
I had a health crisis in France - stzup7
http://www.latimes.com/opinion/op-ed/la-oe-lamar-french-healthcare-20161118-story.html
======
antirez
This is normal on all western Europe states. However France has very high
standards in general about health care and is regarded as one of the best
systems. I think it's time for US citizens to accept that most of Europe has
better life expectancy, lower infant mortality than US, and to be ill is not a
financial tragedy. Moreover the treatment that a low-income and high-income
citizen receives is very similar, so there is a lot less social
discrimination. If this is not enough to show that the US system has issues,
note that also in US, healthcare procedures are generally overpriced compared
to their costs around the world. There is obviously a problem to fix and Obama
was going in the right direction.

~~~
ekianjo
> Europe has better life expectancy,

Diet has a lot more to to about that than medical care.

~~~
Retric
US has 75% higher infant mortality than France which has a real impact on life
expectancy.

~~~
brianwawok
Look at infant mortality for college educated people in the two countries.
Much more interesting. The US has massive population segments on drugs and
other segments here illegal that dont get medical care.

Generally if you are well off, the US is a fine place to be. If you are
addicted or poor, it's not so great.

~~~
alkonaut
Healthcare alone is just one piece of the puzzle. Having a french style
healthcare system without corresponding safety nets in other areas to fight
poverty/addiction/inequality etc would be better than the status quo, but not
very effective.

~~~
kweinber
Important to note that the opioid addiction epidemic is actually exacerbated
by flaws in the US healthcare system, so adoption of standards from France or
elsewhere could help with that too.

~~~
alkonaut
Not to mention how many people need addiction treatment and/or psychiatric
care who are instead incarcerated.

------
iraklism
I still giggle a bit every single time one of these EU healthcare stories pops
up.

It highlights a core difference between one of the two most "advanced" places
in the western world.

For us Europeans, we don't even think that free healthcare, free education (
university included ) , and free state support when things go wrong is a
right.

It is a as essential as a core human function as breathing and blinking. We
don't notice it, it's just there.

And most of us are more than happy to pay higher taxes in order for us ( or
our fellow citizens ) to enjoy these.

Granted , our taxes could be better managed, institutions could be more
efficient, and governments less corrupt. But until someone shows us - with
long term data backing up these claims - that there is a better alternative ,
we will keep giggling .

~~~
jdub
There's another way to look at it that I don't think the USA will be ready to
understand any time soon: Universal health and education are (key parts of)
freedom.

You can even put a market spin on it: None of the risks involved in starting a
small business in Australia have to do with health care for myself, or for
people who might consider joining my small business as employees.

I've never felt as if I'm giving up autonomy or surrendering to the yoke of
the state or whatever. Public universal health care gives me freedom. From and
for so many things.

~~~
fiatjaf
That impression probably comes from the fact that you're not on the payer side
of the bills, you're always on the receiver side.

~~~
ako
I know i pay for these things through taxes, but i think in the end it's
cheaper if we handle this through a tax system. No huge corporations looking
to improve their profits at the cost of service to customers.

I like to think of western-europe as an all-in or full-service country. Maybe
you pay a bit more, but you get way better service, and by not having to
decide and buy yourself you're left with more of what's really important: free
time.

Most of what is state provided is fairly high quality: from health-care, to
education to infrastructure our government does a pretty good job.

~~~
candiodari
Australia has exceptional demographics that make this possible - for the
moment. It won't last, for the same reason it won't in Europe. But, you get to
gloat for quite a while as an Australian, it'll last decades longer than in
Europe, where unemployment makes the current situation untenable. To put it
bluntly: Australia has a participation rate of 65%, dropping slowly (ie.
pretty much perfectly stable for the past, frankly, almost the past century).
Europe has a participation rate of 55%. Now you might think that's not a big
difference, but it's the difference between 1 worker paying for 50% of a non-
worker versus 1 worker paying for 80% of a non-worker. That means the life of
close to 2 people needs to be financed from one job in the EU, whereas in
Australia it's just slightly over 1.

Keep in mind that there is even more leverage, as people who are only employed
to take care of the elderly, the young, ... make up a significant part of the
workforce and shouldn't be counted as employed for this purpose (a
geriatrician, a teacher, a nurse, ... is paid from taxes to take care of non-
workers, that means he doesn't contribute to the economy). Therefore the
numbers in Australia, are about 1 for 1 (ie. tax rate of just shy of ~50%), in
Europe the numbers are really about 1 for 3 (ie. total tax rate of slightly
over ~75%)

But even in Australia it's essentially over. Australians should have started
to have way more kids about a decade ago to prevent what's now pretty much
inevitable. Although once again Australia gets to sit back and watch what
happens in other economies before it's forced to take action itself, like in
the financial crisis. It should do well. Doesn't change the outcome though :
taxes in Australia will have to rise to halve your post-tax income over the
next 2-3 decades. In Europe ... let's not go there, taxing at 100% would not
allow for enough economic activity to support the pensions and healthcare at
the current level of provided care. Dedicating all economic activity in the EU
to just that single purpose is ... not enough. Therefore, elderly care and
health care will have to scale down, a LOT (and may God help them if Trump
follows through on forcing Europe into defense spending). The basic problem
is, the lower the working population gets the more massive the advances in
productivity (the economic kind) have to be. There is a slight issue with
that:

[http://www.tradingeconomics.com/european-
union/productivity](http://www.tradingeconomics.com/european-
union/productivity)

(I've had healthcare in both Europe and Australia though. Let me tell you,
Europe is better. Though I guess it does greatly vary based on the exact
location)

~~~
PrimalDual
I think the story of not having enough young people to pay for older people is
missing a bit of evidence. Especially since if labor were scarce we would be
seeing increases in wages, inflation and a tight labor market. Instead we have
the exact opposite. Really the economy's limiting reactant for the past few
years has been demand not labor especially considering that a 2x improvement
on productivity is not that big if we consider that worker productivity has
been increasing much faster than that over the same period of time. How
governments fund their programs is an issue but relative scarcity of labor (or
resources) in the economy isn't one of them. This is especially true in europe
where lack of inflation has been a real issue for so long.

~~~
candiodari
Ever since the 2000 crisis labour has been abundant. So we can't even use the
labour capacity we have (not enough jobs for everybody). But that is one
perspective. It very much depends on viewpoint even here. On one hand Obama
and the government are lying : there certainly aren't enough jobs to go
around, and so many people are desperate for work. They do tend to "have
work", so the government is not technically lying, but they have part-time
jobs that they would very much like to replace with a full time job.

A simplification that has been valid for pretty much the entire 20th century
has been that a given labourer has a given productivity. So I assume that if
we have 2 young people for every 1 old person or child, for example, that the
economy would work to make that actually happen. This is not guaranteed, of
course, but historically this worked.

As for the productivity measure you mention, that's not what I've seen in the
data. Productivity measurements rose for most of the 20th century, then
flattened across the world starting around 1985 or so. There has been little
to no productivity rise in the US since 2000, and most of the world is worse
off, with the notable exception of China and some smaller parts of Asia.

Lack of inflation rises are masked more than a little bit by government
fudging. By the inflation measures of the 1980s we've consistently seen 3-4%
inflation in Europe (except in the south). The measure currently used in the
US is called "PCE deflator". You should look up why it's called that.

------
clouddrover
The US spends more per capita on health care than other OECD countries, even
ones with universal public health care:

[http://kff.org/health-costs/issue-brief/snapshots-health-
car...](http://kff.org/health-costs/issue-brief/snapshots-health-care-
spending-in-the-united-states-selected-oecd-countries/)

And yet the US has lower life expectancy than those countries:

[https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...](https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy)

~~~
vacri
The fundamental problem to solve, though, is getting money back out of
medicine. American doctors get paid ridiculous amounts more than doctors in
other developed nations. If you want affordable medicine, then medical
salaries are going to have to take a hit, so you can afford more staff
overall.

An example of how much money is in the system: I was talking to a nurse in the
US whose adult son had a series of mental illnesses. She was going to see a
specialist neurologist about one of them. "Why not ask him about all of
them?", asks I. Turns out that in the US, it's quite common for specialists to
specialise into a single syndrome, and will happily reject similar things in
their field that aren't their specialty. I was horrified - here are people
that take a decade and a half of training, all to become a glorified lookup
table. I used to work in a neuro lab myself, and while I could see a motor
neuron specialist perhaps referring on a brain problem to someone more
suitable, the idea that any of the doctors would only take patients with a
_single, prediagnosed_ syndrome... was just alien.

But in the US you can do that, and get ridiculous amounts of money for it.

~~~
alkonaut
US doctors are paid more because they take risks (they have expensive
education, handle expensive treatments etc)

If an MD cost zero to get, doctors would still be paid well, but not crazy
well.

~~~
vacri
'handle expensive treatments'? What, unlike doctors everywhere else? Apart
from the education costs, what is different?

The US also takes in a _lot_ of foreign-trained doctors, who don't have those
same education costs.

~~~
alkonaut
The costs involved are higher (though or course of the same magnitude), but
money seems ever present e.g the concept of malpractice insurance.

Foreign doctors can certainly help lower salaries for doctors but they need to
be a large fraction, if they are a small fraction they'll just enjoy the high
salaries of their US educated peers.

------
fiftypounds
I similar, but much less medically severe, experience with a gallbladder
infection due to stones. This was in Germany. The cost of the sonogram and and
ultrasound was c.a. 100 euro. The blood test was a pittance. And, becuase my
medical German was/is very poor I had an exensive private consultation with
the director of the E.R. who spoke near-natively fluent English.

The total cost: 250 euro out-of-pocket The cost of one sonogram in the US:
$1500 (before insurance)

Healthcare in the US is a byzantine protection racket and very potentially a
means to mass surveilance beyond the scope of public health.

~~~
srean
This is a topic that has come up on HN so many times that I have lost count. I
have come to the conclusion that the US milieu is so dogmatically against any
alternative that the standards of a proof that they will demand to be
acceptable far outstrips the standards that they will demand of other things.
This is the diametric opposite of preaching to the choir. Ultimately its them
who gets handed the shorter end of the stick. Some are rich enough that it
does not affect them as much. What intrigues me is the behavior and
rationalizations of those who cannot escape the adverse consequences. Forget
drug and hospitalization pricing for the moment, just the institutionalized
control (cartelization) of the license to practice medicine is a tell tale
sign.

------
kensai
Medicine is one of those few fields the "socialized" approach is actually the
better one. Of course you would prefer a I-don't-want-to-pay-for-others*
stance when you are young and healthy (ie provided you were not born with a
genetic condition or something similar), but once you start aging and caring,
you start appreciating why Medicine as practiced in Europe makes much more
sense in the end.

*even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright ([https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...](https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Security-and-Medicare-in-the-late-1970s))

~~~
wav-part
_I-don 't-want-to-pay-for-others_ != I will not _insure_ my health.

US health system needs competition more than socialism [1].

[1] [https://mises.org/blog/lack-epipen-competitors-fdas-
fault](https://mises.org/blog/lack-epipen-competitors-fdas-fault)

EDIT: A really good comment from link above.

Mark S - [https://mises.org/blog/lack-epipen-competitors-fdas-
fault#co...](https://mises.org/blog/lack-epipen-competitors-fdas-
fault#comment-2857258347)

 _The culprit in virtually all health care or drug price gouging outrages is
insurance and "free" taxpayer money. Americans want someone else to pay for
their health care -- the insurance pool, Medicare, Medicaid, the VA, the
hospital (if they are indigent). Drug makers know that someone else (not the
patient) is paying for the drug, that payee has no economic incentive to
minimize costs, and so drug makers do not care or have an economic incentive
to control their costs or limit their prices. Somebody else is paying, so who
care what the drug costs. Insurance companies pass costs along in the form of
escalating premiums, so they have no incentive to control costs (especially in
the Obamacare environment where health insurance providers are exiting the
market leaving the remaining firms with a monopoly); giverment health programs
have virtually unlimited access to taxpayer money (and, in the end, money
printed by the Fed), so they have no incentive to control costs; health care
providers also know that the patient is not paying the bill, so they have no
incentive to prescribe or investigate more afforadable alternatives._

 _People never ask "So, what does this drug/treatment cost?" but rather "Do
you accept my insurance?"_

~~~
m_mueller
IMO the US health system needs stricter regulation. Switzerland is doing fine
with a system very similar to Obamacare, with one important difference: Item
prices for health services and goods are regulated by the government. Yes I
know, small rich country yada yada - but if you look at it a bit more closely,
the average Swiss is not that different from the average American - GDP per
capita, median income, most live in diverse but smallish cities, lots of cars,
lots of guns, high (but still way lower) health spending, all quite comparable
- except Swiss have one of the highest life expectancies and can expect
treatment for everything treatable while for many Americans this seems to
become some sort of raindance.

~~~
galacticpony
Have you ever _been_ to Switzerland? I have and I find this comparison absurd.
It is a very small, very wealthy country with almost none of the structural
problems faced in the US.

The nominal GDP in Switzerland is actually much higher than in the US, it's
just that the country is way more expensive to live in. Therefore, when
adjusted for cost-of-living (PPP), the GDP are about equal.

Of course, the absolute amount of money per capita is still much higher, which
lowers the relative cost of, say, medical equipment.

The private healthcare in Switzerland is also compulsory and insurers are
forced to offer a basic, non-profit plan. Furthermore, individual payments may
be subsidized by the government. It's therefore not that different from
Obamacare, nor are private insurers left to the devices of the "free market".

~~~
m_mueller
Hmm. First you call my post absurd, then you basically repeat everything I've
written. The only point really left is that medical equipment is cheaper for
Swiss. I really don't think this makes much of a difference - the main
difference cost wise is what we both wrote: Regulations such that health
providers and insurers have strict boundaries. Btw. I'm Swiss, if it hasn't
been obvious already.

~~~
galacticpony
I called your _comparison_ of the two countries absurd. It's not obvious that
you're Swiss, it's obvious that you're out of touch and it's common for
Americans to make some simplistic argument, pointing at fringe countries like
Norway or Switzerland as an example.

You point at some facts that _happen_ to be similar (when adjusted) for the US
and Switzerland, but it's rather arbitrary. What the hell does gun ownership
have to do with healthcare? And of course, like most industrialized countries,
there are "lots of cars"...

The absolute difference in wealth doesn't affect just medical equipment, it
affects practically everything _besides_ labor. One of the reasons why labor
is so expensive is the high taxes (VAT etc). When the government subsidizes
that expensive labor, it'll get a big part right back.

You also edited your post to agree more with mine (i.e. Obamacare), when the
original point was more like "private insurance can work look at
Switzerland!".

Yes, it _can_ work, if you're wealthy Switzerland and you regulate the fuck
out of everything. Touche...

~~~
m_mueller
btw. I never edited in Obamacare, it was in there from start. The US has
enormous wealth, with a purchase power per capita almost as high as an average
Swiss, times 300 million. I think Americans should stop making excuses. I
don't see what's wrong with comparing anything internationally - you have 150
experiments with different parameters, there's no reason not to use that
knowledge if you want to figure out on how to improve or what not to do.

------
cm2187
The French health system has its own problems.

There is little evaluation of physicians so picking a hospital is very much a
lottery, unless you know insiders who will tell you where to go and not to go.

The system runs a massive financial deficit.

It is run in an administrative way which creates odds behaviors. For instance
department allowances based on % of occupation of hospital beds, which lead
them to keep people overnight unnecessarily to preserve their budgets.

The system is very liberal in term of allowing you to see specialists. That's
great in certain ways. The UK suffers from the opposite, where generalists'
job seem to be to prevent people from seeing a specialist. But it is also a
paradise for hypochondriac patients who will do dozens of useless exams
subsidised by the tax payer.

Like many centralised etatic system (and particularly in France), friends in
the right places, political affiliation and freemasonry are more important
drivers for a career than medecine.

~~~
simias
>There is little evaluation of physician so picking a hospital is very much a
lottery, unless you know insiders who will tell you where to go and not to go.

There are always variations, obviously but in general we have pretty good
doctors AFAIK. If anything we don't have enough of them. I'm not sure how it
relates to the article though, would a more liberal system improve the average
quality of hospitals? Are US hospitals and doctors offer better service that
the french ones? I'm really asking, I honestly don't know about that.

>The system runs a massive financial deficit.

It's still pretty massive but it's steadily shrinking these past few years,
although parts of it might be caused by degrading the service slightly.

The government plans for a balanced budget in 2017, although the opposition
says it's not completely true:
[http://www.publicsenat.fr/lcp/politique/budget-securite-
soci...](http://www.publicsenat.fr/lcp/politique/budget-securite-sociale-
quasi-l-equilibre-arrive-senat-1562864)

This article gives a good overview of the situation as far as I can tell:
[http://www.lemonde.fr/financement-de-la-
sante/article/2016/0...](http://www.lemonde.fr/financement-de-la-
sante/article/2016/09/22/le-deficit-de-la-securite-sociale-reduit-a-son-plus-
bas-niveau-depuis-2002_5002108_1655421.html)

>Like many centralised etatic system (and particularly in France), friends in
the right places, political affiliation and freemasonry are more important
drivers for a career than medecine.

What does that even mean? You went full tinfoil here. Whose career are you
talking about anyway? Do you have any source?

~~~
cm2187
> _would a more liberal system improve the average quality of hospitals? Are
> US hospitals and doctors offer better service that the french ones?_

I am not sure it is a liberal vs non liberal. But doctors like any profession
need to have a way to be evaluated. It is a fact that there are good, average
and bad doctors (like any other profession). I understand that in the US,
insurance companies play this role. They are maintaining detailed statistics
of acceptable success rates and will apply pressure when they see physicians
underperforming.

On careers, I come from a family of doctors, so it's rather a long succession
of first hand anecdotes than articles. Careers in public hospitals are very
much driven by these things at a more senior level. I'm afraid no tinfoil
there.

------
grecy
Of course, this is perfectly normal in the developed world.

My brother broke his leg horribly a few years ago. Ambulance, helicopter,
plane, 3 surgeries, a month in hospital, steel plates, etc. etc.

In Australia, you don't pay a cent out of pocket for that, it's all covered
with taxes.

Similar story in Canada too. Even little stuff like I broke my nose - into
hospital, xrays, time with dr to straighten, appointment a few days later to
check, etc. All free.

The difference is simply that Health Care is run for profit in the USA.
Someone wants to profit off your health (or lack thereof) so you must pay a
lot of money to line their pockets. Some story for Higher education,
incarceration, etc.

~~~
totony
Its the same in Canada, it's not because it appears free that they don't run
for profits. Health care is a massive public spending and shows when you look
at the taxes you (or your employer) pay

------
madaxe_again
I was hospitalised in France last year - and coming from the UK, which has a
social healthcare system too, I was likewise blown away by the quality of
care.

I was staying in a remote house, miles from the nearest village, an hour from
the nearest hospital. After about four days of continuous vomiting in 40
degree heat I caved and called a doctor, in the hope of getting a prescription
for antiemetics over the phone. It's Sunday. I figure it's a long shot but
can't hurt.

Well, I call and she says "sorry, can't give you a prescription over the phone
- but the doctor will be with you in ten minutes". I was sat there expecting a
call back when the doctor _shows up at my house_. Checks me over, says I need
IV fluids pronto, do you want an ambulance for €20 or do you want to get
yourself there.

Wife gives me a ride to the hospital an hour away. The place has recently
undergone big budget cuts so they've mothballed a big chunk of it, and it
looked a bit sad, but inside everything was new and clean, and I'm seen within
a few minutes of arriving. By a consultant surgeon who was called in to arrive
a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and
about six hours later an functioning again, and they're saying I can stay or
leave, my choice, and here's a folder of information for you to follow up on
back home.

All of this cost less than €60, and I honestly felt like I had all of France
mustered and rallied to my care.

I had a similar experience earlier this year in the U.K., and the contrast was
significant - in the U.K. one feels like an irritation and an inconvenience.
"Bloody hell, what's a patient doing here? This is a hospital!". I still got
decent treatment, of course, but it was all with a grumbling, discontented
overtone - and despite it being a new (15 yr) old hospital, unbelievable
amounts of equipment didn't work. There was a diabetic guy on a sugar
monitor/drip on my ward that kept crashing - so their solution was to have him
wake up and reboot it every 20 minutes so he didn't die. They didn't have
another one available.

It's just astonishing to see how two supposedly similar socialised healthcare
systems can end up so very different in their output.

~~~
markharris99
> I had a similar experience earlier this year in the U.K., and the contrast
> was significant - in the U.K. one feels like an irritation and an
> inconvenience. "Bloody hell, what's a patient doing here? This is a
> hospital!".

I'm 50. I remember what London was like way before Labour first got into
power.

Lets look at today. Immigration is way out of control. London has probably 10
million people? It's busting at the seams.

I even travel to the south near the beach. Waiting for a doctor there?
Sometimes up to a month.

I can remember when I would call a doctor and be seen the next day. Not any
more.

The reason for the attitude is that doctors and nurses are at breaking point.
I'm sorry if the down voters don't like hearing this but it's true.

Incidentally I voted to leave. But I think it's too late. We should have left
before Labour got into power with Tony Blair. Like the Democrats in the US,
they wanted immigrants from all over to change the political landscape and
keep them in power. Regardless of native population.

~~~
YeGoblynQueenne
>> Like the Democrats in the US, they wanted immigrants from all over to
change the political landscape and keep them in power. Regardless of native
population.

You're being downvoted to unreadability anyway, but I feel I should clarify
this just for the sake of people who are unaware of it: _immigrants to the UK
don 't get a vote in parliamentary elections_ and therefore Blair's Labour
could bring in the entire population of Asia, he still wouldn't have got a
single vote out of them.

And he couldn't have just given them all British citizenship either: in
general one needs to have residence before being elligible for citizenship.

Residency is obtained automatically after five years of living in the UK (if
you can prove it anyway). Parliamentary elections happen every four years. We
now have a Tory government, the second after ten ish years of Labour. Clearly,
if Blair had a cunning plan it wasn't cunning enough.

And even if the numbers don't move you, think of it this way: if immigrants
had any say in the governing of the UK, the country would not have just jumped
off a cliff with a weight tied around its neck (a.k.a. Brexit).

~~~
KaiserPro
Just to make even clearer, residents cannot vote in general elections, unless
they are from the commonwealth.

------
gerty
I heard an argument some time that European healthcare and health R&D is
indirectly subsidised by the US. The mechanism at works is 1) US consumers are
ripped off by pharma; 2) pharma's higher profits lead to higher investment in
R&D; 3) everyone profits from that and in the European case negotiate lower
prices. I've always wondered to what extent this is true.

~~~
walshemj
allowing the government to negotiate for the best price would be a start

------
kelvin0
I'm sure it's great ... in France. Because here in the province of Québec
(Canada) it's hell on wheels. Granted we have 'free' access to healthcare, but
waiting 24 hours in an emergency room is not uncommon due to the shortage of
Doctors and low incentives for them to work in the public system. I think it's
only marginally better than the USA because it's cheaper, but the actual care
you get is scary bad in most hospitals and clinics. Couple that with an ageing
population, it's a nice recipe for the shitstorm we call healthcare in these
parts ...

~~~
davidy123
You're exaggerating. I've gone to or with multiple emerg visits in Quebec,
none even the most critical issues, and have rarely had to wait for more than
a few hours, including diagnosis and treatment. If you go to the wrong
hospital at the wrong time, it can be worse, but not to the level you
indicate, and sometimes it's faster.

There are sometimes long very wait times for non critical scheduled tests,
which is a problem.

The real problem is people with chronic conditions who will have to dedicate
much more of their life to their health, which is dangerously demoralizing and
a career killer, but I am not sure that's much different in other parts of the
world.

------
tim333
I note the president elect has said in the past:

>"We must have universal healthcare...I'm a conservative on most issues but a
liberal on this one. We should not hear so many stories of families ruined by
healthcare expenses...

I know he flip flops all over the place but maybe if people lobbied, something
could be done.

------
raphaelj
> My individual burden, however, is far more reasonable than

> an American might assume. I pay an annual income tax of

> about 23%.

How comes this number is that low? Tax revenue in France account for about 48%
of the country's GDP[1].

I'm living in Belgium, and my payroll tax is already higher than these 23%.

\--

[1]
[https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...](https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_as_percentage_of_GDP)

~~~
ThePhysicist
In France you pay 0 % taxes for the first 9.700 € of income, then 14 % for
everything up to 26.791 €, then 30 % for everything up to 71.826 €, then 41 %
for everything up to 152.108 € and 45 % for everything beyond that [1]. Hence
23 % effective tax rate sounds reasonable for an average income of around
50.000 €. The tax system in many European countries is similar btw, as is the
health system.

[1]
[https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...](https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_sur_le_revenu_en_France)

~~~
ekianjo
You don't live in urban centers like Paris with 50k revenue.

~~~
corin_
That's a ridiculous statement, many people do. I personally wouldn't, sure,
it's an expensive city to live in (I have lived there), but €50k is I think a
little above the median salary there. You could easily survive on half that if
you needed to, I know many people who do. Not everyone lives in the privileged
world of tech salaries, think through all the jobs people do in Paris and
think if they're all being paid 50k or more..

------
logronoide
For a Western European this is the normal.

~~~
gambiting
As a matter of fact, I'm very surprised he had to pay anything at all. 1300
euro for hospital bed and food? This should be completely free.

~~~
megalomanu
He says he used wifi, TV, telephone, and asked for a better room. If he didn't
ask for this, I think he wouldn't have pay anything. The French hospitals
offer a lot of paid bonuses. I think it's a good thing, it allows to make the
basic needs free.

------
yodsanklai
Just to give a different perspective, I think it's fair to say French people
are very worried that healthcare quality is decreasing. I don't know if it's
really the case but in any case, the system is far from being perfect.

For one thing, some care are very expensive, like dental crowns and implants.
In the article, the author says he had to pay 1300 euros for 47 days in the
hospital. You're likely to pay more for one dental implant, unless you have a
very good insurance in addition to the regular social security (most people
don't).

If you have to go to the ER and if you don't have a life threatening
condition, expect to wait many hours in an overcrowded waiting room. Moreover,
to see some specialists (e.g. eye doctor), you may have to wait for months to
get an appointment. The list goes on...

~~~
RobertoG
It seems to me that, as a society, to choose for a longer waiting list and
uglier waiting room it's a small price to pay in exchange of healthcare for
everybody.

About the decreasing quality: there is a clear pattern where, you cut
financing of public resources and, then, you can show how bad they work and
how best a private system would be.

------
YeGoblynQueenne
I think I (living in the UK, currently an EU country) understand the mentality
behind the US healthcare system(s).

I think it's along the lines of "Why should I pay for someone else's
healthcare?".

I've heard similar arguments from British people (I'm rather more socialist in
my outlook than average, for a UK resident, I fear) and I don't really have an
answer to that. Why indeed?

I'm probably conditioned to answer this with a "duh, because they're your
fellow citizens". But I guess that's not everyone's cup of tea.

~~~
trprog
>"Why should I pay for someone else's healthcare?".

>and I don't really have an answer to that. Why indeed?

Because you don't know what is going to happen in the future. One day you may
wind up broke and be diagnosed with a serious illness. And what about any
children you may have. Wouldn't you like to know that they will receive care
after you are dead no matter what is going on in their life?

~~~
YeGoblynQueenne
Actually, I know exactly what's going to happen (to me) in the future: I'll
eventually grow old, get sick and die in pain. Or maybe I'll just get the "die
in pain" part. That's how it goes, right?

And in the past I was very young and couldn't yet fend for myself. I
benefitted from being born in a developed nation and, like you say, if my
parents had died while I was young, I'd have been taken care of (though in my
country's case it would probably be my extended family that'd have looked
after me, first, and the state would only intervene if I had noone to care for
me).

Like, I totally get what you're saying, but a significant number of people
don't see it that way. Maybe they forget they were once too young, or that
they will one day be too old. Maybe they just think they can do well enough
for themselves that they'll just wing it.

My point is that for many people contributing to things like public healthcare
doesn't make sense.

For instance- in the UK education is not free, and you will hear lots of
people saying, indeed "why should I pay for someone else's education?". That's
much more common than grumbling about having to pay for the NHS, but in the
end it's just the same thing.

------
on_and_off
I am French and live in France right now. Recently I had to undergo a surgical
procedure. Nothing as serious as heart surgery, but still one day at the
hospital and general anesthesia.

This has not affected my personal finances and I only had to focus on getting
better.

I would like to move to the USA but I have got to admit that it frightens me
that this kind of issue would have costed me a lot and a serious health
condition could bankrupt me.

This is not ok. It saddens me that USA have not been able to instore a sane
health care system.

------
bluejekyll
In these discussions I think people often overlook one significant factor in
delivering services to people in the US; population density. The EU and also
France, have a higher population density than the US. The US is 33 per km,
whereas France is 100, based on Wikipedia.

This translates to higher costs because maintaining hospitals in low density
areas raises the cost of care per capita. This is also a reason that inter-
regional train service has never been a good option in the US.

There are regions where it works, but coming up with a one-size fits all
solution is hard. The metropolitan regions of the US have always subsidized
the rural parts. We people of the cities have always paid a fee on our phone
bills that helps reduce the cost of phone service in rural areas, as an
example. I actually dislike this, because I think it subsidizes sprawl.

I believe the ACA is a good step (personally I'd like to see Medicare offered
as on option alongside all state insurance plans), but it does need fixes.
Whatever the solution, it's going to look different from Europe and France in
particular.

------
fiatjaf
"I pay an annual income tax of about 23%."

So you don't pay any kind of VAT?

That also wouldn't mean anything, if the State is not taxing you so much, but
it still has money to finance these things, it is obviously because it is
taxing other people a lot more and using the money to treat your health.

I would not find it very good to have my needs fulfilled with stolen money, as
you seems to be finding.

~~~
nraynaud
VAT is 20% in France, and the biggest source of income for the State. But
social security has a separate budget and is not paid by taxes, but by special
levees on salaries and income.

------
hartator
I think it's worth noting that Americans already pay around 20% more taxes for
healthcare per capita than Frenchs. Where went the tax dollars?
Straightforward corruption is a better answer than "systemic issues".

------
fvdessen
A healthcare system that I like quite a lot is the Belgian one, which is a
nice mix between free market and socialised medicine. In Belgium the
government sets standard rates for different kind of medicines and treatments.
You pay 8% of your income towards a state health fund that refunds all your
health-related spending up to the standard rate. You are free to choose where,
when, and what treatment you get. You pay the cost up-front, and then you get
refunded by the state. But you only get refunds up to a 'reasonable' rate. In
practice most doctors demand little-more than that rate, and thus you get a
full refund. You can also subscribe to a private health insurance if you want
to get refunds for better options.

~~~
trmsw
I agree. The general standard is good (my wife's experience of giving birth
here was much better than my sisters'in the UK) and if you have the money you
can choose to pay more for comfort or convenience.

------
djfm
I'm French, I'm not always proud of my country, but today I am!

------
amelius
There is an interesting documentary about the health care system in Europe:

[http://www.burning-out-film.com/](http://www.burning-out-film.com/)

------
smcl
It'll be a long time until the entire USA implements socialised healthcare (if
it happens at all...) but are there any individual states which have something
resembling a single-payer system, or is this an issue where they all have
roughly the same system?

Also for some reason this reminded me of a BBC story I read a while back -
where "Heavy Legs" is described as a medical condition that only exists in
France:
[http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...](http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7779126.stm)

~~~
phonon
Well, Medicare (health insurance for people 65+) is not that different, and is
essentially a federal single pay program. (Though they don't pay salaries, but
on care provided like regular insurance).

The military health system (for veterans, the VA) mostly have their own
facilities, but don't have the best reputation (and have had some scandals
recently...
[https://en.wikipedia.org/wiki/Veterans_Health_Administration...](https://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014)
)

Medicaid (for poor people) is managed at the state level, and is 50% federal
funded (and each state has different income limits for who is covered)

All three of the above make up roughly half of all US health care spending. At
the state level, some states have additional programs and subsidies, like
[https://en.wikipedia.org/wiki/Massachusetts_health_care_refo...](https://en.wikipedia.org/wiki/Massachusetts_health_care_reform)
and Obamacare tried to create something similar for all states with uniform
availability and coverages along with subsidies (and penalties for people who
voluntarily decline to purchase health insurance).

[https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...](https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act)

So yes, it's a complex kinda mess...but there are too many stakeholders in the
current system for it to be easily changed.

------
partycoder
Healthcare professionals are expensive since they require significant
preparation.

But there is fishy stuff going on too...

1 liter sterile bag of saltwater for intervenous use in American hospitals is
charged at over $300, not considering the cost of the procedure, which can
total $500.

The pharmaceutical industry also does some sort of disservice to society by
inflating prices so much.

Then, some money stays at the insurance companies instead of going to actually
improving healthcare itself.

~~~
ReallyAnonymous
High charges of low cost items are because of the amount of free care
hospitals provide. I'm a physician in South Carolina and I take care of a
tremendous number of fully employed people with no health insurance. Those of
us with insurance pay for those without by paying higher costs. This gentleman
would have probably received the same treatment in the US (at least at my
facility) and received a $300,000 bill, of which he would probably never pay
(bc he cannot). That artificial aortic graft sewn in probably cost the
hospital $1500. It doesn't receive that for free. Nor does it expect the 7-8
people in the operating room or the post operative care to work for free. My
hospital has an operating profit of less than 1% mainly because it provides so
much free care. All I have to do to take care of a patient is declare it an
emergency and there is no stopping of whatever care I feel is necessary to
care for the patient, e.g., a newly diagnosed cancer patient. This, I believe,
is true throughout the USA. And most of the people I take care of have jobs,
but no insurance. Ask how many people that clean hotel rooms have insurance.
How about people that work call centers? That, plus monopolist practices of
the pharmaceutical industry and you have high costs.

And if you want physicians to make 100k - 150k, don't expect me to work 80+
hours a week, not including call. Attorneys give me $500 / hr for
consultations, but in my real job I make $80 / hr, but just work a ton more
hours a week (no overtime bonus, tho). I don't get sick days. I don't get
vacation days. When I don't work, I don't get paid. When I was in private
practice, when I didn't work, I not only didn't get paid, but still had to pay
rent / malpractice / insurance / electric / employees which was about
$5000/week for me. So taking a week off cost me lost revenue and $5000/week.
Medicare pays $600 for taking out a gallbladder. Do the math to see how many
have to be done to take care of the bills.

~~~
partycoder
Thanks for the explanation.

How would you improve this system? Do you think universal healthcare would
help?

~~~
ReallyAnonymous
I think universal healthcare would definitely improve the system. So in the
US, healthy, employed by big corporation people, pay about $17k / year for
family healthcare. Then, when they turn 65, they join medicare and the
insurance companies laugh bc they received premiums for 40 years and then when
people need services, they don't pay.

Imagine if medicare started receiving payment at age 20. By the time someone
turned 60 the return on investment / interest would more than pay for their
care. Insurance companies don't want the average american to know that. I
think that either 1) offer medicare plan for anyone, regardless of age and
discount based upon years of contributions or 2) make insurance companies
allow individuals to pay medicare rates once they turn 65 if they've
participated for, let's say, 15 years.

I'm almost 50 and have used less than $400/year since 21. Yet, I pay $4400 for
a $6000/deductible plan. So I've given my insurance companyn $100k at least in
my lifetime. But when I turn 65, all my care will be covered by medicare.
Trust me, I know what symptoms to say and may have multiple bad symptoms from
age 62-64 and undergo lots of tests, instead of medicare paying for preventive
tests.

The system is broken, but so is politics, so nothing will change. Even Trump
ran under the pretense of allowing us to buy pharmaceuticals overseas, allow
purchase of insurance plans across state lines, make hospital costs
transparent ---> all that would lower costs, but apparently, they won't
happen.. Just like with the democrats. The US healthcare system is controlled
by the pharmaceuticals, suppliers, and hospitals and nothing soon, other than
a Bernie Sanders, will change it. The 3 competing hospitals in my area,
serving less than 1million people have a CEO cost of more than $7 million! So
across the US, I would imagine that total CEO cost is in the billions.

I don't have solutions, only depressing facts.........

------
pentae
Couldnt the US Gov just use Medicare as a private health insurance option that
runs not for profit and offers a lower cost than private insurers? It could
then negotiate low rates with pharma companies and hospitals on behalf of its
customers and eventually justify tax assistance. That would essentially let
the 'free market' stay in effect and be a shortcut past the lobbiests.

~~~
phonon
[https://berniesanders.com/issues/medicare-for-
all/](https://berniesanders.com/issues/medicare-for-all/)

------
CarolineW
But that's socialism, and the USA will _never_ tolerate socialism.

~~~
EliRivers
But only if it's called socialism. If it can be called something else, then it
will be accepted. In my experience, US citizens (not all, obviously; I'm
massively generalising) have been conditioned to be against things labelled
socialism, but the level of economic and political knowledge amongst the
general public is such that if you don't call something socialism, it is
judged on its own merits without people realising.

~~~
CarolineW
Opponents will hang that label on it, and then it doesn't matter whether or
not the general populace would recognise it.

It's interesting that my comment is somehow controversial, because it's been
down to -2, is now back to -1. I wonder whether they are objecting to my
calling "universal healthcare funded by taxes on the general populace"
_socialism,_ or whether they are objecting to the claim that the USA populace
would ever accept a socialist policy.

Indeed, while I've been editing this comment it's gone back down to -2.
Interesting to watch, and I really do wonder what it is that's provoking
people into downvoting it.

 _... and now back to -1. Fascinating!_

~~~
woofyman
You're absolutely correct. Conservatives will label it "socialized medicine".

------
coldcode
While I would like to have read the entire post, the constant flashing ads and
overlays gave me a health crisis and I was forced to abandon the article.

------
digi_owl
The impression i get about US healthcare is that there is a vicious cycle of
insurance agency haggling and hospital profits.

------
ThomPete
Having had two melanomas and most likely to have more and having grown up in
Denmark with universal health-care and now living in the US with insurance
based healthcare I have been thinking about health care in general a lot.

Some random thoughts:

You can never spend enough on healthcare. There is always new machines, new
technologies, new drugs, new treatment types, better educated doctors we could
spend our money on if we wanted to. Furthermore we are treating people earlier
and earlier and for more and more things. The old saying that if you are not
sick it's just because we haven't found the right diagnosis for you seems to
be true.

In effect whether you are in a private healthcare system or a universal one
whether you pay double or your get taxed 100% there will never be enough money
for healthcare.

Now depending on whether you have private healthcare or public healthcare the
way you measure it is completely opposite. In a private healthcare system
everything is a potential profit center. I.e. the more people who are sick the
more money can you potentially make.

In a public universal healthcare system everything is a cost center. You have
a budget and you have to deliver to a politically decided standard.

Both have pro's and cons. To give you an example.

It took me 3 weeks to get a time with my dermatologist in Denmark, when i
finally got it it was the day before I moved to the US. The Danish
dermatologist found one they considered troublesome, but they couldn't
themselves do the biopsy and I had to get a time at a hospital to get it.

I decided to wait until I got to the US ignorant as I was I thought it was
just a question of formalia. But no I had to wait a whole month for my
insurance to work (that is a whole other discussion for another time)

When I finally got it though, I got a reference for a dermatologist same day
and they did the biopsy, same day. Today I am at Sloan Memorial with one of
the best dermatologist in the world getting checked every 3 months having a
complete 3d scan of my body (in blue speedos and a white net) and hopefully we
will be able to make sure that I am being managed properly.

What I am trying to say is that the level of expertise a private healthcare
system allow for is more flexible than a public one because it allow for the
allocation of resources. On the other hand if you look at those let fortunate
than me, with worse healthcare plans etc they will get a less favorable
treatment. I.e. the system isn't evenly distributed.

What the public healthcare system secures is that it's mostly evenly
distributed but with less of a flexibility to build experts as there are
budgets and a bigger need for priorities in any publicly funded system as it's
a cost center.

So you have fundamentally two system where one covers only those with
insurance but allow them to potentially pay their way to the latest treatments
with the best doctors and the other where everyone gets treated but you don't
have the same amount of experts and potential treatments.

Neither systems are really optimal. Do we want to have people die because they
can't get healthcare coverage or because they can't get the necessary
treatment because it doesn't exist in the country they live. I know it's more
complicated than this of course but in broad strokes thats at least my
perspective and this has lead me to the following observations.

1) Both systems are fundamentally financially unsustainable in the long run.
Whether the system succumbs to it's own weight by costing the tax payer too
much to pay for everyone while only delivering average treatments or whether
it's impossible for the insurance companies to secure a large enough part of
the population without leaving too many without proper coverage. Both just
doesn't sound "right" (I know Germany, and Switcherland have some variations
that sound more right but I am not sure they don't fall into the trap of
either the cost center, or the insurance cost issues.)

2) One way to solve it is to ensure that people pay for all the normal
encounters they have with the doctors (sore troth, hernia, back pain etc) but
that you insure yourself against long term illness. In other word we should
pay for normal things but no one should be going bankrupt because they can't
pay for long term or serious illness.

3) By removing the insurance part from a lot of the normal encounters with the
healthcare system and only putting it towards more serious conditions
hopefully doctors will start to compete against each other rather than spend
all their time fighting with the insurance companies.

4) I have a naive hope that technology could somehow limit the cost of many of
the more complicated treatments. Over time hopefully many of the things that
are wrong with us can be treated via gene-therapy hopefully not requiring too
many people to do the actual treatments.

5) I think we have to come to terms with the fact that none of the systems
really work and that all of them have solutions to problems in the other
systems. That way perhaps we can start to break down healthcare into more
discreet parts rather than the giant monster that it is today.

Thoughts?

------
thro32
Real problem in US with health (and education...) is that cost has skyrocketed
out of control. How much is hearth bypass ? $30k? Other countries do that for
$4k with similar quality and better post-op care.

Public health care will just transfer more money from poor to corporations
(like with education). You need to fix the leaks first, for example sponsor
medical tourism to other countries, etc...

~~~
lumberjack
I don't think "the cost skyrocketed out of control". The cost is simply
reflective of the leverage the health care provider and all the middle men in
between hold against the patient.

It's just that in other countries you have the government setting up a
monopsony and dictating costs and salaries.

I don't see how charging $30k for a heart bypass is unreasonable for somebody
making $50k/year.

~~~
thro32
Reducing cost is always good. Is not that mantra of free market and
capitalism?

~~~
subhobroto
It is.

Unfortunately, a free market for helathcare does not exist in the U.S.

------
angry-hacker
Does France really have that low tax rate? Usually it's not only income tax
people are paying over here and once Americans laern the total % of your money
regular Joe pays for the government they are in shock, since they are not used
to having so little money being left on the table.

~~~
ekianjo
> Does France really have that low tax rate

No, its much higher than 23% as claimed by the author. At least in the 30 or
40% depends on your level of income. Its also fair to say that there is a
large amount of households in France that pay no taxes at all.

~~~
omginternets
>Its also fair to say that there is a large amount of households in France
that pay no taxes at all.

It should be specified that this is because the French tax code provides
exemptions to people making less than I-forget-how-much per year.

------
osti
I think one of the reasons the French can afford it is because their doctors
don't get paid an asinine amount like in North America. Imo one of the reasons
healthcare system sucks here is because our doctors get paid way too much, and
that is probably caused by neeldless high entry requirements to become a
doctor.

------
saosebastiao
As a supporter of Single Payer that grew up in a hyperconservative home, this
sort of article completely misses the point for those that oppose it.

To a conservative opponent, getting high quality care at a low out-of-pocket
cost is a result of health care being a redistributive social good, and
"social good" is just code word for "shirking individual responsibility". They
look at this situation and this author like they do their proverbial welfare
queen...a beneficiary of their taxes.

If we actually want to convince them, we have to prove to them that Single
Payer is an objectively more efficient system than insurance. In other words,
were the total incurred costs lower than they would be in a our system?
Because for them, that's an argument that matters.

Unfortunately even I, a strong proponent of single payer, would find a cross
country comparison here to be disingenuous. Because it doesn't matter how
efficient the French are at administering health care. What matters is how
efficiently _we_ would be at administering it. And hands down, we suck at
government administration. Whether it is infrastructure, military, health, or
whatever...everything we do costs more and takes longer than other governments
doing the same thing.

And this is the major reason why our politics suck IMO. We have one side of
the table that is 100% more government because government is awesome, one side
that is 100% less government because government sucks, and nobody is arguing
that we should be making government more efficient. And so we never get nice
things.

~~~
zo1
" _And this is the major reason why our politics suck IMO. We have one side of
the table that is 100% more government because government is awesome, one side
that is 100% less government because government sucks, and nobody is arguing
that we should be making government more efficient. And so we never get nice
things._ "

Well, that'll continue happening as long as you force it to be one giant pie.
If you let people choose in the first place, then _you_ can have your nice
things. You just have to pay for them yourself along with those individuals
that agree with your viewpoint. And the rest of us will have to _choose_ to
either join you, or do it some other way.

All arguments eventually lead to choice. Freedom and consent are fundamental
properties of a libertarian belief system. We don't get to throw those out
just because it'll be efficient. You could argue that it's efficient to just
execute all repeat-criminals, but we don't do that because of fundamental
human rights that are completely separate to the concept of pragmatism and
efficiency.

