Health Care: France vs. America

Roger Cohen of the New York Times today looks into some of the arguments being floated by conservatives who fear France and all its greasy socialists:

I don’t think there’s much to debate when France spends 11 percent of its gross domestic product on health care and insures everyone and the United States
spends 16.5 percent of G.D.P. and leaves 20 percent of adults under 65 uninsured. The numbers don’t lie: The U.S. system is wasteful and unjust.

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The French health system uses a mixture of public and private funding, guaranteeing basic coverage through national insurance funds to which employees and employers make contributions. Most French people supplement these benefits by buying private insurance. The distinctions from the single-payer British system are significant, the results better.

So beyond all the hectoring, the main French-American difference on health care is not ideological but a question of efficiency. Both countries use a mixture of public and private. France is at a very far remove from “socialism.” The United States has already “socialized” a significant portion of its medicine. (Nothing illustrates right-wing ideological madness in the United States better than calls from some to “keep the government out of my Medicare!”)

The real difference is that the French state mandates health coverage for everyone, picks up the tab where necessary (as for the unemployed), holds down costs through a national fee system, and uses mainly nonprofit mutual insurers even for supplemental private coverage. The profit motive is outweighed by the principle of universal health care, with a corresponding effect on doctors’ salaries.