French health care

Many people (Jon Chait also) argue that France has the best health care system in the world.

As of 2003, the average income of a French physician was estimated at $55,000; in the U.S. the comparable number was $194,000.

A visit to a GP’s office (half of the doctors in France are GPs) had a reimbursement capped at 20 Euros, again circa 2003.  It is not hard to pay ten times that amount in the U.S.

Did I mention that health care is a labor-intensive industry?

This is the major reason why French health care is cheaper than U.S. health care.  France also spends less per unit on other inputs, such as prescription drugs.

Note that France still spends more than all or most other European systems, namely about 11 percent of gdp. 

When comparing health care outcomes, France only does slightly better than many Mediterranean countries with obviously non-enviable health care systems.  It is not obvious that France does better on health care outcomes than Japan, again a country with non-enviable health care institutions.  In other words, France spends lots of money making people feel good about their health care processes, with only very marginal measured health care results.  The United States also spends money on customer comfort, albeit in a more expensive and less egalitarian way.

It is easy to argue that the French system is better than that of the United States.  But a defender of the French system must, in reality, fight "a war on two fronts," to paraphrase Derek Parfit.  The French system does not, by the standards which have been erected in the debate, appear noticeably better than many other cheaper systems around the world.  It does spend more money producing "customer satisfaction" and papering over some of the obvious inhumanities of the cheaper systems.  That’s why it is easy to hold up as a model.

The disconnect arises because single-payer defenders wish to use international data to compare health care systems — France > U.S. — while pushing under the table the more radical (apparent) implications of that data, namely that France is spending far too much as well.

If we are going to be umm…transitive here, let’s have the debate where it belongs: expensive health care with marginal impact on measured health outcomes vs. saving lots of money and giving people much less in the way of health care services.  I do think there is a good case for the latter, though looking toward the future I would myself prefer the former. 

I might add I do favor taking action to lower doctors’ wages in the United States.  Letting in a greater number of qualified foreign doctors is step number one.  But if we’re going to criticize the U.S. system for its costliness, let’s put the blame where it belongs.


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