16 ms·

I had a health crisis in France

232 points by stzup7 10y ago

CarolineW 10y ago
But that's socialism, and the USA will never tolerate socialism.
- smcl 10y ago
  Who knows, if someone pitches this to Donald Trump and calls it "TrumpCare" he may be vain enough to push it all the way :)
  - kccqzy 10y ago
    It always makes me think, perhaps due to the ignorance of Trump, he will be more receptive towards progressive lobbying too. Most of us know so little about Trump's actual policies that maybe anything is possible after all.
- EliRivers 10y ago
  But only if it's called socialism. If it can be called something else, then it will be accepted. In my experience, US citizens (not all, obviously; I'm massively generalising) have been conditioned to be against things labelled socialism, but the level of economic and political knowledge amongst the general public is such that if you don't call something socialism, it is judged on its own merits without people realising.
  - CarolineW 10y ago
    Opponents will hang that label on it, and then it doesn't matter whether or not the general populace would recognise it. It's interesting that my comment is somehow controversial, because it's been down to -2, is now back to -1. I wonder whether they are objecting to my calling "universal healthcare funded by taxes on the general populace" socialism, or whether they are objecting to the claim that the USA populace would ever accept a socialist policy. Indeed, while I've been editing this comment it's gone back down to -2. Interesting to watch, and I really do wonder what it is that's provoking people into downvoting it. ... and now back to -1. Fascinating!
    - woofyman 10y ago
      You're absolutely correct. Conservatives will label it "socialized medicine".
  - vacri 10y ago
    Ironically, they're all up for small-scale socialism, aka 'insurance'.
  - eeZah7Ux 10y ago
    The US finances private research, technology development and more using public money more than any other country by calling it "military budged". https://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures https://en.wikipedia.org/wiki/List_of_countries_by_military_... ...but maybe that doesn't count as "socialism" because most of the profits ends up in the hands of private companies?
- mkl 10y ago
  It's not socialism, it's the normal way to do healthcare in a first world democratic society. Most first world countries are not socialist, but have a proper health system like this.
smcl 10y ago
It'll be a long time until the entire USA implements socialised healthcare (if it happens at all...) but are there any individual states which have something resembling a single-payer system, or is this an issue where they all have roughly the same system? Also for some reason this reminded me of a BBC story I read a while back - where "Heavy Legs" is described as a medical condition that only exists in France: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7779126.stm http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...
- phonon 10y ago
  Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but on care provided like regular insurance). The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014 https://en.wikipedia.org/wiki/Veterans_Health_Administration... ) Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered) All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_reform https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance). https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda... So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.
- avar 10y ago
  My impression (as a European) of the US system is that in practice what we have with individual states here in Europe + EU isn't possible in the US, since the federal government taxes are proportionally so high, compared to what individual EU members contribute to the EU. Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen. It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster. So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.
logronoide 10y ago
For a Western European this is the normal.
- gambiting 10y ago
  As a matter of fact, I'm very surprised he had to pay anything at all. 1300 euro for hospital bed and food? This should be completely free.
  - logronoide 10y ago
    True. In Spain it would be 100% free. Maybe he has some kind of private health insurance. Here it's very common when you have kids or you don't want to wait for your turn for non critical medical assistance.
  - megalomanu 10y ago
    He says he used wifi, TV, telephone, and asked for a better room. If he didn't ask for this, I think he wouldn't have pay anything. The French hospitals offer a lot of paid bonuses. I think it's a good thing, it allows to make the basic needs free.
raphaelj 10y ago
> My individual burden, however, is far more reasonable than > an American might assume. I pay an annual income tax of > about 23%. How comes this number is that low? Tax revenue in France account for about 48% of the country's GDP[1]. I'm living in Belgium, and my payroll tax is already higher than these 23%. -- [1] https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_as_percentage_of_GDP https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
- EliRivers 10y ago
  Income tax is not the only tax.
- gambiting 10y ago
  It's probably tiered, like in many other EU countries. In UK for example you don't pay any tax on the first 10k earned, then 20% on anything between 10k and 40k, and then 40% on anything above 40k. I think there's a tier above it as well, but I'm not 100% sure. I know France has more tiers and they are more aggressive(80% being the highest I think?)
  - sgt101 10y ago
    There's a 45% tier and also super tax that kicks in at £100k due to having your £10k allowance removed (so from 100k to 120k you have to pay ~70%)
- ThePhysicist 10y ago
  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.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_sur_le_revenu_en_France https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...
  - 10y ago
clouddrover 10y ago
The US spends more per capita on health care than other OECD countries, even ones with universal public health care: http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ http://kff.org/health-costs/issue-brief/snapshots-health-car... And yet the US has lower life expectancy than those countries: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
- raphaelj 10y ago
  Infant mortality is also 75% higher in the US compared to France: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html https://www.cia.gov/library/publications/the-world-factbook/...
  - barry-cotter 10y ago
    Most of the difference between US and other OECD countries in infant mortality is that the US has a much lower standard for what's considered a viable birth. Basically, lots of what in France are classified as still births would be infant deaths in the US.
    - Normal_gaussian 10y ago
      Using: http://chartsbin.com/view/1445 http://chartsbin.com/view/1445 and https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate https://en.wikipedia.org/wiki/List_of_countries_by_infant_mo... births out of 1000 that are stillbirths: France 3.87 UK 3.50 USA 2.95 Germany 2.43 Infant Mortality (under 5) per 1000 live births USA 5.87 UK 4.38 France 4.30 Germany 3.70 Combining the two for a birthed (Still or not) and didn't make it to 5 rate: USA: 8.8 France: 8.2 UK: 7.9 Germany: 6.1 Obviously the studies aren't matched, but it does suggest that the variance isn't as great as either statistic shows, and there likely is a very strong ranking.
      - brianwawok 10y ago
kensai 10y ago
Medicine is one of those few fields the "socialized" approach is actually the better one. Of course you would prefer a I-don't-want-to-pay-for-others* stance when you are young and healthy (ie provided you were not born with a genetic condition or something similar), but once you start aging and caring, you start appreciating why Medicine as practiced in Europe makes much more sense in the end. *even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Security-and-Medicare-in-the-late-1970s https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)
- wav-part 10y ago
  I-don't-want-to-pay-for-others != I will not insure my health. US health system needs competition more than socialism [1]. [1] https://mises.org/blog/lack-epipen-competitors-fdas-fault https://mises.org/blog/lack-epipen-competitors-fdas-fault EDIT: A really good comment from link above. Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#comment-2857258347 https://mises.org/blog/lack-epipen-competitors-fdas-fault#co... The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives. People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
  - clarkevans 10y ago
thro32 10y ago
Real problem in US with health (and education...) is that cost has skyrocketed out of control. How much is hearth bypass ? $30k? Other countries do that for $4k with similar quality and better post-op care. Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...
- lumberjack 10y ago
  I don't think "the cost skyrocketed out of control". The cost is simply reflective of the leverage the health care provider and all the middle men in between hold against the patient. It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries. I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
  - thro32 10y ago
    Reducing cost is always good. Is not that mantra of free market and capitalism?
    - deleted 10y ago
      [deleted]
    - subhobroto 10y ago
      It is. Unfortunately, a free market for helathcare does not exist in the U.S.
  - deleted 10y ago
    [deleted]
  - developer2 10y ago
    >> I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year. Wow, just wow. You must not have ever had a family member or close friend fall ill. If you think someone making $50k/year is financially capable of paying $30k up front, you need a reality check.
angry-hacker 10y ago
Does France really have that low tax rate? Usually it's not only income tax people are paying over here and once Americans laern the total % of your money regular Joe pays for the government they are in shock, since they are not used to having so little money being left on the table.
- Taniwha 10y ago
  here in NZ I pay the high 30% marginal rate (that includes social security) and get mostly free health care. Drugs have a low co-pay, we have one organisation bulk buying for the entire country The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat
- boudin 10y ago
  There's several taxes. The tax he talks about is what you pay based on your revenues (with several ties, like in the uk). In france we receive what we call a 'salaire brut' which is a salary on which the employer already payed some taxes (which are quite high if i'm not mistaken). On this 'salaire brut' some taxes are automaticaly taken (including some for healthcare), then you obtain what we call 'salaire net', which the money that you get into your account. On this 'salaire net' you still have to pay income taxes (the next year for the previous for the moment, it my change to be taken immediatly on your salary, like in the uk). I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.
- ekianjo 10y ago
  > Does France really have that low tax rate No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.
  - 10y ago
antirez 10y ago
This 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 there is a lot less social discrimination. If this is not enough to show that the US system has issues, note that also in US, healthcare procedures are generally overpriced compared to their costs around the world. There is obviously a problem to fix and Obama was going in the right direction.
- ekianjo 10y ago
  > Europe has better life expectancy, Diet has a lot more to to about that than medical care.
  - collyw 10y ago
    Thats an interesting point, but it would be interesting to see it compared by regions. Southern Europe generally eats a lot healthier than Northern Europe.
    - erl 10y ago
      I am not sure that this is true. Many countries in northern Europe such as Iceland, Sweden, and Norway eat quite healthy. Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north. [0] http://apps.who.int/bmi/index.jsp http://apps.who.int/bmi/index.jsp
      - collyw 10y ago
        Sure, thats why I said generally. The UK and Germany don't have especially healthy diets in my opinion and have a lot more people than the Scandanavian countries that you mentioned.
madaxe_again 10y ago
I 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. It's Sunday. I figure it's a long shot but can't hurt. Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there. Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home. All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care. I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available. It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.
- markharris99 10y ago
  > I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I'm 50. I remember what London was like way before Labour first got into power. Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams. I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month. I can remember when I would call a doctor and be seen the next day. Not any more. The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true. Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.
cm2187 10y ago
The French health system has its own problems. There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go. The system runs a massive financial deficit. It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets. The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer. Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
- simias 10y ago
  >There is little evaluation of physician so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go. There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that. >The system runs a massive financial deficit. It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly. The government plans for a balanced budget in 2017, although the opposition says it's not completely true: http://www.publicsenat.fr/lcp/politique/budget-securite-sociale-quasi-l-equilibre-arrive-senat-1562864 http://www.publicsenat.fr/lcp/politique/budget-securite-soci... This article gives a good overview of the situation as far as I can tell: http://www.lemonde.fr/financement-de-la-sante/article/2016/09/22/le-deficit-de-la-securite-sociale-reduit-a-son-plus-bas-niveau-depuis-2002_5002108_1655421.html http://www.lemonde.fr/financement-de-la-sante/article/2016/0... >Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine. What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?
iraklism 10y ago
I 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't notice it, it's just there. And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these. Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .
- ekianjo 10y ago
  > free education ( university included ) La Fac is one of the worst places to get an education though.
  - zdkl 10y ago
    If you're not in the fac mindset, sure. But still, equal access and cheap education is not something to spit at!
    - bosie 10y ago
      > If you're not in the fac mindset what is a "fac mindset"?
      - binarycoffee 10y ago
        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.
        10y ago
fiftypounds 10y ago
I similar, but much less medically severe, experience with a gallbladder infection due to stones. This was in Germany. The cost of the sonogram and and ultrasound was c.a. 100 euro. The blood test was a pittance. And, becuase my medical German was/is very poor I had an exensive private consultation with the director of the E.R. who spoke near-natively fluent English. The total cost: 250 euro out-of-pocket The cost of one sonogram in the US: $1500 (before insurance) Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.
- srean 10y ago
  This is a topic that has come up on HN so many times that I have lost count. I have come to the conclusion that the US milieu is so dogmatically against any alternative that the standards of a proof that they will demand to be acceptable far outstrips the standards that they will demand of other things. This is the diametric opposite of preaching to the choir. Ultimately its them who gets handed the shorter end of the stick. Some are rich enough that it does not affect them as much. What intrigues me is the behavior and rationalizations of those who cannot escape the adverse consequences. Forget drug and hospitalization pricing for the moment, just the institutionalized control (cartelization) of the license to practice medicine is a tell tale sign.
partycoder 10y ago
Healthcare professionals are expensive since they require significant preparation. But there is fishy stuff going on too... 1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500. The pharmaceutical industry also does some sort of disservice to society by inflating prices so much. Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.
- ersii 10y ago
  That said, even single-payer systems as the ones in Western Europe can have this exact same problem. Like when Region Stockholm / Stockholm County (Responsible for Health Care and Public Transport) in Sweden bought supplies like support socks for 6000 SEK/pair (~645 USD) [1]. I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care. [1] http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte-strumpor-for-6-000-kronor http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte...
- douche 10y ago
  For one operation I had, I was given a turkey sandwich to eat in the recovery room before they would let me leave. Two slices of wonder-bread, one slice of turkey. $36 on the itemized bill that was sent to my insurance. It's nuts.
- ReallyAnonymous 10y ago
  High charges of low cost items are because of the amount of free care hospitals provide. I'm a physician in South Carolina and I take care of a tremendous number of fully employed people with no health insurance. Those of us with insurance pay for those without by paying higher costs. This gentleman would have probably received the same treatment in the US (at least at my facility) and received a $300,000 bill, of which he would probably never pay (bc he cannot). That artificial aortic graft sewn in probably cost the hospital $1500. It doesn't receive that for free. Nor does it expect the 7-8 people in the operating room or the post operative care to work for free. My hospital has an operating profit of less than 1% mainly because it provides so much free care. All I have to do to take care of a patient is declare it an emergency and there is no stopping of whatever care I feel is necessary to care for the patient, e.g., a newly diagnosed cancer patient. This, I believe, is true throughout the USA. And most of the people I take care of have jobs, but no insurance. Ask how many people that clean hotel rooms have insurance. How about people that work call centers? That, plus monopolist practices of the pharmaceutical industry and you have high costs. And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.
fvdessen 10y ago
A healthcare system that I like quite a lot is the Belgian one, which is a nice mix between free market and socialised medicine. In Belgium the government sets standard rates for different kind of medicines and treatments. You pay 8% of your income towards a state health fund that refunds all your health-related spending up to the standard rate. You are free to choose where, when, and what treatment you get. You pay the cost up-front, and then you get refunded by the state. But you only get refunds up to a 'reasonable' rate. In practice most doctors demand little-more than that rate, and thus you get a full refund. You can also subscribe to a private health insurance if you want to get refunds for better options.
- trmsw 10y ago
  I agree. The general standard is good (my wife's experience of giving birth here was much better than my sisters'in the UK) and if you have the money you can choose to pay more for comfort or convenience.
grecy 10y ago
Of course, this is perfectly normal in the developed world. My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc. In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes. Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free. The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.
- totony 10y ago
  Its the same in Canada, it's not because it appears free that they don't run for profits. Health care is a massive public spending and shows when you look at the taxes you (or your employer) pay
digi_owl 10y ago
The impression i get about US healthcare is that there is a vicious cycle of insurance agency haggling and hospital profits.
yodsanklai 10y ago
Just to give a different perspective, I think it's fair to say French people are very worried that healthcare quality is decreasing. I don't know if it's really the case but in any case, the system is far from being perfect. For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't). If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...
- RobertoG 10y ago
  It seems to me that, as a society, to choose for a longer waiting list and uglier waiting room it's a small price to pay in exchange of healthcare for everybody. About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.
- rtpg 10y ago
  The eye doctor thing always confused me. I would have to call 2 months in advance to get a routine eye check! What?? It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine). For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so
gerty 10y ago
I heard an argument some time that European healthcare and health R&D is indirectly subsidised by the US. The mechanism at works is 1) US consumers are ripped off by pharma; 2) pharma's higher profits lead to higher investment in R&D; 3) everyone profits from that and in the European case negotiate lower prices. I've always wondered to what extent this is true.
- walshemj 10y ago
  allowing the government to negotiate for the best price would be a start
pentae 10y ago
Couldnt the US Gov just use Medicare as a private health insurance option that runs not for profit and offers a lower cost than private insurers? It could then negotiate low rates with pharma companies and hospitals on behalf of its customers and eventually justify tax assistance. That would essentially let the 'free market' stay in effect and be a shortcut past the lobbiests.
- phonon 10y ago
  https://berniesanders.com/issues/medicare-for-all/ https://berniesanders.com/issues/medicare-for-all/
osti 10y ago
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.
YeGoblynQueenne 10y ago
I 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.
- trprog 10y ago
  >"Why should I pay for someone else's healthcare?". >and I don't really have an answer to that. Why indeed? Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?
  - YeGoblynQueenne 10y ago
    Actually, I know exactly what's going to happen (to me) in the future: I'll eventually grow old, get sick and die in pain. Or maybe I'll just get the "die in pain" part. That's how it goes, right? And in the past I was very young and couldn't yet fend for myself. I benefitted from being born in a developed nation and, like you say, if my parents had died while I was young, I'd have been taken care of (though in my country's case it would probably be my extended family that'd have looked after me, first, and the state would only intervene if I had noone to care for me). Like, I totally get what you're saying, but a significant number of people don't see it that way. Maybe they forget they were once too young, or that they will one day be too old. Maybe they just think they can do well enough for themselves that they'll just wing it. My point is that for many people contributing to things like public healthcare doesn't make sense. For instance- in the UK education is not free, and you will hear lots of people saying, indeed "why should I pay for someone else's education?". That's much more common than grumbling about having to pay for the NHS, but in the end it's just the same thing.
- 10y ago
ThomPete 10y ago
Having 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?
on_and_off 10y ago
I am French and live in France right now. Recently I had to undergo a surgical procedure. Nothing as serious as heart surgery, but still one day at the hospital and general anesthesia. This has not affected my personal finances and I only had to focus on getting better. I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me. This is not ok. It saddens me that USA have not been able to instore a sane health care system.
fiatjaf 10y ago
"I pay an annual income tax of about 23%." So you don't pay any kind of VAT? That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health. I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.
- nraynaud 10y ago
  VAT is 20% in France, and the biggest source of income for the State. But social security has a separate budget and is not paid by taxes, but by special levees on salaries and income.
tim333 10y ago
I note the president elect has said in the past: >"We must have universal healthcare...I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses... I know he flip flops all over the place but maybe if people lobbied, something could be done.
coldcode 10y ago
While I would like to have read the entire post, the constant flashing ads and overlays gave me a health crisis and I was forced to abandon the article.
amelius 10y ago
There is an interesting documentary about the health care system in Europe: http://www.burning-out-film.com/ http://www.burning-out-film.com/
djfm 10y ago
I'm French, I'm not always proud of my country, but today I am!
bluejekyll 10y ago
In these discussions I think people often overlook one significant factor in delivering services to people in the US; population density. The EU and also France, have a higher population density than the US. The US is 33 per km, whereas France is 100, based on Wikipedia. This translates to higher costs because maintaining hospitals in low density areas raises the cost of care per capita. This is also a reason that inter-regional train service has never been a good option in the US. There are regions where it works, but coming up with a one-size fits all solution is hard. The metropolitan regions of the US have always subsidized the rural parts. We people of the cities have always paid a fee on our phone bills that helps reduce the cost of phone service in rural areas, as an example. I actually dislike this, because I think it subsidizes sprawl. I believe the ACA is a good step (personally I'd like to see Medicare offered as on option alongside all state insurance plans), but it does need fixes. Whatever the solution, it's going to look different from Europe and France in particular.
- deleted 10y ago
  [deleted]
kelvin0 10y ago
I'm sure it's great ... in France. Because here in the province of Québec (Canada) it's hell on wheels. Granted we have 'free' access to healthcare, but waiting 24 hours in an emergency room is not uncommon due to the shortage of Doctors and low incentives for them to work in the public system. I think it's only marginally better than the USA because it's cheaper, but the actual care you get is scary bad in most hospitals and clinics. Couple that with an ageing population, it's a nice recipe for the shitstorm we call healthcare in these parts ...
- davidy123 10y ago
  You're exaggerating. I've gone to or with multiple emerg visits in Quebec, none even the most critical issues, and have rarely had to wait for more than a few hours, including diagnosis and treatment. If you go to the wrong hospital at the wrong time, it can be worse, but not to the level you indicate, and sometimes it's faster. There are sometimes long very wait times for non critical scheduled tests, which is a problem. The real problem is people with chronic conditions who will have to dedicate much more of their life to their health, which is dangerously demoralizing and a career killer, but I am not sure that's much different in other parts of the world.
hartator 10y ago
I think it's worth noting that Americans already pay around 20% more taxes for healthcare per capita than Frenchs. Where went the tax dollars? Straightforward corruption is a better answer than "systemic issues".
saosebastiao 10y ago
As a supporter of Single Payer that grew up in a hyperconservative home, this sort of article completely misses the point for those that oppose it. To a conservative opponent, getting high quality care at a low out-of-pocket cost is a result of health care being a redistributive social good, and "social good" is just code word for "shirking individual responsibility". They look at this situation and this author like they do their proverbial welfare queen...a beneficiary of their taxes. If we actually want to convince them, we have to prove to them that Single Payer is an objectively more efficient system than insurance. In other words, were the total incurred costs lower than they would be in a our system? Because for them, that's an argument that matters. Unfortunately even I, a strong proponent of single payer, would find a cross country comparison here to be disingenuous. Because it doesn't matter how efficient the French are at administering health care. What matters is how efficiently we would be at administering it. And hands down, we suck at government administration. Whether it is infrastructure, military, health, or whatever...everything we do costs more and takes longer than other governments doing the same thing. And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things.
- zo1 10y ago
  "And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things. " Well, that'll continue happening as long as you force it to be one giant pie. If you let people choose in the first place, then you can have your nice things. You just have to pay for them yourself along with those individuals that agree with your viewpoint. And the rest of us will have to choose to either join you, or do it some other way. All arguments eventually lead to choice. Freedom and consent are fundamental properties of a libertarian belief system. We don't get to throw those out just because it'll be efficient. You could argue that it's efficient to just execute all repeat-criminals, but we don't do that because of fundamental human rights that are completely separate to the concept of pragmatism and efficiency.

232 points by stzup7 10y ago

CarolineW 10y ago

But that's socialism, and the USA will never tolerate socialism.

smcl 10y ago
Who knows, if someone pitches this to Donald Trump and calls it "TrumpCare" he may be vain enough to push it all the way :)
- kccqzy 10y ago
  It always makes me think, perhaps due to the ignorance of Trump, he will be more receptive towards progressive lobbying too. Most of us know so little about Trump's actual policies that maybe anything is possible after all.
EliRivers 10y ago
But only if it's called socialism. If it can be called something else, then it will be accepted. In my experience, US citizens (not all, obviously; I'm massively generalising) have been conditioned to be against things labelled socialism, but the level of economic and political knowledge amongst the general public is such that if you don't call something socialism, it is judged on its own merits without people realising.
- CarolineW 10y ago
  Opponents will hang that label on it, and then it doesn't matter whether or not the general populace would recognise it. It's interesting that my comment is somehow controversial, because it's been down to -2, is now back to -1. I wonder whether they are objecting to my calling "universal healthcare funded by taxes on the general populace" socialism, or whether they are objecting to the claim that the USA populace would ever accept a socialist policy. Indeed, while I've been editing this comment it's gone back down to -2. Interesting to watch, and I really do wonder what it is that's provoking people into downvoting it. ... and now back to -1. Fascinating!
  - woofyman 10y ago
    You're absolutely correct. Conservatives will label it "socialized medicine".
- vacri 10y ago
  Ironically, they're all up for small-scale socialism, aka 'insurance'.
- eeZah7Ux 10y ago
  The US finances private research, technology development and more using public money more than any other country by calling it "military budged". https://en.wikipedia.org/wiki/List_of_countries_by_military_expenditures https://en.wikipedia.org/wiki/List_of_countries_by_military_... ...but maybe that doesn't count as "socialism" because most of the profits ends up in the hands of private companies?
mkl 10y ago
It's not socialism, it's the normal way to do healthcare in a first world democratic society. Most first world countries are not socialist, but have a proper health system like this.

smcl 10y ago

It'll be a long time until the entire USA implements socialised healthcare (if it happens at all...) but are there any individual states which have something resembling a single-payer system, or is this an issue where they all have roughly the same system? Also for some reason this reminded me of a BBC story I read a while back - where "Heavy Legs" is described as a medical condition that only exists in France: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7779126.stm http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...

phonon 10y ago
Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but on care provided like regular insurance). The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration_scandal_of_2014 https://en.wikipedia.org/wiki/Veterans_Health_Administration... ) Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered) All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_reform https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance). https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda... So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.
avar 10y ago
My impression (as a European) of the US system is that in practice what we have with individual states here in Europe + EU isn't possible in the US, since the federal government taxes are proportionally so high, compared to what individual EU members contribute to the EU. Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen. It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster. So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.

logronoide 10y ago

For a Western European this is the normal.

gambiting 10y ago
As a matter of fact, I'm very surprised he had to pay anything at all. 1300 euro for hospital bed and food? This should be completely free.
- logronoide 10y ago
  True. In Spain it would be 100% free. Maybe he has some kind of private health insurance. Here it's very common when you have kids or you don't want to wait for your turn for non critical medical assistance.
- megalomanu 10y ago
  He says he used wifi, TV, telephone, and asked for a better room. If he didn't ask for this, I think he wouldn't have pay anything. The French hospitals offer a lot of paid bonuses. I think it's a good thing, it allows to make the basic needs free.

raphaelj 10y ago

> My individual burden, however, is far more reasonable than > an American might assume. I pay an annual income tax of > about 23%. How comes this number is that low? Tax revenue in France account for about 48% of the country's GDP[1]. I'm living in Belgium, and my payroll tax is already higher than these 23%. -- [1] https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_as_percentage_of_GDP https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...

EliRivers 10y ago
Income tax is not the only tax.
gambiting 10y ago
It's probably tiered, like in many other EU countries. In UK for example you don't pay any tax on the first 10k earned, then 20% on anything between 10k and 40k, and then 40% on anything above 40k. I think there's a tier above it as well, but I'm not 100% sure. I know France has more tiers and they are more aggressive(80% being the highest I think?)
- sgt101 10y ago
  There's a 45% tier and also super tax that kicks in at £100k due to having your £10k allowance removed (so from 100k to 120k you have to pay ~70%)
ThePhysicist 10y ago
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.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_sur_le_revenu_en_France https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...
- 10y ago

clouddrover 10y ago

The US spends more per capita on health care than other OECD countries, even ones with universal public health care: http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ http://kff.org/health-costs/issue-brief/snapshots-health-car... And yet the US has lower life expectancy than those countries: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

raphaelj 10y ago
Infant mortality is also 75% higher in the US compared to France: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html https://www.cia.gov/library/publications/the-world-factbook/...
- barry-cotter 10y ago
  Most of the difference between US and other OECD countries in infant mortality is that the US has a much lower standard for what's considered a viable birth. Basically, lots of what in France are classified as still births would be infant deaths in the US.
  - Normal_gaussian 10y ago
    Using: http://chartsbin.com/view/1445 http://chartsbin.com/view/1445 and https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate https://en.wikipedia.org/wiki/List_of_countries_by_infant_mo... births out of 1000 that are stillbirths: France 3.87 UK 3.50 USA 2.95 Germany 2.43 Infant Mortality (under 5) per 1000 live births USA 5.87 UK 4.38 France 4.30 Germany 3.70 Combining the two for a birthed (Still or not) and didn't make it to 5 rate: USA: 8.8 France: 8.2 UK: 7.9 Germany: 6.1 Obviously the studies aren't matched, but it does suggest that the variance isn't as great as either statistic shows, and there likely is a very strong ranking.
    - brianwawok 10y ago

kensai 10y ago

Medicine is one of those few fields the "socialized" approach is actually the better one. Of course you would prefer a I-don't-want-to-pay-for-others* stance when you are young and healthy (ie provided you were not born with a genetic condition or something similar), but once you start aging and caring, you start appreciating why Medicine as practiced in Europe makes much more sense in the end. *even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Security-and-Medicare-in-the-late-1970s https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)

wav-part 10y ago
I-don't-want-to-pay-for-others != I will not insure my health. US health system needs competition more than socialism [1]. [1] https://mises.org/blog/lack-epipen-competitors-fdas-fault https://mises.org/blog/lack-epipen-competitors-fdas-fault EDIT: A really good comment from link above. Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#comment-2857258347 https://mises.org/blog/lack-epipen-competitors-fdas-fault#co... The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives. People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
- clarkevans 10y ago

thro32 10y ago

Real problem in US with health (and education...) is that cost has skyrocketed out of control. How much is hearth bypass ? $30k? Other countries do that for $4k with similar quality and better post-op care. Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...

lumberjack 10y ago
I don't think "the cost skyrocketed out of control". The cost is simply reflective of the leverage the health care provider and all the middle men in between hold against the patient. It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries. I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
- thro32 10y ago
  Reducing cost is always good. Is not that mantra of free market and capitalism?
  - deleted 10y ago
    [deleted]
  - subhobroto 10y ago
    It is. Unfortunately, a free market for helathcare does not exist in the U.S.
- deleted 10y ago
  [deleted]
- developer2 10y ago
  >> I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year. Wow, just wow. You must not have ever had a family member or close friend fall ill. If you think someone making $50k/year is financially capable of paying $30k up front, you need a reality check.

angry-hacker 10y ago

Does France really have that low tax rate? Usually it's not only income tax people are paying over here and once Americans laern the total % of your money regular Joe pays for the government they are in shock, since they are not used to having so little money being left on the table.

Taniwha 10y ago
here in NZ I pay the high 30% marginal rate (that includes social security) and get mostly free health care. Drugs have a low co-pay, we have one organisation bulk buying for the entire country The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat
boudin 10y ago
There's several taxes. The tax he talks about is what you pay based on your revenues (with several ties, like in the uk). In france we receive what we call a 'salaire brut' which is a salary on which the employer already payed some taxes (which are quite high if i'm not mistaken). On this 'salaire brut' some taxes are automaticaly taken (including some for healthcare), then you obtain what we call 'salaire net', which the money that you get into your account. On this 'salaire net' you still have to pay income taxes (the next year for the previous for the moment, it my change to be taken immediatly on your salary, like in the uk). I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.
ekianjo 10y ago
> Does France really have that low tax rate No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.
- 10y ago

antirez 10y ago

This 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 there is a lot less social discrimination. If this is not enough to show that the US system has issues, note that also in US, healthcare procedures are generally overpriced compared to their costs around the world. There is obviously a problem to fix and Obama was going in the right direction.

ekianjo 10y ago
> Europe has better life expectancy, Diet has a lot more to to about that than medical care.
- collyw 10y ago
  Thats an interesting point, but it would be interesting to see it compared by regions. Southern Europe generally eats a lot healthier than Northern Europe.
  - erl 10y ago
    I am not sure that this is true. Many countries in northern Europe such as Iceland, Sweden, and Norway eat quite healthy. Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north. [0] http://apps.who.int/bmi/index.jsp http://apps.who.int/bmi/index.jsp
    - collyw 10y ago
      Sure, thats why I said generally. The UK and Germany don't have especially healthy diets in my opinion and have a lot more people than the Scandanavian countries that you mentioned.

madaxe_again 10y ago

I 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. It's Sunday. I figure it's a long shot but can't hurt. Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there. Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home. All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care. I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available. It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.

markharris99 10y ago
> I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I'm 50. I remember what London was like way before Labour first got into power. Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams. I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month. I can remember when I would call a doctor and be seen the next day. Not any more. The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true. Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.

cm2187 10y ago

The French health system has its own problems. There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go. The system runs a massive financial deficit. It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets. The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer. Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.

simias 10y ago
>There is little evaluation of physician so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go. There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that. >The system runs a massive financial deficit. It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly. The government plans for a balanced budget in 2017, although the opposition says it's not completely true: http://www.publicsenat.fr/lcp/politique/budget-securite-sociale-quasi-l-equilibre-arrive-senat-1562864 http://www.publicsenat.fr/lcp/politique/budget-securite-soci... This article gives a good overview of the situation as far as I can tell: http://www.lemonde.fr/financement-de-la-sante/article/2016/09/22/le-deficit-de-la-securite-sociale-reduit-a-son-plus-bas-niveau-depuis-2002_5002108_1655421.html http://www.lemonde.fr/financement-de-la-sante/article/2016/0... >Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine. What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?

iraklism 10y ago

I 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't notice it, it's just there. And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these. Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .

ekianjo 10y ago
> free education ( university included ) La Fac is one of the worst places to get an education though.
- zdkl 10y ago
  If you're not in the fac mindset, sure. But still, equal access and cheap education is not something to spit at!
  - bosie 10y ago
    > If you're not in the fac mindset what is a "fac mindset"?
    - binarycoffee 10y ago
      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.
      - 10y ago

fiftypounds 10y ago

I similar, but much less medically severe, experience with a gallbladder infection due to stones. This was in Germany. The cost of the sonogram and and ultrasound was c.a. 100 euro. The blood test was a pittance. And, becuase my medical German was/is very poor I had an exensive private consultation with the director of the E.R. who spoke near-natively fluent English. The total cost: 250 euro out-of-pocket The cost of one sonogram in the US: $1500 (before insurance) Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.

srean 10y ago
This is a topic that has come up on HN so many times that I have lost count. I have come to the conclusion that the US milieu is so dogmatically against any alternative that the standards of a proof that they will demand to be acceptable far outstrips the standards that they will demand of other things. This is the diametric opposite of preaching to the choir. Ultimately its them who gets handed the shorter end of the stick. Some are rich enough that it does not affect them as much. What intrigues me is the behavior and rationalizations of those who cannot escape the adverse consequences. Forget drug and hospitalization pricing for the moment, just the institutionalized control (cartelization) of the license to practice medicine is a tell tale sign.

partycoder 10y ago

Healthcare professionals are expensive since they require significant preparation. But there is fishy stuff going on too... 1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500. The pharmaceutical industry also does some sort of disservice to society by inflating prices so much. Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.

ersii 10y ago
That said, even single-payer systems as the ones in Western Europe can have this exact same problem. Like when Region Stockholm / Stockholm County (Responsible for Health Care and Public Transport) in Sweden bought supplies like support socks for 6000 SEK/pair (~645 USD) [1]. I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care. [1] http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte-strumpor-for-6-000-kronor http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte...
douche 10y ago
For one operation I had, I was given a turkey sandwich to eat in the recovery room before they would let me leave. Two slices of wonder-bread, one slice of turkey. $36 on the itemized bill that was sent to my insurance. It's nuts.
ReallyAnonymous 10y ago
High charges of low cost items are because of the amount of free care hospitals provide. I'm a physician in South Carolina and I take care of a tremendous number of fully employed people with no health insurance. Those of us with insurance pay for those without by paying higher costs. This gentleman would have probably received the same treatment in the US (at least at my facility) and received a $300,000 bill, of which he would probably never pay (bc he cannot). That artificial aortic graft sewn in probably cost the hospital $1500. It doesn't receive that for free. Nor does it expect the 7-8 people in the operating room or the post operative care to work for free. My hospital has an operating profit of less than 1% mainly because it provides so much free care. All I have to do to take care of a patient is declare it an emergency and there is no stopping of whatever care I feel is necessary to care for the patient, e.g., a newly diagnosed cancer patient. This, I believe, is true throughout the USA. And most of the people I take care of have jobs, but no insurance. Ask how many people that clean hotel rooms have insurance. How about people that work call centers? That, plus monopolist practices of the pharmaceutical industry and you have high costs. And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.

fvdessen 10y ago

A healthcare system that I like quite a lot is the Belgian one, which is a nice mix between free market and socialised medicine. In Belgium the government sets standard rates for different kind of medicines and treatments. You pay 8% of your income towards a state health fund that refunds all your health-related spending up to the standard rate. You are free to choose where, when, and what treatment you get. You pay the cost up-front, and then you get refunded by the state. But you only get refunds up to a 'reasonable' rate. In practice most doctors demand little-more than that rate, and thus you get a full refund. You can also subscribe to a private health insurance if you want to get refunds for better options.

trmsw 10y ago
I agree. The general standard is good (my wife's experience of giving birth here was much better than my sisters'in the UK) and if you have the money you can choose to pay more for comfort or convenience.

grecy 10y ago

Of course, this is perfectly normal in the developed world. My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc. In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes. Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free. The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.

totony 10y ago
Its the same in Canada, it's not because it appears free that they don't run for profits. Health care is a massive public spending and shows when you look at the taxes you (or your employer) pay

digi_owl 10y ago

The impression i get about US healthcare is that there is a vicious cycle of insurance agency haggling and hospital profits.

yodsanklai 10y ago

Just to give a different perspective, I think it's fair to say French people are very worried that healthcare quality is decreasing. I don't know if it's really the case but in any case, the system is far from being perfect. For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't). If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...

RobertoG 10y ago
It seems to me that, as a society, to choose for a longer waiting list and uglier waiting room it's a small price to pay in exchange of healthcare for everybody. About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.
rtpg 10y ago
The eye doctor thing always confused me. I would have to call 2 months in advance to get a routine eye check! What?? It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine). For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so

gerty 10y ago

I heard an argument some time that European healthcare and health R&D is indirectly subsidised by the US. The mechanism at works is 1) US consumers are ripped off by pharma; 2) pharma's higher profits lead to higher investment in R&D; 3) everyone profits from that and in the European case negotiate lower prices. I've always wondered to what extent this is true.

walshemj 10y ago
allowing the government to negotiate for the best price would be a start

pentae 10y ago

Couldnt the US Gov just use Medicare as a private health insurance option that runs not for profit and offers a lower cost than private insurers? It could then negotiate low rates with pharma companies and hospitals on behalf of its customers and eventually justify tax assistance. That would essentially let the 'free market' stay in effect and be a shortcut past the lobbiests.

phonon 10y ago
https://berniesanders.com/issues/medicare-for-all/ https://berniesanders.com/issues/medicare-for-all/

osti 10y ago

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.

YeGoblynQueenne 10y ago

I 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.

trprog 10y ago
>"Why should I pay for someone else's healthcare?". >and I don't really have an answer to that. Why indeed? Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?
- YeGoblynQueenne 10y ago
  Actually, I know exactly what's going to happen (to me) in the future: I'll eventually grow old, get sick and die in pain. Or maybe I'll just get the "die in pain" part. That's how it goes, right? And in the past I was very young and couldn't yet fend for myself. I benefitted from being born in a developed nation and, like you say, if my parents had died while I was young, I'd have been taken care of (though in my country's case it would probably be my extended family that'd have looked after me, first, and the state would only intervene if I had noone to care for me). Like, I totally get what you're saying, but a significant number of people don't see it that way. Maybe they forget they were once too young, or that they will one day be too old. Maybe they just think they can do well enough for themselves that they'll just wing it. My point is that for many people contributing to things like public healthcare doesn't make sense. For instance- in the UK education is not free, and you will hear lots of people saying, indeed "why should I pay for someone else's education?". That's much more common than grumbling about having to pay for the NHS, but in the end it's just the same thing.
10y ago

ThomPete 10y ago

Having 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?

on_and_off 10y ago

I am French and live in France right now. Recently I had to undergo a surgical procedure. Nothing as serious as heart surgery, but still one day at the hospital and general anesthesia. This has not affected my personal finances and I only had to focus on getting better. I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me. This is not ok. It saddens me that USA have not been able to instore a sane health care system.

fiatjaf 10y ago

"I pay an annual income tax of about 23%." So you don't pay any kind of VAT? That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health. I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.

nraynaud 10y ago
VAT is 20% in France, and the biggest source of income for the State. But social security has a separate budget and is not paid by taxes, but by special levees on salaries and income.

tim333 10y ago

I note the president elect has said in the past: >"We must have universal healthcare...I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses... I know he flip flops all over the place but maybe if people lobbied, something could be done.

coldcode 10y ago

While I would like to have read the entire post, the constant flashing ads and overlays gave me a health crisis and I was forced to abandon the article.

amelius 10y ago

There is an interesting documentary about the health care system in Europe: http://www.burning-out-film.com/ http://www.burning-out-film.com/

djfm 10y ago

I'm French, I'm not always proud of my country, but today I am!

bluejekyll 10y ago

In these discussions I think people often overlook one significant factor in delivering services to people in the US; population density. The EU and also France, have a higher population density than the US. The US is 33 per km, whereas France is 100, based on Wikipedia. This translates to higher costs because maintaining hospitals in low density areas raises the cost of care per capita. This is also a reason that inter-regional train service has never been a good option in the US. There are regions where it works, but coming up with a one-size fits all solution is hard. The metropolitan regions of the US have always subsidized the rural parts. We people of the cities have always paid a fee on our phone bills that helps reduce the cost of phone service in rural areas, as an example. I actually dislike this, because I think it subsidizes sprawl. I believe the ACA is a good step (personally I'd like to see Medicare offered as on option alongside all state insurance plans), but it does need fixes. Whatever the solution, it's going to look different from Europe and France in particular.

deleted 10y ago
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kelvin0 10y ago

I'm sure it's great ... in France. Because here in the province of Québec (Canada) it's hell on wheels. Granted we have 'free' access to healthcare, but waiting 24 hours in an emergency room is not uncommon due to the shortage of Doctors and low incentives for them to work in the public system. I think it's only marginally better than the USA because it's cheaper, but the actual care you get is scary bad in most hospitals and clinics. Couple that with an ageing population, it's a nice recipe for the shitstorm we call healthcare in these parts ...

davidy123 10y ago
You're exaggerating. I've gone to or with multiple emerg visits in Quebec, none even the most critical issues, and have rarely had to wait for more than a few hours, including diagnosis and treatment. If you go to the wrong hospital at the wrong time, it can be worse, but not to the level you indicate, and sometimes it's faster. There are sometimes long very wait times for non critical scheduled tests, which is a problem. The real problem is people with chronic conditions who will have to dedicate much more of their life to their health, which is dangerously demoralizing and a career killer, but I am not sure that's much different in other parts of the world.

hartator 10y ago

I think it's worth noting that Americans already pay around 20% more taxes for healthcare per capita than Frenchs. Where went the tax dollars? Straightforward corruption is a better answer than "systemic issues".

saosebastiao 10y ago

As a supporter of Single Payer that grew up in a hyperconservative home, this sort of article completely misses the point for those that oppose it. To a conservative opponent, getting high quality care at a low out-of-pocket cost is a result of health care being a redistributive social good, and "social good" is just code word for "shirking individual responsibility". They look at this situation and this author like they do their proverbial welfare queen...a beneficiary of their taxes. If we actually want to convince them, we have to prove to them that Single Payer is an objectively more efficient system than insurance. In other words, were the total incurred costs lower than they would be in a our system? Because for them, that's an argument that matters. Unfortunately even I, a strong proponent of single payer, would find a cross country comparison here to be disingenuous. Because it doesn't matter how efficient the French are at administering health care. What matters is how efficiently we would be at administering it. And hands down, we suck at government administration. Whether it is infrastructure, military, health, or whatever...everything we do costs more and takes longer than other governments doing the same thing. And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things.

zo1 10y ago
"And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things. " Well, that'll continue happening as long as you force it to be one giant pie. If you let people choose in the first place, then you can have your nice things. You just have to pay for them yourself along with those individuals that agree with your viewpoint. And the rest of us will have to choose to either join you, or do it some other way. All arguments eventually lead to choice. Freedom and consent are fundamental properties of a libertarian belief system. We don't get to throw those out just because it'll be efficient. You could argue that it's efficient to just execute all repeat-criminals, but we don't do that because of fundamental human rights that are completely separate to the concept of pragmatism and efficiency.