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Duel: France and America, scalpels at 10 paces

Fri, Apr 3rd, 2009
Posted in Commentary

I picked France because it is the poster child of indulgent laziness and "nanny statism" for all those rugged individualists who live by the code "I made mine all by myself without help from anyone, now you get yours without help from me."

You know the kind of person who writes to the paper, "if they can't take care of them they shouldn't have kids. Why should I be taxed to take care of them?" Implying I guess if the kids suffer it will teach the parents a thing or two.

Most of the time these knuckle draggers use the term socialism to describe all of Europe's healthcare systems. The American Enterprise Institute seems to be most responsible for changing the definition of socialism because the way they explain it Webster's Unabridged Dictionary's definition is "too narrow". That is it didn't include all systems the AEI doesn't like. Socialism is defined appropriately as a system where the government owns and operates the means of production and distributes the benefits.

Let's see if you think France operates a socialists system. The French don't think so and they are across the channel from the only European country that does, the United Kingdom.

The French system of payment for healthcare was the most expensive in Europe in 2001 at 3,000 dollars per year per person. That is half the U.S. cost of over 6,000 dollars that year. By some measures the Swiss system now is the most expensive European system. Still the Swiss are 1/3rd less than the U.S

The French pay for healthcare increasingly by taxes on earned and unearned income equally. The monies go into regional pools that are administered by private insurance companies. These funds cover basic healthcare along with a small co-payment for routine or minor health problems. Private insurers can sell policies to cover co-payments or medical frills. The policies are cheap and 90% of the French have supplemental policies.

The insurers are severely limited in underwriting policies that exclude patients that are likely to become ill and must accept all applicants. There is no reason to cancel or exclude such patients for the sicker you are the more the pooled funds care for the patients. About thirty expensive chronic conditions are paid for in full as long as needed. These are things like all cancers and cancer treatments (including the most expensive and/or experimental drugs), diabetes, heart disease, emphysema, asthma, multiple sclerosis, and other such long standing diseases. Medical bankruptcy due to illness or injury is unheard of there.

Doctor's offices are private practice offices and more than half are what we call primary care offices. There is no maldistribution of physicians in France. Other than university hospitals and municipal hospitals the hospitals are owned and operated by religious or are private hospitals, just as in America.

France has many more physicians per capita than the U.S. Their income, on average, is about twice the average French citizens' while in the U.S. the average physicians' income is between 4 and 5 times the average income. This disparity is cushioned by several factors. While competition for placement in French medical schools is great, once accepted the education is free. Doctors graduate with essentially no debt. Medical liability suits are uncommon in the tort adverse legal system. Plus, most large awards are for continued care of the patient and for suffering this is not an issue in a system where the patient will be cared for under any circumstance. Malpractice insurance is cheap.

The French have developed a computer generated billing system and payment is extremely prompt or interest is paid. The French doctor needs no extensive office staff. It is quite likely when you call a primary care doctor's office in France the doctor will answer the phone and you may never see a non-medical person employed in their office. There are no back office personnel fighting with dozens and even scores of insurance companies with their own unique rules over payment.

The doctors agreed to participate only if given complete freedom and control over medical decisions. They can refer any time to anyone. Patients can see any doctor, including specialist, at any time without referral. Both patient and doctor are free to make their own decisions.

French patients see their doctor twice as often as Americans and stay in the hospital much longer after surgery than Americans. No child in France goes without immunization unless the parents have religious or some other reason to object to standard immunization.

There are no waiting lists for any procedure. That includes elective surgery as well as urgent surgery. France has even become a destination site for other Europeans where some waiting lists occur.

In 2001, after extensive review, the World Health Organization named their system and care the best in the world at half the cost of the U.S. We were named 37th just ahead of Cuba. We had a lot of apologists and folks that tried to pick apart the WHO study. Recently they did a new study of 19 advanced nations on amenable death rates per country (deaths that could have been prevented with appropriate and adequate care). America finished 19th, dead last.

It occurs to me even if we don't want to adopt the French system wholesale, the French minister of health and other officials involved with their system over the years could give the new administration more good advice in an afternoon than the AMA, the insurance industry, the pharmaceutical industry, and the sclerotic Senators and Representatives at the first healthcare forum.

Dr. Robert Sauer of Preston writes about health and medical issues for the Journal. He can be reached at r.sauer@mchsi.com

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