French Health Care: Giving Birth in Paris

On a placid Parisian night last March, my wife, Chrystèle, who is French, and I were in a public hospital delivery room waiting for our baby boy to settle into the right position for birth. He was in no hurry. Hours passed languidly, counted off by the periodic beeps of machines monitoring the expectant mother and our unborn infant.

There's a lot to worry about when your wife is in labor. There are moments of discomfort, jubilation, and chest-hollowing anguish. But mostly there are moments of waiting in which all sorts of stress-inducing thoughts can fill your mind. The unforgettable time when you introduce a new life to the world is surrounded by moments when you realize that you could lose your baby, or even your wife.

In the silence, I mulled becoming a father at the nadir of the worst global economic crisis in my life even as my profession, print journalism, was on the ropes. The thing about impending parenthood, I was told, is that a distinctive form of clarity comes when you hear the baby's first cries.

Suddenly a machine began beeping urgently. Within a minute, the delivery team was agitating around Chrystèle. The baby was under extreme stress. His heart rate was falling fast. Chrystèle's blood pressure was declining precipitously, too. An intern quickly escorted me out to the hallway, trying not to alarm me—and failing.

The hallway echoed with paternal helplessness. Doors to various delivery rooms and maternity rooms opened and closed, leaking a slow-motion cacophony of birth and baby sounds: cooing, screams, laughter, wailing. To avoid thinking about how little I could—or should—affect things in the delivery room, I began speaking to another fretful father-to-be. Just seven months pregnant, his wife was about to give birth to a baby so small he would be able to hold it in his hand. It struck me that if either of us were in the U.S., we would face concerns beyond the immediate health of mother and baby.

Most of my insured friends in the U.S. confront a jumble of calculated gambles that balance affordability and probability, copays and deductibles. One couple in Oakland, Calif., was ecstatic because they "only" had a $1,200 copay for their full-package birth—everything from labs to epidural to two nights in the hospital (and it would have covered inducing labor, if necessary). How that much money, on top of their insurance premiums, could go with the word "only" became clear when they told me that the hospital billed the insurance company $30,000.

A colleague in New York, whose wife has high-grade insurance coverage through her work, paid $15 copays for numerous checkups, as well as an additional $500 for two nights in a private recovery room.

Friends in Los Angeles wrote me to say that after meeting numerous deductibles, the nightly cost of their hospital room was $100 for the child they had in a public hospital and twice that for their second child, in a private one, among other uncovered costs. "We definitely had to be concerned about how many days she had to spend in the hospital," my old friend wrote. Uninsured parents in California cities can get a bill of around $16,000 for a basic birth.

But it was the experiences of a married, self-employed friend of mine in northern California that best highlighted the risks of a U.S. birth, even with insurance coverage.

Since her pregnancy began in 2007 and she delivered in 2008, she and her husband had to pay the $4,000 deductible twice, as well as cover the many holes in their coverage. To avoid a likely hospital bill of at least $10,000, they opted for a home birth with a midwife that would have cost $4,500 (including prenatal care) if all went well. But unexpected expenses, even after the exhausted parents-to-be battled their insurance company to get the costs lowered, added up. Then the birth became complicated. After 12 hours of labor, the midwife sent them to the hospital. "I felt crushed that I had failed, and the money issues were definitely in the front of my mind," my friend later wrote me. That midwife's decision may have been the safe one, but it brought substantial additional costs. Today, nearly two years on, they are still paying off their $15,000 in bills.

In France, by contrast, citizens aren't billed at all for the night in the delivery room or the additional three nights in a small hotellike room (where fathers can sometimes sleep on a mattress on the floor). Maternity ward staff offer breast-feeding counseling, and tend to both mother and baby in other ways. Diapers and medication are free in the hospital, as are C-sections and anesthetics, when they are necessary. So is follow-up coverage. Better yet, there are no copays for anything to do with birth, no deductibles, and no risk of having your insurance canceled just because you used it.

Even without insurance complexities to worry about, births rarely go entirely as expected. Back in the delivery room, when I saw the top of the head of my first-born boy, I awaited that cinema-meets-real-life moment when his mouth would reach the air and he would offer up a touching I-am-alive wail. Instead, the midwife had to twist his limp little body out of Chrystèle. His eyes were closed, his skin was a troubling shade of blue, and he was unconscious. She rushed him out of the room for resuscitation. His mother and I were suddenly alone in the room, in shock, amid strange feelings of anticlimax and fast-growing concern. Our baby had arrived in body, but not yet in soul.

In the U.S., in addition to mortal concern for our newborn, we would have been confronted by troubling secondary thoughts: Is the baby's resuscitation covered? Is there a copay on that? Could this affect the baby's own insurance coverage? After all, an insurance company initially denied coverage to the newborn infant of friends of mine in Venice, Calif., for a preexisting condition—even though he had just come out of a well-insured womb.

French medical care isn't perfect, and it all comes at a cost, one that my wife and her compatriots pay in taxes. French people have less cash in hand to purchase iPods, portable computers, monster trucks, and RVs, among other things. Cars are more expensive, as is gasoline. But in exchange for ending up with fewer euros in pocket, French people expect their government to provide high-quality health care that leaves them to worry about their health, rather than their coverage. And France is generally ranked at the top of global health-care rankings—and at a per-person cost that is a fraction of what we in the U.S. pay.

Health care is such a complicated topic that any system is going to need to improve itself when possible. But when your child does offer up his first wail—as did ours, less than a minute after Luka Matthew Pape was born—it is among the most unforgettable moments in a parent's life. So what is the value of that moment arriving untainted by financial concerns and arguments with insurance companies? Priceless.