I have arthritis in my lower back, presumably as the result of a fall from a tree many years ago. I don't have arthritis anywhere else, which I guess is pretty good for a man of 81, but the arthritis in my back is a doozie. It has caused misc. pain from time to time over the past three or four years, and last year, just before Christmas, I was in so much pain that I could scarcely walk or stand up straight, or sleep through the night, or sit at my desk for more than a few minutes at a time. When my son happened to come by for lunch one day, he took one look at me and said, "Dad, look at yourself! You're incapacitated! You've got to go to the hospital!" And without further ado, I went to Hospital #1, a public hospital. (I chose the hospital, just as I have always chosen my doctors and dentists, after researching Paris hospitals on the internet and talking to friends and my GP.) At Hospital #1, I was given lots of morphine to keep me comfortable, and I was finally given two cortisone shots directly in the spine, on two successive days. The shots were administered under a local anesthetic, and they were administered so skillfully that when I asked the doctor to tell me when she was going to begin she told me that she had already finished. Apparently the shots eliminated (or substantially reduced) the swelling of the spine caused by the arthritis, but my problems were far from over. According to the doctors, the sciatic nerve that comes out of the spine and goes down the leg all the way to the big toe had been severely injured by the compression caused by the arthritis, and my entire right leg and foot still hurt like mad. In other words, in terms of pain I was really not much better at the end of my hospital stay than I had been at the beginning. But after the cortisone shots, I was discharged from Hospital No #1, which did not do rehabilitation. I was discharged, but ........ the hospital social worker (social workers are a regular fixture of French hospitals) made arrangements for me to began treatments in a hospital that does do rehabilitation. Several days after I left Hospital #i1, therefore, I began rehab treatments at Clinalliance, a "private" hospital. All of the arrangements for my admisssion to and treatment at, Clinalliance had all been made by the social worker at Hospital #1, a public hospital. I don't see any particular difference between the private and public hospitals in France, except that Clinalliance is a much warmer and friendlier place than the public hospitals that I have known. (Clinalliance also has marginally less terrible food.) At Clinalliance I was a patient of the "hopital du jour," the day hospital. (I guess that's "outpatient services" in the US. ) That meant that I went three times a week (subsequently reduced to two)-- to spend one hour in a therapeutic pool and one hour doing PT. In both the pool and the PT room, the patients -- there were usually between 4 and 8 of us -- were accompanied by several physical therapists, who gently gave us directions on proper exercises and movements. Every two weeks I had an appointment with the doctor to evaluate my progress. The PT room at Clinalliance is elaborately equipped with high-tech treadmills, ladders, rubber balls of all sizes, stationary bicycles and exercise beds that move up and down. There is even a machine with a tipping and moving floor and a TV screen that shows the patient's attempts to remain on balance as the floor moves around. (This machine was too high-tech for me. I prefer exercises that demand less intellectual rigor.) When I started out at Clinalliance, the doctor-in-charge gave me a prescription for some kind of morphine-based pain medicine. She told later me that she had given me the highest dose of that medicine that she had ever written. On her scale --and she sees a lot of patients -- I was apparently in considerable pain --and on mine too! I gradually reduced that pain medicine to zero, although I admit that on those days when I had to do a lot of running around, I sometimes took a small (not morphine-based) pain pill. I spent a total of 5 months at Clinalliance, going twice a week for PT and the pool. At the end of that time, I had pretty much returned to normal, although the doctor told me that the sciatic nerve had been damaged, and that nerve regeneration takes a long time. She urged me to continue a regular course of swimming and exercise, and I have followed her advice, using a public pool and my adaptation of the exercises I learned at Clinalliance. By the end of the first two months at Clinalliance, I had gone from a person who was doubled over with pain and could not walk two steps without a cane, to a person who used a cane only when I had a lot of walking ahead of me. For short trips, I did not use the cane at all -- and I walked upright, although usually at a somewhat reduced version of normal speed. I was even able to walk up stairs in a normal way. I no longer needed any pain medicine, and today, nearly a year after I first entered Hospital #1, I never take pain medicine and I walk pretty well, although usually at a reduced speed, and often with a cane, particularly for long distances. I sleep and sit normally. That is a big change. I'll close with a word on the French medical system. All of this superb treatment -hospital stays, hospital visits, doctors, medicines, X-rays, RMIs and everything else -- cost me nothing. Nor did I have to pay for the hospital- taxi that took me to and from Clinalliance, which is on the opposite side of Paris from my home. I do have a mutuelle, a private insurance policy that supplements my membership in the French system. Without going into details, I'd say that my mutuelle pays for everything that the public system does not cover. With my mutuelle, everything is paid, 100%, from soup to nuts, including a large private room. For all of these benefits, I pay my mutuelle about $150 per month. I think is not too bad for a person of 82. Getting into the French health care system was a hassle, not because the requirements were forbidding but because the French bureaucracy is forbidding. I have now been in the system for 10 or 15 years, and because I am a foreigner, until recently I made a small annual payment of (something under $1000) to continue my membership in the system. The law has now been changed and I pay nothing. The bottom line is that the entire saga of my painful back basically cost me nothing but the $150 per month that I pay my mutuelle. And the treatment that I received --which is the same treatment that is given to poor people, middle class people and as far as I know, to rich people everywhere in France-- was superb. As Marie Antoinette said to one of her courtiers, What else could the people ask? And why has America so categorically rejected this superlative system?