My Mother Waits Three Weeks, Your Dermatologist Sees You Tomorrow
An investigation into the last mile of French healthcare
Lire en français →My Mother Waits Three Weeks, Your Dermatologist Sees You Tomorrow
By Aminata Kouyate, with contributions from Leonie Marchand and Colonel Pierre Dumas
My mother is 64. She’s lived in Aulnay-sous-Bois since 1990. She cleaned hotel rooms at Roissy for twenty-five years, paid her contributions every month without missing one, and never complained. The last time she needed to see a GP, she waited three weeks. Doctor Mensah, who’d run the practice on Rue des Coquetiers for twenty-two years, retired in 2023. Nobody replaced him. So my mother did what everyone in the 93 does: she went to the emergency room at Robert-Ballanger. For back pain. With a six-hour wait and a room full of people who, like her, had nowhere else to go.
I tell this story, and people say: that’s one case. No. That’s Seine-Saint-Denis.
68 GPs per 100,000 residents in the 93. The national average: 120. Central Paris: 300. Four times more doctors twenty minutes away by train. They call it a medical desert. I call it a political choice repeated every year in every budget law for thirty years.
The national sleeping pill
There’s a sentence that puts France to sleep. “The best healthcare system in the world.” It comes from a WHO report published in 2000 — a quarter of a century ago. The WHO itself stopped publishing that ranking because the methodology didn’t hold up. But the sentence holds. It holds like a sedative. Every time an emergency department closes at night, every time a rural maternity ward disappears, every time a DREES report shows territorial inequalities are widening, someone trots out that sentence and everyone goes back to sleep.
Claire Beaumont, who writes better than all of us, counted six major healthcare reforms since 2002. The Kouchner law. The T2A hospital funding system. The HPST law. The Pacte territoire-sante. Ma Sante 2022. The Segur accords. Six reforms. Hundreds of millions in consultations, working groups, reports. Not one touched the architecture. They changed the names. The directorates. The acronyms. They created new ones — ARS, CPTS, MSP, GHT — to give the impression something was moving. Nothing moved.
France ranks sixteenth in Europe for avoidable mortality. Sixteenth. Behind Spain, Portugal, Greece. Countries we’ve looked down on for decades. But we have the best system in the world. Sleep well.
Healthcare at two postal codes
Request a dermatology appointment in Sector 1 in Paris. Average wait: nine months. Request the same appointment in Sector 2, with an 80-euro surcharge. Wait: next week. The same doctor, sometimes. The same neighborhood. But a different postal code on your bank statement.
That’s two-tier medicine. It’s not a risk. It’s a fait accompli.
87% of ophthalmologists practice in Sector 2. In dermatology, the ratio is comparable. In psychiatry — I’ll come back to that — it’s a massacre. The system no longer functions as universal coverage. It functions as a toll road. If you can pay the surcharge, you pass. If you can’t, you wait. And if you wait too long, your condition worsens, you end up in the ER, and it costs ten times more for the public purse. But that’s invisible. Overwhelmed ERs make the occasional TV news report. The GP who never came to set up practice in Aulnay makes nothing at all.
In Seine-Saint-Denis, a resident has half the chance of finding a doctor compared to the French average. A quarter compared to a Parisian. And Seine-Saint-Denis is not a village in the Creuse three hours from everything. It’s twenty minutes from the Gare du Nord. It’s a million and a half people. It’s the youngest department in metropolitan France. And it’s the one where people die earliest.
Ines, 26, depression, seven months’ wait
Leonie Marchand, who has the courage to say things the way they’re lived when you’re 24 with no inheritance, tells the story of her friend Ines. Diagnosed with depression. Needs psychiatric follow-up. Wait time for a first appointment at a CMP in Lyon: seven months. Seven months. Ines ended up signing up for BetterHelp. In English. With a therapist in Texas. Because France, in 2026, is incapable of treating the mental health of its young people.
The government created Mon Soutien Psy. On paper, it’s wonderful: eight sessions reimbursed with a psychologist. In practice, the reimbursed rate is 30 euros. The actual rate for a psychologist in private practice: 60 to 70 euros. Find me a psychologist who accepts 30 euros. Find me one. It’s the same mechanism as everywhere in the system: you advertise a right, you set a rate so low that nobody can practice at it, and you let the market fill the gap. The coverage is legal. The access is fictional.
One in five people aged 16-25 reports depressive symptoms. One in five. And the state’s answer is eight sessions at a rate nobody accepts.
Leonie is right to be angry. We should all be angry.
When paracetamol depends on the Taiwan Strait
Colonel Pierre Dumas, thirty years in the DGSE and the military health service, put a file on the table that nobody wanted to open. 80% of the active pharmaceutical ingredients used in France are manufactured in China and India. Eighty percent. Paracetamol, amoxicillin, ibuprofen — the staples of every French family’s medicine cabinet — depend on supply chains crossing the Pacific.
In 2009, France had a billion surgical masks in stock. In March 2020, when Covid hit, 117 million remained. And we discovered it in real time, on television, like everyone else. Healthcare workers were wearing garbage bags.
Dumas calls this a national security breach. He’s right. And he’s not being alarmist — he’s being clear-eyed. The day a geopolitical crisis closes a strait, a port, a shipping lane, France no longer has the means to treat a headache. This isn’t a movie scenario. It’s a documented, calculated, known vulnerability that every government for twenty years has chosen to ignore because importing is cheaper.
Sanofi paid out 4.4 billion euros in dividends in 2023. That same year, the ANSM recorded 4,600 episodes of drug shortages or supply tensions. Shareholders collect billions, and pharmacies display out-of-stock notices. We live in a country that builds Airbus jets but can’t guarantee the production of paracetamol.
340,000 euros
That’s what health-related absenteeism costs my company every year. 200 employees. Half earn between 1,600 and 2,000 euros net. When they’re sick, they don’t go to the doctor. Not out of negligence. Out of arithmetic. The doctor is forty minutes away by public transport. The appointment is in two weeks. Taking half a day off means lost wages. So they come to work with a fever, a locked back, a cough that’s lingered for three weeks. And one day, the locked back becomes a herniated disc, the cough becomes chronic bronchitis, and they go on long-term sick leave. I lose an employee. The national health insurance pays daily allowances for months. The hospital handles an emergency that could have been a twenty-minute GP visit.
When Gabriel Bastiat talks to me about “price signals” and “economic distortions,” I tell him: come spend a week in Aulnay. I’ll show you the signal. The medical practice that opened on Rue Michelet — a municipal health center, salaried doctors, no surcharges. Within eighteen months, five businesses set up around it. A bakery. A dry cleaner. A hair salon. Two phone shops. One medical practice, and the end of the street was transformed.
That’s the multiplier effect. It’s not macroeconomic theory. It’s Rue Michelet. One euro invested in a neighborhood health center generates between 1.5 and 3 euros in economic return — in avoided sick leave, avoided ER visits, earlier diagnoses, local commerce. Healthcare is not a cost. It’s an investment. And like all investments, it pays more when you put it where the need is greatest.
What I learned in Bamako
Every summer, I go back to Mali to see my family. And every summer, I see a healthcare system that has almost nothing. No Secu. No Carte Vitale. No universal health coverage. Under-equipped hospitals. One doctor per 10,000 residents in some areas.
And yet. In my aunt’s neighborhood in Bamako, there’s a community health worker. Her name is Fatoumata. She knows every family in her zone. She knows who’s diabetic, who’s pregnant, who hasn’t had their children vaccinated. She visits, she talks, she refers. She’s not a doctor. She does prevention, connection, follow-up. With ten times fewer resources, Mali has invented something France has forgotten: care that goes to the people instead of waiting for them to come.
The first time I came home and told colleagues about it, they laughed in my face. Mali, a model for France? Yes. Because in Aulnay, we have the money — France spends 12.1% of its GDP on healthcare, more than Germany, more than the UK — but we don’t have the fabric. The PMI mother-and-child clinics are closing. Municipal health centers are running deficits. The corner pharmacist is the last link in the chain, and he’s drowning in paperwork. We destroyed what Dumas calls the “intermediary institutions” of healthcare — the family doctor who knew three generations, the neighborhood nurse, the social worker who connected the dots — and we replaced them with nothing. Except Doctolib. Which is a private company.
Build, don’t reform
I’m neither an economist nor a doctor. I’m a business owner who employs 200 people in Seine-Saint-Denis and who sees every day what the absence of care does to people and to the books. Here’s what I propose, concretely.
1,000 multidisciplinary health centers in five years. Priority to disadvantaged neighborhoods and medical deserts. Salaried doctors — that solves the problem of setting up in private practice, which nobody has managed to fix with bonuses in twenty years. Nurses, pharmacists, psychologists, midwives, under one roof. Integrated teleconsultation for specialists, because Maxime Vauban is right on one point: technology can extend human presence, not replace it. Estimated cost: 2 billion over five years. The return in avoided emergencies and sick leave will exceed it.
Community health mediators in every disadvantaged neighborhood. The Bamako model adapted to France. Recruited locally — in the neighborhoods, not in Paris. Trained in six months. Paid properly. They do what Fatoumata does in Bamako: prevention, referral, connection. And they create local jobs. Pierre Dumas, when he talks about “cantonal health nodes” inspired by the military health service, says the same thing in different vocabulary: a proximity mesh, autonomous but connected, with a clear chain of responsibility.
Pharmaceutical sovereignty over fifty essential molecules. Dumas is right, and the convergence on this point is total: you can’t be a nuclear power that depends on China for paracetamol. Relocation of production, a dedicated fund of 3 to 5 billion, a health reserve of 50,000 mobilizable personnel. Healthcare is defense.
Mental health: reimbursement at the actual rate. 60 to 70 euros per psychological consultation, not 30. Direct access without the mandatory GP referral. Doubling of CMP places for 16-25 year-olds. Cost: 1.5 billion per year. That’s the price so Ines doesn’t have to discuss her depression in English with a therapist in Texas.
Total territorial transparency. Annual publication, municipality by municipality, of the number of doctors, wait times, avoidable ER visits. Let people see the numbers. Make it impossible to say “I didn’t know.” Because everyone knows. We just choose not to look.
Last mile
I work in logistics. My job is the last mile — the most expensive one, the one everyone wants to avoid, the one where the difference between a delivered package and a lost one is decided. Healthcare in France has the same problem. We have magnificent university hospitals, world-class researchers, a health insurance system the whole world once envied. But the last mile — the one between healthcare policy and the actual patient, in their actual town, with their actual life — that last mile, we abandoned it.
My mother has never read Keynes. She’s never heard of the multiplier effect. But she knows one thing: when the medical practice on Rue des Coquetiers was open, the neighborhood was better. People got treated. Children were vaccinated. The elderly didn’t die alone. And when it closed, something broke that was never repaired.
We spend 300 billion a year on healthcare in France. We have 6 million people without a regular doctor. Those two figures, side by side, tell you everything you need to know.
The money is there. The need is there. What’s missing is the decision to send one toward the other.