$200 Minus $200

Having a baby in Paris gave me a crash course in socialized medicine—and a new, very French definition of “costly.”

In this series, an American in Paris pits the French welfare state against the U.S. market economy in five key categories: childbirth and health care, preschool, higher education, immigration, and shopping.

When I got pregnant with my daughter, I had been living in France for only about six months, and hadn’t yet received my Carte Vitale, France’s universal health care card. The day I went for my first sonogram, my midwife warned me that I should brace myself for a big bill. “Since you don’t have your Carte Vitale yet,” she said, “it’s going to be costly.”

I’m an American, and accustomed to American medical costs—I’d always worked for small businesses, where company insurance usually came with high co-pays and out-of-network deductibles. So of course I tensed up. “How much will it be?” I asked the midwife fearfully. “Will it be—more than 1,000 euros?” (That’s about $1,300 at today’s exchange rate.)

She looked at me like I was crazy. “No, it won’t be that much!” she exclaimed.

The final bill for the appointment was 150 euros, or about $200, which I paid in full, and for which I was later reimbursed in full.

In other words, “$200 minus $200” counts as a “costly” medical bill in France.

France is a proud welfare state, where public spending accounts for 53 percent of GDP—the second-highest percentage in the developed world (only Sweden’s is higher). The U.S. is the third-lowest, at 36 percent (ahead of Ireland and South Korea). Having a baby so soon after moving to France gave my husband and me a crash course in one of the largest components of the French welfare state: its medical system, which has often been called the best in the world.

France’s health care system is a public/private hybrid: Everyone is covered to a certain extent by the government’s Assurance Maladie, but most people also have private insurance, called a mutuelle, that is either offered through their employer or bought on the private market. There’s a thriving private insurance market in France—one that the Affordable Care Act can only dream of. Private medical insurance is advertised on the sides of buses and alongside movie previews in theaters, and there are plans geared toward numerous niches: college students, freelance professionals, and people who work in restaurants, to name a few.

Because my husband worked at a French company, he immediately began paying into the system, which covered me as well while I wasn’t working. In addition, my husband’s employers provided a choice of mutuelle; the top-of-the-line plan, which we signed up for, cost about 50 euros ($68) a month. By contrast, in the U.S., I’d been paying about $350 a month with an additional $50 co-pay for each doctor’s appointment.

Our first task was to find a place to have the baby. I’d suspected I was pregnant for two weeks before I took a pregnancy test, not wanting to be overly anxious. This was my first mistake. “You must call the maternités now—vite! Vite!” my friend Anais practically yelled at me when she heard. And she was right: Six weeks pregnant, I was already too late to get a spot in many of Paris’ public maternity wards. Only then did I learn that most Parisian women call the hospital the day they miss their period. I have a friend who walked to her local hospital with her pregnancy test in hand the minute she found out.

This kind of crowding, especially in bigger cities, is one of the downsides of a government-run health care system. On the upside, had I managed to book a bed in one of the public wards, my birth would have been completely free, paid for entirely by the government’s Assurance Maladie. Everyone pays into Assurance Maladie through charges that are taken directly from their paycheck. (Unlike Americans, French employers and workers quote salaries as net, not gross—so your salary is what you receive after deductions for health care and other social services.) From the sixth month of pregnancy to 11 days after a child’s birth, the government covers a woman’s medical expenses in full.