Universal Health Coverage and Victims of the US System

In 2001, the World Health Organization (WHO) ranked France as the best country in the world for health care. In contrast, the United States ranked 37th.
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Opponents of health care reform have spread a few erroneous myths about the French health care system, describing it as "socialized medicine" that restricts the patients' right to choose their own doctors. This myth, among others, is not true.

Although the French government is working to reform their system, France today presents an instructive example of government-run health care that successfully provides universal coverage and high-quality care. In fact, in 2001, the World Health Organization (WHO) ranked France as the best country in the world for health care; in contrast, the United States ranked 37th. WHO's criteria included universal coverage, responsive health care providers, freedom of choice for patients, doctors' freedom to make medical decisions, and the health and longevity of the country's population.

Among the other misleading myths about the French health care system is that the government controls doctors' decisions about treatment, that there are long waiting lists for specialized procedures, that doctors offices are crowded, and that it is impossible to get an appointment. Not one of these myths is true.

Dr. Jean-Francois Lacronique, professor of medicine at the University of Paris who lived in the US for several years, explains that the US and French health care systems have similar objectives. "The challenges in France and the United States are the same," he points out: "To reconcile three different objectives: egalitarianism (equal access), excellent quality care, and economics."

The French, like Americans, are covered through their jobs. However, under the French system, the unemployed and indigent have basic health care. The French government is exploring the idea of raising taxes to pay for health care; however, in a recent poll the French people, though satisfied with their system, stated that they are against paying a new tax to maintain it.

Last month, knowing that I was researching an article on health care in France, an American friend in Paris whom I will call A invited me to accompany her when she went for her mammogram so that I could witness the efficiency and privacy of the clinic for myself. By the time A was dressed and ready to leave the clinic, she had her results. Unfortunately, they revealed a spot on her breast and she was immediately scheduled for a biopsy. Although A lives in the US, she previously lived in France and prefers to have her medical tests done there. Even though she has insurance in the US and doesn't have it in France, it is less expensive for her to pay out-of-pocket in France. If she were covered under the French system, it would be even less expensive. Unfortunately, after I returned to the US, A e-mailed me that her tumor is malignant and that she prefers to remain in Paris for treatment.

Another American friend who has lived in Paris for twenty years told me that when her husband had triple bypass surgery in France last year, it cost the equivalent of 20,000 American dollars even though he doesn't have French insurance; while in the US, it would have cost him 300,000 dollars. I could tell you even more stories.

There are several reasons why health care is more affordable in France than it is here. Physicians in France earn approximately twice what the average French person earns while in the US, physicians earn eight times more than the average American. Why? For one thing, it is the cost of education. When students are accepted into medical school in France, their tuition is covered by the government, so doctors do not carry the burden of heavy debt when they graduate -- and that cost is not passed on to patients. The French legal system, too, has an impact because it isn't a litigious as ours, rather it is tort-adverse, thus doctors do not have to fear malpractice suits and the high cost of malpractice insurance, as they do in the US -- and that cost is not passed on to patients.

Also, the French (under their Social Security system) have efficient standardized billing and electronic patient reimbursement, which eliminates the expense of non-medical staff and billing specialists to handle time-consuming, wasteful paperwork. In his call for health care reform, President Obama has emphasized the need for similar efficacious, streamlined measures to help reduce costs and expedite care in the US.

Finally, several years ago, the French government established a program to reduce the cost of pharmaceuticals and lab tests called "Vitale."

How did the French government develop its health care system? They worked with private insurers and health care providers. Medical doctors agreed to participate in government-operated health care as long as the law protected patients' freedom of choice and doctors' control over medical decisions.

On the business side, the government worked with the insurance industry by permitting them to administer government health care funds. Also, private insurers offer supplemental insurance for expenses not covered by Social Security. Since ninety percent of the French have the supplemental insurance, the industry hasn't lost profits, but instead is thriving.

The key to the French government's approach to health care perhaps, is the willingness to provide affordable care to everyone. Hopefully, in the US, health care providers, the insurance industry, and Congress now have the will to look beyond their individual interests, work with the Obama administration, and together develop a mutually beneficial system that provides affordable quality care for all. According to the latest polls, 53 percent of the American people want health care reform. If our allies the French can do it, so can we.

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