It seems rather that whatever happens is going to be more of our present costly and inefficient model, representing the powerful interests of the current providers, the doctors and insurers, and not the interests of taxpayers and the insured/uninsured.

Furthermore, although all the talk in Washington is about keeping the costs down, there are no  proposals out there that would do this.

Instead by its criminal failure to address this problem Congress is putting off onto future generations of Americans that day of reckoning which will come, when the costs of medical care can’t be met and more and more people than the present 50 million uninsured will go without essential services.

And throughout all these goings on in the Congress the no-nothings on the right accuse President Obama of wanting to turn the United States into something more like Germany or Belgium, worst of all, France — a “social democracy” where, according to these voices on the right, spreading the wealth around, or redistribution, is the government’s main concern.

The irony here is that France might very well be the one health care model that we could adopt in our country and to everyone’s advantage.  By the numbers alone it works. France spends $2,401 per capita on health, while the US spends $4,497 (almost double!). In return, life expectancy is 68.1 in the US, 71.5 in France. Infant mortality: 4 per 1000 in France, and 7 per 1000 in the US. And maternal mortality: 8.8 in France, and 10.5 in the US.

The World Health Organization rated the French system the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country’s population. In that same ranking the United States ranked 37.

The French system has much to recommend it. In particular the French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as “socialized medicine.”

It is true that the French doctors make less money, but the lower incomes are considerably allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free.

For a more complete comparison treatment of health care in France and America go to Paul V. Dutton’s book, “Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France.”

For this Blog posting I have drawn substantially on Dutton’s Boston Globe op ed piece of 8/11/2007. Much of the above is taken from that writing.

Now the Museum, ancien hotel, or residence of the rich and famous during several hundred years, has some 100 rooms all dedicated to the history of Paris, a history which is for most of us, the history of France.

Walking through the rooms is walking through the history as told by brief texts attached to paintings, sculptures, and innumerable objects, many donated and many rescued from Parisian buildings that had been destroyed by war, revolution, or just time and the weather.

This history, much more than school history, comes alive through the hundreds of representations of people and events that one stops to look at among the tens of thousands of objects that fill the hundred rooms, and one finishes one visit with plans, resolutions even, to read up on Lutèce, le serment du Jeu de Paume, la Commune, and Juliette Greco, among the many other subjects and objects that have caught one’s attention.

The room dedicated to pre-history and Lutèce, or the Roman Paris, was particularly interesting. Because the Roman Paris, or the bits that remain of it, in particular the baths (thermae) of Cluny, named after the 16th century Hôtel de Cluny built around them, and les Arènes de Lutèce. Both “ruins,” now city parks, are within a few minutes walk of our apartment.

Here is Roman Paris.

And here is a description of the Roman Arènes or amphitheatre:

Erigées au premier siècle de notre ère, les Arènes de Lutèce sont aujourd’hui un oasis d’histoire gallo-romaine au milieu des immeubles haussmanniens qui l’entourent. Typique de l’architecture gallo-romaine, l’amphithéâtre était un haut lieu de combats de gladiateurs contre des fauves, pouvant accueillir près de 15.000 spectateurs. Le chaland peut d’ailleurs apercevoir des cages qui retenaient les bêtes antiques sur le côté de l’amphithéâtre. Comme tous les autres bâtiments de la ville, les arènes furent détruites lors des invasions barbares. Enfouies pendant des siècles dans le sous-sol parisien, elles furent redécouvertes lors du percement de la rue Monge au cours des grands travaux des années 1860.

Here is a model of what the stadium might have looked like in Roman times:

And here is what you will see today, if you visit there now, some 2000 years later. (You won’t see “les combats de gladiateurs contre des fauves,” although perhaps a game of boules, and certainly kids kicking a ball around.)

I often ask myself this question, “can we find in the history of Paris (France) a satisfactory explanation of why France is the way it is today?” And as I strolled slowly through the rooms and up and down the stairs of the museum I wondered what if any was the connection between what I was looking at and what France is today.

One famous exhibit in the museum does seem to have absolutely no connection to Paris before or Paris (France) afterwards. And in fact there are always those people and events that quickly assume a place for themselves, outside of the continuum of history, allowing one to directly experience them with little or no knowledge of the times in which they lived.

The greatest writers and artists certainly belong to this category. Less so the famous men and women who in this museum have only a part to play in the history of this city. Taken out of that context we would not know them at all.

The famous exhibit is the bedroom of Marcel Proust. There is absolutely no connection to be made between this and France today, or with the France of any time.

Proust did live and write in Paris, in fact he wrote much of his Remembrance of Things Past while sitting up (or lying down) in the bed shown below. But other than being this famous writer’s bedroom this exhibit has no special interest. Proust’s achievement stands no less out of the times in which he lived, out of the bedroom here exhibited, than out of the much, much earlier Roman Paris or Lutèce.

However, there are many people and events exhibited in the museum that are in a line taking us right up to today. The Serment dans la salle du Jeu de paume, à Versailles, that took place on January 20, 1789, is one. Here the tiers état, or what we would call the people, made a solemn vow “to never separate and to assemble together wherever the circumstances demanded it, right up until the time when the Constitution would be firmly established in the realm.”

“Les députés se réunissent” … [and swear] « de ne jamais se séparer, et de se rassembler partout où les circonstances l’exigeront, jusqu’à ce que la Constitution du royaume soit établie et affermie sur des fondements solides.» (The painter is Jacques Louis-David)

The connection with today is clear. For today the people are still swearing not to separate, not to stop demonstrating, not to stop striking, until their wishes are met. Evidently their wishes have not been met, and the “Constitution” is not yet on solid foundations.

In fact the Serment du Jeu de Paume has, wthin just 250 years, resulted in a state where forward movement, where progress, seem no longer possible. For the country, France, is divided, not between clergy, nobility, and the tiers état, but between and among the people themselves.

Todoay in the country, France, as in the countries of most of the developed world, there are only tiers état or people. The clergy and the nobility are no longer players on the scene.

In France in particular, and in other countries to a lesser extent, the divisions among the people, right from left, liberal from conservative, those with more from those with less, prevent them from working together. And instead they only fight with one another over the spoils, those spoils left behind by their former masters.

The day was cold, especially for us haven’t left Tampa just two days earlier, but the water in the Fontaine was running strong.

« Plus il lisait, plus Thomas s’effarait de s’apercevoir qu’il n’avait fait qu’effleurer le sujet jusqu’à présent. Alors quadruplait sa vitesse de lecture, accumulait les articles les plus passionnants dans ses tiroirs, dans des mallettes soigneusement étiquetées, sous son lit ; et quand ses yeux accrochaient un titre extraordinaire, il interrompait ses découpes, lisant en diagonale le contenu de l’article qui avait retenu son attention ; cela lui faisait penser à un autre article passionnant qu’il avait lu quelques semaines auparavant qui aboutissait rigoureusement à la conclusion inverse…mais de qui ? Et où l’avait-il mis ? Thomas se mit à chercher frénétiquement partout dans l’appartement. Il alla dans les endroits les plus improbables pour remettre la main dessus ; il fouilla la huche à pain, la réserve de savon sous l’évier, les bas de sa femme, puis il se mit à quatre pattes sur son bureau pour mieux mener l’enquête. Un grondement menaçant retentit. Thomas leva les yeux et vit soudain une vague monstrueuse d’articles de presse se dresser devant lui. Autour de lui, un océan de journaux déchaînés faisait tanguer et tourbillonner son bureau de la façon la plus dangereuse. Pas de doute, il ne tiendrait pas longtemps. Thomas tenta frénétiquement d’attraper un article sur la théorie des mèmes qui filait sous le bureau à toute allure. Manqué. A présent, il fallait s’accrocher.”
(taken from an email from Eric Degardin in Paris)

Cohen writes: "Yet, for all its enduring seductiveness, Paris has ceased to be the city that I knew. The modern world has sucked out some essence, leaving a film-set perfection hollowed out behind the five-story facades. The past has been anesthetized. It has been packaged. It now seems less a part of the city’s fabric than it is a kitschy gimmick as easily reproduced as a Lautrec poster."

Cohen ought to have known that the city that he knew in his youth, any city, would be gone in his middle age, no matter what the time and circumstances. Things that we once knew and once loved will always be gone in time. If they disappear while we are still alive that's probably a good thing, because it means we have lived a long time.

The "briny oysters, the glistening mackerel on their bed of ice at the Rue Mouffetard, the drowsy emptied city in August, the unctuousness of a Beef Bourguignon…" Cohen says that these things can be experienced for the first time only once.

Perhaps for him, but they still can be experienced. These things in particular are still there for others to experience for the first time, which indeed is what is happening. Go to Paris today if you want to see it.

For me the greatest change to Paris during my lifetime was the dismantling and removal of the central Paris market, Les Halles, and its relocation to Rungis in the southern suburbs. And in fact this was happening while Cohen in the seventies was experiencing his Paris, I assume, for the first time. The disappearance of Les Halles was, and is, for me a real loss, probably greater than anything Cohen writes about.

Evidently Cohen never knew Les Halles. He could get a glimpse of them if he were to watch the 1963 comedy, Irma La Douce, starring Jack Lemmon and Shirley MacLaine. The Forum des Halles, which stands in their place does, by itself, summarize the changes that have come to Paris, as to all cities. And yes, one can regret the loss, but for even more visitors whose first experience of Paris is now, there is no lament for the past.

In regard to what Cohen says about "the glistening mackerel on their bed of ice at the Rue Mouffetard, the
drowsy emptied city in August…," that such "things can be experienced for the first time only once," I would say in response, what about Proust, and the story of the Madeleine? Wouldn't Proust's experience be a second first time, one probably that we have all known? These experiences, second first times if you will, are still mine whenever I go to Paris.

In fact, I have been returning to Paris every year, often more than once, for some 30 years or more. When, for example, I enter the Brasserie, Le Terminus Nord, for the nth time, knowing that escargots, gratinées, steak-frites and other such, are awaiting me, each time does seem like a first time, and in some respects these later experiences are even more completely satisfying than the earlier ones.

Isn't it true that many of the things that we do over and over again, running, swimming, writing an op ed piece, and many more, lose nothing of their original, first time delight? In that sense we don't lose Paris.

Hitler's general, who made sure that Paris survived the German departure from the city, was on to something. If Cohen were right and the German had agreed with Cohen's reasoning, he might have let Paris be destroyed, for in that case gone probably for him also would have been the city's pungency, perhaps known from his, the German's, youth.

But the German general knew otherwise, and the city was left standing, there for me in the sixties, and for Cohen ten years later, and for countless others. Paris "in its loss" is still the world's city most visited, and for most for the first time.

Sure, I too have felt many times, and in particular since the smoking bans of this year, the absence of the sharp Gauloises odor in the cafés, but is this really any different from the London visitor, returning to the city some time after the era of open cesspools and their sharp, deeply unpleasant odor, and wondering what had happened to his London?

And more important is this sort of thing a loss, or is it a gain? Is the city any less for the loss of the odor of Gauloises, or that of open sewers? Cohen might have better asked is the city any less for having lost, since the seventies half or more of its cafés.

When Cohen says that the city was glorious in its squalor, and that the glory has been lost in the now sanitized city, is he implying that the absence of heavy smoking, open sewers, sidewalks laden with dog poop, myriads of prostitutes standing in doorways, and innumerable other such vignettes of his Paris of the seventies, that all this represents the loss of something important and vital? Rather don't we simply have a healthier city than we did then?

So, isn't his lament the lament of the Romantic, the lament for the loss of our pasts? For it is true, and always was and always will be true, that "memories are like the sound of hunters’ horns fading in the wind." Is there any city in the world the memories of which one might not say the same thing?

Havana, perhaps? Only because I and Cohen didn't know Havana before Castro. In spite of the absence of modernity in that city does that mean that there is still something left of its glorious past? No, not necessarily. What we have there is exactly what Cohen says we have, "a unique aesthetic, freed from agitation, caught in a haunting equilibrium of stillness and decay.

Finally, when Cohen says that "squalor connects," is he implying that order and cleanliness don't, or at least don't connect as much? Again isn't this the cry of the incorrigible romantic? One smiles, for yes there are those among us who do hold on to the past as if it were indeed, in all its squalor, a golden age never to be equaled. The realists among us know, alas, that reality, our reality is something else entirely.

Yes, Roger, your Paris is gone, as you saw by the flare of a Russian match. Mine is gone also. But so are so many dear people and things of my youth and middle age. That, Roger, is life, and rather than regret what we no longer have we need always to look for the beauty that is always there with us in the present, to all that we do have and value, and not lament what we have lost.