Thursday, September 03, 2009

Guess what, America: The French hate socialized medicine too!

Long before right-wing Americans started attacking so-called 'socialized medicine,' the French had been deriding it for decades.

Although popular opinion in the States is that any form of 'single payer' system is inherently 'socialist' (like France's, for example) the truth is; the definition is far narrower than that.

So just what is 'socialized medicine?' And, more importantly, what isn't it?

Well, the very definition of 'socialism' is a society in which the people (i.e. the state, or government) owns the means of production. Thereby bodies like The United States Postal Service are inherently socialist. The government doesn't just pay for the postal service - it physically owns and operates it as well.

In that respect, one of the few true examples of 'socialized medicine' is Britain's 'National Health Service' - in which the British government builds, owns and operates hospitals, and employs the doctors and nurses who work there.

That's why the NHS is 'socialised medicine.' Socialist principles are deeply ingrained in every part of the structure and organisation of the NHS. It's state-run healthcare from the ground up.

In comparison, almost all of the health care systems incorrectly accused of being 'socialized medicine' are very far from that.

France, for example, has a rich, diverse and effective private health care system - yet ill-informed Americans continue to incorrectly identify it as 'socialized.'

Ask any Frenchman and they'll tell you that the 'socialized' system across the English channel is an abboration. They've mocked it for decades - fueled by the same horror stories now appearing in the American media.

French health care, much like that in America, is provided by general practitioners in private practice, or hospitals and clinics owned by 'for profit' companies or non-profit foundations. In short, their health care infrastructure is alarmingly similar to ours - and offers just as much choice, individuality and variety as the one in the United States.

Where the difference between the French and American system comes into play is how an individual's health care is actually paid for. While Americans pay private health insurers to cover the cost of their medical treatment, French people are billed a percentage of their payroll in a similar fashion to the American 'Social Security' payments.

In this fashion, 80% of medical expenses are covered by the government funds and the remainder is paid 'out of pocket' much like an American co-pay. To cover the remainder, a slew of private complementary insurance plans are available.

Over 85% of French people have private insurance in addition to their mandatory government payments - meaning that there's a highly competitive private health insurance industry that covers costs Americans are unfairly left paying for themselves.

It's the fact that the government collects and reimburses the majority of medical payments that causes confusion for some Americans - and encourages them to call the system 'socialist.' That's actually far from being true.

The government reimburses private industry for providing health care - and in that respect, makes it about as 'socialist' as the townships and cities across America who use property tax payments to pay private companies to pick up the trash every other week.

'Socialized medicine' is only an applicable description when it's the government that owns and operates the providers of health care - doctors, clinics and hospitals. In France, health care is provided privately, just like it is in America.

The debate currently raging about American health care isn't about who provides the medical care - just how it's paid for. In that respect, 'socialized medicine' has never been a topic that's been on the table - just a foolish right-wing red herring.

The question is actually whether the government should offer a health coverage fund to provide competition with private insurers.

The right-wing throw up many objections to this - that the government funds would ration health care, or make choices about what care is and isn't available through their 'public option.' A cursory examination of the French health care system proves that these concerns are largely unfounded.

In France, individuals can still choose which doctor they go to, they can choose what treatments they want and almost all of them (including homeopathy) are reimbursed. In that respect, they exceed, rather than rival, the choices available to Americans.

How many times have you have a private insurer refuse to cover a medical expense - from birth-control pills to a full operation - sometimes even after the fact?

And as far as rationing goes - well, France is listed by the World Health Organization as offering the best overall health care in the world. The United States is listed just 37th on that list. Similarly, the average life expectancy in France is almost a decade longer than in America. That's statistically enormous.There are certainly no 'death panels' in Paris, unplugging grandmere when she costs too much to treat.

The French health care system is, in many respects, a shining example of how government and private industry can work together to provide excellent health care for a nation's citizens.

Combining the edge and competition of the private sector with the financial security of a government fund has helped create what is arguably the leading health care system in the world.

And all the ingrediants to emulate it - and exceed it - are available to us here in America.

I'm not suggesting an entirely government-funded health care system, but I am arguing that a public health care option is a vital ingrediant in whatever reform is instigated.

Whether that public health care option remains, expands or shrinks is entirely up to the private health insurers who exist alongside it. It's up to them to prove that private industry can exceed public care - not for us to take their lobbyists' word for it.

And for fans of a single-payer system - stop using Britain's NHS as an example. There's a much better one just across the channel and we could reap its benefits with only a few adjustments to our current system.


Tom said...

Sorry, I've started a new job as an adjunct professor, so I have less time to bum around commenting on blogs.

I just looked at the Wikipedia article on Health care in France. Assuming it's accurate, I have the following responses.

The system charges a 12.8% tax on employers, and a 6.8% tax on employees. That's 17% of the cost to employ someone going to health care.

That seems a bit high. By comparison, I pay about 7.5% for my insurance.

Looking at the amounts paid to doctors, they seem to be absurdly low. 22 euro for a generalist consultation... that's $31 at the current rates.

My doctor is paid $185 for the same thing.

I'm really wondering if the standard of care can be the same for so much cheaper. If so, then the real problem is one of efficency, rather than the funding source.

(I suspect that I'm getting better care. My checkup included an electrocardiogram for example.)

Honestly, the French model seems to be a relatively expensive monopsony. A single payer gets to choose what it will pay. And that's what it is, because it seems that even with private insurance, the prices that can be paid to the hospitals remain fixed.

For 22 euro, it's hard to justify performing tests that eat into your profit.

The life expectancy of a Frenchman is 79.73 years. The life expectancy of an American is 77.8. Two years is hardly a decade, but it seems like a lot.

Let's look at the numbers a little closer. Specifically, let's look at white Americans, which matches the demographics of France most closely, and let's look at 1-year-olds, to take out our differing definition of infant mortality.

When we compare like with like, the US life expectancy goes up to 78.7. We're talking a one year difference... which is probably explainable by other means.

(For example, more Americans own cars, which probably drops our average down due to more accidents.)

Roland Hulme said...

I insist you change your user identity to 'Professor Tom' THIS INSTANT!

First off - you're absolutely right about the life expectancy and I'll change that. I pulled it from memory and I used the life expectancy of a French woman against the life expectancy of an American man - and got both figures wrong - and there's a decade difference between those to - but only one year, as you mentioned, when comparing apples to apples and men to men.

As for the taxation question... That 17% in France (as far as I understand it) incorporates all of social security, so comparing the American social security payroll taxes PLUS the cost of health care put it on a much more level playing field. That matches the fact that Americans spend MORE on health care than the French (although the French spend more than most other countries.)

According to the economist, the US also spend MORE tax dollars on providing health care than the French - so while I don't know the specifics or how it's split out, some people in America are clearly paying MORE tax than French people to provide health care - and then paying for health insurance on top of that.

And as for quality of care - I can only speak anecdotally, but most people I've spoken to have said it's EXCELLENT. It's certainly a world away from the NHS.

I've known somebody who had a heart bypass, somebody else who had emphysema and a few others who got a whole slew of tests and treatments you wouldn't have ever imagined getting in Britain.

I can only conjecture that it's as good as America, but I certainly think it's comparable whereas I really don't think you can claim the NHS is even remotely close to offering the quality of American care. I'll have to do more research.

Occasional Professor Tom said...

You know, I think part of the problem with the right today is that we're opposing Obamacare, but not really putting out something better. So here's my idea of a health reform plan.

1) Every citizen and permanent resident will receive a voucher (say for $3000), every year, to pay for health care.

2) Someone will set minimum standards for health care. Ideally, we can use the various states for this, provided we allow people to shop across state lines for healthcare. But more probably, the fedgov will do this.

Having the states be the regulators would tend to help prevent rent-seeking. Right now, we're in a condition where if chiropractic lobby can convince the state legislature that their services must be part of insurance, everyone in the state's rates will go up to pay for it. In my plan, people can choose to get cheaper insurance from states with less requirements. This helps legislators reduce rent-seeking.

3) Insurance will be provided by HMO-style private insurers. These insurers will be able to charge any price they like, but will be subject to two conditions, if they choose to take the vouchers. The first is that plans must be fixed price, and they must take anyone with a voucher. (I'd allow preexisting condition exclusions, however. I might also allow evidence-based price adjustments for conditions like smoking and obesity)

The second condition is that they must provide at least the minimum level of care specified by their regulator.

The insurance companies will be allowed to refund money to their customers. So if the voucher is $3000, and the pool costs $2800 to insure, then the company can choose to take $200 profit, give $200 cash money back to consumers, or some mix.

4) The regulator would serve as a place to appeal the insurer's decisions. That's the important difference between this plan and a more traditional public option--- the regulator is hostile to the insurance companies, rather than working for the same organization.

5) We need to put some price sensitivity back into the system. Probably the best way is something like the French system, where patients pay 30% of non-catastrophic health costs. Information technology should be used to provide doctors and patients with a real-time feel for how much services will cost, something that will hopefully re-introduce a culture of price sensitivity to medicine.

6) We need to aggressively pursue efficiency improvements. I suspect that by tapping into the profit motive, and making people price sensitive, we could encourage more efficient medicine.

7) Tort reform would reduce the cost of malpractice insurance, which could seriously reduce costs.

8) I'd expect this system to eventually supplant medicare/caid, treating everyone equally regardless of age.

Finally, rather than presenting a giant bill as a Fait Accompli, reform should be accomplished with a series of smaller bills, each of which can be easily understood by citizens and congresscritters alike. If you give me a 50 page bill, I can understand it, improve it, optimize it. But give me a