a western country. I'm just not convinced there is.

Anonymous said...

It helps when the US is subsidizing Europe and other countries prescription cost. We pay the high prices and everyone else gets the same medicine for pennies on the dollar.

Anonymous said...

Wow. Your friend sure did hate being here. I am glad she is happy and enjoying France. That's wonderful.

Now, how much does that universal care cost?
That was a doc visit. How about wait time for surgery? or chemo? Instead of a fairy tail, lets dig into the entire system.

US needs to change healthcare. No question. Drug companies seem to be pulling a lot of strings. I can remember before that happened, no problems and no heavy costs for doc visits and scrips.

Anonymous said...

Here is our own government’s assessments of the French Healthcare System interesting note about how much of the French GDP is devoted to funding their entire medical system, including research. This is because there is very little profit to be made investing in biotech research in France. So the entire system is taxpayer subsidized.

Anonymous said...

The average doctor in France earn about $143k per year. The average primary care physician in the U.S. is earning over $200k. Comparing health care systems isn’t as simple as apples to apples .That isn’t to say we can’t learn from the French or German systems, but it’s more complicated than what appears at first glance. Would the government compensate doctors enough to attract competent people into the profession? You have to consider how changes work in a wholistic manner.

Anonymous said...

Big Pharma, Big Banks, and Big Insurance own Congress! Too much power to overcome for the little guy.

anonymous said...

fish you better start out explaining to your rubes just what an expat is.

Anonymous said...

If you make as little as $32k in France you'll pay ~30% federal income tax. Somebody is paying for all that utopian healthcare.

Anonymous said...

Thanks for the propaganda Kingfish.

Anonymous said...

My experience with socialized medical in Japan: I made an appointment to have my teeth cleaned. I showed up for my appointment, waited not too long, and was escorted to the room and seated in a chair and met the hygienist.

Just before we started, the English-speaking dentist asked me which teeth I wanted cleaned.

I asked him what he meant, "which ones." He said shakai hoken -- social insurance -- will pay for one half one day, the patient has to make an appointment to come again for the other half.

The thought of walking around with a half-dirty mouth made me feel icky. So I asked him how much it would be to have all of them cleaned at once. 5,000 yen, he said, which was at the time, memory serving correctly, about $35.

I told him to tell the hygienist to do them all and I'd just pay out my own pocket, which he did tell her and she did comply and I did pay and we all left happy.

Conclusion: I was overall happy with the experience. Sure, Murka needs reform. In a perfect world, Murkins would get it, too. But it won't happen so long as insurance companies are one of the main funding sources behind political campaigns.

True story, too, all of it.

Anonymous said...

In Germany it’s not that great unless you PAY more money. All the idiots in the U.S. hear is FREE/AFFORDABLE and start convulsing. I get FREE healthcare in the military also. There’s always something attached with that “free” but people don’t research beyond some IG post. Not saying we couldn’t or shouldn’t do better with our healthcare system.

Anonymous said...

Americans are too stupid to have a system like France. This isn’t even political to the French people. It is a source of national pride. Plus Diet plays another role. Americans consume enormous quantities of GMO corn syrup and pesticide/antibiotic infused goyslop. The French feed their livestock better food than what the average American consumes.

Anonymous said...

That is a wonderful description of a single healthcare experience, but it does hint of bias. With comments like "screaming children, loud cell phone conversations, the rustling of insurance paperwork. There's no receptionist asking me to update forms or verify coverage...," and "I don’t need to call my insurance. I don’t need to wait hours. I don’t need to plead with anyone behind a counter. I don’t even have to come back hours later," it paints the worst of pictures. I don't experience any of that when I go to the doctor. And, what is the additional tax burden that covers this and what are the limits? All of my friends in Germany have supplemental plans as well.

Anonymous said...

Sounds like the lady lives in an “Eastover” type neighborhood with a “personal physician” nearby. What about healthcare in immigrant areas of Paris? I imagine it’s a little different.

Anonymous said...

Not the experience my family in a western European country has had. Two are dead; months of waiting for cancer treatment. Another friend brought her mother to USA from this same country and she was immediately treated and still alive. As bad as the healthcare has fallen in USA, I will take it over what they have anywhere else.

Anonymous said...

For a much less rosy picture of healthcare in England take a look at 'Hospital' on Amazon. I'll stick with the US version, flawed as it may be.

Anonymous said...

I’m not that up to date on global health care cost. This little story made me feel all good inside. I am very familiar with our system. I just have one question and one observation. If something cost $100 and you pay $20. Who pays the difference. Also when some rich European needs advanced medical care, why do they come to the good ole USA to get their care.

Anonymous said...

There are no free lunches - someone is paying for this, and to be fair, there is a whole lot that has been left out of this story.

Anonymous said...

I nominate @3:02 PM for the comment of the century. That video was very enlightening!

Anonymous said...

Possibly, maybe even probably, a true experience for someone of her age and current medical condition.

But change the scenario- make her twenty years older (mid-70's let's say) and let her have what in the US would be a basic heart problem, requiring what could be performed here in many hospitals in our state as an outpatient procedure and covered by Medicare or Medicaid. But no, not in this so-called wonderful system across the ocean (or up north of the border in Canada). There the answer would be - too expensive, you can just die.

Actually story, for a well- healed, medically connected individual, with the ability to travel across the border to the US and pay for the surgery out of pocket. But mo, their system said at 75 he wasn't worth the expense and saved that 'friendly office visit' for the next French's.

Besides, my personal care physician Hannover kept me waiting more than five minutes - in the waiting room or in his exam room. True, I have to drive six miles from my house to his office - but I e never encountered those screaming kids or whatever KF's paramour is so convinced we have to face here.

And, at least so far, my government is not spending a massive amount of our federal dollars with a single-payer health care system.

Anonymous said...

I will be 83 in September. Until recently my health has been excellent. A good friend was my primary until he recently retired. The Big C caught me in December of 2024 and my bladder was removed. I have no complaints about my care or cost. But I am concerned about the delivery system. We worry about government being in control but now we need to be concerned about Big Corporations being in control. Every Dr I now see is part of a “corporate “ medical delivery systems that dictates how long they can be with a patient which can affect their income. The prescription drug industry is even worse.
The cost is increased by uncessary layers in the distribution system.

Anonymous said...

“When I decided to become an expat, this knowledge—paired with my passion for life's finer pleasures: art, food, and culture—guided my decision. Joie de vivre, indeed!” Wow, what a snobby start to the column.

But wait till she needs oncology workouts, a CT, or something other than OTC drugs.

What a rube!

Steve said...

A government can subsidize a lot when you don’t have to spend much on your defense because, you know, the big guy across the pond has got your six.

anonymous said...

when mick jagger needed heart surgery , guess where he went.
hint.....it was not france.






Anonymous said...

In the good ol' USA, we insist that our doctors and hospital administrators be wealthy, I mean filthy rich. However, they do have stressful lives having to determine locations for the various vacation homes that they own. Unfortunately, most cannot afford more than a couple of vacation homes, so must choose carefully, mountains or beach, country or city. It is a stressful life for sure. But there is hope now that they have a filthy, rich president and cabinet in office that these sad rich people may find relief.

Anonymous said...

French farmers are concerned about the fact ths the EU will be importing beef from South America which will be far cheaper than beef produced in France. There may not be much livestock left to feed when the French farmers can’t make a living raising cattle. That said, much of the food in Europe is healthier than in the US because of restrictions on unnecessary additives that can be harmful. That is something the RFK is seeking to address..

Anonymous said...

Believe it or not, America’s healthcare system is for some also a source of national pride.

anonymous said...

3:33 is right about the canadian health care system. canadians have a saying...........'if you get sick ,run for the border''

Anonymous said...

7:32 am Yes, thanks to our teaching/research hospitals and NIH and CDC and FDA but those institutions are being gutted.
While travelling in Italy, a family member became ill. Like France the doctor and pharmacy was " neighborhood" convenient and cheap. Much of the costs is how we buy pharmaceuticals. Those countries buy in bulk at less cost and that savings is passed along. Some of our teaching hospitals benefit from that. Interestingly, several years ago for thyroxin, BCBS of MS paid less of consumer cost that BCBS of Ala. . The same pill cost more than twice as much in MS, but now they've combined and the same higher cost. They also denied things regularly but fortunately we had the ability to challenge denials and won each time. I'm pleased to have Medicare with a supplemental now. We consulted a health insurance specialist and glad we did! All we ever pay now is our yearly ,very reasonable deductible.

Anonymous said...

It's worse now that doctors "clinics" are using a business model. They also have artificially created specialties so they can shuffle one patient to other "partners". Once upon a time, you had one primary physician and one doctor who could do a broken arm and a broken leg and one endocrinologist who could treat more than one organ.

Anonymous said...

the commenters in this thread are white-hot derek zoolander levels of stupid. You people live in Mississippi. France is like 100 years more advanced than where you live. Hell, Arkansas is more advanced. Bulgaria, Poland, and Latvia are more advanced than Mississippi. Geez, work on your self awareness and willfull ignorance people!

Anonymous said...

Personne prétentieuse et snob.

Anonymous said...

0904– very valid point. I worked in hospital Respiratory Care for 30 years.Patient goes to see a doctor, and there is a consultation put in for any possible specialist. Everyone gets a piece of the pie. If you cough, pulmonary specialist, if you fart, GI specialist, if you have a headache, Neurological specialist…old hospital joke- you have cancer in the right lung, sorry, I’ll have to call in a specialist, I only treat the left lung! And then there’s the insurance s companies, who dictate what a doctor can and can’t do, then attempt to deny any benefit they possibly can… it is the height of the ridiculous.

anonymous said...

the fact that BCBSHIELD holds a virtual monopoly over healthcare in mississippi doesn't help the efficiency of medical care.
BCBS owns the mississippi legislature , the ms dept of insurance, the courts, and the governors office.
the legislature will never do anything to BCBS. their monopoly WILL CONTINUE.

Thus Blogged Anderson said...

All these fools yapping how that can’t possibly be true are why America is backwards & will remain backwards.

Our gated subdivisions teem with doctors. In Europe, most earn more like college professors. And they do great work, because it’s their profession.

Anonymous said...

You don’t experience a waiting room and receptionist when you go to the doctor in the US? You’re never asked for your insurance card?

Bullshit.

Anonymous said...

Only a mentally ill person would flee the greatest nation in the history of all humanity and then write such a disrespectful comparison from abroad. And only the most pathetic and lonely simp would amplify that mental illness.


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