Skeptics of this argument ask why the French public did not blame the government after the heat wave, causing France's Surgeon General, Dr. Lucien Abenhaim, to resign in shame, if the problem was not entirely related to the health care system? The reason is cultural.

In July 1995, Chicago and the Midwest of the United States suffered their own terrible heat wave crisis. Poor city preparations and weak public statements led to the death of over 700 people. The pre-condition of the city was very similar to French inadequacy. Dr. Eric Klinenberg, professor of sociology at New York University and author of Heat Wave, remarked that "France in August looked a lot like the United States in July."

The reactions toward public officials have been remarkably different however, due to stark differences in political culture. Abenhaim was forced to resign because French political culture by nature is reactionary, demanding political accountability. In part, some sympathy is in order for the French government, since they were the most honest and open of affected countries about the statistics, only to be pounced upon by the media. Following the US heat wave in 1995, no one was held accountable. Instead of examining a heat wave as a crisis with social and political ramifications, the city government of Chicago interpreted it as an "act of God," making remarks even blaming the victims for being "negligent." This fatalistic attitude, though later tempered and corrected with new reforms and preventative measures, shows a laissez-faire approach to assessing the causes of the heat wave tragedy, and general indifference or ignorance by the public. Klinenberg offers as rhetorical question, "could you see the US Secretary of Health and Human Services resigning after a devastating heat wave?" The answer is no, and the justification is a different political culture. Lalande simply and comically explains, "the French are used to criticizing everything." The point of these examples is to show that to blame the health care system alone is neither valid nor fair; to fully solve the issue, one must look beyond shallow and immediate attacks and overcoverage by the media to deeper sociological and cultural problems.

It is important to note, that French political culture, as discussed earlier, also makes it difficult for Raffarin to implement desperately needed economic reforms. Originally proposing to reduce reimbursements for prescription drugs and reduce pay-roll taxes and the deficit, Raffarin's plans are being put on the back burner as his approval ratings have slipped from 60 percent in January to 40 percent in recent polls. With constant criticism and the health care budget deficit of almost $12 billion this year, it is difficult for any type of reform to strike a balance between government cost and profit. Also continuing to breach the 3 percent ceiling set by the euro stability pact, Raffarin will have to move quickly, radically, without fear, to end his hot spell.

Solutions for the Future

Overall, the solutions and remedies to prevent another August 2003 will require a careful blend of pragmatism, idealism, time, radicalism, and cooperation. Recently, French Health Minister Jean-François Mattei and Raffarin unveiled plans to raise revenue for hospitals and the elderly. They proposed a tax on tobacco products, which would raise an estimated EUR 800 million (US$1 million) for the insurance system and reduction of the deficit, an extra work day by way of recompense, and the elimination of France's eleven national holidays to help fund improvements in hospitals and life for the elderly.

As one can surmise, these rather creative policies were met with hostility by many, from a lobby organization representing France's 34,000 tobacco vendors to hospital doctors all over the country. Pelloux brushes the reform ideas aside as "stupid; it's been done and tried in Germany."

However, it appears that Raffarin's solutions, radical as they might be, would be an excellent starting point to distribute more money to the hospitals and medical workers as well as to improve facilities to the elderly. Of course, now especially in the heat wave's aftermath, the government must take this opportunity as a learned adaptation, and implement strongly worded warnings to the media and perhaps even open cooling centers in different regions of France far in advance of any possible disaster. The biggest challenge will simply be, as Lalande summarizes, "to organize the holiday system and find some money somewhere."

The relationship between independent general practitioners and hospitals must also be addressed. This can be remedied by reforming independent medical clinics and encouraging moderate, informed use so as not to overwhelm hospitals. Clearer insurance plans must be designed and some economists, such as Patrick Lenain of the OECD, have advocated screening and monitoring to prevent wasteful visits. Referral systems must be updated constantly and expanded to monitor patients and provide data and a sense of permanence of care, with recommendations and provisions for a longer, continuous relationship between patient and the same practitioner, while keeping a multitude of options, which France continues to provide. An unlikely model for comparative change can be found in India, which regularly suffers from bouts of heat waves, killing over 1,400 people a year. Yet, from 2000 to 2002, India implemented early warning and proactive community orientated programs to inform people on the dangers of heat waves, even suggesting that individuals stay in the shade for the greater part of the afternoon. As a result, India saw a substantial decline in casualties.

More time, however, must be spent on dealing with the sociological and cultural aspects of the problem. Here, France can look to the United States as a tangible example. The United States has made sustained efforts to promote sociological and physiological adaptations following such tragedies as the heat wave of 1995. A University of Virginia study conducted by Bob Davies and Wendy Novicoff clearly shows that the United States has gotten more comfortable—or physiologically orientated—to major heat. On average, annual excess mortality from heat-related deaths has decreased by 80 percent since 1960, even with the situation of higher temperatures as a result of global warming. The same is true in Spain, where according to Pelloux, "the Spanish people are historically and culturally prepared to deal with heat."