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Articles    H3'ed 3/17/10

Health Care and Alternative Health in France

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By science, I mean the search for underlying mechanisms of action, as opposed to the systematic exploration of what makes people feel better, which is also scientific, but represents a different kind of science, a comparative trial-and-error kind of science.

Mechanism of action studies gain the grants and the best presentation slots at conferences and the highest status, because that is what our culture truly values. We assume that explaining how something works makes it suddenly valid.

Explanatory pluralism teaches us that many levels of explanation exist and getting one right doesn't eliminate all the others. So explaining HOW might become an infinite regress, always one more level to go. Nevertheless, it's fun and keeps the scientists off the streets.

I spoke about Native American healing, first in relation to cancer and then in relation to psychosis. I joked that the Lakota elders I know were glad that neuroscience was finally catching up to the Lakota.

Finally a few words about the French health care system, for it appeared to be as profit-driven as our own. 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.

Again, we find yet another example in which the highest income arises from spending the least time with patients. Somehow we have to change this on a global basis so that people get the time that they need and the stories which need to be told get time for to be heard. I hope we will someday find the way to do that.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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