France’s Health Care System Punishes Patients to Cut Costs
Tags: Europe, Obamacare.
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Ah, the last bastion of “see, socialized medicine works“:
When Laure Cuccarolo went into early labor on a recent Sunday night in a village in southern France, her only choice was to ask the local fire brigade to whisk her to a hospital 30 miles away. A closer one had been shuttered by cost cuts in France’s universal health system.
Ms. Cuccarolo’s little girl was born in a firetruck.
France claims it long ago achieved much of what today’s U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
In recent months, France imposed American-style “co-pays” on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. “A hospital doesn’t need to be money-losing to provide good-quality treatment,” President Nicolas Sarkozy thundered in a recent speech to doctors.
It doesn’t work. It can’t work. Its stupid to think it could possibly work. We’re dealing with people here, for crying out loud. If you make it less than real cost to use a thing, then it will be used more than it should be – and then you’re stuck either charging more, cutting services or trying to do both. “Do both” is what France seems to have opted for (while the UK and Canada seem to have come down hard on the side of cutting services).
What should health insurance be? Coverage for chronic and/or catastrophic injury or illness, with various provisions for pregnancy. A trip to the doctor should cost $50. If it costs that much, people will only go when they need to – and they’ll go without any worry because if it starts to become more costly than a regular office visit plus, perhaps, a few regular tests and minor procedures, then the insurance is going to kick in and take care of it. We’ve been mind-bogglingly stupid over this thing for 40 years.
Fortunately, it looks like ObamaCare will drive the final nail in the socialized medicine coffin. After that, we might be able to start a rational debate about what we want insurance to be for.
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92 Responses to “France’s Health Care System Punishes Patients to Cut Costs”
Caucus of Corruption
Mine, for one.
No, self employment taxes are not marginal, they’re calculated based on total income.
Actually Frog, I can’t think of a small business making less than !06 K that could afford multiple employees.
That should read “$106 K”
Count-
First of all, the effective tax rate for self-employed people is commiserate with those who are not self employed (not all of the earnings of their company are taxed). Second of all, since FICA is a flat tax rate, raising or removing the income cap is the same thing, effectively, as a marginal increase (assuming you made more than $106.8k).
Rana,
Its not an either/or proposition. Allow people to do what they wish and then do what you can to support charity for those who slip through the cracks.
As it is, I’m cooking up a “National Endowment for Life” which will cover this area.
CO,
Well, given that my father-in-law got an MRI last Sunday within two hours of arriving in the emergency room – yeah, I think you guys would.
Rana,
In a sole proprietorship the income of the business is the income of the owner. A marginal tax is a tax on the last $ earned. All earnings above the cap would be taxes at the same rate as earnings below the cap.
Sorry, I forgot to add that this maes it an average tax not marginal. 12%
Rana,
Kenneth Arrow is a mindless, big government, socialist. Anyone that leads the IPCC group think organization can only be labeled as such. Also, the document you linked to is nothing more socialist propaganda. You see, Kenneth is an example of “those that can’t do, teach”.
You, on the other hand are a Marxist, for some reasone terrified og capaitlism and free markets. I can only guess this stems from your lack of self confidence in succeeding in a free market environment, where hard work and business acumen are rewarded, and allegiance to group think usually fails.
I completely understand.
I will wager to say that Rana has never employed one person, has never ran a business, has never had to scrutinize a P&L, and make the decisions necessary, both from the profit and expense side of the ledger, to make the business viable.
No, instead, Rana prefers to pontificate from the ivory tower on societal theorems, and on aggregate tax rates to sustain government delivered programs. Morons like Rana are a dime a dozen and what ails our society. We need people that aren’t afraid of getting into the mix, and producing goods and services that will sustain employment for others,
Amazona: Remember, back when Social Security had a huge base, it was a great idea. As long as there are enough people at the bottom to contribute a relatively small amount to add up to a lot for a few at the top, it works just fine. When the ratio shifts, as it has been in France, the math doesn’t work any more. That is when the fewer at the bottom have to put in more and more to accommodate the larger number at the top.
That’s a good point. But it’s not limited only to public plans. The same math applies to private plans. How could it not?
Anyway, this has been an informative thread. Good job, guys! Personally, I’m rather partial to a state-level, or multi-state regional level non-profit “co-op” approach, along the lines that Tim Pawlenty recently outlined. That, combined with centralizing, digitizing and streamlining health records, and breaking down state-by-state barriers that insurance companies currently face, along with breaking the special status that large employers currently enjoy at the expense of small ones (not to mention self-employed individuals), and diversifying rather than concentrating plan alternatives (e.g., incentivizing and securing so-called “cafeteria options” and “health savings accounts”) would go a long way to providing a solution that would be both efficient in the short term and fleet of foot in the long term.
Unfortunately, that’s about as pithy as I can offer my ideas. And in trying to be pithy I’ve probably lost most folks. The basic problem is that it goes without saying that the best solution to a situation as complicated as the current health care situation is likely to be as complicated as the situation is.
CO, since when is it the purpose of government to assure that “everyone” is “completely satisfied” with anything?
Herein lies the major difference between left and right—the role of government in the lives of people. The Right believes that the federal government of the United States has a pretty clear-cut role—to provide for a national defense, to oversee interstate commerce, and to engage in international diplomacy. There are some other functions— a national currency, for example—but that’s pretty much it. We believe that the role of any government is to provide a safe haven within which the individual can prosper according to his talents and ambition–”safe haven” meaning with adequate rules and regulations, if necessary for interstate commerce, to protect people from crime and fraud.
According to our Constitution, anything beyond this purposely limited scope is the responsibilty of the state, or of the people.
The Left believes that somehow, for some reason, in some way, it is the job of government to guarantee happiness and “complete satisfaction” to all. It is this Utopian dream that prompts them to try to constantly add on to the burdens they have already heaped upon government. Now it is not enough to have a law against murder, for example, but we have to have a law that amplifies the law against murder if the Thought Police identify a certain class of antagonism toward the victim. (As if wanting to kill the victim is not antagonistic enough.)
The abject silliness of anyone thinking that “everyone” can be “completly satisfied” with ANYTHING is laugable, but to then assert that it is the repsponsibility of any government to try is simply unrealistic and in direct contradiction to our Constitution.
But something else supplements the market, and the thing I put stress on in the paper are the elements that put a non-economic influence on the market: professional commitments to provide a service, to engage in services that aren’t self-serving. Standards of caring decided by non-economic actors. And one problem we have now is an erosion of professional standards. In a way there is more emphasis on markets and self-aggrandizement in the context of healthcare, and that has led to some of the problems we have today. – Kenneth Arrow
In other words, Kenneth has zero confidence in the individual doctor. What a moron. I would like him to address the effect that trial lawyers (DNC bedfellows), have on the equation. Do you suppose that they have an influence on not only who practices medicine, but who can afford to practice medicine, and what medicine they practice.
Arrow is just another ivory tower idiot.
rico, I like your ideas, and found them to be quite pithy. There are so many solutions to a complex problem, and this is a vastly complex nation where it is impossible to have a “one size fits all” approach to any problem. A solution to discrete and unique health care problems would be, and should be, different in Appalachia than in Seattle, different in the bayous than in skyscraper country.
The Founding Fathers understood this concept way back in the day, long before they could even conceive of the vast scope and size of this nation. This is why they worked so hard to be unambiguous and clear in their determination to limit, as severely as possible, the scope and reach and power of the federal government, and to place most of the governing power at the local level.
Of course, cluster—the radical Left despises and distrusts the proletariat, and is determined that only the vastly superior intellect and morality of a ruling elite can impose the kinds of regulation necessary to make everything run the way this same elite class has determined, from the heights of its innate superiority, the way is best for the mewling classes below.
The rules for them, of course, are different. They, being so superior and all, should not have to be constrained by the same rules they impose on the lower classes. So it has always been in socialist regimes, and so it shall always be.
Oopsie, pushed the wrong button. Anyway as an addendum to what I already said…
The bottom line is that it seems to me that one would be hard pressed to provide an example where both government-heavy and private-heavy solutions have failed more dramatically virtually everywhere they have been attempted than in the field of health care. It thus seems to me that a more flexible, innovative approach is required. That’s not to say that every attempt will be equally successful, but IMO it would be hard to find a better test-bed than the republican (small “r”) nature of the US of A.
Pawlenty is smart man, and I like a lot of what he proposes, thanks for the link rico. And you are also right amazona, that’s why I like the cafeteria option approach to healthcare, and encouraging more people to enter the profession of healthcare in all regions. The more accessible care is, and the easier it is to conduct business, the cheaper healthcare will be.
That being said, I also wouldn’t mind seeing a government sponsored, or insured, catastrophic health plan, to protect lower, and moderate income families that have members with cancer, aids, etc.
Amazona: rico, I like your ideas, and found them to be quite pithy. There are so many solutions to a complex problem, and this is a vastly complex nation where it is impossible to have a “one size fits all” approach to any problem. A solution to discrete and unique health care problems would be, and should be, different in Appalachia than in Seattle, different in the bayous than in skyscraper country.
Yeah, exactly. Obviously some things are better if they’re federally standardized. But equally obviously there are some things that aren’t. I don’t mean to imply that I possess it, but it seems to me that “wisdom” lies in effectively and efficiently differentiating the two.
I remember when I was young and so passionate about the messages of Bob Dylan—I totally immersed myself in his early work and thought he was a prophet, and I swallowed all the messages he put out there. I was quite righteous and pompous in my “knowledge” of the various evils of the rich, capitalism, greed, hypocrisy, and so on. Bob and I, we knew it all.
Giving Dylan credit, he has the intellectual honesty to acknowledge his youthful know-it-all whine of protests. In one later song he wrote:
Right and wrong, I defined these terms
Quite clear no doubt somehow..
But I was so much older then,
I’m younger than that now.”
I wonder if rana will ever have the innate honesty and self-reflection to look back on this period of his life and realize what a snot-nosed pseudo-intellectual he is, posturing as a lecturer to us based on what he has been told by his uber-liberal “teachers”.
He just doesn’t come across as having the integrity of Dylan, or the desire for truth I discovered.
rico, how’s about having “wisdom” defined as adherence to the Constitution?
Also by the way, as far as I can tell “tort reform” has been relegated to the state level. I’m not a constitutional lawyer or anything, but for whatever reason (and at least as far as health care is concerned) it has either not been tested at the federal level, or rejected. Either way, it is currently the states which determine the statutes in that regard. Whether or not that will change if regulations are structured on a more federal level is open to question, I guess. But at any rate, tort reform has not proven to be effective in curbing health care costs at the consumer level. It has been shown to be effective in curbing malpractice insurance costs. But considering the overall cost of malpractice insurance accounts for 1% of the overall cost of health care, the likelihood of it being an important element in the overall equation is pretty close to nil. That’s not to say it shouldn’t be pursued, but if you’re inclined to view it as some kind of panacea for reducing health care costs, you’re very likely to be seriously disappointed.
It’s amazing what life teaches you when you actually have to live it. All of our resident liberals are young, naive and institutionalized, therefore the only thing that can fall out of their empty heads is that what has been fed to them.
Amazona: rico, how’s about having “wisdom” defined as adherence to the Constitution?
You seem to be anticipating my comments. As you yourself have indicated in the past, the “interstate commerce” clause of Article 1 provides the necessary “wiggle room”.
rico,
You’re confusing healthcare with health insurance. In fact a lot of people are. Tort reform will lower the cost of doing business as currently, insurance for doctors is so prohibitive, that many can not afford to practice.
We need better “health care”, and tort reform will fo a long way in reducing the cost of doing business for doctors, especially in the lesser populated areas.
Cluster,
Additionally the cost of “defensive medicine” needs to be included, according to IBD less-than-necessary procedures propagated by a doctor’s desire to not be sued because he didn’t run the full battery of tests and try every protocol known has caused adds an additional 5% to 9% to Health insurance costs.
Taly
Even more reason for tort reform.
Amazona: I remember when I was young and so passionate about the messages of Bob Dylan—I totally immersed myself in his early work and thought he was a prophet, and I swallowed all the messages he put out there.
Personally, I always likened Dylan’s voice to fingernails on a chalkboard. Like Leonard Cohen (to cite a notable example), I appreciated his work, but I preferred to listen to others sing their songs. My personal muse of the time was Joni Mitchell. She still is — at least in the sense that she still appears on my playlist. I have one tattoo, which was partially influenced by her. I got it in the stage of my life I called then, and still do, my “blue period”, the most difficult time in my life. It’s a depiction of a stormy night, in varying shades of blue, on my chest just below my clavicle. Obviously one influence was Van Gogh. Another was Miles Davis. But the influence that tied it all together was Joni. I’ll leave it to you to connect the dots.
Anyway, the signature tune of hers for me was “The Last Time I Saw Richard”. I suppose it helped that Richard is my name, but it went far beyond that. I captured my cynicism of the time, and the conflict I felt in extricating myself from it:
Richard, you havent really changed, I said
Its just that now youre romanticizing some pain thats in your head
You got tombs in your eyes, but the songs
You punched are dreaming
Listen, they sing of love so sweet, love so sweet
When you gonna get yourself back on your feet?
Oh and love can be so sweet, love so sweet
Fortunately it was only a phase, those dark cafe days.
cluster: You’re confusing healthcare with health insurance. In fact a lot of people are. Tort reform will lower the cost of doing business as currently, insurance for doctors is so prohibitive, that many can not afford to practice.
Did you not read what I wrote? Did you not read what I wrote in the past? Are you being intentionally ignorant?
Bean Counter: Additionally the cost of “defensive medicine” needs to be included, according to IBD less-than-necessary procedures propagated by a doctor’s desire to not be sued because he didn’t run the full battery of tests and try every protocol known has caused adds an additional 5% to 9% to Health insurance costs.
Would it be too much to ask of you to provide a link?
rico,
If you assert that tort reform will have minimla impact, you’re not talking about health care, rather health insurance. Effective tort reform, will have a huge impact on doctors insurance premiums and will help a great deal in bringing doctors back to lesser populated areas.
Get the government and lawyers as far away from doctors and patients as possible, and you will begin to see affordable health care.
I have never seen you write about that.
And I will refrain from commenting on your “blue period”.
Nice song—I never paid much attention to Joni Mitchellm but what I heard I liked. Dylan has held up well: I still hear his old stuff on the radio, and in retrospect his early voice is a lot more palatable than his later coyote-caught-in-a-fence vocalizations. I guess I am more tolerant of gravel-being-shaken-in-a-can voices—I love a lot of Tom Waits, though I have to admit I have used his stuff to clear a room when guests have lingered too long. Slip a little Tom Waits in the CD player and people are looking for their coats in about two minutes………
The thing is, youth can and often is a period of dark brooding and searching for truth and meaning, which makes the young so vulnerable to the Utopian promises, mixed with scorn for “the Establishment”, offered by the Left.
The old saying still holds true: If you are not a liberal when you are young, you have no heart. When you are not a conservative when you are older, you have no brain.
I see some of that utter conviction the utter rightness known only by the very young shown here in some of the posts by the obviously callow. And up to a point, I tolerate it. But the purpose of youth is not only to take passionate stances but to learn, and the fact that our youth are indoctrinated rather than taught, and therefore have so little ability to be open to new ideas or to process information when it is offered is very frustrating.
Another thing that is so annoying about our resident juvies is their conviction that political discussion is really just a mud-slinging free-for-all, that any level of viciousness is OK if you can cloak it in the guise of political discourse, and that the goal is to annihilate the opponent rather than to reach a common ground of at least understanding if not agreement. It’s kind of a Jerry Springer meets James Carville downgrading of civil discourse.
BTW, the only tattoo I ever considered was based on the lyrics of a Dylan song, but though I am tall I was never large, and couldn’t figure out how to work in the entire epic imagery of “along the beach where hound dogs bay/at ships with tattooed sails..”
cluster: If you assert that tort reform will have minimla impact, you’re not talking about health care, rather health insurance. Effective tort reform, will have a huge impact on doctors insurance premiums and will help a great deal in bringing doctors back to lesser populated areas.
Actually, all the reliable evidence suggests that tort reform will have an impact on what doctors pay for malpractice insurance, but has little to no impact on the cost of health care at the level of the consumer. And that includes the impact on “defensive medicine” practices. Why? I don’t know for sure, but I would say it’s because those issues do little in and of themselves to shift the emphasis from treatment to outcome. They may be important insofar as to prevent blowback (and even that’s not obvious), but every indication is that they will not, and (given the available evidence) cannot, be successful in and of themselves.
Rico,
Exactly. And lowering doctors premiums allows many doctors to open their doors back up, especially in small towns around this country where doctors have closed offices. This will greatly help health care accessibility for small town, lower income families and well worth the effort.
Wouldn’t you agree.
Amazona: I love a lot of Tom Waits, though I have to admit I have used his stuff to clear a room when guests have lingered too long.
While that may be true of “Rain Dogs” on, I’m still a big fan of Tom Waits. He’s a hoot in concert (then again, I haven’t seen him live in about 20 years). But my experience is that if you want to be sure to clear a room, put on Cap’n Beefheart. I’m a big fan of him too, but I readily admit that no matter where you try to pick up his discography his music is an acquired taste. And perhaps that explains the following…
The old saying still holds true: If you are not a liberal when you are young, you have no heart. When you are not a conservative when you are older, you have no brain.
I dispute that. Rather, I have found elements of both ideologies, as currently conceived, wanting. Does that mean I’m “wishy washy” or “lacking conviction”? I guess it goes without saying that I’m not the best judge when it comes to judging myself (that might be a concept you might contemplate as well). But I hope that no matter how old I get (just as I did when I was younger) I will continue to refuse to choose between heart and mind. That had always been a false dichotomy to me. Rather, I have always, and will always, strive to consolidate them — always, in everything. That consolidation is, to me, the basic foundation of Truth in its most everlasting, most immutable form.
cluster: And lowering doctors premiums allows many doctors to open their doors back up, especially in small towns around this country where doctors have closed offices. This will greatly help health care accessibility for small town, lower income families and well worth the effort.
Wouldn’t you agree.
In a word, no. To do so I would require reliable evidence that malpractice premiums were the primary reason why doctors have fled rural areas. You might come up with anecdotal evidence here are there, but that doesn’t really do it. At least I would hope you realize that. For one thing, the doctors in question have obvious self-interest issues. For another, most of them are not very well trained in statistics. Actually, that’s an understatement.
A fun little factoid:
The number of administrators and bureaucrats outnumber the number of doctors in Britains socialized healthcare system.
Do you want that rico?
And are you blaming the doctors for ignorance and self interest as the reason why rural areas lack their services?
Okay, I’m back from vacation.
To the original post, I grew up over 20 miles from the nearest hospital. I currently live at least 15 miles away and a large number of people in the surrounding area can be 80-100 miles away from a hospital. Women have babies in the US in cars, taxis, ambulances, fire trucks, or in their homes. Are these a reflection on our health care system?
It seems the op-ed author is taking a normal situation (being 30 miles from a hospital) and using it as an indictment of the entire system. Pretty lame attempt, actually.
cluster: The number of administrators and bureaucrats outnumber the number of doctors in Britains socialized healthcare system.
Do you want that rico?
And are you blaming the doctors for ignorance and self interest as the reason why rural areas lack their services?
Am I supposed to believe you just because you said it? Likewise, am I to believe your source, whatever it is, just because they said it? Likewise, am I to believe the so-called “administrators and bureaucrats” are in the public sector rather than the private sector? In short, could you provide some details to back up your statement?
Unlike you I have provided credible documentation for each of my points in previous threads. You, on the other hand, claimed you have no facility with Google — a claim which you subsequently admitted was a lie. So really… who is more believable? More to the point, can’t you offer anything credible? Or are you limited to just saying no?
Mind you, this is an issue where I definitely side more with Republicans (tho not the RRR contingent), and with Blue Dogs, than with Dems in general. As I’ve said since before the 2008 election I generally sided with McCain’s approach to health care reform than I did Obama’s — and certainly more than the Dem House. But I don’t think any approach, thus far, has sufficiently crossed all the T’s and dotted all the I’s. My congressman, Gary Miller, hasn’t scheduled any town hall meetings as of yet. I suspect it’s because he’s still embroiled in a host of questionable real estate transactions, but I don’t know for sure. But anyway, I would very much like to question him on the health care issue. I hope I get the chance.
As I keep saying:
1. Show me one single government program that is well run, efficient, within budget, and accomplishing its goals, and
2. Show me a plan which puts the same restrictions on all politicians and union officials and members—on the entire country.
3. Show me how a national government health care plan can possibly be constitutional.
Then come back to me with a plan for government-run health care.
Till then, as most of us are happy with the insurance we have, isolate the specific problems and address them—or, rather, let local governments address local issues and keep the feds limited to issues which can be covered under interstate commerce laws.
ricorun,
Well, you shouldn’t doubt such an assertion as its certain to be based on reality. Or do you think that a government-run health program would put a premium on health care providers in the talent pool? This is a bit dated, but only from 2006:
Rather a lot of managers, don’t you think? A 30% increase in staff results in a 100% increase in managers. How much you want to bet this is reflected all the way through the system?
Mark, again (and regardless of their accuracy) why you are using data on the UK system as a comparison? More to the point, why are you suggesting I use them? It’s pretty obvious my ideas don’t resemble anything of the sort. Wouldn’t it be better to first agree that health care in this country needs some significant reform, then work from there? Or do you believe that health care in this country doesn’t need reform? If it’s the latter then I’d say all credible evidence disagrees with you. But hey, when has that stopped you? When push comes to shove you can always appeal to your own personal authority, right?
rico, I tend to believe the people I’ve discussed the NHS with–here in England. Currently, I’ve had mixed reviews. It’s good with primary care issues, but when you get to catastrophic illnesses, the praise isn’t so positive. And yes, there are waiting lists for certain procedures.
You guys seem content to let the government run your lives. they already run the banks and the auto industry, so why not health care. I just feel sorry for the elderly when the governement institutes another “cash for clunkers” scam…