Thursday, August 6, 2009


What Would France Do?

That's what a lot of folks in the pro-national health care crowd are asking. France, they claim, has squared the health care circle and found ways to cover everyone adequately without exploding costs.

Not so fast.

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. ...

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. ...

And service cuts ... are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.

The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.

How does France's system work?
French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it.
Sounds simple enough.
France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.
Even better. What's not to like?
The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.
Oh. I see.

So France's national health care system is leading to either a tyranny of the bureaucracy -- where Ayn Rand's "aristocracy of pull", not people's willingness to pay or a doctor's recommendation, determines who gets care -- or national bankruptcy.

Why are we supposed to be so hot to adopt national health care, again?

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