Wednesday, April 13, 2005

Un Repas Gratuit?

Non, Kevin:

Total out of pocket cost in this case, which was higher than normal because this guy has an expensive GP, was about a hundred bucks. That socialized medicine stuff is hell, isn't it?

The reason France's medical care is pretty good, is that it isn't socialized medicine. It isn't even single-payer. However, it is expensive; taking over 20% of payroll for most:

France has a reputation for central direction, but French health care is based on a compromise between egalitarianism and liberalism. All citizens are said to be equal, yet choice and competition are fiercely protected.

In France, individuals can identify on their pay slips how much they are paying for coverage and thus can form a view about whether the cost is justified. Consequently, the standard of care guaranteed by the state reflects the personal preferences of people who are self-sufficient through work. It is this high standard of care that is made available to all. France performs well on nearly all health status measures; when the World Health Organization ranked the world's health care systems in 2000, France was at the top of the league.

Compulsory health insurance covers the whole population, and contributions are charged as a percentage of income. Until recently, employers paid 12.8 percent of salary and employees 6.8 percent... but employees pay 0.75 percent of their salary toward health insurance plus an additional general social contribution of 7.5 percent of their whole income, including interest, dividends, and other earnings. Most, but not all, of this general social contribution goes toward health insurance.

Altogether, this means that the total cost of health insurance is about 20 percent of payroll, including the employer's and employee's contributions. The insurers are non-government, nonprofit agencies, which owe their allegiance to employers and employees. In addition to their compulsory contributions, most employees pay an additional voluntary 2.5 percent of their salary to a mutual insurer.

The French have complete freedom to choose their doctor, whether a general practitioner (GP) or specialist. They typically pay their doctor's fee and then file a claim for 75 percent to 80 percent of the payment. Because requiring payment up front might deter the poorest people from seeking care, about 6 million people are not required to pay.

....No doubt, it will be said that the French government has been trying to control costs. It has, but it has done so under a system that deliberately encourages responsible consumer demand by requiring modest consumer payments. ....

The result has been that, as the government has tried to lower expenditures since the 1970s, the French people have taken up the slack. In the 1960s, about 30 percent of the French people paid privately for supplemental health insurance. The proportion increased to 50 percent in the 1970s, and today about 85 percent of the people purchase private supplemental insurance.

To a central planner, the French system may look like a chaotic mess, but in reality it is a pragmatic blend of consumer choice, professional autonomy, central regulation, and a government-backed guarantee for the poor that exceeds [Great Britain's] NHS standard by far. Like the Belgians, the Dutch, and the Germans, the French, in their own way, have discovered how to universalize the benefits of a competitive market. The NHS, in contrast, has universalized the drawbacks of the public sector.

However, even with the above built-in incentives, France is heading for trouble as their population ages. Probably much worse trouble than the U.S. faces.

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