It is interesting that the comparisons are always made to the worst of the public health care systems, which are undoubtedly in Canada and England.
Canada has effectively communized its doctors, refusing to permit any of them to truly practice privately. Britain does allow private practice, but costs are prohibitive.
When Mrs. Clinton decided to try and nationalize American health care, her model was essentially the German model of insurance pools.
But I am going to talk about none of those models, nor Cuba nor Tadjikistan. I'm going to compare the US with the best system of public health care: France.
FReepers love to hate France, which is fine.
But let us be objective.
How can one objectively measure and compare health care systems? I would say that two numbers give a good, though not perfect, feel: life expectancy and infant mortality.
Neither of these things are perfect, of course. The Japanese diet is very heavy in fish, as is the Swedish, and they live longer. Is this because Japanese and Swedish health care are superior, or because they eat a lot of fish?
But Canada, America, France, Britain and Germany: these are comparable countries. The heaviest drinkers in that group are the French; the heaviest smokers, I believe, are the English, although the French are much heavier smokers than the Americans. The dietary practices of all of these countries are generally poor. Americans and Canadians eat fast food. The Germans eat tons of sausage. The French butter their cheese. And the English eat, well, garbage.
So, we are comparing relatively comparable groups, with no stellar dietary practices among any. And the French are heavier smokers and much heavier drinkers than the Americans. But they live longer than any of the countries mentioned. They also have the lowest infant mortality rates. Those things are attributable to health care.
The thread already discusses the bad things about the British, Canadian and German health care systems, the heavy hand of government, rationing, etc.
What is the French system?
It is not "government health care", really.
The French system is the American health care system: doctors are independent and free. There are public and private hospitals. Entry into the medical profession is unrestricted and available to any students who want to study it and get good grade. And anyone can go to any doctor or facility he chooses. There is all of the liberty of the American system in the French system, and none of the heavy-handed restrictions.
So, what is the DIFFERENCE then?
The difference is that primary health insurance - NOT provision of health care, but insurance to pay for health care - is provided by the national health insurance, called "Social Security" - the Secu.
You go to the doctor, you pay, yourself. And then you send the bill off to the Secu. The Secu reimburses you the portion of that which is covered according to the schedules. The schedules are relatively generous, but there is a co-pay element for most things of 10-20%. The fact that you have to pay for the care first, out of pocket, and then be reimbursed is itself a deterrent to abuse. The 10-20% co-pay is also a deterrent to abuse.
Everyone is covered. Everyone pays taxes, of course.
Now, if you think about it, America already has this system. It's called "Medicare" and it covers all retirees. In France, Medicare covers everyone from prenatal care through death. That's the difference. So, in France there is nobody who is not covered. That is one advantage of the system.
A second advantage of the system is that everyone is in the pool. Pooled insurance is always cheaper per capita than individual or small group insurance, and the bigger the pool, the more the cost is spread.
What are the disadvantages of the French system?
Three:
(1) People who do not have the means to initially pay for the care have to scramble a bit. Of course the truly indigent get state assistance, but it is true that you pay out of pocket first, and get reimbursed later. This is intentional. It's a deterrent to abuse and hypochondria. Not a huge deterrent but a deterrent. The advantage of doing it this way is that the doctor is paid at once. Medical practitioners do not have to battle with the insurance company the way American doctors do. The individual submits his or her claim to the Secu.
(2) The co-pay. 20% of health care expenses can be quite high for expensive conditions like cancer. Once again, the truly indigent are covered, but everyone else isn't. The solution, of course, is found in the free market. There is a robust private health insurance industry in France, which aims exclusively at the "Gap". Of course, the same is true in the United States with Medicare "Gap" coverage.
(3) The French system is expensive. Let's not kid ourselves here. The French have the best health care system in Europe, and are about the only ones to have a thriving pharmaceutical and medical research industry (because the doctors are free and therefore, like Americans and unlike English and Canadians, have an incentive to research and advance new techniques), but it costs a lot more per capita than the English, Canadian or German system. The French pay a lot more in taxes for their Secu than the Germans or English do. But it's still cheaper than the American system, and it produces better results.
Now, when I saw that Mme Clinton was studying health systems and going to propose something for the United States, I was surprised that, having studied different systems, she opted for a quasi-German system instead of the French system. Clearly she was not aiming at the highest quality of care - or she would have chosen the French public insurance system. She was looking for something much cheaper. The trouble with that is that it just isn't as good, and Americans will never accept that.
Americans, like the French, want the highest quality medical care in existence. And they are willing to pay a premium for it. The French system delivers as high, or higher, standard of care as the US, at a very high price compared to the rest of Europe, but at a moderate (though not low) price compared to America.
Part of this is the effect of economies of scale. Having one pooled insurer cuts down on costs, as the article says.
There are other structural differences with the USA, though, which do come into account. In America, licensing is by state. This is nonsensical. The human body does not change jurisdiction by jurisdiction. But the American Medical Association has a monopoly on access to the profession, and uses licensing requirements and rigidities to maintain a sort of protected guild system. This, of course, inflates the cost of care for Americans and reduces the mobility of doctors. But this is only a small thing.
The key difference between the French and American system which accounts for a substantial portion of the difference in costs is not medical at all. It is the incomprehensibly bad - if not outright insane - American legal system, in which a spilt cup of hot coffee results in a $2 million fee, and normal bad luck in medicine is invariably sued for millions. American malpractice insurance is tens of thousands of dollars a year, and this of course drives the cost of medicine sky high. Also, American doctors practice extremely defensive medicine, undertaking unneccessary tests that have no medical value, but which protect against lawsuits. Doctors get sued in France too, but things are limited by a naturally conservative legal system that does not like to be used like a slot machine and which does not award significant punitive or speculative damages.
Strip those elements away, and French health care is only a bit less expensive than American, and a LOT more expensive than the other European alternatives. But everyone is covered, and it produces better average results than the American.
It's a good system.
Of course, therefore, Mme. Clinton did not even consider it.
I scratched my head and pondered WHY at the time, and why NOW, whenever national health systems or insurance is discussed in America, the bad models are always cited to, but never the good French model, which really allows the market to ration the care, and relies upon taxes and private insurance to pay for it...and still ends up cheaper per capita than the US system...
It took me some time to figure out WHY the French system is ignored in the US. On the right, of course, ANY sort of "public" system is met with hostility, and anything French MUST be bad. But that is only what we should expect to hear.
But why does the American LEFT ignore France's model and focus on the Canadian and British models? Many Americans of the Left know France. They are not wholly ignorant.
I pondered this long, and then it hit me.
The American Left ignores the French model because it is too free. The doctors are left free to do as they please. And the private insurance companies still have a substantial and lucrative 20% niche. Patients are not herded through gatekeepers and HMOs. French medicine is as free to its participants as American. The only difference is the public insurance pools and universal insurance coverage (and, of course, a sane legal system).
The American Left does not like this model, because there is no control. The doctors are not controlled. The patients are not controlled. The insurance companies are free to compete in their niche. American leftists do not JUST want universal coverage. They want universal coverage WITH PATRONAGE, POWER and POLITICAL CONTROL.
And that is emphatically NOT the French system.
The French system still has a large research sector, and is quite expensive by European standards precisely because it is NOT centrally controlled. The professional bodies of doctors oversee the medical profession itself. Not the funding bureaucrats.
This is too free.
Americans always talk about Canada and Britian and their not-very-good health systems because that's all the American LEFT ever proposes to them. The American left, like the left everywhere, above all desires not quality care but COMMAND.
If America is driven by politics and needs to adopt a national health system, the Americans will be fools to not consider and adopt the French system. It is the only one that has the requisite degree of freedom, which Americans hold almost as dear as the French. The Americans have flirted with the German-style HMO system. It is better than the British system, to be sure, but it is still heavy handed, and the doctors command the patients and the patients cannot choose their care or go to specialists without permission.
This is absurd.
If America is going to have national health care, it should be INSURANCE that is national, and not health SERVICES. There should be co-pays, and private insurance for the gaps. And the doctors must be left free. And there must be tort reform. The French system is the only ones the American people would ever be able to stomach. Which is why the Americans have adopted it...for everyone over 63, in Medicare.
Perhaps it will make it more palatable if Americans pretend that it is not French?
1. The U.S. has a much higher portion of its population living in exurban and rural areas where top-quality health care services may not be readily available. Countries with large portions of their citizens living in urban areas tend to rank very high on any list of health statistics based on life expectancy -- mainly because someone who suffers a serious illness or injury is far more likely to receive immediate care in an urban area than in a rural area.
2. The U.S. ranks relatively poorly in life expectancy and infant mortality compared to other industrial nations simply because we have much more of a libertarian outlook than other countries (and are far less homogenized), which means we have a much higher incidence of almost any physical/psychological pathology that could potentially reduce a person's life expectancy. For example, as recently as a few years ago a term like "crack baby" couldn't even be translated into Japanese -- because there was never any need to come up with a term to describe something that doesn't exist in that culture.
I'm not as egalitarian as the French. I would rather leave the government out of health-care and just get the cost down with Tort reform. Medicare was a socialist mistake. Let Bill Gates and Hollywood create a foundation for underprivileged assistance.
Excellent observations, especially this one. American politicians are sometimes EXTREMELY nasty. Both Nixon and Clinton used the IRS against their political enemies. Hillary, who had more than 900 FBI files on political enemies stolen, would not hesitate to deny medical treatment to any of them had she the power, and THAT type of danger is the BIGGEST reason to keep medicine out of the hands of those who monopolize power (governments, duh).
"There is danger from all men. The only maxim of a free government ought to be to trust no man living with power to endanger the public liberty." -- John Adams, 1772"There is one safeguard known generally to the wise, which is an advantage and security to all, but especially to democracies as against despots. What is it? Distrust." -- Demosthenes: Philippic 2, sect. 24
"All of history attests that the centralization and concentration of power breed despotism." -- H.A.Scott Trask
"Government is not compassion ... Government is nothing more than structured, widespread coercion ..." -- Glen Allport
"What the government is good at is collecting taxes, taking away your freedoms and killing people. It's not good at much else." -- Tom Clancy on Kudlow and Cramer 9/2/03
"The two enemies of the people are criminals and government, so let us tie the second down with the chains of the Constitution so the second will not become the legalized version of the first."-- Thomas Jefferson
"The United States was supposed to have a limited government because the founders knew governmental power attracts swarms of crooks, demagogues and despots as surely as horse manure attracts swarms of horseflies." -- Rick Gaber
"As government grows, its increased power to grant favors or inflict pain attracts more people who would abuse the system." -- John Fund
"The coercive power of government is always a beacon to those who want to dominate others -- summoning the worst dregs of society to Washington to use that power to impose their will upon others." -- Harry Browne
"Force always attracts men of low morality." -- Albert Einstein
"Give government the weapons to fight your enemy and it will use them against you." -- Harry Browne
"Give a good man great powers and crooks grab his job." -- Rick Gaber
"Any time you give power to government, it will be abused, it will be enlarged, it will be used in ways you never intended." – Harry Browne on The Drudge Report 7-31-99
"Political power is everywhere the most serious threat to liberty. The more power politicians have, and the more able they are to disregard constitutional rules, the more serious the threat. Precedents for expanding government power are sure to be exploited by politicians more dangerous than those who set the precedents." -- Jim Powell
"Power tends to corrupt, and absolute power corrupts absolutely." -- Prof. John E. E. D. Acton
"Power draws the corrupted; absolute power would draw the absolutely corrupted." -- Colin Barth
"Power kills; absolute power kills absolutely." -- Prof. R. J. Rummel
"The greater the power, the more dangerous the abuse." -- Edmund Burke
"Grant no power to government you would not want your worst enemies to wield against you." -- "Smokin'" Joe Freeper
-- all culled from THIS PAGE