I noticed something really interesting in the French primary election last week. I read the platforms of all 10 candidates, and not one made a significant proposal to reform the French National Healthcare System.

No one from the left, no one from the right, no one from the center. It was a complete non-issue.

Other social issues, such as retirement pensions, unemployment payments, job training, education, and welfare payments were all major topics for several candidates.

The national deficit/debt was also a major issue for the candidates.

But, not healthcare. Not a word from anyone.

I thought this was strange, considering that healthcare has been at the center of U.S. elections for 20+ years. Yet, in France, silence from all parties from the far left through the center, to the far right.

I decided to ask my French wife why no one proposed changes to the healthcare system? She just looked at me like it was a stupid question and said, "Why would they?"

And so, perhaps the WHO is right. The French health care system really is the best in the world. If during a broadly contested presidential election, no one even mentions even a minor change, at a bare minimum we must assume the current system is wildly popular among the French people. This is certainly the impression I have from the dozens of French people I know.

In any case, next time you hear some Republican ranting about how Europeans hate socialized medicine, remember this. Not a single party across the French spectrum suggested even a minor change to the healthcare system.

I find it amazing that France is hardly mentioned in the healthcare debates here. They spend far less per capita, and they achieve far better results.

That said, yes, France has been struggling to contain costs for years now. They have succeeded. They increased deductibles. Most people that instinctively denounce the French system have no idea how it operates. A quick guide to the Mutuals should open up the discussion.

Partisan discussion of healthcare are useless. For the liberals, they should note that the French tax system is very regressive. Making $24k in France could mean at least a third paid in taxes for their SS system. But, it's a better system. For Conservatives, their system is run far better, and they reacted quickly when forecasts showed their costs were untenable going forward.

In the US, it appears that we are simply going to raise deductibles to the point where healthcare costs decline simply do to people's lack of ability to pay them. In the end, this leads to much higher costs due to lack of earlier treatment, and that never ends well.

"Partisan discussion of healthcare are useless. For the liberals, they should note that the French tax system is very regressive. Making $24k in France could mean at least a third paid in taxes for their SS system. But, it's a better system. For Conservatives, their system is run far better, and they reacted quickly when forecasts showed their costs were untenable going forward.

In the US, it appears that we are simply going to raise deductibles to the point where healthcare costs decline simply do to people's lack of ability to pay them. In the end, this leads to much higher costs due to lack of earlier treatment, and that never ends well. "


---

I can just see the howls as folks here would be asked to pay 'only 1/3rd' of their income in 'social taxes'.

Right now, those making 24K a year pay NO income taxes, pay only 4% to SS and a few percent to Medicare....then not only get all that back in 'rebates' but even more !.......

Plus, if they have employer health insurance, it is likely lower than the cost in France. You forgot to mention most folks in France who work also pay for 'supplement insurance'..otherwise they pay 30% of the medical bill themselves!......

And after they pay 1/3 rd of their paycheck in 'social taxes'.....what is left over is taxed at 20% because of the VAT on anything they buy!.....

Yeah.....their 'health care' costs are lower, but only because everyone subsidizes the 'free' college education for doctors. they have no debt. Why? Because taxpayers have been socked every year to pay for it. Medical facilities? Built by the taxpayer - and their 1/3rd of paycheck plus 20% of what is left over.......and did we forget to mention real estate taxes and car taxes each year?


t.

It's not just France. All the political parties in Canada agree, in general, in universal healthcare. If fact, that is the norm is most advanced countries. The US is the exception.
Let's not fool ourselves. The overall cost of healthcare in the US is dramatically higher that all other countries as a % of GDP. It's the armies of accountants, lawyers, insurance companies and other special interest groups that are opposing universal healthcare in the US.
Their lobby groups are very effective.

I, for one, do not agree that 20-30% of GDP should be spent on healthcare. It's absolutely atrocious. I do agree that while the issue of healthcare has taken up so much of the time spent on our nation's issues, hardly any of the discussion has anything to do with cost. The exception to that are the legions that are trying to prevent the government from doing the spending.

I do agree, and the figures now support it, that one of the primary reasons healthcare costs here are so high has been overuse. Sticking people with the responsibility of more and more out of pocket costs has indeed put a damper on their zest for overuse.

A correct assessment of the tax situation there T. I can only imagine what would happen if we had the same tax system they do in France.

I find the number of recs amusing. It's good point you make, but you offer nothing else. If you wanted a good discussion and really open it up, you needed to step outside the box.

I'm a fan of the French system, but I doubt ANY Democrat would support the way it's funded, nor the increases in costs to common people.

Perhaps the lower income folks in Francr are far more tolerant and understanding of having their paltry incomes reduced by a third.

What say you OP?

Are you open to that sort of taxation to get what you want?

I do agree, and the figures now support it, that one of the primary reasons healthcare costs here are so high has been overuse.

Huh? That claim is totally irrational. How can one "overuse" healthcare?

Sticking people with the responsibility of more and more out of pocket costs has indeed put a damper on their zest for overuse.

Ah, THERE is your problem !! You are confusing PRICE with USE. Well, to fix THAT problem is very simple. Charge $10k for one aspirin--everywhere. That wull cut down on "overuse" of aspirin--right? And repeat that solution with all medical stuff. How can it NOT succeed? It is applying your theory of what causes the healthcare problem--consumers not paying enough for healthcare.

America is much bigger, and much more diverse.

*someone* here used that as an excuse for some of Caliphornia's problems.

Again, comparing France to America is a non starter.

Jedi

"That claim is totally irrational. How can one "overuse" healthcare?"

Easy...free 'scooters' for tens of thousands who really don't need them.

free 'home health delivery of meds' at 50% higher prices...

constant advertising about 'free' stuff for Medicare folks.......

People run to the doc for a common cold.....want a 'cure'......

people don't get flu shot..then spend 50 or 100 bucks on flu medicine, visit the doc...to save 20 bucks on a flu shot..or maybe even a free flu shot under their health plan....

too many irresponsible kids who won't buy insurance.....in France you are going to pay for it with 30% taxes on your income REGARDLESS of what you make...even minimum wage....and then 20% tax on everything you buy!.....with what little you have left......

I'm sure there are lots of 'nurse' practitioners in Europe providing care.

My mother's cousins in Sweden complained constantly. You didn't have the same doc. You went to 'the clinic'. Most of the time you saw a different doc....and he/she could really care less. You started at square 1 with your problems. Got the 'standard treatment' even if it wasn't working. You got X....then you get 'fix #1'.....doesn't matter if fix #1 isn't working. The next doc you see takes your 'complaint' and gives you the same thing. You seldom/never see the same doc.

He managed to live to late 80s along with other cousins.

THen I could tell you about my 84 year old friend in England needing bypass surgery....18 month waiting list since he was 'old'.....he died after 17 months..... of suffering....


t.

I noticed something really interesting in the French primary election last week. I read the platforms of all 10 candidates, and not one made a significant proposal to reform the French National Healthcare System.

We should adopt their system and call it FrenchCare. Then, when everyone freaks out, we'll wrap it in a flag and call it FreedomCare.

I'd suggest you pick up a copy of this week's Economist and read what's going on in the French elections. Long story short: the French electorate is not prepared to make any hard choices. They all believe they can keep eating their free lunch as long as they want.

BTW. The mag also calls Hollande "dangerous" and says he's the wrong guy for France. The only guy who did try to spell out what needed to be done got single digits.

I noticed something really interesting in the French primary election last week. I read the platforms of all 10 candidates, and not one made a significant proposal to reform the French National Healthcare System.

No one from the left, no one from the right, no one from the center. It was a complete non-issue.

What the French for: "if it ain't broke, don't fix it"?

culcha

I do agree, and the figures now support it, that one of the primary reasons healthcare costs here are so high has been overuse.

Huh? That claim is totally irrational. How can one "overuse" healthcare?

Sticking people with the responsibility of more and more out of pocket costs has indeed put a damper on their zest for overuse.

Ah, THERE is your problem !! You are confusing PRICE with USE. Well, to fix THAT problem is very simple. Charge $10k for one aspirin--everywhere. That wull cut down on "overuse" of aspirin--right? And repeat that solution with all medical stuff. How can it NOT succeed? It is applying your theory of what causes the healthcare problem--consumers not paying enough for healthcare.

___________________

Very irrational responses Jerry. My statements are backed up by doctors, hospitals, and the economists looking at healthcare costs.

You don't need to go overboard and get all ridiculous to make a point. You Have Not made a point.

Nobody is talking about $10k aspirin.

But let's do this. Let's adopt the system in France, and pay for it, Just Like the French Do. Is that a deal?

If you don't think healthcare is overused in this country, you haven't seen reality.

But let's do this. Let's adopt the system in France, and pay for it, Just Like the French Do. Is that a deal?

The total French bill for all their government services is 56% of their GDP. No thank you.

Not a single party across the French spectrum suggested even a minor change to the healthcare system.

If ever the US government is tasked with providing healthcare for the French then we will know how to do it.

As for American patients, I don't think they'd like the way France restricts their access to specialists. That was the horn that American efforts at cost containment by HMOs died on.

Easy...free 'scooters' for tens of thousands who really don't need them.

free 'home health delivery of meds' at 50% higher prices...

constant advertising about 'free' stuff for Medicare folks.......

You are whining about overuse NOT of healthcare but abuse of the system *by business* for their own profit.

You didn't have the same doc. You went to 'the clinic'.

So what? That is the way medical practice is going these days. All the fancy medical eqpt has a large cost--and a rapid replacement rate with newer/better stuff--an individual doctor simply can not afford. And doctors DO leave one place and move somewhere else. They are NOT as reliable as they used to be. Plus, there are a huge number of specialists and not so many general care physicians--because there is a lot more MONEY in being a specialist. So, in other words, you are whining about the "free market" and doctors making professional decisions about their jobs based on that "free market".

The REAL problem is the fact insufficient doctors and other medical personnel were trained. But that is ALSO a "free market" choice. People who COULD have become doctors decided to become investment bankers instead--because those jobs paid more AND required less training at a far lower cost. Hey, choices have consequences.....

You started at square 1 with your problems. Got the 'standard treatment' even if it wasn't working. You got X....then you get 'fix #1'.....doesn't matter if fix #1 isn't working. The next doc you see takes your 'complaint' and gives you the same thing. You seldom/never see the same doc.

Then they didn't do their job--same as happens everywhere else. The JOB of the healthcare system is to get the patient well again. Getting the correct diagnosis is key to the solution. Which treatment will work is a matter of historic record AND luck--IF the diagnosis is correct.

free 'home health delivery of meds' at 50% higher prices...


My insurance company prefers that my medications are delivered to my home. It's cheaper that way.

jerryab says

"I do agree, and the figures now support it, that one of the primary reasons healthcare costs here are so high has been overuse."

Huh? That claim is totally irrational. How can one "overuse" healthcare?


The big example is the use of heroic measures to prolong -- for months in many cases -- the life of someone who will never be fully conscious again before dying. What's irrational is the desperate belief that a miracle will occur and Grampa will go into remission, sit up in bed, and demand ham and eggs for breakfast.

"My insurance company prefers that my medications are delivered to my home. It's cheaper that way. "


Mine did too....

But the med sat in the back of the non-airconditioned Post Office vehicle in 100 deg weather, maybe even in the sun, for 8 hours before the mail lady got around to delivering mail to my house at 4:45

The meds said 'keep at room temperature' below 80 degrees.....

I'm sure some of the meds really got fried waiting for delivery that way. Maybe in AZ it was even worse with 120 deg temps and likely 150 deg in the back of the delivery vehicle in the sun.


Has your medicine been fried so it is no longer effective?

A lot of meds can't take 100 deg for 4 hours...no less 8...

and then who knows how long some of it sits in mailboxes...those bunches of mailboxes right out in the desert sun....

or maybe 50 below up in MN...when the meds say ...keep at temps between 65 and 85 degrees on them?

and they freeze? liquid stuff freezing solid....

hmmmm...

yepper....

I prefer to go to the pharmacy. I figure I got a better chance of less fried meds.

t.

All of that other stuff is irrelevant to my point, which you corraborated. Home delivery is cheaper, not more expensive as you first claimed.

"All of that other stuff is irrelevant to my point, which you corraborated. Home delivery is cheaper, not more expensive as you first claimed"


I'm sure a lot of the stuff peddled for home delivery is stuff folks really don't need, but since Medicare provides it 'free'..it gets sent.

and,no...my mail delivery was MORE expensive than the Walmart pharmacy. They had better prices on generics.......but I had no choice. I had to pay a few bucks more for prescriptions by mail. Each.....plus a 'convenience' fee. I go to the Walmart at least once a week anyway.

I didn't need fancy stuff.

Now, on my drug plan, I pay even less at the Walmart pharmacy....I got 200 deductible Humana/Walmart drug plan..cheapest thing out there....and it is about half as much as my 'by mail' provider was charging me.

Plus my meds don't fry in the back of the TX heat delivery trucks for 8 hours.....


t.

The big example is the use of heroic measures to prolong -- for months in many cases -- the life of someone who will never be fully conscious again before dying.

That is not "overuse". That is IMPROPER use. Huge difference.

The total French bill for all their government services is 56% of their GDP. No thank you.

Blatant lie.

France spent 11.8% of its GDP on healthcare in 2011.

The US spent 17.4% of its GDP on healthcare in 2011.

http://www.oecd.org/dataoecd/46/2/38980580.pdf

Let's adopt the system in France, and pay for it

Deal--as a starting point. Savings of $800+B in cash--to start.

Then add on Single-Payer to save even more ($200B to $600B/yr ADDITIONAL savings). Or don't you want to save MORE money?

So, total savings--right NOW--vary from $1.0T to $1.4T without including other savings.

I get paid $100B/year--tax free, of course--for coming up with the idea and documenting how the savings are real.

Perhaps the lower income folks in Francr are far more tolerant and understanding of having their paltry incomes reduced by a third.

What say you OP?

I say, kindly and politely, that you should have looked up French income tax rates before posting.

In your example of $24,000 per year, that translates to an income of about 18,000 Euro. In France, the brackets are approximately:

0-6000 Euro @ 0%
6-12000 Euro @ 5.5%
12-26000 Euroe @ 14%

In other words, our low-income French person has an effective income tax rate around 7%.

If you add all of the VAT, fuel taxes, and all of the other fees they pay, it might add up to 30% of their income. However, in exchange, they are receiving world class health care, heavily subsidized daycare for their children, free public school starting at age 3, low-cost university educations for their children, and retirement benefits starting at age 62/65 (depending on years worked). All of that is definitely worth what they are paying.

I am not suggesting that France is some sort of worker's paradise. It sucks to be poor in France, just like it sucks to be poor in any country. I'm just answering your specific question about whether or not the low-income people are OK with their tax rate. I suspect the overwhelming answer is Yes (with the exception of fuel taxes at current prices. Everyone hates the price of fuel--ironically, no matter what it is).

sf

Right now, those making 24K a year pay NO income taxes, pay only 4% to SS and a few percent to Medicare....then not only get all that back in 'rebates' but even more !.......

In the U.S., the tax code is as it is due to Conservative ideology. Conservatives over the past 30+ years have repeatedly claimed that people know best what to do with their money and the government should get out of the business of directly providing services.

Therefore, for the lower income brackets, the U.S. policy has been to have a Negative Income Tax. This is straight from Milton Freidman. The idea is that if low income people need to buy health insurance, they will do so with the cash rebate, and it will be much more efficient than a government run program. So, low income people in the U.S. pay few taxes and fees, but they receive nearly none of the benefits of low-income Europeans.

http://en.wikipedia.org/wiki/Negative_income_tax

Plus, if they have employer health insurance, it is likely lower than the cost in France. You forgot to mention most folks in France who work also pay for 'supplement insurance'..otherwise they pay 30% of the medical bill themselves!.....

You make a good point that the French system has two tiers--public and supplemental, but they do not work as you describe.

Everyone, even tourists I believe, are covered by the public system. This system works like Medicare and reimburses costs based on a negotiated rate between the government and public hospitals. If you go to a public hospital, they will provide the treatment at the public rate and your cost will be reimbursed 100%.

The supplemental insurance covers the added cost of the private hospitals and clinics, more experimental treatments, private rooms, and so on. The cost of private service can be up to 30% higher than the public service.

The supplemental insurance is typically an employment benefit, so that is a wash with the U.S. for most jobs which would include an insurance benefit. However, nearly all French people carry supplemental insurance because it is remarkably affordable, and the insurance companies cannot deny coverage due to pre-existing conditions. My mother and father in law are in their mid-late 60's and retired. Their supplemental insurance costs $200/month for the two of them.

I'd suggest you pick up a copy of this week's Economist and read what's going on in the French elections.

Don't need to. I see it on the news every night.

Long story short: the French electorate is not prepared to make any hard choices. They all believe they can keep eating their free lunch as long as they want.

If I wanted to sound like you, I'd write, "FAIL!".

It's actually very much a personality issue. A majority of the French people simply don't like Sarkozy. He's too loud, to brash, likes his Rolex, his supermodel wife's rock star crowd, and friends with megayachts too much. He tried to tone it down the last couple years, but the French aren't buying it.

The only similar case I can think of was Gordon Brown in the U.K. It didn't matter what his policies were; he just came across as a snobby, arrogant jerk. Cameron didn't need better ideas to beat him. (Although I have to say that Hollande is nowhere near as charismatic as Cameron. Hollande comes across as a bit of a pipsqueak.)

The other thing going against Sarkozy is that France has been ruled by the UMP for almost 20 years. That's a long time for any party to remain in power in a modern democracy.

BTW. The mag also calls Hollande "dangerous" and says he's the wrong guy for France. The only guy who did try to spell out what needed to be done got single digits.

Not surprising that the Economist would be against a candidate from the left.

Hollande has made a ton of promises that he will have a very tough time keeping--unless he can renegotiate the Euro treaty. That is why the mainstream Europeans consider him dangerous. The concern is that if there is no longer agreement within the Euro Zone between France and Germany--Europe's two largest economies--there is simply no agreement and the whole thing falls apart.

In any case, I suspect it is inevitable that Hollande will win. He's just too far ahead in the polls and too many French people have simply tuned out Sarkozy. They just don't like him.

Wednesday night there is the debate between Sarkozy and Hollande. I suspect Hollande will literally have to wet himself and run off the stage in shame to lose the election at this point.

sf, voting for Sarkozy

Not surprising that the Economist would be against a candidate from the left.



I’ve read stories that say Sarkozy would have been very comfortable in the Vichy government.

I’ve read stories that say Sarkozy would have been very comfortable in the Vichy government.

That's the latest attack against Sarkozy from the Left.