La Maladie

We’ve had the misfortune of having to do a deep dive on the Maladie Assurance, or the French national health insurance, in the last few months. I am going to be brief in talking about our experiences and what we’ve learned.

The insurance covers about 75 percent of medical visits as reimbursements sent directly into your French bank account. Most people have supplemental insurance, called a Mutuelle that covers the remaining 25 percent. We do too.

If you have a chronic disease, such as Crohn’s or Diabetes, or have a serious illness such as cancer, French health covers 100 percent of your medical visits. In my husband’s case, this extends to one month post-op in a rehabilitation center in the hills where he has a view of the old town of Vence and the Mediterranean Sea.

When you are hospitalized, you don’t pay upfront. The hospital registers your treatment with French health, and contacts the Mutuelle for the 20 euros a day that is not covered. Yes, you read that right — without the Mutuelle we’d be out a mere 20 euros a day.

We were impressed with our doctors, all of whom spoke at least decent English, the surgeon being quite fluent. In my mind, the fluency in the official common language of the European Union was a good sign, because it means doctors “keep up” by reading studies, collaborating with other medical institutions on the Continent and attending conferences. The intensive care and other nursing staff were also top notch, although mostly monolingual.

With most public health systems, there is no extra money to spend on niceties such as lovely art on the wall, fresh paint or well-kitted out waiting rooms such as we’ve seen in the US. The hospital with which we grew familiar was a bit of a shock, however. The first waiting room I was in was quite depressing, with mismatched, junk yard type chairs, tears revealing the stuffing and all.

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The surgeon said to me, unprovoked, “Don’t worry. The building is ancient but the surgery is very modern.”

There’s little paperwork for doctors, and therefore, no front office. Often a doctor will make his/her own appointments. You pay them directly and they give you a form for the insurance reimbursement. My husband’s surgeon had one staffer, and that is probably because he is also a Professor at the leading medical institution in the area.

To arrive at the building where we were assigned for visiting hours, you could walk about 15 minutes uphill or wait for a shuttle that, it being the holiday season perhaps, almost never arrived.  So walk I did, and, it being the holidays, I was always the only person making the trip past darkened and decrepit-looking buildings, only to arrive to my destination where it seemed the only lights that were turned on were in the specific room where my husband was recovering. I was creeped out.

It turned out that these buildings that hardly inspired confidence are slated for demolition. The wallpaper on hospital staff monitors showed a rendering of the soon-to-be-built complex, one that takes advantage of its hill top setting, its natural garden landscape of olive trees and umbrella pines, and its views over Nice and the Sea.

French doctors don’t seem to have the same communication protocols of the US. For example, I never got word when my husband was out of surgery. No call, nothing. I called the hospital, nada. I went to the hospital only to be sent home. In the end, I just showed up again, and by luck in the darkened “lobby” found a staffer who showed me the way to the ICU. There I had a hissy fit about the lack of communication. I did finally get a call from the surgeon’s office — the next day, almost 24 hours later — saying simply that the surgery had been a success with no details offered. By then, of course, I’d forced myself on the staff and gotten more than the gist.

Visiting hours were limited. In our case, one visitor at a time, only 5-7pm, no exceptions. Out of the ICU, hours were more generous — 1pm to 7pm.

Now, is all this beneficence sustainable? My own GP doctor seems to think not. In her waiting room, among the out of date magazines strewn about a coffee table, is a book titled “The Coming Collapse of the Assurance Maladie.” However, it seems the Sécu, the social security service that includes the insurance, operates in the black.

One thing is for sure. You’d get more than a few Gilets Jaunes (see previous post) in the streets if L’Assurance Maladie was ever threatened with cutbacks.

 

 

 

 

 

 

 

 

 

 

 

 

 

Posted in expat, France, health care, Nice, France | 5 Comments

Les Gilets Jaunes

Last week I spent a few days in Paris, between two weekends. Several US-based friends emailed me to suggest I avoid the city because of the news reports of protests and violence by the Gilets Jaunes “movement.”  It never entered my mind to avoid the city, which is as enchanting as ever, well-worn but not worn-out, with too many fine exhibits to see, the best window shopping anywhere and the most beautiful cafés in France.

Paris, France December 2018

To be serious: certainly, the violence that has occurred has been heartbreaking, and shocking. The protests have taken place in cities all over France, including here in Nice, and in Avignon where we recently spent a weekend.

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But Paris has seen the worst behavior. It’s been suggested that the violence is instigated by political groups who benefit from chaos under Macron, the opposition leaders such as Melanchon on the left and Marine LePen on the right, and Putin’s human bots.

And of course, there’s speculation that the protests would not have occurred if not for the mobilization power of Facebook and the fake news circulating on the platform.

I don’t know. The French like to protest and have a long history of angry demonstrations, and I’m talking about post-French Revolution. I’m not sure they need help to pull them off. Rumor has always been part, unfortunately, of political mobilization. Remember the storming of the Bastille in 1789 to free the King’s prisoners? How surprised the mob was to find just one old guy there. That didn’t stop them from killing the guardian to get inside, though.

Which brings me to my unease about the Gilets Jaunes, and the fact that the “movement” could be co-opted by elements who care less about economic justice and more about burning it all down. The Tea Party and the US GOP certainly is a model. The impetus exists among far-right parties elsewhere in Europe. Facebook is just one of their very effective tools. Even as French opinion overwhelmingly supports the primary message of the Gilets Jaunes, that many people need financial help, what is the national mood on the protests themselves?

In one of the isolated, kind of somnolent rural villages where the issue of fuel prices is of deep concern, a cafe owner told us “The guillotine is next.” He proceeded to refer to Macron as “royalty” and “autistic.”

No doubt, the anger runs deep.

 

 

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The Italian Market

It’s been years that I’ve wanted to visit the huge Friday market in the Italian border town of Ventimiglia. This week we made it there, undeterred by cold and rainy weather. We were so glad we did.

Now, Ventimiglia the town is nothing to write home about. Actually, one might write that it is unprepossessing at the very best, and downright rundown and esthetically devoid at its most correct. But it’s Italy, and besides, it carries its own historical interests.  Because the border line moved so often over the centuries, people would find themselves living in one country but working in the other and in the modern era were given legal leniency to do so. Market vendors speak Italian and French, and there are shoppers from each country. The local dialect is related to dialects along the near French Riviera.

Plus, you can get real cappuccino there, not the ersatz version you get in Nice.

market day in ventimiglia

Bringing our shopping caddy on the train was the right decision. We picked up a moist Grana Padana for grating over pasta, a creamy mozzarella da bufala and firm salad tomatoes to eat together, sweet and crisp fennel for my salads, sheep milk ricotta for toast, unfiltered olive oil from the nearby hills, mushroom ravioli, dandelion honey from the apicoltore, colorful vegetables for soup, juicy and sweet clementines and more, at about half Nice prices for similar products. The same probably goes for a comparison with Milano.

clementines at ventimiglia market

I had mentioned it was cold and damp. When even my feet started to chill, I broke down and bought a nice sweater for five euro that did the trick.

When shopping was done, we tucked into a low key trattoria for lunch and a glass of wine. That’s how you make market day a special event.

On the train home, we sat next to friendly young man who, from his accent and appearance, seemed to be from West Africa. At the border with France, the train stopped, border police entered, and, after asking the man for his papers and finding them unsatisfactory, took him off the train. Whether you go by train or car or on foot, crossing that border will bring you in contact with immigrants and the border authorities. It is a situation that won’t change anytime soon.

 

 

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La Cuisine

There’s a lot to be said about French food, but the south is not where the best dishes originated. So while Nice is not a culinary hotspot, it has its high points. Among them are soupe de poisson (fish soup), farcis (stuffed vegetables), socca and panisse (starchy and savory things made from chick pea flour) and, my favorite sandwich in the whole world, the pan bagnat, which is essentially a Salade Nicoise in a bun.

Each season has its special market offerings. In autumn, the standouts are porcini mushrooms (cèpes) and the arrival of Beaujolais Nouveau wine.

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In Italy, the porcini are an immense cause for celebration in markets and kitchens all over the north of the country. Here, there’s less of a to-do about them. I did find fresh ravioli with cèpes filling, and hit them up three times in one week. Oh, my, how sweetly earthy and distinctive a taste. In-between, I chopped up a bunch, cleaning off the dirt delicately with a sharp knife to preserve as much of the plant as possible,  sautéd them in olive oil and garlic with some “giroles” (otherwise known as chanterelles or finferle).

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I already can’t wait for Beaujolais Nouveau season 2019.  This week was the launch of the 2018 dégustation, where wine bars and restaurants host tasting gatherings. There is no escaping the fact you are in France and no where else in the world if you participate in one, as I did. Bottles being poured for young and old, charcuterie and fromage being eaten, lots of jambon on small, crowded tables, ensconced wall-to-wall within the din of happiness.

The fruity young wine is a good quaff, but it’s not an exceptional vintage. Happily, that keeps the price of revelry to an affordable level. And you can take home a bottle for as little as 7 euro.

beaujolais

 

 

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Les Fumeurs

You can’t be a non-smoker and not be shocked, saddened and sickened by the popularity of cigarettes in France. In some French minds, smoking cigarettes is one of many indicators of Gallic superiority to Americans, with their puritanically oppressive anti-smoking attitudes and regulations.

Yesterday, I was going through children’s books in a library (looking for an easy read in French on Vercingetorix) where I saw a cartoon book about some French character in which he is smoking in nearly every frame. Passengers on smoke-free buses and trains stick butts in their mouths and get lighters and vapes out as they are disembarking to save precious seconds before they can start inhaling again. On a regular basis I witness some poor shriveled soul, with barely the strength, lifting up their hand to light the cigarette dangling from their lips.

smoker, Nice, France iphone November 2018

But a new day might be on the horizon. The health authorities, if not the general medical staff population who take smoke breaks outside clinic doors so that they reek of cigarettes all day long, are on the case. November is “mois sans tabac,” or tobacco free month, a nationwide campaign for helping the French fight their addiction. It comes complete with a “get ready to quit” kit, insurance-covered cessation aids at the pharmacy, and a phone app that serves as a digital coach on going cigarette-free.

Apparently, since the annual campaign was launched a few years ago, one million French have done just that. Of course, other measures, like higher cigarette taxes, anti-smoking ad campaigns and new highly visual packaging showing grisly cancerous organs and “le tabac tue” (tobacco kills) in large print, have played a supportive role.

France, and EU member in general, have come a long way since the days when smoking was allowed everywhere — inside restaurants and bars, in doctors’ offices and airports, on any mode of transport, on any beach, park or classroom — basically wherever you liked. Several years ago, after a week of hacking and coughing my way through Paris, I couldn’t wait to get on the actual smoke-free aircraft taking me back to the US to get away from the toxic clouds of smoke in the airport. There’s a long way to go, but I can breathe more easily now.

 

 

 

 

 

 

 

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Weather

Despite its reputation as a haven from bad weather, the French Riviera does experience fall and winter seasons, during which it rains regularly. This year, there’s been more rain than usual.

woman with umbrella on promenade

Here in Nice, we’re lucky it’s just been lots of rain. In southwest France and the close-by department of Var, named for the river which usually flows thinly, there have been days on end of flooding. Likewise in the Aude, which has seen the worst damage from the unusual pattern of precipitation.

The periods of heavy rain are triggered by moist air rising from the warmer than usual Mediterranean Sea, then meeting the Alps and colder air.

Unlike their US counterparts when weather has becomes catastrophic of late, French officials don’t refrain from invoking “climate change” by means of explanation. The phenomenon has been tied to record heat during the last few summers, an increase in the stink bug population and the incidence of locally transmitted dengue fever. Chikungunya and West Nile viruses are other mosquito-borne diseases now present in southern France, due to climate change. By the end of the century, summer heat is expected to reach 50 degrees Celsius (122 Fahrenheit).

Will southern France become an ecological extension of North Africa? Do we have to be worried about the vineyards surviving? And camembert? Will there be any escape from extreme summer heat? Should we invest in air conditioning companies?

For now, the Niçois don’t seem too deterred from their regular Promenade habit by inclement times. In fact, you could say that the grey light and pounding waves only add to the ever-present romance in the air.  Be merry.

lovers on the promendade

 

 

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Céret and Collioure

Onwards to Occitanie, and Céret and Collioure. These small towns are very near the Spanish border, Barcelona a two-hour drive away. We took a forested mountain road to the border, ears popping, taking in peaceful views over wild country and the Pyrénées Orientales. Down in the valley, we could hear the soft clang of cowbells. It is a primitive sound that shakes me out of the present every time I hear it.

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The border was marked, but this being a Schengen zone there were no guards. How different being here must have been during the World Wars, when Spain was neutral and its villages harbored French escapees from the conflict who crossed these mountains. During the Spanish Civil War of the late 1930s, leftist combatants and civilians reversed those tracks to seek refuge in France.

The language Occitan (or the language of the Occitanie, langue-d’oc), has largely died out. But Catalan is widespread and there is a common, far from cosmopolitan, identity between these people and the Catalans across the border. The restaurants feature Catalan dishes and in Céret street signs are in French and Catalan. Locals dance the Sardanes at festivals and bulls run the streets every year to celebrate Bastille Day.

The locals retain a distinct accent however, a little nasal, where they say “aine” instead of “oin” (in the French). I like regional differences, and more so if they stem from the middle ages, so I found it a thrill to hear, but I recall many northern speakers of pure French disliking it.

We were enchanted by little Céret, probably for the same reasons the many famous artists who spent several years there. The local art museum exhibits their works, including Picassos, Matisses, Derains, Chagalls, Braques and Soutines. Other than enjoying the ghosts of the past, there is little else to do but while away time enjoying the light (300 days of sun a year), the clean air, the tranquility and the trails into the mountains.

In our lovely Art Nouveau apartment we felt as if we were in a living diorama, with its decor evocative of the interiors seen in paintings of the earlier era and its classic view over a courtyard.

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Collioure, on the Mediterranean Sea, also attracted those painters. Here, you could paint all day without being disturbed by noise, people, things to do, or unwanted stimuli of any kind. Being off-season during our visit, it had a particularly throwback vibe. The French Riviera must have been like this 60 years ago. First of all, there was hardly anyone there. Surrounding it were pine forested hills, with little sprawl. It felt cut off,  the absence of crowds and dazzling light transforming the town into a blessed haven.

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But don’t go there! It’s too quiet. You’ll be bored. No reason to check it out at all. Trust me.

 

Posted in Céret, Collioure, expat, expat life, France, Occitanie, Travel | 7 Comments