August, and golden oldies. Serious thought is forbidden this month, which is why every middle-aged pop critic in America is still waxing on Woodstock and talking about how Janis changed the world and Arlo shut down the New York State Thruway, man. The vacuousness of August might explain why the White House thought it was the perfect month to go Kerouacing with Obamacare — ending up in Montana, no less.
I wonder how it would play in Paris? After all, this is the month that marks what must surely be one of the most important anniversaries in the history of government-run medicine. But so far, there’s been scant mention of the August 2003 heatwave that descended on France and left the nation’s oldest and weakest citizens to the mercy of a state-run health-care system.
Summer heat generally makes many Parisians happy, because in August, almost every working person in France takes an annual congé and leaves stonking hot Paris for places even hotter. The evacuation of the cities is a grand tradition: Families pack kids and dogs and leave empty streets to the tourists, and those too old or frail to travel. In an emergency, there’s always a hospital nearby, and Assurances Maladies — the government-run insurer that covers the ailments of one and all — to pay the bill.
But July 2003 had been miserable. On the 28th, Dr. Patrick Pelloux, the president of France’s association of emergency-room doctors, took a look at the long-range forecast, the number of health-care workers who would be off-duty, and the number of doctors and nurses left behind who were restricted by law from working more than 35 hours. He issued a warning saying the number of available hospital beds would be reduced by “25 to 30 percent” — not enough to meet an emergency situation. President Jacques Chirac and the government of Prime Minister Jean-Pierre Raffarin, including Health Minister Jean-François Mattei, disregarded the warning — and left town.
Right on time, on August 1, Météo-France warned of a canicule — a heatwave, one that most of France only learned about sitting in traffic jams in their Peugeots on the sweltering roads to the beach. By August 4, the temperature in parts of the country had reached 40° C (104° F), and more than 300 people — almost all of whom were elderly and alone — had died.
The next day, a blanket of heat covered almost the entire country — and by August 7, Paris hospitals were collapsing in chaos under a flood of elderly victims who made their way to a hospital — only to find there were no beds, no staff, and — as throughout energy- and environmentally conscious France — no air conditioning. In some hospital rooms, even those filled with unattended elderly people, temperatures reached 120° F.
On August 8 alone, more than 1,000 people died. In just four days, the death toll was staggering. The network of 39 hospitals and clinics serving the Franciliens — the residents of Paris and the surrounding Île-de-France — was put on alert and ordered to increase capacity, somehow.
On August 10, Pelloux issued another warning and chastised his superiors. “At the level of the health ministry,” he said, “absolutely nothing is happening. They venture to speak only of ‘natural deaths.’ ” Health minister Mattei responded furiously from his vacation getaway, issuing a statement saying the death rate was “comparable to previous years, except in certain facilities and one or two départments in the Île-de-France.”
On August 12, some 2,200 people died.
By now, the actual death toll was more than 10,000. Raffarin, at his villa in the south of France, held a casual press conference and denounced “partisan politics.” Meanwhile, jammed funeral homes began turning bodies away and a rather alarming number of corpses began stacking up — because nobody was around to identify them. Still, coverage in the French press was muted, irregular, and not particularly alarming. The best coverage came from the Paris bureau of the Guardian.
On August 13, another 2,000 people died. Raffarin authorized Paris-area hospitals to implement the government’s so-called “White Plan,” which would allow local administrators to recall medical-health workers from vacation. Pelloux immediately responded that help was needed everywhere in the country.
That same day, Jean-Louis San Marco, director of the National Health Prevention and Education Institute, told the Guardian, “We are facing a human drama, carnage the like of which doubtless has never been seen in France. Yet the impression given is of radio silence. It makes me want to scream.” The next day, Mattei announced that 3,000 people had died from the canicule so far. In fact, the death toll had already passed 12,000. Aides to Chirac, who had been silent so far, reassured the nation that the président was “closely following the situation.”
On August 15, a cabinet meeting was convened to deal with the disaster. Mattei explained to his colleagues, and the nation, that the reason so many old people had died was because “there are more and more [of them].” Clearly, that situation would soon change. As one health worker told journalist Amelia Gentleman, “We are witnessing the sudden disappearance of an entire generation of people aged over 85.” Would Mattei resign? Jamais, he said. “I have work to do.”
On August 16, the temperature dropped a bit, so Raffarin played it cool and called for “solidarity, not political debate.”
Three days later, Mattei said he had investigated the matter and found that he had done nothing wrong. On August 20, Raffarin said the government would try hard to figure out how many people had died, and promised to have official figures within a month. The next day, a tanned Chirac finally spoke to the nation via television. He promised that the government would make a bold plan so something like the canicule catastrophe would not happen again. He also consoled the families of “the many people who had died alone in their homes.” Meanwhile, hundreds of bodies were still lying about unclaimed, despite calls for relatives to come forward, including a very well-publicized appeal from the mayor of Paris on August 24.
It took almost six months before the French government admitted 15,000 of their most vulnerable citizens died in the heat wave. The bold, new plan promised by Chirac? The government would make sure every hospital has one air-conditioned room. And next time there’s a canicule, the government promised, the elderly will be told to avoid going to the hospital and instead go to the movies.
Every August, a handful of passing mentions of the canicule appear in the papers. Many government ministers make a show of taking their holidays within reach of Paris. But the emergency now seems like something that happened long ago. For the last three summers, it’s been hard to ripen tomatoes, and there’s little mention of heatwaves any more.
Ironically, in the U.S., poor and elderly patients who present themselves for care in an emergency situation at most community hospitals would be given treatment, often paid for by the hospital’s insured patients. But health care in France is still assumed to be a government responsibility, even when that responsibility is one the government obviously can’t always meet. The French pay taxes that together amount to nearly 70 percent of their income, and they expect the government to take care of their health — despite what happened to so many of their grandparents. Nevertheless, the service is facing cutbacks, as David Gautier-Villars reported in the Wall Street Journal a few weeks ago, because of its escalating cost. People are furious — in fact, more furious at the government’s health-care cutbacks than they were at the government’s health-care failure.
So, unlike Woodstock, the events of August 2003 changed little. A poll taken in France after the event — but before the final death toll was made public — showed that barely half those asked thought the government should have done better. There was not much of a public debate about the nature of personal responsibility, the obligations of family, the dangers of inflexible bureaucracies, the risks of trusting the government alone to care for the lives of men and women unable to care for themselves. Even raising these questions is enough to trigger outrage in those who, like many French, need to believe in the supremacy of state care. For example, much of this story was told, often in the same words, in my unfortunately titled 2005 book, Vile France. A reviewer for the Boston Globe said reporting this kind of thing was “shameful.”
He was, of course, a middle-aged rock critic. This week, he was writing about Woodstock.