Yesterday evening, while walking to the bus stop to go home for the weekend, I noticed that the advertisement had changed, and had a Kabuki actor. To my great delight, on approaching close enough to read it, it was indeed for Kabuki, in Monaco! I could hardly believe my eyes. As long-time readers may remember, I’ve always loved Japanese culture and the Japanese language, and five years ago, nearly went to teach English in Japan, having been accepted by an elementary school on the outskirts of Kyoto. Kabuki is a popular form of Japanese theatre that was founded some 400 years ago. Invitation to Kabuki is an excellent site with information about its particularities.

Once at home, I went straight to the “Kabuki in Monaco” website to reserve tickets, and was overjoyed that I could get a spot for next Saturday evening’s performance. The first two kabuki actors are the most prestigious in Japan: Ichikawa Danjuro XII and his son Ebizo XI, of the Narita-ya kabuki guild. From their site: “Narita-ya is the yago, or guild name, of the Ichikawa family, the best known acting family in Edo kabuki. Narita-ya is also the earliest known yago in all kabuki.” As for the third, Nakamura Tokizo V is a well-known onnagata actor, meaning he plays female roles. The play they’ll be performing, “Narukami“, likely means that Nakamura will play Princess Taema, one of his best roles, and one of the Ichikawas will play the priest Narukami — indeed, the “Narukami” link has video of Nakamura Tokizo V and Ichikawa Danjuro XII playing those very roles.

As for the dance “Kagami Jishi” (The Mirror Lion, 鏡狮子 in Japanese), I was able to find it on YouTube, in several parts. It’s played by a different actor (Bando Tamasaburo V), and has nice commentary in English:
- Kagami Jishi, part I
- Kagami Jishi, part II
- Kagami Jishi, part III
- Kagami Jishi, part IV
- Kagami Jishi, part V
- Kagami Jishi, part VI
- Kagami Jishi, part VII

In my previous post on French health care, I went over the basics of how things are done here. In this post I’ll compare some statistics, citing Canada and the UK as well since those two countries have often been the focus of recent debate in the US.

The last time the World Health Organisation (WHO) ranked world health systems was in 2000 — they no longer produce rankings since it’s so complex a task. Here are how the four countries fared:
1. France
18. United Kingdom
30. Canada
37. United States
Countries such as Colombia, Saudi Arabia, Morocco and Chile also ranked higher than the US.

Life expectancy has become part of the debate in the US currently. These rankings were taken from the list of countries by life expectancy:
8. France, with an overall life expectancy of 80.87 years
14. Canada, overall life expectancy 80.34 years
37. United Kingdom, overall life expectancy 78.7 years
45. United States, overall life expectancy 78.06 years
The French live nearly 3 years longer than Americans, on average.

Another key issue is pregnancy and childbirth. Here are a few stats taken from Wikipedia’s list of countries by infant mortality rate. The first number is the infant mortality rate per 1,000 live births, and the second is the under-five mortality rate per 1,000 live births:
Iceland: 2.9 and 3.9 (they have the best numbers)
France: 4.2 and 5.2
Canada and the UK: 4.8 and 6.0
USA: 6.3 and 7.8

In France, pregnant women have 3 sonograms and blood tests (one per trimester), with a three-hour blood test around the 4-month mark. All covered at 100%. Anything beyond that’s deemed necessary is also covered 100%. Mothers-to-be get 6 weeks of paid vacation legal minimum before their birth date — it can be extended, for instance if the pregnant woman lives more than an hour’s commute from her offices. They then get 10 weeks after giving birth. Fathers get 11 days of paid vacation (18 days if they’re father to twins or more). Postpartum exams are covered. Parents are given allocations familiales depending on their need; all get a basic “starter” minimum of several hundred euros. There are also allocations to help cover childcare if/when the mother returns to work. Mothers have the option of working 4 days a week instead of 5; fathers can now do this too (but only one member of the couple can do this, and there is a sort of “salary cut” in that a few — less than 10 — vacation days are removed if they choose the “4/5 work week” as it’s called).

All this and per capita, in France we pay half what Americans do: Health Care Spending in the United States and OECD Countries (2007).

From another scientific study, Americans Spend More on Health Care But Are Not Healthier:

The study is the first to use a universal set of standards to compare the quality of health care in the five countries surveyed. The researchers found that no country scored the best or worst overall and that each country was the best and worst in at least one area. The study is published in the May/June 2004 issue of the journal Health Affairs.

Peter S. Hussey, lead author of the study and a doctoral candidate in the Department of Health Policy and Management, said, ”It is well known that the United States spends much more on health care per capita than other countries, and it is commonly assumed that we have the best health care system in the world. However, the results of our study show that the United States performs better than other countries in only a few areas, while performing worse in others. This raises the question of what Americans receive for all of the money devoted to health care.”

Overview
France has a public health system called “Sécurité Sociale”, also known as “Assurance Maladie”. It has a standardized, automatic, electronic system for processing bills and reimbursements. Every French citizen enrolled in “sécu”, as it’s called for short, receives a green card with a microchip, called “carte vitale“. The carte vitale contains only insurance-related information; no medical records are stored on it.

It is also illegal to publicly advertise pharmaceutical products and medical services in France. Quote from the linked article: “Direct-to-consumer advertising is forbidden in France for reimbursed and prescription-only drugs, with the exception of vaccines and products used [to help quit smoking].” Pharmacists, doctors, hospitals, etc. can only have office signs, for instance, and there are no TV advertisements for prescription medication.

Sécu covers a range of percentages, up to 70%, of basic care: general practitioner visits, opthalmologists, dentists, prescriptions, and so forth. Emergency care is always 100% covered. Prescription medication for chronic conditions is also always covered at 100%.

To cover the remaining percentage of basic care, you can choose a private health insurer. In France, those known as “mutuelles” (mutuals) are required to be non-profit, and also cannot advertise. They usually cover 100% of the remainder, with some exceptions for optical and dentistry. I happen to have one that covers 100% of everything, optical and dentistry included. For optical and dentistry there are reasonable limits, which means I can get “only” one free pair of prescription eyeglasses per year, for example, and there is an upper limit to the frames’ price.

Going to the doctor, the pharmacy and the ER
For regular doctor visits, when you go to the doctor, you show your carte vitale, which is put in a special reader. Since doctors can set their own rates — the government does not control them, it only sets a maximum amount beyond which it won’t reimburse — you pay for the appointment at the end. Your payment is reimbursed by the sécu at the going percentage, and the sécu transmits the details to your supplemental insurer, who then reimburses the rest per your policy — all electronically and automatically, direct to your bank account if/when you give your account details. (As a tangent, bank accounts are highly secure in France, and so it’s quite safe to give out a “deposit permission”. No one can take money from an account if all they have is the deposit info.)

When you go to a pharmacy, you again show your carte vitale. If you’ve been to the pharmacy before and they have your supplemental insurance information on record, you don’t need to show it again since they link it with your carte vitale. Since prescription medication prices are set by the government, if your supplemental insurance covers them at 100% beyond sécu rates, you won’t have to pay anything. At all. It’s processed automatically. (This is a VERY weird sensation when you’re an American and used to paying — 10 years later and I’m still not used to being given a bag of medication and just walking out.)

For emergency care, an example: three years ago I fell off my mountain bike and nearly broke my ankle. I had to call an emergency number. The firemen — they’re also trained EMTs here and so answer medical emergencies as well as fires — took me to the closest hospital. I was evaluated immediately on arrival. Only once they saw that I was at no immediate risk did the hospital ask me for my carte vitale. The firemen/EMTs hadn’t asked me for anything; they gave the hospital whatever information they needed. I had some X-rays and the wound was cleaned, then I was told to go to my general practitioner for follow-up, and I was sent home.

That was it. No bill. I was given copies of my X-rays and the doctors’ evaluations to show my GP, but nothing more.

My GP then prescribed physical therapy, an ankle brace, and pain medication. All of it was covered at 100%, and the only thing I had to “pay” for was the doctor’s appointment — as described earlier, it was automatically reimbursed 100%.

Paperwork and prices
To show how basic care is documented, I took a photo of my latest sécu and private health insurance reimbursement statements, along with a shot of my carte vitale so you can see what it’s like.

For information, my GP charges 22 euros. A specialist I go to regularly for my preexisting condition (covered 100%, because there’s no concept of “preexisting condition” in France) charges 45 euros. A packet of ten 500mg aspirin costs about 3 euros over-the-counter; it’s free when prescribed. A three-month supply of the Pill costs 27 euros. (The Pill is one of the only prescription medications not to be covered by sécu, so we do pay out of pocket for that — it’s the only prescription med I’ve ever had to pay for.) I don’t know what ER/hospital stays are charged because mine have always been entirely covered.

My supplemental health insurance costs me 20 euros a month. The national health insurance is paid as part of employer taxes; in my case, my employer pays 320 euros a month. That amount is paid directly to national health care, my salary is not affected. Everyone, not just employees, enrolled in sécu is covered, and as you can see from my case, you don’t have to be a French citizen in order to be able to enroll — you just have to work or study in France.

Conclusion
The only thing I have to worry about is having my carte vitale on me. If I don’t have it, it doesn’t matter, I’ll still be covered — I’ve been able to return to a doctor/laboratory/hospital (yeah, I’ve been around) with my card after minor emergencies when I hadn’t had my card on me at the time, no questions asked. I don’t have to worry how much anything costs. I don’t have to avoid doing sports out of the fear I might hurt myself and lose insurance coverage. I don’t have to worry about being able to afford medication. In the 10 years I’ve been in France, my health has honestly become something I only ever think about when I’m ill or injured, and even then all I need to do is call my doctor. I’ve always been able to get an appointment the same day.

A quick catch-up post: a month ago I had the chance to take a helicopter ride over the Bay of Cannes. We had fifteen minutes in a Robinson R44 (four-seater helicopter) and flew to the nearby Îles de Lérins. Six years ago I did something similar in a small plane, where we flew over the Estérel from Cannes airport. That time I got to fly, but not this time, though I did get some gorgeous photos.

One of the photos was of trains along the coast that looked like miniatures from above. Not long afterwards, I found the fun tiltshiftmaker.com and tweaked that photo to truly look like a miniature train scene! I did the same to a train over a stone bridge I shot in Tende two years ago, and to a photo of Nice’s port that I took last autumn. That last photo is the same one I use for the title header here — I love how it turned out.

Tomorrow I’ll be going to the Russian Orthodox cathedral, which isn’t far from my place, and then to Nice’s port to better shoot some small boats whose colors caught my eye last week (I only had my mobile phone at the time).

Above is a photo I took of a Vallauris ceramic bowl I found in a secondhand shop today (2 euros!). I didn’t have a bowl I could use for fruit; this one is perfect. On that same ceramics note, a friend in Nice recently commented that tomettes are from Salernes, a village in the Var. There’s a site about ceramics there that showcases some very tempting wares from several ceramists. Apparently tomettes are in fact still made there.

Thanks to this post on MetaFilter, I learned that Japan is celebrating 1,000 years of “The Tale of Genji“. The New York Times has an article with a beautiful slide show.

One of the loveliest articles on kimono I’ve seen in a while, on a kimono artist I’ve admired for years: The San Diego Union-Tribune — To dye for:

Itchiku Kubota’s works reach back to a mythic golden age of Japanese textiles.

In 1937, a promising 20-year-old Japanese artist, Itchiku Kubota, paid a visit to the Tokyo National Museum. He saw a fragment of a 17th-century textile with imagery so vivid he stared at it for hours. The technique used to make it, tsujigahana, was lost to history. But Kubota vowed to recreate it in his own work.

“This find seemed like a revelation from God,” he would recall, “and I vowed then to devote the rest of my life to bring its beauty alive again.”

An exhibition catalogue of Kubota’s, and Kimono as Art: The Landscapes of Itchiku Kubota are both available on Amazon for very reasonable prices. A few more online photos of the exhibit can also be found here, where clicking on the thumbnails will open a “super-sized” view that gives a much better idea of the kimono in three dimensions. The Itchiku Kubota Art Museum has its own website, in Japanese of course.

Up close, Kubota’s work is awe-inspiring. Keep in mind he saw that tsujigahana fragment in 1937: “Kubota didn’t have an exhibition until 1977 simply because he wasn’t satisfied with his method until then.” Forty years later. I was able to find a video about tsujigahana dyeing, also in Japanese, that shows more common tsujigahana designs on kimono.

Tsujigahana is a type of shibori, which is among my favorite techniques. Kanoko was named in part after kanoko shibori, for which there’s a video too! (I do believe I’m going to spend several hours watching all of the related dyeing videos!)

Update: I found two videos on shibori that are in English, done by the Nagoya City Public Relations Section (focusing on Arimatsu / Narumi shibori), and which describe the process from start to finish really nicely:
Shibori: Traditional Craft, part 1
Shibori: Traditional Craft, part 2
(Note to fellow kimono lovers: the poster of all these videos, narablog, has dozens of gorgeous videos on all sorts of techniques, including bingata, Okinawa weaving, Edo komon, kurume and san-in kasuri, tsumugi and more.)

I’m posting for one reason and one reason only: The Compostopedia. It includes The Big Book of Compost, readable in-line at that link or by download. It’s “a searchable PDF of the 1956 World Health Organization manual on Composting”; “one of the best resources on composting [they] have ever seen.” Indeed it is!!