Salt of the Earth

Healthcare in France, disappearing expertise and the rise of the bureaucrat class...

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Bill Bonner, reckoning today from Poitou, France...

People wonder what life in France is really like. We’ve been here so long, it all seems very normal to us. We no longer notice things that, to a visitor, might seem strange or fascinating.

But we went to the local hospital last week. How does a public medical system work, you might wonder? Our experience is probably not very indicative, but we’ll give it to you anyway.

First, a perspective. In France, medical spending per person is about $6,500. In the US, it’s nearly twice as much…$12,200. Is the US system twice as good? The life expectancy in France is 82 years. In America, it is only 80. Go figure.

We had already seen our local GP. He advised us to see a specialist. So, we drove the 15 minutes to Montmorillon. We got to the reception area and found that a line had already formed.  

‘Oh no…a government-run health system…It’s going to be a disaster,’ we muttered.

We took a number. We waited. The numbers appeared on an electronic screen as they were called. But the wait was short.

Bedside Manners

A polite woman at the front desk then asked why we had come. Realizing that we weren’t French she asked: “are you enrolled in the public health system?”

‘Uh oh…this could be a problem,” we thought.

But no…

“No problem, you can pay in cash for the visit.”

Meanwhile, our regular doctor showed up.  

We first met Jean-Paul a quarter of a century ago. He rode up to the house on a BMW motorcycle after we had called his office. Back then, it was an aged aunt, with dementia, who needed attention. And since then, over the years, he has come often – for Elizabeth when she was thrown from her horse, for a son after he was hit by a flying tennis racket, for all of us when we had covid. He is no “Dr. House,” astonishing his colleagues by diagnosing weird ailments. He is a practical, sensible, country doctor with many years of experience treating ordinary people for ordinary medical problems.

Jean-Paul was wearing a white clinical coat. We said ‘bonjour.’ We shook hands. He led us to a room and made an introduction to a younger man in lime-green pants, who looked like he was on his way to the golf course.

In America, a new doctor – whatever his specialty – will generally want you to fill out a long questionnaire with your medical history going back to the crib. His assistant will verify that your insurance is up to date. Then, when you finally get an appointment, the doctor will ask questions about how well you sleep and whether you’re allergic to peanut butter.

Instead, after exchanging only a few words with Jean-Paul, relating to golf, the specialist examined our scalp. Seeing no reason for alarm, ten minutes later, we had said goodbye to them both and were ready to leave.  

“How much was the consultation,” we asked at the front desk, getting out our wallet.

“Twenty-five euros,” came the answer.

We were just getting up to leave, when Jean-Paul appeared again.  

“There’s another specialist here today….I asked her if she could look at you too.”

He directed us down the hall to a dermatologist. About 50, with close cropped gray hair, she looked friendly, but had a no-nonsense air about her.

Disappearing Experts

Patients who were hoping for a long chat with a sympathetic professional would doubtless have been disappointed. Did we ever smoke? Did either parent die of cancer? Have we had sexual relations in the last 6 months? With a man? With a woman? She had no more interest than the other specialist.

“Were you out in the sun a lot when you were growing up,” was all she wanted to know.

“Well…I lived in California for a while…and went to the beach.”

“Oh…bon…take off your clothes,” she directed.  

Slightly embarrassed, we did as bade. She inspected with a magnifying glass. And then, seeing nothing of interest, she got out her tools and proceeded to ‘burn’ off a few spots on our scalp.    

“There…that ought to do it. Wear a hat.”

“Oui, bien sur.”

We dressed and were out of her office within 15 minutes.

Back at the front desk, our GP appeared again. 

“How did it go?”

“Fine…nothing unusual.”

“Great…see you soon.”

The whole experience had taken about 45 minutes – with our own doctor leading the program…and two specialists on the case. And the total bill, which we paid with a credit card, set us back a total of 80 euros.

But like so many things in France, it depended on local connections and local expertise (otherwise, we wouldn’t have known whom to talk to; we would have been at the mercy of the administrators). And the local experts are disappearing.

Jean-Paul has been a good local doctor. But he is retiring. He’s leaving his practice to a younger man in December.

You may recall when we reported on our visit to Sicily, two months ago. We visited a town – Troina – that was giving away houses to try to attract new people.  

The town was nearly deserted.  But the problem wasn’t only that it had few residents.  It also had few bakers, or chefs, or plumbers, or local doctors. That is, it lacked the small business people and professionals that make small towns function.  

Cause and Effect

The same thing is happening in France’s burgs and villages. The people who make the bread and plaster the walls are leaving, retiring or dying. Our local cabinet maker, Jean-Pierre, died a few years ago. His replacement, Rene, just retired. The plasterer, Guy, retired a decade ago; no one took his place. The gas station closed after it was unable to meet EU environmental regulations. The electrician left his business with his son, who turned out to be shiftless. And the last café in town closed after the owner – an Englishwoman – went back to the UK.   

Whether it is cause or effect, is not clear, but the lack of competent local professionals corresponds to an increase in large-scale, ready-made suppliers farther away. It is hard to find a plasterer, for example. But hardly anyone uses them anymore; pre-cast plaster board – imported from Eastern Europe – is cheaper. And windows are no longer made of local, aged oak, by the skilled village carpenter; they’re made in the Czech Republic of exotic, imported woods and vinyl. 

“France is a mess,” a friend volunteered at dinner. “The system is rotten.

“You can’t find anyone to fix your plaster…or your dishwasher…and yet, millions of young people are unemployed, living on welfare…or they’re at the university wasting their time studying biodiversity or sex roles.  

“And that’s not the only problem. The retirement system keeps people from working. Either you retire or you lose your benefits. And if you retire, you are prohibited from working.

“So we have all these people in their ‘60s who know how to do things, but they can’t do them. And they all expect to be supported by people in their 20s and 30s…who don’t know how to do anything and don’t want to learn.

“The schools teach people to be administrators, bureaucrats, functionaries. And, of course, more recently, they think students should go into finance, because that’s where the money is.

“But I don’t need any more suits, paperwork or blah-blah. I want someone who can fix my roof…or make a good croissant…or even a good cup of coffee.”

More on the ‘salt of the earth,’ tomorrow…     

Regards,

Bill Bonner