STEVE INSKEEP, host:

It's MORNING EDITION from NPR News. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne. Today in Your Health we continue our series on European countries that provide health insurance for all their citizens at a fraction of the cost that the U.S. spends on health care. NPR's Joseph Shapiro went to France to look into its system and joins us now to talk about that.

And Joe, we've all, I think, heard of the French health care system, and what we've heard is it's good health insurance and it costs less than healthcare costs here in America. How is that possible?

JOSEPH SHAPIRO: You know, Renee, the government plays a big role in health care and it keeps costs down. It collects payroll and income taxes for a national insurance fund. There are negotiations with medical unions to set doctors fees. And government regulates most hospital costs. But although the government insurance system pays most of a person's health care costs, it doesn't pay all of them. And to pay the rest the French also buy private insurance or, like Americans, they get it through their employers.

MONTAGNE: So pretty familiar, in a certain way, as you've just described it. What was the biggest difference that you found?

SHAPIRO: What struck me in France is that the sicker you are, the more coverage you get. There're 30 conditions - like cancer, diabetes, mental illness - where the national health fund picks up all the costs.

MONTAGNE: Which sounds expensive for the government.

SHAPIRO: Well, it is. It's one of the most expensive systems in Europe. And it's run deficits of billions of dollars a year. So benefits are being cut and more charges are being shifted to patients. But still, it's not as expensive as in the U.S. The French spend about half as much per person and the money seems to go farther.

So this morning I want to show you what we found out when we looked into the care for new mothers and their babies.

(Soundbite of music)

SHAPIRO: At the domed basilica of Sacré-Cœur, a violinist plays the favorites for the tourists. This is the highest spot in Paris and the city spreads out below like a stage set. We've come to Paris to meet two young American mothers who live here. France embraces new mothers with things like nurses who make home visits and months of paid job leave before and after a baby is born. To the French, it's not a luxury. It's an investment in healthy families and children.

(Soundbite of sneeze)

Ms. MARY LOU SARAZIN: Bless you.

SHAPIRO: On this cheery spring day, Mary Lou Sarazin takes us to the gardens behind the basilica. She finds a bench in the sun with her baby.

Ms. SARAZIN: (Singing) Ludivine, Ludivine, you're the prettiest babe I've ever seen.

SHAPIRO: Her daughter, Ludivine, was born in November.

Ms. SARAZIN: (Singing) You don't walk, nor can you talk, but somehow you stole my heart. Oh, yes. Let's do the Ludivine dance.

SHAPIRO: Mother and baby get approving smiles from people who pass by. Mary Lou says pregnant women and new mothers seem to hold a special status here.

Ms SARAZIN: In France, it just seems that it's so family oriented. A pregnant woman is seen and regarded as a very special moment.

SHAPIRO: But it wasn't so special back in the United States. She came to Paris to teach English. She got pregnant. She married. Her visa expired, so she returned to New York to complete her graduate studies and to have the baby at home. But already pregnant, she couldn't find insurance she could afford. She did get some coverage through New York Medicaid, the state program for the poor and uninsured, but that just covered her prenatal care. Once the baby was born, she'd be uninsured again.

Ms. SARAZIN: I just felt like when I was in New York, it's always like stress, stress, stress. I just didn't like the care I was receiving. And I didn't want to stress out about something I shouldn't have to stress out, not during the time of my pregnancy.

SHAPIRO: So Mary Lou headed back to Paris. Today, she says she misses the United States, but if she and her French husband have more children, she says they'll stay in France.

Ms. TANYA BLUMSTEIN: Hi. Hi, sweetie.

SHAPIRO: We meet a second American mother, Tanya Blumstein. She and her husband, Tomas Lacronique, pick up their 14-month-old daughter, Ella, at the apartment of a neighborhood day care provider.

Even this private day care is heavily subsidized by their French health insurance.

After college, Tanya moved to France to work in the film industry. She met Tomas, but then his company sent him to work in New Jersey, so they traveled back and forth. When Tanya got pregnant, she moved to Manhattan to be with him. And there she tried to buy health insurance for herself. Every American insurer turned her down. The reason: She was pregnant, although the insurance agents had their own less pleasant ways of describing it.

Ms. BLUMSTEIN: Because they said we don't insure a house on fire. I had a pre-existing condition, which was pregnancy. I just couldn't believe it.

SHAPIRO: In the States, Tomas had Blue Cross Blue Shield insurance, but Tanya couldn't get on his policy because they weren't married yet. So...

Mr. TOMAS LACRONIQUE: We got married.

Ms BLUMSTEIN: Down to City Hall in New York.

SHAPIRO: It wasn't the wedding they'd planned.

Ms. BLUMSTEIN: A lot of people don't even know we're married, because I want to do something, you know, as we'd hoped to do a little more spiritual than, you know, next.

(Soundbite of laughter)

SHAPIRO: Once they were married, Tanya did get on her husband's insurance. But even then they found the American system daunting. Tanya pulls out a stack of papers from that time.

Ms. BLUMSTEIN: I have my notes here. I was trying to navigate all this. And so my questions: I was like, wait, what is deductible out of network? What is co-insurance? Will they pay at New York rate if submitted to local, because it was a New Jersey thing? And first visit $3,000, follow-up $175. Out-of-pocket L and D package is $5,000.

SHAPIRO: Tanya and Tomas loved living in New York and to be in a country where there's so much choice and it's so easy to be a consumer - except, as they found out, when it comes to health care.

Mr. LACRONIQUE: Everything is so simple when you want to get a cab or rent a car, eat fast food. But once it gets to serious issues - your health - then it gets hellish. It's really complicated.

SHAPIRO: So Tanya left Tomas in New York and returned to Paris to have her baby. Tomas later changed jobs to be with his family in France.

Ms. BLUMSTEIN: The French system, it's just - it's easy. It's clear. For example, this is something after Ella was born. And it says - I'm translating in French - since the birth of your daughter Ella, the health insurance covers all of the fees. And it explains, you know, in the third month between this date and this date, fourth month, fifth month, sixth month. And this, no matter what, you don't even pay a cent.

SHAPIRO: There's a neighborhood health clinic where she can show up with the baby anytime, even without an appointment. And when Ella got a stomach flu earlier this year, a doctor made a house call at 3:00 in the morning on a Sunday. It was all paid for by health insurance.

This is the kind of comprehensive coverage that gets France's healthcare rated the best in the world by the World Health Organization.

(Soundbite of baby crying)

SHAPIRO: One key to making the system work are the local government nurses who make home visits to pregnant women and to parents and their babies. Today, the nurse is wearing black Chuck Taylors. Nadege Heurtebise is making a home visit to the brightly painted apartment of a mother and father whose son was born two weeks ago here in the town of Chartres.

Ms. NADEGE HEURTEBISE (Nurse): (Speaking French)

SHAPIRO: The nurse asks how the baby sleeps and eats. She tells the parents about vaccination schedules, well-baby visits, and about their options for subsidized day care. She weighs the baby, then watches the mother breast-feed to see if there are any problems.

The visit takes an hour. It costs the young parents nothing. There's not even any paperwork to sign.

One thing the nurse doesn't do is the family's laundry. Americans may think otherwise, especially if you saw the Michael Moore documentary "Sicko." The movie contains a memorable scene where a state worker goes to a new mother's home to do her wash.

Back at the nurse's office, I meet her boss, Dr. Marie-Paule Martin. She saw "Sicko" too.

Dr. MARIE-PAULE MARTIN: I had a great laugh. With Michael Moore, it's very caricature.

SHAPIRO: A caricature, she says, because only on occasion, like when there's a medical complication after birth, does a state-paid housekeeper do a mother's laundry. Still, even without laundry service, the French health system ran almost $9 billion in deficit last year. That's forced cuts in some health care. But the basic benefits to mothers and their children remain the same.

Joseph Shapiro, NPR News.

MONTAGNE: And there's more on how France's health care system stacks up against other European countries and America at npr.org/yourhealth.

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