I think one of the reasons the French can afford it is because their doctors don't get paid an asinine amount like in North America. Imo one of the reasons healthcare system sucks here is because our doctors get paid way too much, and that is probably caused by neeldless high entry requirements to become a doctor.
I had a health crisis in France
111–120 of 312 posts
Re: I had a health crisis in France
#112I think I (living in the UK, currently an EU country) understand the mentality behind the US healthcare system(s).
I think it's along the lines of "Why should I pay for someone else's healthcare?".
I've heard similar arguments from British people (I'm rather more socialist in my outlook than average, for a UK resident, I fear) and I don't really have an answer to that. Why indeed?
I'm probably conditioned to answer this with a "duh, because they're your fellow citizens". But I guess that's not everyone's cup of tea.
Re: I had a health crisis in France
#113Having had two melanomas and most likely to have more and having grown up in Denmark with universal health-care and now living in the US with insurance based healthcare I have been thinking about health care in general a lot.
Some random thoughts:
You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.
In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.
Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.
In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.
Both have pro's and cons. To give you an example.
It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.
I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)
When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.
What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.
What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.
So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.
Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live. I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.
1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues.)
2) One way to solve it is to ensure that people pay for all the normal encounters they have with the doctors (sore troth, hernia, back pain etc) but that you insure yourself against long term illness. In other word we should pay for normal things but no one should be going bankrupt because they can't pay for long term or serious illness.
3) By removing the insurance part from a lot of the normal encounters with the healthcare system and only putting it towards more serious conditions hopefully doctors will start to compete against each other rather than spend all their time fighting with the insurance companies.
4) I have a naive hope that technology could somehow limit the cost of many of the more complicated treatments. Over time hopefully many of the things that are wrong with us can be treated via gene-therapy hopefully not requiring too many people to do the actual treatments.
5) I think we have to come to terms with the fact that none of the systems really work and that all of them have solutions to problems in the other systems. That way perhaps we can start to break down healthcare into more discreet parts rather than the giant monster that it is today.
Thoughts?
Re: I had a health crisis in France
#114I was hospitalised in France last year - and coming from the UK, which has a social healthcare system too, I was likewise blown away by the quality of care. I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. I…
Well ever since Thatcher i get the impression that the UK has been trying to dismantle the NHS. Supposedly one of the first things done in Scotland after getting more internal autonomy was to reverse the changes from back then.
Increasing private provision in the NHS would probably make it more similar to the French system!
There's a lot of talk about privatisation of the NHS, but personally I'm really not ideologically attached to the idea of a state-owned health service provided coverage is still universal and free at the point of use.
Re: I had a health crisis in France
#115Earlier quoted context omitted.
If you're not in the fac mindset, sure. But still, equal access and cheap education is not something to spit at!
> If you're not in the fac mindset what is a "fac mindset"?
fac = faculté, basically a French university.
I guess what the parents refer to is that Universities in France are not as elitist as in other countries; the most prestigious higher education public schools are often considered to be the so-called "grandes ecoles" (engineering schools) or some specific administration/economics schools.
Re: I had a health crisis in France
#116Earlier quoted context omitted.
In France you pay 0 % taxes for the first 9.700 € of income, then 14 % for everything up to 26.791 €, then 30 % for everything up to 71.826 €, then 41 % for everything up to 152.108 € and 45 % for everything beyond that [1]. Hence 23 % effective tax rate sounds reasonable for an average income of around 50.000 €. The tax system in many European countries is similar btw, as is the health system. [1] https://fr.wikiped…
You don't live in urban centers like Paris with 50k revenue.
50k€ is above the 90th percentile. Maybe even the 95th.
Re: I had a health crisis in France
#117Earlier quoted context omitted.
Look at infant mortality for college educated people in the two countries. Much more interesting. The US has massive population segments on drugs and other segments here illegal that dont get medical care. Generally if you are well off, the US is a fine place to be. If you are addicted or poor, it's not so great.
Healthcare alone is just one piece of the puzzle. Having a french style healthcare system without corresponding safety nets in other areas to fight poverty/addiction/inequality etc would be better than the status quo, but not very effective.
Important to note that the opioid addiction epidemic is actually exacerbated by flaws in the US healthcare system, so adoption of standards from France or elsewhere could help with that too.
Re: I had a health crisis in France
#118This is normal on all western Europe states. However France has very high standards in general about health care and is regarded as one of the best systems. I think it's time for US citizens to accept that most of Europe has better life expectancy, lower infant mortality than US, and to be ill is not a financial tragedy. Moreover the treatment that a low-income and high-income citizen receives is very similar, so the…
> Moreover the treatment that a low-income and high-income citizen receives is very similar, so there is a lot less social discrimination.
Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!
I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.
On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...
Re: I had a health crisis in France
#119I was hospitalised in France last year - and coming from the UK, which has a social healthcare system too, I was likewise blown away by the quality of care. I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. I…
The system in France is very different from the system in the U.K. Instead of having a national health service that employs the doctors, they have a system a lot like Obamacare, but with national price controls.
For details on the French system see The Healing of America by T.R. Reid. It also covers the U.K. and several other countries.
Re: I had a health crisis in France
#120I still giggle a bit every single time one of these EU healthcare stories pops up. It highlights a core difference between one of the two most "advanced" places in the western world. For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right. It is a as essential as a core human function as breathing and blinking. We don'…
There's another way to look at it that I don't think the USA will be ready to understand any time soon: Universal health and education are (key parts of) freedom. You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees. I've never felt as if I'm giving up a…
But someone has to pay for the health care, so they're losing some freedom (money in this case). That person gives up freedom also on the pricing of your healthcare.
Note: that person may be you, depending on taxation