I have advocated the French system as a model for reform of the US health care system. It is the most expensive in Europe and also has the highest satisfaction level of any national program in the world. Now they are having more trouble with cost.
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. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
My impression has been that Canada and not France has been the model for the Obama reformers. France allows private practice, free choice of physician and hospital and the majority of the system is fee-for-service. Maybe things have changed in recent years.
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. “A hospital doesn’t need to be money-losing to provide good-quality treatment,” President Nicolas Sarkozy thundered in a recent speech to doctors.
My information is that the French system always required co-pays and, in fact, required payment in advance with the patient reimbursed by the health plan later. Maybe they have changed the system since 2000, when most of my information was produced, and have suffered from the moral hazard problem created by prepaid care.
My information was that:
The basic principle of French healthcare is avance de frais, or payment directly from patient to doctor. The freedoms of personal payment, freedom to choose a doctor and the doctor’s freedom to practice, are fundamental to the French system. The patient is reimbursed by insurance, 80% by Securite Sociale, and the rest by assurance complementaire but the principle is supported by the French when they are surveyed and they are suspicious of “free care” as wasteful and liable to abuse.
Maybe this has changed in recent years.
And service cuts — such as the closure of a maternity ward near Ms. Cuccarolo’s home — 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.
I have favored the French approach because it seemed to be controlling the overuse that is always associated with free care.
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. 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.
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.
The system, as it was described in 2000, was chiefly funded by payroll deduction but subsidies may have increased in the past few years. The CMU, the taxpayer supported program for the poor, may have been flooded with applicants just as the “government option” would be flooded with those previously paying for their own care in company health plans.
I suspect that the French economy is capable of paying much less than our own economy could afford. Eleven percent of our economy would far less than we now pay for a system that does not cover 47 million (although that figure is suspect). Maybe the increasing number of illegals in France are stressing the system, just as they are stressing our own system.