In The Land Where the Customer is King


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by Jack Cashill
Published in ingramsonline.com - October 2009

In the inescapable health-care debate, we hear a good deal about the Canadian health system, the British system, the French system.

What we do not hear about, however, are Canadian health consumers, British consumers, French consumers, or American consumers, for that matter. 

Our reformers, such as they are, design their plans under the assumption that consumers everywhere are all alike. False assumption. They ain’t. I found this out the hard way.

In the way of background, some years back I accepted a Fulbright to teach at the University of Nancy in eastern France. Overall, it was a swell experience and I loved the country, but as I learned, the French really are different from you and me.

As a first, in-class assignment for my students, I asked them to write an essay on why they had chosen the University of Nancy. They tittered. When I inquired why, they explained that they had no choice. They lived in the region. This is where they went. End of discussion, end of assignment.

The students went from class to class en bloc. In the French tradition, they formed an informal syndicate among themselves, chastised overachievers, ostracized dissenters, and went on strike six times during the course of the year, on the last occasion when the graduating seniors demanded that the university find them jobs. Those kids now run the country.

They will undoubtedly have made great fonctionnaires—civil servants who work for the government or a govern- ment-sponsored institution. To a large extent, France is a country of fonctionnaires. As early as 1600, France could claim some 3,000 of them, filling such prophetically dubious posts as “inspector of Oranges.”

My favorite was the guy who manned the gate at the university parking lot. Each morning, he carefully checked the same sticker stuck on my car in the same place as it was every other morning. When satisfied, he would wave me through as though he had chosen me—barely and grudgingly—among the elect at the last coming.

That he guarded a lot of some 50 spaces, never more than half full in an area where parking was otherwise free and plentiful, troubled him not a bit. He had a function, filled it nobly—if a bit leisurely—and God help the man who mucked with it.

The attitude fonctionnaire confuses Americans into thinking the French hate us. What the French hate are customers—of any race, creed, color, or point of origin.

America has its own fonctionnaires, of course, not all of them charming, but here many public service providers, the good ones, model their delivery on private sector norms. In France, the private service providers—mom and pop shops excluded—model themselves on the public. As a result, our DMVs are more cheerful and customer-friendly than their department stores. 

French travelers recognize the difference between the- ir service economy and ours. One of my students, who had recently spent a year over here, wistfully described America as “the land where the customer is king.”

A month into my stay in France, I unexpectedly got in touch with my inner American consumer, my inner king. The item consumed was health care. The actual patient was my two-year-old daughter.

It all started innocently enough. My daughter fell from her trike, as two-year-olds do. When two days later she woke with a swollen elbow, I took her to the emergency room of the children’s hospital in town.

There we sat for hours on metal folding chairs in a dim, narrow corridor immersed in a squall of screaming tykes. Finally, a med student called us in, rubbed some alien nostrum on my daughter’s elbow, and said she would be all right. 

She wasn’t. The next morning, her arm was swollen to her shoulder like a sausage, and her temperature registered somewhere between bake and broil, 105 degrees to be precise. We sped back to the hospital, the “Children’s Mercy” equivalent of our metro. By 8 a.m., they had her admitted and taken to a bed, unmade, amidst a sea of forlorn children in a vast, Dickensian ward with squeaky wooden floors and dingy windows unwashed since World War I. 

The head doctor—or “grand patron” as he was known in this no-nonsense hierarchy (literally “big boss”)—had just finished his rounds. I was told he would see my daughter at 5 p.m. 5 p.m.! No way. I stopped the doctor at the door and asked in fractured French that he check her out now. He looked at me the way one might a pesky Jehovah’s Witness, frowned in disbelief, and just kept on walking. Welcome to the world of socialized medicine.

Politicos beware: Hell hath no fury like an American consumer scorned. In my own case, once snubbed by the grand patron, my latent sense of consumerism kicked in like an adrenalin surge. The Bruce Banner of American consumerism—I have never sent a meal back in my life—I was mutating into an Incredible consumer Hulk. I started pulling strings—the power lever in any socialized economy—and putting up a fuss the way only an American would or could.

A week earlier, we had met a British family in our neighborhood. The wife had told us that her sister, a doctor, would be visiting. I drove to their house and found them sitting in their bathrobes, sipping tea and eating those awful scones that only the British could love.

I asked the sister to come with me to the hospital. She told me that she couldn’t, that she did not have authorization. I apologized for being obnoxious and then turned into the Hulk right before here eyes. I explained that I was no longer asking. I was demanding. I wasn’t leaving the living room until she left with me.

American consumers can be intimidating. By 9 a.m., she was examining my daughter in a French hospital, the most severe breach of international protocol since the British destroyed the French fleet at the outset of World War II.  By 10 a.m., I had the grand patron back—my boss at the university had intervened. By 10:30, my daughter was under general anesthetic, having her arm drained and disinfected. 

She spent the next two days in the hospital. My wife and I took turns playing grand patron, all day long. The nurses were unused to this. French parents visited briefly and passively. They asked few questions and rarely, if ever, challenged the authority of the nurses. We were all over their cases. The care, excuse my French, really sucked. On the plus side, however, the food was great.

The World Health Organization rates France the world’s best health system. (We are 37th, right behind Costa Rica). The people that staff WHO come from cultures where consumers are serfs, not kings. Socialized health-care systems count on their fealty, their obeisance. We did not have it in us.

“Are all Americans like you?” one nurse asked at our departure, thrilled that we were leaving. “No,” I answered proudly, “Most are even worse.”


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