
Why I prefer French health care - pw0ncakes
http://reason.com/archives/2009/12/07/why-prefer-french-health-care
======
Semiapies
Welch does hit it on the head. The current US system is nothing like a free
market, and it sucks. France's system (and Germany's) sucks rather less than
the UK's or Canada's - or the US's.

I'd advocate for a freer health care market, but that's not on the table. In
lieu of that, I'd advocate a more French-style system, but that's not on the
table. So, I generally just sit health care debates out, aside from talking
side issues with people.

~~~
froo
I have issues relating to other's health care problems. I suppose here in
Australia we're spoiled.

For example. I have the best private health coverage I could find and I pay
less than $130 a month AUD; but it doesn't stop there. We still have a free
health care system if you're ok with waiting for major ops.

In terms of what it would cost me for a GP visit. My current GP costs about
$20 a visit but often I can claim the majority back with our Medicare Bulk
Billing system (not to be confused with the US Medicare.)

Our system seems to work extraordinarily well. Those who want to pay for
health care can (like I do, it's not that expensive) ... those who can't
afford too are still covered by our free system.

~~~
xenophanes
One thing you don't mention is the cost of the "free" system. Remember,
TANSTAAFL.

~~~
froo
Oops, sorry I wrote the comment when I woke up in the middle of the night.

Ok, Medicare in Australia is a funded by an income tax levy that every
Australian pays, set at 1.5%. It's an almost paltry sum of money when you
consider it's free healthcare.

My private health insurance also receives a rebate from the Australian
Government. From what little I understand about the system, the Australian
Government funds this out of my Medicare levy I pay, so that I'm not paying
twice.

We also have plenty of other medical programs running in Australia - like the
Pharmaceutical Benefits Scheme which helps low income people afford the
medications they require. I'm not up on the numbers, but I think it caps the
costs of certain medications at about $5

It works well, I don't know too many people that complain about our system at
all. The cost of health care certainly isn't an issue at all that weighs on
too many peoples minds

------
smutticus
Framing the argument as socialist vs capitalist is not helping us work towards
a real solution to America's health problems. France is not a socialist
democracy nor is the USA a true capitalist republic. We need to dissociate
ourselves from idealology driven plans and name calling.

That said I have enjoyed the medical care of The Netherlands and the USA at
different times and I much prefer the Dutch system. It's just cheaper and less
hassle. They're both public/private organized but for whatever reason the
Dutch system is just easier for me to deal with. I don't know which one is
socialist or which one is free market or whatever. The Dutch one is just
cheaper and I get better service.

Maybe the USA can attain lower costs and better service through introducing
more competition. Or by training more doctors or public support. I don't care
what idealology my elected leaders pick. Just come up with a plan, show me
what I have to pay to go to the doctor and I'll decide if I move back to the
USA when my time in Holland is up. But that's not going to happen if we as
Americans can't move away from infantile and outdated idealogical debates
rooted in cold war fear mongering.

------
anamax
Whether or not the French, Canadian, German, or UK govt can do healthcare
doesn't tell us anything about whether the US govt can do healthcare.

What is it about Medicare and other existing US govt healthcare that convinces
folks that the US govt can do healthcare on a larger scale?

That's why I make my offer.

Let's give Obama free rein wrt healthcare for folks whose healthcare is
already done via the US govts at any level. Not just Medicare/Medicaid (and
the state programs), the IHS and other programs, but local, state, and federal
employees as well. I'll even throw in companies that get more 70-80% of their
revenue from govt. That's easily 40%+ of the population.

Note that those folks are already under "single payer".

In return for free rein, the cost per covered person is capped at today's
rates for the first two years and then decreased 5%/year each year for the
next four years. Since single payer advocates claim at least a 30% savings and
that's just a touch over 20%, that per-person savings should be a slam dunk.

To sweeten the pot, he can use the money from the per-person cut to increase
the number of people covered. I'm willing to consider letting other
folks/companies buy into the program for the budgeted amount.

The only thing non-negotiable is the total amount spent per person. Yes, he's
free to negotiate, remove import restrictions, and the like. However, he can't
force people to accept the prices that he'd like to pay - he can only refuse
to do biz with folks who don't charge what he'd like. And, if he removes
import restrictions, that applies to everyone, not just folks under obamacare.

At the end of six years, we'll know for sure whether the US govt can do
healthcare. Heck - I suspect that we'll know earlier.

Deal?

~~~
DennisP
The German system is not government healthcare. Everybody has private,
nonprofit insurance. Arguably they're less socialized than we are, since they
have no Medicare, Medicaid, or VA. Japan is the same, with more choice than
Germany: 2000 insurance companies, take your pick.

What they share with France: a mandate, a national price list for services, no
claim denials allowed for anything on the pricelist, no coverage denials,
electronic medical records, subsidies for the poor.

They do better on stats than we do, at much lower cost.

~~~
anamax
> They do better on stats than we do, at much lower cost.

Irrelevant because that doesn't imply that the US govt can do that. (Also
irrelevant because the German and Japanese populations are very different.)

That's why I proposed the experiment - let's see what the US govt can do.

Many of us prefer Google to other search engines. Google's existence proves
that better is possible, but it doesn't prove that Yahoo or Bing can do better
than they do.

~~~
DennisP
My point is that we shouldn't exactly be relying on the U.S. government to do
it. The best systems in the world are highly regulated but not actually run by
governments.

One of the things they do, though, is force a price list on providers,
something you've taken off the table.

On the other hand, the VA actually has quite a good reputation these days.
That's sort of your experiment right there. Costs are holding steady despite a
pretty messed-up patient population, doctors and patients like the system,
they have a very good electronic medical records system (which they've
opensourced, btw) and they use those records to analyze the data and use the
treatments that the evidence shows are most effective.

It's been widely reported that about 98,000 people a year die from avoidable
medical errors, a lot of it from medication errors. Most hospitals won't talk
about their error rates. The VA told everybody, then they fixed it. For
example, in a VA hospital every patient has a barcoded wristband. So does
every nurse, and every medicine bottle is barcoded too. Every time a nurse
gives a patient a pill, she scans all three barcodes, and a computer checks to
make sure the patient is getting the right medicine at the right time.

Most private hospitals have little incentive to fix errors, and certainly none
to report them. Reporting just gets you sued, and in a fee-for-service system,
fewer errors just means less money.

~~~
anamax
> My point is that we shouldn't exactly be relying on the U.S. government to
> do it. The best systems in the world are highly regulated but not actually
> run by governments.

My point is that the US govt will be doing the regulating.

Note that the US govt doesn't actually provide medical services under medicare
either - it just "regulates" them.

I didn't say anything about what Obama could do - free rein means he gets to
decide. He can go with regulation, govt hospitals, whatever.

> in a fee-for-service system, fewer errors just means less money.

IIRC, Medicare mandates fee-for-service. Under the terms of my deal, Obama
gets to change that.

My private health care doesn't work on a fee-for-service system (at least as
far as doctors and medical staff are concerned). I doubt that it's the only
one.

Yes - it's in the US. If its existence surprises you....

------
martythemaniak
This is one of the funnier (funny as in sad) aspects of the US Healthcare
debate - while half the populace is railing on and on against some imaginary
gargantuan bureaucracy, from an end-user perspective healthcare systems like
Canada's are great. You have a simple periodic billing system (every
paycheque) and access to everything is a simple card-swipe away.

~~~
SamAtt
Your point really isn't valid. The questions in this debate are quality of
care and and cost. People against systems like the one in Canada claim they
will cost too much and be of a poorer quality than what the U.S. has now. So
ease of use doesn't invalidate anyone's point

The argument you make is like someone claiming McDonalds is better than a Fine
Restaurant for the diner. Because you can swipe your card at the counter in
Mcdonalds where you have to get a pen and fill out the receipt at a
Restaurant.

~~~
RyanMcGreal
>People against systems like the one in Canada claim they will cost too much
and be of a poorer quality than what the U.S. has now.

They might claim this, but they would not have the data to back the claim up.

* Canadian health care costs less than half the money, per capita, as American health care.

* Median wait times in Canada are the same as or better than in the US.

As someone who lives in Canada and has had many opportunities to experience
Canadian health care - from head injuries to electrocution to infected burns
to pneumonia - I can state anecdotally that the publicly funded, single payer
medical care I and my family have received has been uniformly timely,
professional, skillful and professional.

~~~
SamAtt
I'm not disputing your number per se in the I think the U.S. system is too
expensive and I suspect the system in Canada is cheaper than the ugly hybrid
the U.S. has. But having said that, as someone whose looked at the numbers,
the facts you quote are largely bull (sorry)

If you look at the breakdown of things you'll see that a lot of the cost
difference is because people in the U.S. have a choice and they choose the
more expensive option. There are also issues of tort reform which the U.S.
desperately needs. Because the current system leads doctors to order thousands
of dollars in additional treatments to rule out things that Canadian doctors
don't have too (and while the actual suits themselves are a relatively small
portion spent on health care it should be mentioned that the U.S. pays 4 times
more per capita on malpractice suits)

As for wait times it's true but the base line number doesn't take into account
the fact that many don't have health care. Again I reiterate the U.S. system
is screwed up. But the fact is people with insurance in the U.S. tend to have
shorter wait times and it's only when you factor in things like free clinics
and government programs that the wait times rise above those in Canada.

~~~
barrkel
Doctors don't need the threat of tort to have an economic incentive to
oversupply health care, while consumers of health care have a significant
asymmetric information disadvantage, so they cannot necessarily contradict
their doctor's advice.

Meanwhile, non-mandatory health insurance, in the absence of other factors, is
a recipe for adverse selection.

~~~
SamAtt
If you're going to take the point that doctors are dishonest than pretty much
anything goes so I don't see your point as being valid. But assuming doctors
are professionals with a degree of integrity the only reason they'd over treat
is if they felt they could lose their practice for not doing so (and if they
knew other doctors felt the same way and would over treat in the same way)

As for your last point i can't really refute it because you didn't really back
it up and if it were obviously true than the health debate would be settled
already.

~~~
barrkel
If you're going to take the point that incentives don't matter, you're going
to have to back it up, because it sounds like you're saying that capitalism -
the profit motive - doesn't work. Is ordering an extra test - just in case -
malpractice? Is not doing another scan, because it's expensive, morally
superior? Are you saying that we should expect economically efficient care
from doctors out of their benevolence?

"It is not from the benevolence of the butcher, the brewer, or the baker that
we expect our dinner, but from their regard to their own interest." Are
doctors different?

Adverse selection is also a pretty basic economics concept. You can read more
about its applicability to health insurance here - and cites more:

<http://ideas.repec.org/p/wbk/wbrwps/2574.html>

------
Judson
It is important to note that with the current tax rates as high as they are
(on the _caugh_ rich, $150,000+), we can't feasibly move to a system like
France's would (all things constant) raise tax rates even more, without
reducing spending[1].

The key point the author suggests, and which I agree, is the breaking down of
market barriers such as:

\- Why do I need a $200+ doctors visit to a "specialist" to get a prescription
anti-fungal creme? (Answer: FDA)

\- Why does a visit to a "doc-in-a-box" cost me $25 (copay) and my insurance
company $75+ when I was only there for 15 minutes (after a 30min wait)?

(Answer: AMA regulates supply of doctors. We may have needed that before
technology basically automated routine doctors visits, but we don't need such
stringent accreditation for a bad cold diagnosis (flu scare).)

[1] <http://online.wsj.com/article/SB124958049241511735.html>

~~~
orblivion
Does France not have their equivalent of the FDA and AMA?

~~~
marshallp
The problem is American doctors are smug elitist's who believe they're worth
half a million dollars a year and american society believes they're worth it
too (possibly through watching too much medical dramas on television).

Every other country in the world treats theur doctor's as humanitarians who
deserve an above average but honest wage.

~~~
Judson
I guess the real question is, do you have to go to school for 10 years to be a
generic MD who can read the output of a machine and tell me my white blood
cell count is elevated so I probably have an infection.

Here is an antibiotic.

btw, I'm not saying that years of school aren't worth it for docs that are
more specialized (aka surgery)

~~~
orblivion
"I guess the real question is, do you have to go to school for 10 years to be
a generic MD who can read the output of a machine and tell me my white blood
cell count is elevated so I probably have an infection.

Here is an antibiotic."

No, and this is what pisses me off about things like the FDA. They set the
standard for risk, instead of letting the market find the appropriate level.
And they've set it pretty high, and now basic shit is needlessly expensive and
complicated. Cutting corners (ie, letting nurses handle it) is just fine. It
might lead to more accidents, but it'll free up doctors to help a lot more
people and more than make up for it.

------
SamAtt
There are two parts of this piece: the Anecdotal and the Macro.

Anecdotal evidence seems irrelevant to me. My experience with the U.S. system
is completely different from his. I've never wanted to go to a Doctor that was
"out of network", I can always get an appointment next day, my co-pay is $10,
meds are never more than $20 or so and my insurance company has never come
back wanting money from me. Does that make me right? Of course not.

On the macro he's still against France's system for it's "punitively high tax
rates that will have to increase unless benefits are cut" and he still
endorses a free market system so I don't see this piece proving anything in
that regard.

~~~
orblivion
Well what it does prove is that the European system isn't the unmitigated
disaster that conservatives and libertarians here claim it is. I'm personally
all for a free market system, but I think it's counterproductive to be in
denial when the other side brings up a damning data set.

~~~
SamAtt
Pardon me for quoting from something I wrote above but I didn't want to
retype. The bottom line is Data Sets can lie (though I agree single-payer is
certainly not the disaster some make it out to be). The quote...

If you look at the breakdown of things you'll see that a lot of the cost
difference is because people in the U.S. have a choice and they choose the
more expensive option. There are also issues of tort reform which the U.S.
desperately needs. Because the current system leads doctors to order thousands
of dollars in additional treatments to rule out things that Canadian doctors
don't have too (and while the actual suits themselves are a relatively small
portion spent on health care it should be mentioned that the U.S. pays 4 times
more per capita on malpractice suits) As for wait times it's true but the base
line number doesn't take into account the fact that many don't have health
care. Again I reiterate the U.S. system is screwed up. But the fact is people
with insurance in the U.S. tend to have shorter wait times and it's only when
you factor in things like free clinics and government programs that the wait
times rise above those in Canada.

------
ErrantX
France is a poor general comparison for the reasons specified later. The UK
system is something of a compromise of the two and worth consideration.

Actually I thought about this a little today:

The US system is biased towards the extremely ill - it is essentially a bet
against you getting an uncommon illness.

The UK system is biased towards the mildly ill - if you have an uncommon
illness it doesn't work as well. So it is a bet against not getting an
uncommon illness.

~~~
ZeroGravitas
Rarity and severity are two different things. I can't tell which you mean.

I would guess the UK system would bias against rarity since if you make
spending decisions centrally you can get more bang for buck, the more people
get the disease.

~~~
ErrantX
Im talking rarity I think, yes. Because common and uncommon illnesses can be
severe.

My point is that in the UK you can go see a doctor and get drugs with little
effort/cost etc. Whereas if you have something rare or costly the chances of
effective care diminish.

It's the reverse in the US because basic care is fairly expensive (if you need
it) but if you have a rare or chronic condition the care is available.

------
maxharris
This is a great example of why libertarians are not to be confused with
Objectivists.

Objectivism provides the essential philosophical basis for individualism and
long-term rational selfishness required to properly support political
conclusions in favor of freedom. Libertarians, on the other hand, don't know
or understand the philosophy from which many of their political conclusions
were copied, and are thus susceptible to reverting to political conclusions
that appear momentarily practical, or consistent with altruism (which many
libertarians implicitly embrace).

On top of that, "libertarian" has come to means so many things that it means
nothing - there are libertarians in favor of and against abortion, in favor of
and against anarchy, in favor of and against anti-trust regulation, to name a
few random examples.

Objectivism isn't pervasive enough yet for political change based on it to
occur, and libertarianism is a political dead end (because it's not consistent
with the terrible mixed bag of present-day American values, or with itself.)
So if you consider yourself a libertarian, and you don't like where Welch and
his ilk are heading, I invite you to read Ayn Rand and new scholarly works
that examine her philosophy deeply (Tara Smith's "Ayn Rand's Normative Ethics:
The Virtuous Egoist".)

~~~
philwelch
I read way too much Ayn Rand myself when I was about 17. Seven years later,
I've found that Rand contradicts herself in a number of places--chief among
them, as cited by generations of anarchist libertarians, is the inherent
contradiction between the non-aggression principle and government. Where she
doesn't contradict herself, she makes handwavy arguments backed by vague
assertions about human nature which, by and large, don't hold up to the actual
evidence.

I've also found that treating social and political issues as axiomatic
mathematical systems is the wrong way to go about things in the first place.

Finally, you may have misread the central point of the article. It wasn't an
unreserved support of socialized medicine, but rather an acknowledgement that,
whatever the problems socialized medicine has, the fucked-up, cronyist mixed
system we have in this country is even worse.

~~~
maxharris
You misunderstand Rand. The important thing about her philosophy is her
ethics, her epistemology and her metaphysics. My opinion is that once this is
understood, the contradictions you see cease to exist. (Specifically, non-
aggression is a conclusion, and is not axiomatic.)

The political stuff is just a downstream consequence of a much deeper set of
ideas. It's important, but politics is at the periphery of Objectivism (in
that Objectivism has political implications, just like any other philosophy),
far from the core.

~~~
jbooth
Ethics? Deliberate life-long selfishness isn't ethical.

Regardless of the window dressing. Every villain in history has had moral
window dressing that claimed they were really good guys.

~~~
maxharris
"The meaning ascribed in popular usage to the word “selfishness” is not merely
wrong: it represents a devastating intellectual “package-deal,” which is
responsible, more than any other single factor, for the arrested moral
development of mankind.

In popular usage, the word “selfishness” is a synonym of evil; the image it
conjures is of a murderous brute who tramples over piles of corpses to achieve
his own ends, who cares for no living being and pursues nothing but the
gratification of the mindless whims of any immediate moment.

Yet the exact meaning and dictionary definition of the word “selfishness” is:
concern with one’s own interests.

This concept does not include a moral evaluation; it does not tell us whether
concern with one’s own interests is good or evil; nor does it tell us what
constitutes man’s actual interests. It is the task of ethics to answer such
questions."

"There is a fundamental moral difference between a man who sees his self-
interest in production and a man who sees it in robbery. The evil of a robber
does not lie in the fact that he pursues his own interests, but in what he
regards as to his own interest; not in the fact that he pursues his values,
but in what he chose to value; not in the fact that he wants to live, but in
the fact that he wants to live on a subhuman level (see “The Objectivist
Ethics”).

If it is true that what I mean by “selfishness” is not what is meant
conventionally, then this is one of the worst indictments of altruism: it
means that altruism permits no concept of a self-respecting, self-supporting
man—a man who supports his life by his own effort and neither sacrifices
himself nor others. It means that altruism permits no view of men except as
sacrificial animals and profiteers-on-sacrifice, as victims and parasites—that
it permits no concept of a benevolent co-existence among men—that it permits
no concept of justice."

~~~
jbooth
Yeah, and if you ever wake up, you'll realize that your own interests are
_enormously_ bound up with the interests of society at large.

You drove to work today on a public road or public transit, were kept safe by
publicly funded police departments and most likely hold a knowledge-worker job
that you're capable of doing in large part because of public education
(probably).

But, yeah, you're a self-reliant rugged individualist. I get it.

~~~
maxharris
Well, that's how things are right now, but that doesn't bother me as much as
it used to. Rand's best quote on that is, "anyone who fights for the future,
lives in it today."

Rand shows that the world doesn't _have_ to be the way it is right now; she
presents a logically consistent philosophy, which we can use to guide
ourselves to much greater heights of achievement.

~~~
jbooth
Communism's logically consistent. There are people who say that communism is
actually a really good idea, Russia just implemented it poorly.

Can you see some parallels between that and the point you're trying to make?

In what world would it make sense to privatize, say, road building and make
every road a toll road? It'd be even more of a mess than private health
insurance. (EDIT: equivalent mess to the government producing toilet paper, if
you'd rather)

Anytime you manage to neatly distill reality to the point where a simple sound
byte is the solution to all of our extremely different problems, you've
probably entered fantasy land.

~~~
maxharris
Communism is not consistent with man's requirements for survival. (Unlike
animals, man's essential and unique method of survival requires the use of his
mind. For anyone that doubts that Communism deprived men of the full use of
their minds, see the sordid history regarding Lysenkoism, or the way
photocopiers were guarded behind bars in Soviet Russia.)

Objectivism holds that it is not enough to think about something in isolation
to determine its validity. It is equally important to compare ideas with
observable facts, and throw out those that are not factually supported as
false. ("The true in theory is the successful in practice.")

~~~
jbooth
Communism makes grandiose assertions about human nature in one direction,
you're just making them in another. Capitalism is the better mode for most
things, but in the real world we have nuance. Invoking Capital Letterisms
generally doesn't solve any problems.

------
100k
> Those who (like me) oppose ObamaCare, need to understand (also like me,
> unfortunately) what it’s like to be serially rejected by insurance companies
> even though you’re perfectly healthy.

So he opposes "ObamaCare" but loves the French system (no surprise, the French
system is clearly one of the best in the world) which he has access to by
virtue of marrying a Frenchwoman.

New Reason health care plan: marry a European!

------
jcnnghm
If we want lower-cost health care, we should enact stricter intellectual
property laws, and require other countries license and pay full fair for
medical advancements made in the United States. 82% of global R&D spending in
medicine comes from the United States.

The author of the article was frivolously using medical resources, which is
why he couldn't get insurance. If he has been so healthy that he hasn't missed
more than three days of work due to illness since 1986, why does he need
"routine checkups" every four months. If I was looking at that from the
perspective of an insurer, the conclusion that I would draw is that, should
this guy ever actually come down with something, he'd be in the hospital for
months.

~~~
DennisP
Three times a year is frivolous? In Japan people go to the doctor an average
of 14 times a year. They spend six percent of their GDP on healthcare and have
virtually no waits even for elective surgery. The U.S. spends 17 percent.

As for IP, what we should really do is get rid of pharmaceutical patents
entirely. There are plenty of other ways to fund the research. Half is funded
by the government anyway, and a lot of what the big pharms fund is "me-too"
drugs and ways to extend existing patents, which makes the spending numbers
kind of misleading.

