One System for All: Fighting for Universal Access to Health Care
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Julie Castro is a young doctor from France, a country that proves that it is possible for a nation to offer quality health care for all. All legal residents have access to coverage, and immigrants gain the right to access after three months. Those served by the medical system – including the very poor and the gravely or chronically ill – are likely to receive better care in France than anywhere in the world. Moreover, the sicker you are, the less you pay. Dire illnesses, like tuberculosis or cancer, some chronic conditions like diabetes, and major operations like open-heart surgery, are covered by the social security at 100%.
The French system’s slogan is, “Everyone contributes according to his resources and receives according to his needs.” And this is not just rhetoric. Ever since the 1940s, France has made budgetary decisions to turn this dream into reality. But in France, as in many other countries, the logic of the market is now slicing away at universal access. As has been proven elsewhere, and as some in French civil society are now realizing, a strong health care system can only survive if the population ﬁghts to protect it.
My interest in health emerged as a way to take action in the ﬁght for social justice. During my medical studies, I did internships in Africa and India and worked in a refugee camp along the Thai-Burmese border. At the same time, I became more aware of the anti-globalization movement. It appeared to me that it was addressing the structural causes of ill health: inequality at both the global and local levels. Today, while I’m working on the ﬁght against AIDS in Mali, I’m also one of those defending the idea that access to public health in France is a right.
Even with its problems, the French health system is a good one. It’s a distributive system. Universal access to health care is one basic value.
Our system offers equity, not making any distinction according to class, race, or gender. It could be summarized as ‘one system for all.’ In theory, poor people don’t have to pay when they go see a doctor. Today, if you arrive in a bad state in a public hospital in France, you’d be cured – wherever you come from, documented or undocumented, whatever your language, all in the same way a government minister would.
Another practical advantage, I think, is the quality of care. Even if the infrastructure is overwhelmed and lacks people, the quality of public health care is still good. In France, the best doctors and best care are to be found in the public hospitals and in the university teaching hospitals.
But the system is under great threat now. A sentence you can hear everywhere is, “There’s a hole in social security” [the fund which pays for health care, retirement, and other social beneﬁts]. We’re told, “Okay, the health system is too costly, money is lacking, we have to spend less.” Now in the hospitals, doctors are told not to prescribe too much of this or that, and all health workers are even trained not to use too much gauze – because it’s all reimbursed by social security.
Talking about a hole is a ﬂawed statement. Long-term beneﬁts – like lives saved, illnesses prevented, and years of work spared – aren’t included in this consideration. It’s an ideological stance, a question of where we decide to put our money.
We already see how this is playing out in the US. American medicine has a reputation that you can be dying in front of a health facility, and they’ll ask you, “Do you have insurance?” And, if you don’t, you just die. This is very shocking to many French people. The other thing that we observe from this side of the ocean is the stigmatization of very poor people.