My $6.48 cataract surgery

When it comes to socialized medicine, the eyes have it

Over the past 18 months, I’ve had a run of bad luck with my vision. First, emergency surgery to repair a detached retina in my left eye, quickly followed by cataract surgery in the same eye. Then, two weeks ago, cataract surgery on the right one.

Things are still a bit blurry as I await a new prescription for eyeglasses, and the daily rounds of eye drops are a drag. But I can’t complain about either the treatment or the expense. The physicians, especially my ophthalmologist, were superb. And the costs? 

Out of pocket: A grand total of 6 whole Euros. That’s $6.48 in ‘merican currency.

Obviously, that’s a bit deceptive. We pay French taxes, known as social charges, which go toward medical care, and a monthly fee for supplemental medical insurance.

So I can’t estimate the true cost of my surgery. 

But, c’mon – 6 Euros? Makes me wish I had a third eye!

And that was for everything: Doctor visits, diagnostic imaging, anesthesia, pharmacy, hospital fees, the new lens, and the 15-minute laser procedure itself. They even served me a cup of yogurt and a muffin before sending me on my way. 

The hospital never asked for my credit card. It didn’t even send me an itemized bill.

Instead, all I did was show my green Carte Vitale, the all-important healthcare card that the French government gives to all residents. I didn’t have to worry about co-pays or HSAs or Medicare Advantage or any of the rigamarole that goes along with everyday healthcare billing in America.

Which, aside from the low cost, is the thing I like the best about the French system. People, including myself, gripe about the red tape here. But when it comes to healthcare, the system is remarkably streamlined. 

As an immigrant, getting onto the French health insurance system – known as CPAM, for Caisse Primaire d'Assurance Maladie – involved some paperwork, naturally. We had to wait three months after moving here before submitting an application, which required us to provide various residential and bank records to prove we were living in France. This step trips up some expats, especially those who simply mail in their materials, only to discover they got misplaced. We hand-delivered an inch-thick portfolio of records and spoke personally to a friendly, efficient CPAM rep.

Weeks later, our Cartes Vitale arrived and we celebrated yet another step in our journey.

Next, we signed up with a mutuelle, a private, non-profit company that provides supplementary insurance coverage. It’s not mandatory, but is highly recommended because CPAM pays only the first 70 percent of your healthcare bill. 

Our policy costs about 220 Euros (or $237) a month for the two of us. That’s a little high compared to some plans here, but it’s about a quarter of what we were paying for Theresa’s Obamacare and my Medicare when we left the U.S. two years ago.

As I said, though, it’s more than just the low cost that has me loving this system.

It begins with finding a medical provider – a family doctor, specialist, laboratory, X-ray tech, whatever. Almost everyone uses a website called Doctolib, an all-in-one scheduling, communications and check-in system. You select a provider with criteria including geographic location, specialty and even English-speaking capability. Theoretically, I can use Doctolib to send emails to my doctor and she can reply with reports and prescriptions. 

When I show up at the doctor’s office, the receptionist (or the physician herself, in many cases) scans my Carte Vitale. Its microchip contains only my name, social security number and reimbursement info. She hands it back when I leave and swipes my bank debit card for the office fee, typically between 25 and 65 Euros. Within two days, the fee is reimbursed by CPAM (70 percent) and our mutuelle (30 percent) with a pair of direct deposits into our bank account. 

It’s like the EZ-Pass of medical billing: no waiting and completely seamless.

For my cataract surgery, some costs – including the anesthesiologist, out-patient hospital services and even some of the eyedrops -- were covered 100 percent by CPAM. I never even knew how much they cost until I logged onto CPAM’s website (known as Ameli, for assurance maladie en ligne) for a full rundown of the procedure.

Meanwhile, I didn’t have to worry about collecting receipts or filling out forms or getting pre-approvals from inconsiderate insurance company reps. When the doctor says you need medical care, you get it, period.

Why is it so much easier here?

I think it’s because healthcare in France is regarded as a universal right, not a privilege for a few. It’s not subject to labor union bargaining or confusing eligibility requirements or your ability to pay five-figure annual premiums. Everyone here is cared for, equally, regardless of wealth. And by treating everyone equally, the system does away with prescription medicine “donut holes” and insurance riders and existing conditions and gold-silver-bronze-insurance packages, and all that other nonsense that Americans must contend with. Is it perfect? No. But at least reform is not thwarted by profit-hungry insurance companies or narrow-minded politicians warning about the dangers of socialized medicine. 

Friends, this is what socialized medicine looks like:

It’s a simple green card, and it fits in my wallet.

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Full disclosure I: Our doctor is tough to track down sometimes. And that is a problem here, especially when it comes to scheduling an appointment with a specialist. Theresa had to wait five months to get a tooth pulled last year.

Full disclosure II: To those who wonder about the quality of care, I had my former ophthalmologist in Philly check out my French surgeon’s wôrk on my retina. He called it “as professional as any surgery I’ve seen.”

Full disclosure III: That 6 Euros I had to pay? Under CPAM, everyone must pay 2 Euros per doctor visit – rich, poor, the employed, the retired, everyone. I had 3 office exams, that’s 6 Euros. It helps offset some of the costs of medical care but, more importantly, sharing a nominal cost, equally, is a symbolic acknowledgement of the value of healthcare for everyone.