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September 07, 2007

Descent into Darkness

An American in France tells of his experiences with the French system. As you may imagine, it's ghastly, unsettling, stuff, full of prompt appointments and helpful specialists. Conservatives, it's worth saying, have much the same reaction when faced with the horrors of high-quality, socialized care.

September 7, 2007 in Health of Nations | Permalink


No, no. The American inclination to avoid the doctor is a GOOD thing. We need to create even GREATER disincentives, so people will use less medical care. That story about this fellow seeking and obtaining prompt, effective and inexpensive care for his sick child is an example of everything that's WRONG with the French system.

Posted by: Bloix | Sep 7, 2007 9:41:06 AM

And yet they magically spend way less per person on health care than we do. And that's where his non-health-policy-wonkishness shows through. French taxes likely have more to do with their unemployment insurance than their health insurance, seeing as how their care is much cheaper than ours. I would imagine our system of healthcare tied to employment is a far greater disincentive to entrepeneurialism than the French health care system.

Posted by: spike | Sep 7, 2007 10:00:48 AM

At the first link:

as someone with an entrepreneurial bent, I also recognize to what degree the social charges needed to fund France's generous medical system function as disincentives to initiative. But I wonder if the American system doesn't serve to hide those disincentives in the exaggerated cost of seeking care.

That's a good point. It's impossible to measure just how many innovative risk-takers are discouraged by France's high taxes vs. how many are discouraged by the USA's high costs. But those of us who want UHC need to remember that American entrepreneurial spirit is not something that needs to be sacrificed for the greater good. Rather, we have profound disincentives to start a business, quit a bad job or go back to school to train up for a new career.

In fact, since a huge number of new small businesses are financed with SBA loans, taking prohibitive healthcare costs out of the equation might help more people to take their good ideas directly to the marketplace.

I know we shouldn't have to couch arguments for every progressive program in terms of efficiency and market gains, but that doesn't mean we need to ignore the benefits we're likely to accrue.

Posted by: Stephen | Sep 7, 2007 10:05:10 AM

Sure, sure, next you'll be trying to get us to think about trying French food or French wine. I don't think you know what a slippery slope you're looking at here, pal.

Posted by: El Cid | Sep 7, 2007 10:08:16 AM

I have a friend who recently moved to France. A particularly middle-of-nowhere part of France, really. He got a hernia. This is what he had to do:

Not have insurance
Didn't need an appointment
Walked into a doctor's office that day
Got fixed that day
Paid 25e

All better.

Posted by: North | Sep 7, 2007 10:35:17 AM

I have what I think is a pretty good idea for a small business that would probably employ 5-10 people. There is no way I can pursue that and take the risk of leaving my family without medical care during the typical 2-3 unprofitable startup years, so I stay in the corporate cube.

Did you say stifling of innovation? Perhaps this effect is not undesired by the large corps that have reasonably good heath plans?


Posted by: Cranky Observer | Sep 7, 2007 10:40:16 AM

Moreover, Cranky, if you did start the business and you were interested in being a decent employer, you would immediately be saddled with paying for health insurance for your employees. Right now in my office we lay out about $1,200 a month for employees with family coverage, $400 for single coverage. (We are old fashioned enough to pay the full freight for our employees.)

So we stifle innovation again -- or make people take the crap shoot of going uninsured. And this system takes 14% of our GDP. Someone explain again why this is better?

Posted by: Klein's Tiny Left Nut | Sep 7, 2007 10:50:04 AM

Funny serendipity...

Exactly the same symptoms...couldn't swallow properly,
regurgitated... a lot (that's different from vomiting).

Went...pretty much exigently..to the VA where the same endoscopy was done.
Same pathogenesis...GERD.

In my case dilation only, no Barrett's carcinoma but..
Had that been the case? the VA would have sent me to where that
(long scary esophagectomy operation would best have been done).

I was way luckier than your redeemed 'conservative' but had the same benefits
from a homegrown social medicine 'scheme', our VA, or...

So it would seem from this good experience and story

Posted by: has_te | Sep 7, 2007 10:59:43 AM

When I saw Ezra's title for this entry on the RSS feed, I thought it was going to be his take on having to read and comment on today's David Brooks column.

Maybe that's coming up?

Posted by: Mimir | Sep 7, 2007 11:21:14 AM

(For the record, David Burgess died just under a year after that IHT column. His column gets quoted often, so it's worth mentioning.)

Posted by: pseudonymous in nc | Sep 7, 2007 6:07:00 PM

"For the record, David Burgess died just under a year after that IHT column."

From info in Burgess piece, it is likely he had esophageal cancer. He says that survival rate (in France?) is 15% for 3 years.

If it is true, US survival rates are quite a bit better.
From www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_esophagus_cancer_12.asp?sitearea=:

"The American Cancer Society estimates during 2007, 13,940 deaths from esophageal cancer will occur.
Now, 17% of white patients and 12% of African-American patients survive at least 5 years after diagnosis. These figures refer to patients with all stages of disease, so survival rates in earlier stage disease will be higher. "

Make what you will from this.

Posted by: mik | Sep 8, 2007 6:54:44 PM

I have a brief experience with French health system. It is very good, in my experience it is better than German or US.

France spends about half of what the USA spends per capita. At least partially it is the result of French physicians making about $55K/year, about 3-4 times less than their American counterparts.

Posted by: mik | Sep 8, 2007 6:59:22 PM

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