13 ms·

The French way of cancer treatment

285 points by MaysonL 13y ago

bsaul 13y ago
All of this is true, but americans have to realize one thing : all the drugs for cancer are created in the US. Because your system in general is expensive but that makes it possible to do research. Our doctors are not billionaires, our private hospitals aren't making an insane amount of money, and the state is collapsing under its debts. So almost nobody has the money to run research, and when they do, drug companies look for the american market to cover their costs.
- steve_barham 13y ago
  Source? If you look at expenditure on pharmaceutical research and development in the UK vs. the US, you see that 9% of global R&D expenditure is UK based, and 49% is US based. This very closely matches the population differences between the UK and US (at a population of 63M vs. 317M). Within Europe, the UK represents 23% of all pharmaceutical R&D funding; France is only slightly lower at 20% of the total. http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_United_Kingdom#Research_and_development http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_... http://en.wikipedia.org/wiki/Demographics_of_the_United_States http://en.wikipedia.org/wiki/Demographics_of_the_United_Stat... http://en.wikipedia.org/wiki/Demographics_of_the_united_kingdom http://en.wikipedia.org/wiki/Demographics_of_the_united_king...
  - bsaul 13y ago
    Source is a very close friend of mine who's doing research in biology, and who knows how things work here vs the US. He witnessedthe difference in how the interns are paid, how the researcher are paid, how the labs are funded, gow modern the equipments are, and how much money the pharma corp are ready to spend todevelop new drugs. And this is a completely different world. Now you're perfectely right and the market size is a big factor. I should have compared europe vs the US. The conclusion would have been the same.
    - marvin 13y ago
      The US healthcare industry runs at a profit, so your point is moot.
    - kalleboo 13y ago
      How people is paid also reflects the cost of education - in Europe higher education is vastly cheaper than in the US (in many cases free). If American researchers end up with $200,000 in college debt and a European has $10,000, they'll be requiring different salaries.
  - tsotha 13y ago
    The research expenditure isn't meaningful to the consumer. The question is where the companies intend to profit off of that research, and whether they would bother if they were only reimbursed what the NHS pays.
- duedl0r 13y ago
  bullshit
  - jamesaguilar 13y ago
    FYI: http://ycombinator.com/newsguidelines.html http://ycombinator.com/newsguidelines.html
    - factorizer 13y ago
      I upvoted him/her. Because parent posted bullshit.
- scriptproof 13y ago
  Pharmaceutical not equal doctors. The former is not funded by doctors but by the patients. So it will be better to extend medicaid to more people to fund the former...
  - bsaul 13y ago
    It's an ecosystem. Doctors and hospitals are the pharma industrie customers for many many things such as medical equipment. Doctors in france fees have their fees regulated by the state. They can't charge what they want. If the fee in the OP story was 18€ it's not because the doctor think it's fair to be paid just like a maid, but because the state fixed the price. And fixed prices is a big reason why our social security has been working in the last decades in France, and why medicaid may not work in the US. It is an ecosystem, where everyone has to aggree on keeping the prices down.
- cmapes 13y ago
  They [drug companies] are satisfied with the status quo because they ARE making money. The problem is that the FDA makes it near impossible for biotech startups to develop revolutionary and competitive oncology tech. Investors don't want to invest in early/mid stage biotech companies due to the extreme risk. Essentially these startups could have a viable product, yet get stonewalled by the FDA for years while waiting for trials and run out of money and dry up. In many cases it's not really the research that drives the cost, but rather the ability to charge the cost they do because people want to live. I understand that perspective is controversial and some will down-vote me for it. One instance was when my Dad had Metastatic Melanoma and was on DTIC therapy (Dacarbazine). It was nearly $20k per infusion. Are you kidding me, $20K/infusion!? They did 8-10 infusions. Unfathomably expensive. Oh and DTIC is one of the crappy old drugs from the 1970's. Anyone who believes that the cost to produce the drug is anywhere within several orders of a magnitude of what it costs patients is delusional. TL;DR The FDA and their non-startup friendly political processes are suppressing new players from emerging in the medical field who could create companies with revolutionary treatments. These treatments would bring a natural balance back to medical pricing through free market principles. Instead we're stuck with the current oligopoly where there's no major inventive to create cures which would cost billions in research while simultaneously ending hundreds of billions per year in recurring revenue on current semi-effective treatments. /rant
  - james1071 13y ago
    That is not true at all. It is not at all difficult to get a cancer drug approved, providing of course that it works.
- mikeash 13y ago
  US medical R&D spending is about $500/year per capita. US overspending on medical care compared to other first-world countries is about $3000/year per capita. That doesn't account for more than a small part.
  - twoodfin 13y ago
    That's a fair point, but R&D isn't the only thing encouraging the development of new drugs and technologies. A huge market willing to "overpay" is a massive driver. Look at the history of MRI penetration in Canada vs. the U.S. for an oft-used example. Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable.
    - DanBC 13y ago
      > Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable. That doesn't mean those meds are effective or even not actively harmful. People willing to pay tens of thousands of dollars to gamble on getting an extra 4 weeks of shitty quality life doesn't sound like a good way to run medication development.
- robbiep 13y ago
  An of touted argument that is patently and demonstrably false and if you had of done some research you would know that
- route66 13y ago
  Isn't it a much simpler explanation that healthcare should never be a free market as one of it's participants, the "patient" is not participating voluntarily? (This is not a direct response to your post, but I place it here as you put a market argument upfront)
  - bsaul 13y ago
    I'm not judging the systems. I, personaly, much rather live under the french nhs than the US one. But i just wanted to provide some perspective to that generaly over optimistic OP post. The fact that cancer drugs are created in the US is not a coincidence. It's an ecosystem where there is a lot of money to be made, and as we know it in IT, money drives innovation.
    - eropple 13y ago
      ICI discovered tamoxifen before AstraZeneca bought them. They're British. Femara (letrozole) and Afinitor (everolimus) are Novartis (Switzerland). Campostar was discovered by Pharmacia, a Swedish company that's now part of Pfizer. The U.S. by no means has a monopoly on "cancer drugs".
      - bsaul 13y ago
        It would be interesting to see where the labs for those companies are, and what's their primary market. But thanks, i didn't know that. Maybe the british and swiss R&D isn't in such a bad state as France.
  - dantheman 13y ago
    The majority of health care costs are non emergency, at that point it's no different than needing food.
    - beagle3 13y ago
      It's very different from food: While the majority is not emergency, the majority IS chronic conditions, which are not comparable to food: If McDonald is too expensive for you, you can switch to Ramen. If Insulin is too expensive for you, what do you switch to? If Radiation therapy is too expensive, what 7do you switch to? If Dialysis is too expensive for you, what do you switch to? If psychiatric drugs (for bipolar disorder, or schizophrenia) are too expensive for you, you lose the ability to be part of society. Totally unlike food, despite being non-emergency. The moment you have patents on drugs (which you do), and a $400M cost-of-bringing-to-market independent of the resarch (which you do), it's not a free market. Totally unlike food.
- gambiting 13y ago
  That is simply not true. A company behind a few leading cancer treatment drugs that are in use today is Novartis - and that's a Swiss company: http://en.wikipedia.org/wiki/Novartis http://en.wikipedia.org/wiki/Novartis
  - seanmcdirmid 13y ago
    To be fair, the Swiss pay only second to Americans in health care costs (~10%) and have the private but mandatory insurance thing also.
- Adirael 13y ago
  It's not the case that americans would stop spending on health care if they went social. They'll spend a bit less, but I don't think it would make an impact on research. They will still look to the american market to cover their costs because it's the biggest market. It doesn't matter if it's the taxpayer's pocket or the private insurance paying out.
  - bsaul 13y ago
    The thing is,in my opinion, you can't have a balanced insurance system with health costs as high as the US ones. So you would have to force everyone to reduce their rates, and thus decrease the cash generated by this economy ( and thus less R&D) French doctor rates are fixed (unless they decide to have their fees not rembursed by the NHS), and they are orders of magnitude lower than the US ones ( remove one and sometimes two zeros for exam fees). And even with thoses restictions, french NHS is struggling economicaly.
- bsaul 13y ago
  Didn't expect so many downvotes on that post. It seems many people here ( most of them living in the US i presume) don't want to hear about the downsides of a system i'm currently living in. I suppose this is a too sensitive subject to have a pros/cons type of discussion. French NHS works because everybody accepts to lower the rates of everything. We ( the french) live in a pseudo state-regulated health economy. When you're doing this, you're reducing the total amount of money that's flowing into that economy, which logically impacts the financing capabilities for R&D. Other people have said the same thing : http://www.nber.org/digest/may05/w11114.html http://www.nber.org/digest/may05/w11114.html
- iXce 13y ago
  According to [1], the amount of money invested in research in Europe and in the US seems to be of the same magnitude. And it makes sense to me to claim that the "drugs are created in the US" to prove your point. When you have developed a treatment, you can sell it worldwide, thus making profit worldwide to pay for the development/future developments. Not to mention that France has some very edgy teams working on cancer treatments, such as for leukemia at Hopital Saint Louis in Paris or for various cancers at Hopital Paul Brousse and Institut Gustave Roussy in Villejuif (for instance they are sort of world leader on chronotherapy of cancers, team of Pr. Francis Levi) [1] http://www.nejm.org/doi/full/10.1056/NEJMp1311068 http://www.nejm.org/doi/full/10.1056/NEJMp1311068
danielhunt 13y ago
I'll be the first to admit ignorance on the Medicaid fiasco in the US, but stories like this really drive home the difference between European and US mentalities to healthcare Being Irish, I'm used to a public healthcare system that, while slow and filled with red tape, does actually work. Private health insurance is expensive and quickly becoming something that can mean the difference between paying your mortgage or not, but still is seemingly better than whatever is going on across the pond Definitely worth a read, if only to highlight the stark difference in approaches.
- masklinn 13y ago
  And of course US healthcare is no faster and no less filled with red tape, unless you have significant amount of money (and even then, the red tape of having to negotiate with and coordinate care actors still falls on the patient or their family)
  - davidw 13y ago
    Oddly enough, here in Italy, regular doctor visits have very little red tape. They just type your name in their computer, and then get on with asking what you are there to see them for. If you need a prescription, they print one out for you, that you can take to the pharmacy. By and large, Italy is not a stellar example of how to run a country, but the health care system is less bureaucratic and easier to deal with than the US, and generally not something you have to worry about much. That said, it's not perfect, either. When our son was born here, it felt very much like a factory operation with the pregnant woman as an input and a woman+child as the output. I felt they were competent in the event that anything went wrong (in our case, everything was fine), but it was all very impersonal and felt designed to maximize throughput. I was not allowed to be with my wife for most of her labor, for instance.
yoha 13y ago
As a French, I must say that we are so much used to this system that it seems obvious. And, French being French, we like to complain about the flaws (well, there are some). But whenever I read this kind of article, I realize that this is not obvious at all and that, in the States, you have to pay for your health like for any groceries. This is when I understand what people means when they say that France is a socialist country: we have very strong public service. This means that police, fire fighters, healthcare, school and so on are mostly public: we have no militia, prisons have no incentive to get more people jailed by bribing judges, fires are fought without caring if the flat's owner can pay for it, people are being taken care of without delay for checking if there private insurance will accept it, and kids from poor families have a firm chance of getting a good education. The amusing part is that having this critical services being managed by the state seems so obvious to us that we don't think we are specially socialists (well, the French social party seldom wins the presidential elections). I guess it would seem odd for the government to nationalize a company, but it would be nearly impossible for them to try an privatize a critical public service.
- k-mcgrady 13y ago
  I'm in the UK and we also have these same free public services. No matter how many ways an American explains it to me I cannot understand how their system can ever work better. In fact it seems barbaric to me. I think that in theory, in a perfect world, a completely free market or a libertarian society could work - but in reality it's never going to. The societies with the best standard of living in the world are ones like France that have social services that every one pays for through tax. I guess we have the added benefit in Europe that if we truly don't like our tax system and want a more private system based country we are free to move and work in any other EU country that meets our needs.
  - robbiep 13y ago
    For completeness I must chime in and declare the Australian system shares more similarities with the French, UK, Canadian, German, New Zealand... The list goes on- countries than we do with the US system
duedl0r 13y ago
welcome to Europe
- scotty79 13y ago
  My life partner got for her brain tumor: brain surgery by one of the two top neurosurgeons in my city (0.7 mln population), radiotherapy combined with chemotherapy (linear accelerator lifetime dose, themozolmide 6 weeks), chemotherapy (themozolmide 6 months), mri checkup every 6 months. Everything fully covered by her basic state health insurance that costs you 50$ per month (rougly 10 pizzas) if you are not employed anywhere and you registerd your own company. Proportionally less if you are employed for less than 60% of average pay and more if for more. Costs you nothing if you are unemployed and registerd as unemployed or you have a husband or wife that is covered. You can also pay it out of your pocket if you don't feel like working or visiting unemployment office every few months to check there's still no work you could try. What is more it's nearly in full deductible directly from your tax so it costs you even less. It's Poland so neurology ward was overcrowded and begged for renovation and radiotherapy mask was initially too tight, but we don't care, she was given two years and counting of full quality life witout any unnecessary burden on her, us and our families.
  - gambiting 13y ago
    I would never ever complain about the Polish healthcare. The oncology clinic in Warsaw was the one of the pioneers in treating GIST(rare type of stomach cancer) with then-new Glivec - Initially, my father has been given less than a year after being diagnosed with GIST. He has been alive and very well for over 8 years now after the diagnosis, having had two operations and taking a box of Glivec(~$3000 USD box) every month. The hospital even pays for his train tickets to Warsaw so he can get his medicine every month. He has never paid anything for his treatment, that's all national healthcare system. And yes, the waiting rooms get a bit crowded - who cares, he still gets the best cancer treatment in the country,for free. As a kid, I always dreamed of living in America - now I wouldn't want to do it even if someone paid me to. Nope.
yread 13y ago
Even though the article started with saying it's stage 4 I kind of expected he would survive :(
- michaelochurch 13y ago
  Pancreatic cancer has a terrible prognosis as it is, and Stage IV (metastasis) makes that worse. If the cancer makes it into the bloodstream, and isn't wiped out completely by the chemo (cancer cells have an evolutionary dynamic like antibiotic resistance; this is why chemo drugs can stop working before they kill all the cancer) it's very likely that it's a chronic illness and terminal within 5 years: often much less.
puppetmaster3 13y ago
In USA, we have legalized corruption to pay more for less: http://en.wikipedia.org/wiki/Karen_Ignagni http://en.wikipedia.org/wiki/Karen_Ignagni
pilooch 13y ago
Both my parents, and my sister have faced life threatening diseases, with lifetime treatment required. Call it bad luck. They benefit a 100% health insurance coverage for these diseases, for free. Had it not been the case, our family would not have been able to cope. This shared insurance system builds the society I want to live in. IMO France now needs to rebuild its economy so it continues to support this gold standard system. Let's not let it degrade.
pilooch 13y ago
Both my parents, and my sister have faced life threatening diseases, with lifetime treatment required. Call it bad luck. They benefit a 100% health insurance coverage for these diseases, for free. Had it not been the case, our family would not have been able to cope. This shared insurance system builds the society I want to live in. IMO France now needs to rebuild its economy so it continues to support this gold standard system. Let's not let it degrade.
scotty79 13y ago
US hospitals created entities to negotiate with the suppliers to get better deals for them. At some point they stupidly decided that these entities can finance themselves by taking percentage on transactions (as opposed to being financed by the hospitals according to entities needs as it was till then). Then the thing went downhill from there. Entities got free, became for profit, concentrated, and now they stand in the middle between hospitals and suppliers taxing the trade between them and punishing everyone that wants to get free by making deal with other business partners of that hospital/supplier more expensive.
kremlin 13y ago
French care for mothers giving birth could be better. My wife had to pay for a private midwife because the standard French treatment is to drug up the mothers as a matter of course and perform c-sections something like 10 times as often as necessary. Maternity wards are basically treated like baby drive-thrus. In and out as quickly as possible. Which isn't to contradict that French health care is good; just pointing out an area in need of improvement.
- shin_lao 13y ago
  It really depends on where you get treatment. Healthcare in Paris is excellent (but you might get unlucky, sure), in smaller cities it might be harder to get an appointment with specialists.
- ronaldx 13y ago
  I recently heard that the French offer relatively few post-natal services in terms of baby care, but do offer vaginal exercise classes for new mothers: http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.single.html http://www.slate.com/articles/life/family/2012/02/postnatal_... I found that representative of a great healthcare system: they are not just doing the minimum or the obvious or unnecessary 'nannying', but taking a holistic approach to postnatal care.
- Jare 13y ago
  In Spain it seems the reverse: public institutions push the natural birth route much harder, whereas private clinics routinely perform C-sections or fully medicated or induced birth simply for their own convenience or to collect the extra money from the insurer. After the baby is born and all is well, public hospitals will assist moms to breastfeed if needed, whereas private places just want you out of there ASAP. If I want convenience and pretty flowers for simple procedures I'll go with private, but for anything serious public all the way.
jokoon 13y ago
Just like chomsky said it in the corporation documentary, some institutions do a much effective job if they operate at a loss. For the simple reason that those insitution makes sure the whole country benefits from them. Often profit will bring more destruction. Profit driven economy is important for competition, it applies for many market, like luxury, automobile, housing, furniture, etc, and it's also important when the government need to make expenses: they will buy from the company who offer a good service at a fair price. That's where capitalism fails. Capitalism doesn't directly make the poor wealthier, but if you make programs that help the poor, it will always have benefits to the rich. That's what I don't understand when the wealthy wants the poor to not be given aid: it might increase the wealthy's relative wealth, but not their absolute wealth. I think the wealthy don't like socialism not because it doesn't reward their effort or their wealth, but because it gives them less decision power in general. Which is stupid, since wealthy people have a career in business, not in politics. I guess it boils down to an inferiority complex. Also don't forget france's budget is mostly financed by the valude added tax, which doesn't exist in the US.
nolok 13y ago
Interesting bits from one of the linked articles >In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree? >I question the W.H.O. methodology, which has serious problems with data reliability and the standards of comparison. A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs. They examined avoidable mortality — that is, deaths whose risk of occurrence would be far lower if the population had access to appropriate health care interventions. In that study, based on data for the year 2000, France was also ranked No. 1, with the lowest rate of avoidable deaths. The United States was last, in 19th place, with the highest rate of avoidable deaths. That’s a severe indictment of our health care system in my judgment and calls attention, quite justifiably, to the high performance of the French health care system. http://prescriptions.blogs.nytimes.com/2009/09/11/health-care-abroad-france/#h[IqtTas,2,3] http://prescriptions.blogs.nytimes.com/2009/09/11/health-car...
- _pmf_ 13y ago
  > The United States was last, in 19th place, with the highest rate of avoidable deaths. Alas, a negligible price to pay for Freedom™.
  - swombat 13y ago
    France is a free country, by any sensible definition of the term. Sure, you can coin a definition of "free" that excludes France, but you can do that for any country, including (and perhaps especially) the United States. (or perhaps you were being sarcastic)
    - escape_goat 13y ago
      Purely on mechanics, the "by any sensible definition" clause does make this a classic "no true Scotsman" argument. What you probably wish to argue is something like: "Those unique 'American freedoms' that ostensibly result in such a crappy health care system --- and the inevitability and necessity of this is highly debatable --- do not contribute nearly as much to actual freedom as you seem to think." What you are actually arguing is: "There exists no sensible definition of freedom wherein the citizens of the United States are free and the citizens of France are not." A disagreement which continues from this point will devolve quickly into an argument about when and how ideas are "sensible". This is perhaps a really interesting topic when pursued in its own right, but the assertion has, at that point, effectively derailed future debate about the different freedoms enjoyed by the French and Americans.
tluyben2 13y ago
As others have said; this is normal in the EU (I'm not aware of exceptions in the EU). And I have never had to talk about finance at all in relation to healthcare; I think it's insult to injury to have to navigate insurance policies, bills etc while you or someone you love is ill, dying or died. Especially when you have insurance companies wiggling out of their responsibilities by not paying is a side of this much loved capitalism which I would not like to see appear here.
negrit 13y ago
French living in the US here(California). I had to go to the general practitioner and I still don't understand how they can come up with prices as high as $400 when it cost me 22 euros back home for the exact same service. Also my insurance company in France would rather pay for my flight ticket to go back home instead of going to the hospital in the US. I've been in the US for almost 2 years now and it still puzzle me that I had to pay for STD test(!) and I still don't understand the US healthcare system.
- p4bl0 13y ago
  Paying for STD tests? It means that it is not anonymous either… What a shame. For non-French people: in France it is standard that STD tests can be done anonymously and for free by anyone (you are never asked any identification information, everybody can do it even non-French person).
  - arjie 13y ago
    In the US, you can get either confidential testing or anonymous testing. You have to pay for both, but the former results in your insurance provider being informed of your test. Some states also have only confidential testing. I know people who are very careful about this because they don't want premiums going up. These things all add friction to the process in a time of high stress. As a user experience, it is of very poor quality.
- facepalm 13y ago
  To be fair, probably in France it costs much more than 22 Euros, too, but the extra cost is borne by the public.
  - brohee 13y ago
    Nope, that's what an "under convention" GP gets for a visit (there is an issue with that number not having followed inflation in a long time). The patient will pay very little of it, nothing if completely covered (CMU). Doctors make less money in France than in the US, but are still plenty well off.
mnml_ 13y ago
You also need to understand something about French healthcare : money is where the risk is. Our Intensive care services are amazing, however basic depts are not that great.
prestadige 13y ago
My suspicion is that both health care systems are unsustainable because of rising geriatric care costs. To counter this we'll be forced to navigate the minefields of legal euthanasia and life extension technologies.
rwissmann 13y ago
This. All this hate for the European health care systems is just misguided and ignorant. Health care delivery is one of the few sectors of the economy that the US is not world class in (despite having the best medical research). We all have our national pride and there are real philosophical difference on how to organize societies - and these differences matter. Being smart however includes the ability to sometimes ignore one's ego, compare solutions based on their merit, and learn from each other where possible.
- danmaz74 13y ago
  All this hate for the European health care systems is just misguided and ignorant Not really... a part of it is misguided and ignorant; the other part is highly informed and very well guided.. towards ever increasing profits.
beilabs 13y ago
My father passed away from cancer, he was given 3 months to live. I often believe he received a sub-standard level of care and wonder would things have been different if he lived in a country like France. Work hard and pay high taxes all your life. Your country should take care of you when you need it the most.
ck2 13y ago
The US will never have humane health care like France as long as we are locked into the insurance driven model. And that fate has pretty much been sealed now for the next few generations, maybe even hundreds of years. There are now many millions of people in the US that will never have health care under the insurance model because of the medicaid gap caused by the loophole the supreme court made and the states that refused medicaid expansion.
fuckpig 13y ago
Flogging the old "European socialism is the best" dead horse again, I see. Comparing radically different countries always yields good results, right? It's important to also note the French are bankrupt and have massive internal problems. It's great they shifted all of their effort into health care. It will make a nice epitaph.
DanielBMarkham 13y ago
As an American, I've been reading these kinds of articles for decades: country X has awesome attribute Y, why can't we have it? Best I can figure, country X also has these undesirable attributes A, B, and C. The premise here is that you can pick and choose various best features of wildly divergent societies and then combine them, like eating at a buffet bar. I do not believe this premise is valid. If you want socialized French-style medicine, then you also get national strikes that shut everything down, Mediterranean time reckoning, really bad enviornments for startups, and so on. That doesn't make the effort worth abandoning. American healthcare is broken and it has remained broken through major political turmoil designed, presumably, to fix it. Just at some point, you have to decide for yourself whether or not you want to form political opinions based on how emotionally moved you can be from listening to just part of the story, or whether diving deeper is worth it for you. I applaud the French system's strengths and the efforts to improve our own. I'm just not sure how much here is useful. There's much more to this than "But if we could only just expand Medicaid!"
- michaelochurch 13y ago
  If you want socialized French-style medicine, then you also get national strikes that shut everything down, Mediterranean time reckoning, really bad enviornments for startups, and so on. That's ridiculous. All the European countries have healthcare systems that are far more civilized than ours. Not all of them have those problems. Also, it's not that Europe is a bad environment for startups. It's that Silicon Valley (for all its defects) is the best environment for startups in the world, and there's a power law distribution. (Whatever #2 is, it's not even close.) The US minus Silicon Valley is no better than Europe in terms of supporting entrepreneurs.
ThePhysicist 13y ago
I think you could call this article the (North) European way of cancer treatment, since overall the healthcare systems and standards are pretty comparable in most of European countries (with the exception of some new member states and a few southern countries). In fact, as a EU citizen your public health insurance card will even cover treatment in other member states in some cases, although "health tourism" is in general not possible (http://en.m.wikipedia.org/wiki/European_Health_Insurance_Card http://en.m.wikipedia.org/wiki/European_Health_Insurance_Car...). Personally I lived in Paris for three years and always tried to go back to Germany to see a doctor (which rarely happens) since I perceived the hygienic standards at hospitals and private practices to be a bit lower than in Germany, but maybe I'm a bit biased there as a German ;)
michaelochurch 13y ago
After all, people come from the all over the world for treatment at Sloan Kettering. This is one of those claims that has to be attacked. Day after day, I hear people defend our horrible healthcare system by claiming that people on the "global rich list" still come "to the US" for healthcare. That was true in the 1980s. Not now. No one who knows anything thinks highly of our healthcare system in general. Even if you have insurance, the quality of care is inferior to what many countries have for free. What is true is that very wealthy people (for whom money is no issue) travel to specific doctors for treatment, especially when getting an experimental procedure. If that doctor's at Sloan Kettering, they go to New York. If she's in Paris, they go to France. If she's at Hopkins, they go to Baltimore. If that doctor's in London under NHS, they go to the UK. No one comes "to the US"; some people come to specific specialists. Anyway, if you're an average American-- little wealth, no connections, unable to afford treatments insurance won't cover-- you're probably not going to be able to get appointments with those specialists no matter what. The U.S. insurance-dominated healthcare system is a world-class embarrassment. It's the first sign that we're no longer a first world country.
hartator 13y ago
Am I the only one who doubt that this is the truth? I am living in both Paris and the US. It's not what I have experienced. In Paris, one of my friend has been hit by a motorcycle. The motorcycle run away. She hits the ground and nobody cares. She was disoriented with weird bubble on the skull. I call the french 911, they send the firehouse department who came for finally asking me to go get my car to get her to the hospital. When she can walk, they don't have to take her. I mean WTF?. I took her to the hospital, lot of homeless people, cold waiting room. We wait for 2 hours for her to be taking care of and after that we wait for another 4 hours. The hospital staff were making fun of her because she can't remember her first name and a lot of stuff because of the disorientation (She is pretty so maybe they wanted to take advantage of the situation or something, wtf). Duh? They finally say the scanner didn't revealed anything and send us home. Actually she had blood in her skull and suffer from permanent brain damage now. I mean WTF? Yeah we've paid something like 7 euros I guess, but what's the point if it's for getting treatments from the middle ages? In opposite, one of my friend got in a car accident in Austin. They wanted to run away, they were DUI but finally get caught. He get to the hospital by an ambulance. Duh? And I finally join him in the hospital. Wahoo, this is day and night. The hospital have scanners or IRMs in every rooms and he has been take of right away. Someone was checking on him every 15 minutes or so. Plenty of devices with computers (duh!) and electronic devices (duh!). And the hospital food was not that bad (for hospital food I mean)! Everything clean and warm, people professional. He didn't get to pay anything because of good coverage.
- Luc 13y ago
  Anecdotes. Duh?
  - hartator 13y ago
    The original article is an anecdote too.
- lepouet 13y ago
  one of the little flaws of our system ( i'm french) is that all being free a lot of people go to the emergency when a simple visit to the doctor would suffice, this mean emergency rooms are often surcharged and nurses have to prioritize who can see a doctor first and long waiting time when you are not in a critical condition. I have been in a motorcycle accident, the "fire house departement" ( we call them that but they do 90% medical emergency, they are trained for that ) arrived promptly, i had to wait 1h as i was not in a critical condition but i had all the treatment and analyses you say you had in dallas. And i live in a small country town. The only other thing who feel real in your account is that the hospital might feel old ( walls, paint, etc. ). Your friend might not tell you everything or he had a very bad exeptionnal experience who is not representative.
radovanb 13y ago
Great video on why US health care costs are so high: http://www.youtube.com/watch?v=qSjGouBmo0M http://www.youtube.com/watch?v=qSjGouBmo0M
vasilipupkin 13y ago
http://www.worldlifeexpectancy.com/cause-of-death/all-cancers/by-country/ http://www.worldlifeexpectancy.com/cause-of-death/all-cancer... US has better cancer survival rates than France
- agarden 13y ago
  This is getting to the point. The question I had at the end of the article was, would her father have survived if he had stayed in New York to be treated? But I think that chart is ranking cancer deaths per 100,000 people in the general population. Death rate of people who have been diagnosed with cancer would be much more informative.
  - vasilipupkin 13y ago
    I don't have the link, but I think it's somewhat established that US cancer survival rates ( of those who have been diagnosed ) are better than in Europe
  - lilsunnybee 13y ago
    Survival rate for pancreatic cancer, especially stage IV, is very low regardless of being in the US or elsewhere: http://www.cancer.org/cancer/pancreaticcancer/overviewguide/pancreatic-cancer-overview-survival-rates http://www.cancer.org/cancer/pancreaticcancer/overviewguide/...
Fizzadar 13y ago
I'm glad to see this on the HN homepage, it's about time americans started questioning why their insurance/healthcare system is focussed on money and not health.
cognivore 13y ago
This is apples to oranges. The French system is designed to provide medical care. The American system is designed to make money.
nickpp 13y ago
One advantage Western Eropean health car has that is not very often talked about is the brain drain from Eastern Europe. Countless well prepared doctors from countries like Bulgaria and Romania leave to work and live in France, UK or Germany. They are happy with the higher standar of life and better income in the west. However their education is subsidized by the East with the losses never recouped. Without those doctors, the health care in Western Europe would be significantly worse, kind like how Silicon Valley would be without immigrants.
- DanBC 13y ago
  There is a similar problem with nurses being recruited from other poorer places. Another problem is that clinicians make mistakes, and those mistakes kill people, and the risks of those mistakes rise with Whatever national language as a second language.
joesmo 13y ago
A similar system in the US would allow millions to stop being dependent on their jobs for health insurance and possibly not accept the horrible working conditions they have here simply to avoid dying uncared for in a hospital. We can't possibly have that here however. "Capitalism" (meaning oligarchy / monopoly based market control to Americans) must be applied dogmatically to everything, regardless of outcome.

285 points by MaysonL 13y ago

bsaul 13y ago

All of this is true, but americans have to realize one thing : all the drugs for cancer are created in the US. Because your system in general is expensive but that makes it possible to do research. Our doctors are not billionaires, our private hospitals aren't making an insane amount of money, and the state is collapsing under its debts. So almost nobody has the money to run research, and when they do, drug companies look for the american market to cover their costs.

steve_barham 13y ago
Source? If you look at expenditure on pharmaceutical research and development in the UK vs. the US, you see that 9% of global R&D expenditure is UK based, and 49% is US based. This very closely matches the population differences between the UK and US (at a population of 63M vs. 317M). Within Europe, the UK represents 23% of all pharmaceutical R&D funding; France is only slightly lower at 20% of the total. http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_United_Kingdom#Research_and_development http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_... http://en.wikipedia.org/wiki/Demographics_of_the_United_States http://en.wikipedia.org/wiki/Demographics_of_the_United_Stat... http://en.wikipedia.org/wiki/Demographics_of_the_united_kingdom http://en.wikipedia.org/wiki/Demographics_of_the_united_king...
- bsaul 13y ago
  Source is a very close friend of mine who's doing research in biology, and who knows how things work here vs the US. He witnessedthe difference in how the interns are paid, how the researcher are paid, how the labs are funded, gow modern the equipments are, and how much money the pharma corp are ready to spend todevelop new drugs. And this is a completely different world. Now you're perfectely right and the market size is a big factor. I should have compared europe vs the US. The conclusion would have been the same.
  - marvin 13y ago
    The US healthcare industry runs at a profit, so your point is moot.
  - kalleboo 13y ago
    How people is paid also reflects the cost of education - in Europe higher education is vastly cheaper than in the US (in many cases free). If American researchers end up with $200,000 in college debt and a European has $10,000, they'll be requiring different salaries.
- tsotha 13y ago
  The research expenditure isn't meaningful to the consumer. The question is where the companies intend to profit off of that research, and whether they would bother if they were only reimbursed what the NHS pays.
duedl0r 13y ago
bullshit
- jamesaguilar 13y ago
  FYI: http://ycombinator.com/newsguidelines.html http://ycombinator.com/newsguidelines.html
  - factorizer 13y ago
    I upvoted him/her. Because parent posted bullshit.
scriptproof 13y ago
Pharmaceutical not equal doctors. The former is not funded by doctors but by the patients. So it will be better to extend medicaid to more people to fund the former...
- bsaul 13y ago
  It's an ecosystem. Doctors and hospitals are the pharma industrie customers for many many things such as medical equipment. Doctors in france fees have their fees regulated by the state. They can't charge what they want. If the fee in the OP story was 18€ it's not because the doctor think it's fair to be paid just like a maid, but because the state fixed the price. And fixed prices is a big reason why our social security has been working in the last decades in France, and why medicaid may not work in the US. It is an ecosystem, where everyone has to aggree on keeping the prices down.
cmapes 13y ago
They [drug companies] are satisfied with the status quo because they ARE making money. The problem is that the FDA makes it near impossible for biotech startups to develop revolutionary and competitive oncology tech. Investors don't want to invest in early/mid stage biotech companies due to the extreme risk. Essentially these startups could have a viable product, yet get stonewalled by the FDA for years while waiting for trials and run out of money and dry up. In many cases it's not really the research that drives the cost, but rather the ability to charge the cost they do because people want to live. I understand that perspective is controversial and some will down-vote me for it. One instance was when my Dad had Metastatic Melanoma and was on DTIC therapy (Dacarbazine). It was nearly $20k per infusion. Are you kidding me, $20K/infusion!? They did 8-10 infusions. Unfathomably expensive. Oh and DTIC is one of the crappy old drugs from the 1970's. Anyone who believes that the cost to produce the drug is anywhere within several orders of a magnitude of what it costs patients is delusional. TL;DR The FDA and their non-startup friendly political processes are suppressing new players from emerging in the medical field who could create companies with revolutionary treatments. These treatments would bring a natural balance back to medical pricing through free market principles. Instead we're stuck with the current oligopoly where there's no major inventive to create cures which would cost billions in research while simultaneously ending hundreds of billions per year in recurring revenue on current semi-effective treatments. /rant
- james1071 13y ago
  That is not true at all. It is not at all difficult to get a cancer drug approved, providing of course that it works.
mikeash 13y ago
US medical R&D spending is about $500/year per capita. US overspending on medical care compared to other first-world countries is about $3000/year per capita. That doesn't account for more than a small part.
- twoodfin 13y ago
  That's a fair point, but R&D isn't the only thing encouraging the development of new drugs and technologies. A huge market willing to "overpay" is a massive driver. Look at the history of MRI penetration in Canada vs. the U.S. for an oft-used example. Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable.
  - DanBC 13y ago
    > Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable. That doesn't mean those meds are effective or even not actively harmful. People willing to pay tens of thousands of dollars to gamble on getting an extra 4 weeks of shitty quality life doesn't sound like a good way to run medication development.
robbiep 13y ago
An of touted argument that is patently and demonstrably false and if you had of done some research you would know that
route66 13y ago
Isn't it a much simpler explanation that healthcare should never be a free market as one of it's participants, the "patient" is not participating voluntarily? (This is not a direct response to your post, but I place it here as you put a market argument upfront)
- bsaul 13y ago
  I'm not judging the systems. I, personaly, much rather live under the french nhs than the US one. But i just wanted to provide some perspective to that generaly over optimistic OP post. The fact that cancer drugs are created in the US is not a coincidence. It's an ecosystem where there is a lot of money to be made, and as we know it in IT, money drives innovation.
  - eropple 13y ago
    ICI discovered tamoxifen before AstraZeneca bought them. They're British. Femara (letrozole) and Afinitor (everolimus) are Novartis (Switzerland). Campostar was discovered by Pharmacia, a Swedish company that's now part of Pfizer. The U.S. by no means has a monopoly on "cancer drugs".
    - bsaul 13y ago
      It would be interesting to see where the labs for those companies are, and what's their primary market. But thanks, i didn't know that. Maybe the british and swiss R&D isn't in such a bad state as France.
- dantheman 13y ago
  The majority of health care costs are non emergency, at that point it's no different than needing food.
  - beagle3 13y ago
    It's very different from food: While the majority is not emergency, the majority IS chronic conditions, which are not comparable to food: If McDonald is too expensive for you, you can switch to Ramen. If Insulin is too expensive for you, what do you switch to? If Radiation therapy is too expensive, what 7do you switch to? If Dialysis is too expensive for you, what do you switch to? If psychiatric drugs (for bipolar disorder, or schizophrenia) are too expensive for you, you lose the ability to be part of society. Totally unlike food, despite being non-emergency. The moment you have patents on drugs (which you do), and a $400M cost-of-bringing-to-market independent of the resarch (which you do), it's not a free market. Totally unlike food.
gambiting 13y ago
That is simply not true. A company behind a few leading cancer treatment drugs that are in use today is Novartis - and that's a Swiss company: http://en.wikipedia.org/wiki/Novartis http://en.wikipedia.org/wiki/Novartis
- seanmcdirmid 13y ago
  To be fair, the Swiss pay only second to Americans in health care costs (~10%) and have the private but mandatory insurance thing also.
Adirael 13y ago
It's not the case that americans would stop spending on health care if they went social. They'll spend a bit less, but I don't think it would make an impact on research. They will still look to the american market to cover their costs because it's the biggest market. It doesn't matter if it's the taxpayer's pocket or the private insurance paying out.
- bsaul 13y ago
  The thing is,in my opinion, you can't have a balanced insurance system with health costs as high as the US ones. So you would have to force everyone to reduce their rates, and thus decrease the cash generated by this economy ( and thus less R&D) French doctor rates are fixed (unless they decide to have their fees not rembursed by the NHS), and they are orders of magnitude lower than the US ones ( remove one and sometimes two zeros for exam fees). And even with thoses restictions, french NHS is struggling economicaly.
bsaul 13y ago
Didn't expect so many downvotes on that post. It seems many people here ( most of them living in the US i presume) don't want to hear about the downsides of a system i'm currently living in. I suppose this is a too sensitive subject to have a pros/cons type of discussion. French NHS works because everybody accepts to lower the rates of everything. We ( the french) live in a pseudo state-regulated health economy. When you're doing this, you're reducing the total amount of money that's flowing into that economy, which logically impacts the financing capabilities for R&D. Other people have said the same thing : http://www.nber.org/digest/may05/w11114.html http://www.nber.org/digest/may05/w11114.html
iXce 13y ago
According to [1], the amount of money invested in research in Europe and in the US seems to be of the same magnitude. And it makes sense to me to claim that the "drugs are created in the US" to prove your point. When you have developed a treatment, you can sell it worldwide, thus making profit worldwide to pay for the development/future developments. Not to mention that France has some very edgy teams working on cancer treatments, such as for leukemia at Hopital Saint Louis in Paris or for various cancers at Hopital Paul Brousse and Institut Gustave Roussy in Villejuif (for instance they are sort of world leader on chronotherapy of cancers, team of Pr. Francis Levi) [1] http://www.nejm.org/doi/full/10.1056/NEJMp1311068 http://www.nejm.org/doi/full/10.1056/NEJMp1311068

danielhunt 13y ago

I'll be the first to admit ignorance on the Medicaid fiasco in the US, but stories like this really drive home the difference between European and US mentalities to healthcare Being Irish, I'm used to a public healthcare system that, while slow and filled with red tape, does actually work. Private health insurance is expensive and quickly becoming something that can mean the difference between paying your mortgage or not, but still is seemingly better than whatever is going on across the pond Definitely worth a read, if only to highlight the stark difference in approaches.

masklinn 13y ago
And of course US healthcare is no faster and no less filled with red tape, unless you have significant amount of money (and even then, the red tape of having to negotiate with and coordinate care actors still falls on the patient or their family)
- davidw 13y ago
  Oddly enough, here in Italy, regular doctor visits have very little red tape. They just type your name in their computer, and then get on with asking what you are there to see them for. If you need a prescription, they print one out for you, that you can take to the pharmacy. By and large, Italy is not a stellar example of how to run a country, but the health care system is less bureaucratic and easier to deal with than the US, and generally not something you have to worry about much. That said, it's not perfect, either. When our son was born here, it felt very much like a factory operation with the pregnant woman as an input and a woman+child as the output. I felt they were competent in the event that anything went wrong (in our case, everything was fine), but it was all very impersonal and felt designed to maximize throughput. I was not allowed to be with my wife for most of her labor, for instance.

yoha 13y ago

As a French, I must say that we are so much used to this system that it seems obvious. And, French being French, we like to complain about the flaws (well, there are some). But whenever I read this kind of article, I realize that this is not obvious at all and that, in the States, you have to pay for your health like for any groceries. This is when I understand what people means when they say that France is a socialist country: we have very strong public service. This means that police, fire fighters, healthcare, school and so on are mostly public: we have no militia, prisons have no incentive to get more people jailed by bribing judges, fires are fought without caring if the flat's owner can pay for it, people are being taken care of without delay for checking if there private insurance will accept it, and kids from poor families have a firm chance of getting a good education. The amusing part is that having this critical services being managed by the state seems so obvious to us that we don't think we are specially socialists (well, the French social party seldom wins the presidential elections). I guess it would seem odd for the government to nationalize a company, but it would be nearly impossible for them to try an privatize a critical public service.

k-mcgrady 13y ago
I'm in the UK and we also have these same free public services. No matter how many ways an American explains it to me I cannot understand how their system can ever work better. In fact it seems barbaric to me. I think that in theory, in a perfect world, a completely free market or a libertarian society could work - but in reality it's never going to. The societies with the best standard of living in the world are ones like France that have social services that every one pays for through tax. I guess we have the added benefit in Europe that if we truly don't like our tax system and want a more private system based country we are free to move and work in any other EU country that meets our needs.
- robbiep 13y ago
  For completeness I must chime in and declare the Australian system shares more similarities with the French, UK, Canadian, German, New Zealand... The list goes on- countries than we do with the US system

duedl0r 13y ago

welcome to Europe

scotty79 13y ago
My life partner got for her brain tumor: brain surgery by one of the two top neurosurgeons in my city (0.7 mln population), radiotherapy combined with chemotherapy (linear accelerator lifetime dose, themozolmide 6 weeks), chemotherapy (themozolmide 6 months), mri checkup every 6 months. Everything fully covered by her basic state health insurance that costs you 50$ per month (rougly 10 pizzas) if you are not employed anywhere and you registerd your own company. Proportionally less if you are employed for less than 60% of average pay and more if for more. Costs you nothing if you are unemployed and registerd as unemployed or you have a husband or wife that is covered. You can also pay it out of your pocket if you don't feel like working or visiting unemployment office every few months to check there's still no work you could try. What is more it's nearly in full deductible directly from your tax so it costs you even less. It's Poland so neurology ward was overcrowded and begged for renovation and radiotherapy mask was initially too tight, but we don't care, she was given two years and counting of full quality life witout any unnecessary burden on her, us and our families.
- gambiting 13y ago
  I would never ever complain about the Polish healthcare. The oncology clinic in Warsaw was the one of the pioneers in treating GIST(rare type of stomach cancer) with then-new Glivec - Initially, my father has been given less than a year after being diagnosed with GIST. He has been alive and very well for over 8 years now after the diagnosis, having had two operations and taking a box of Glivec(~$3000 USD box) every month. The hospital even pays for his train tickets to Warsaw so he can get his medicine every month. He has never paid anything for his treatment, that's all national healthcare system. And yes, the waiting rooms get a bit crowded - who cares, he still gets the best cancer treatment in the country,for free. As a kid, I always dreamed of living in America - now I wouldn't want to do it even if someone paid me to. Nope.

yread 13y ago

Even though the article started with saying it's stage 4 I kind of expected he would survive :(

michaelochurch 13y ago
Pancreatic cancer has a terrible prognosis as it is, and Stage IV (metastasis) makes that worse. If the cancer makes it into the bloodstream, and isn't wiped out completely by the chemo (cancer cells have an evolutionary dynamic like antibiotic resistance; this is why chemo drugs can stop working before they kill all the cancer) it's very likely that it's a chronic illness and terminal within 5 years: often much less.

puppetmaster3 13y ago

In USA, we have legalized corruption to pay more for less: http://en.wikipedia.org/wiki/Karen_Ignagni http://en.wikipedia.org/wiki/Karen_Ignagni

pilooch 13y ago

Both my parents, and my sister have faced life threatening diseases, with lifetime treatment required. Call it bad luck. They benefit a 100% health insurance coverage for these diseases, for free. Had it not been the case, our family would not have been able to cope. This shared insurance system builds the society I want to live in. IMO France now needs to rebuild its economy so it continues to support this gold standard system. Let's not let it degrade.

pilooch 13y ago

scotty79 13y ago

US hospitals created entities to negotiate with the suppliers to get better deals for them. At some point they stupidly decided that these entities can finance themselves by taking percentage on transactions (as opposed to being financed by the hospitals according to entities needs as it was till then). Then the thing went downhill from there. Entities got free, became for profit, concentrated, and now they stand in the middle between hospitals and suppliers taxing the trade between them and punishing everyone that wants to get free by making deal with other business partners of that hospital/supplier more expensive.

kremlin 13y ago

French care for mothers giving birth could be better. My wife had to pay for a private midwife because the standard French treatment is to drug up the mothers as a matter of course and perform c-sections something like 10 times as often as necessary. Maternity wards are basically treated like baby drive-thrus. In and out as quickly as possible. Which isn't to contradict that French health care is good; just pointing out an area in need of improvement.

shin_lao 13y ago
It really depends on where you get treatment. Healthcare in Paris is excellent (but you might get unlucky, sure), in smaller cities it might be harder to get an appointment with specialists.
ronaldx 13y ago
I recently heard that the French offer relatively few post-natal services in terms of baby care, but do offer vaginal exercise classes for new mothers: http://www.slate.com/articles/life/family/2012/02/postnatal_care_in_france_vagina_exercises_and_video_games.single.html http://www.slate.com/articles/life/family/2012/02/postnatal_... I found that representative of a great healthcare system: they are not just doing the minimum or the obvious or unnecessary 'nannying', but taking a holistic approach to postnatal care.
Jare 13y ago
In Spain it seems the reverse: public institutions push the natural birth route much harder, whereas private clinics routinely perform C-sections or fully medicated or induced birth simply for their own convenience or to collect the extra money from the insurer. After the baby is born and all is well, public hospitals will assist moms to breastfeed if needed, whereas private places just want you out of there ASAP. If I want convenience and pretty flowers for simple procedures I'll go with private, but for anything serious public all the way.

jokoon 13y ago

Just like chomsky said it in the corporation documentary, some institutions do a much effective job if they operate at a loss. For the simple reason that those insitution makes sure the whole country benefits from them. Often profit will bring more destruction. Profit driven economy is important for competition, it applies for many market, like luxury, automobile, housing, furniture, etc, and it's also important when the government need to make expenses: they will buy from the company who offer a good service at a fair price. That's where capitalism fails. Capitalism doesn't directly make the poor wealthier, but if you make programs that help the poor, it will always have benefits to the rich. That's what I don't understand when the wealthy wants the poor to not be given aid: it might increase the wealthy's relative wealth, but not their absolute wealth. I think the wealthy don't like socialism not because it doesn't reward their effort or their wealth, but because it gives them less decision power in general. Which is stupid, since wealthy people have a career in business, not in politics. I guess it boils down to an inferiority complex. Also don't forget france's budget is mostly financed by the valude added tax, which doesn't exist in the US.

nolok 13y ago

Interesting bits from one of the linked articles >In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree? >I question the W.H.O. methodology, which has serious problems with data reliability and the standards of comparison. A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs. They examined avoidable mortality — that is, deaths whose risk of occurrence would be far lower if the population had access to appropriate health care interventions. In that study, based on data for the year 2000, France was also ranked No. 1, with the lowest rate of avoidable deaths. The United States was last, in 19th place, with the highest rate of avoidable deaths. That’s a severe indictment of our health care system in my judgment and calls attention, quite justifiably, to the high performance of the French health care system. http://prescriptions.blogs.nytimes.com/2009/09/11/health-care-abroad-france/#h[IqtTas,2,3] http://prescriptions.blogs.nytimes.com/2009/09/11/health-car...

_pmf_ 13y ago
> The United States was last, in 19th place, with the highest rate of avoidable deaths. Alas, a negligible price to pay for Freedom™.
- swombat 13y ago
  France is a free country, by any sensible definition of the term. Sure, you can coin a definition of "free" that excludes France, but you can do that for any country, including (and perhaps especially) the United States. (or perhaps you were being sarcastic)
  - escape_goat 13y ago
    Purely on mechanics, the "by any sensible definition" clause does make this a classic "no true Scotsman" argument. What you probably wish to argue is something like: "Those unique 'American freedoms' that ostensibly result in such a crappy health care system --- and the inevitability and necessity of this is highly debatable --- do not contribute nearly as much to actual freedom as you seem to think." What you are actually arguing is: "There exists no sensible definition of freedom wherein the citizens of the United States are free and the citizens of France are not." A disagreement which continues from this point will devolve quickly into an argument about when and how ideas are "sensible". This is perhaps a really interesting topic when pursued in its own right, but the assertion has, at that point, effectively derailed future debate about the different freedoms enjoyed by the French and Americans.

tluyben2 13y ago

As others have said; this is normal in the EU (I'm not aware of exceptions in the EU). And I have never had to talk about finance at all in relation to healthcare; I think it's insult to injury to have to navigate insurance policies, bills etc while you or someone you love is ill, dying or died. Especially when you have insurance companies wiggling out of their responsibilities by not paying is a side of this much loved capitalism which I would not like to see appear here.

negrit 13y ago

French living in the US here(California). I had to go to the general practitioner and I still don't understand how they can come up with prices as high as $400 when it cost me 22 euros back home for the exact same service. Also my insurance company in France would rather pay for my flight ticket to go back home instead of going to the hospital in the US. I've been in the US for almost 2 years now and it still puzzle me that I had to pay for STD test(!) and I still don't understand the US healthcare system.

p4bl0 13y ago
Paying for STD tests? It means that it is not anonymous either… What a shame. For non-French people: in France it is standard that STD tests can be done anonymously and for free by anyone (you are never asked any identification information, everybody can do it even non-French person).
- arjie 13y ago
  In the US, you can get either confidential testing or anonymous testing. You have to pay for both, but the former results in your insurance provider being informed of your test. Some states also have only confidential testing. I know people who are very careful about this because they don't want premiums going up. These things all add friction to the process in a time of high stress. As a user experience, it is of very poor quality.
facepalm 13y ago
To be fair, probably in France it costs much more than 22 Euros, too, but the extra cost is borne by the public.
- brohee 13y ago
  Nope, that's what an "under convention" GP gets for a visit (there is an issue with that number not having followed inflation in a long time). The patient will pay very little of it, nothing if completely covered (CMU). Doctors make less money in France than in the US, but are still plenty well off.

mnml_ 13y ago

You also need to understand something about French healthcare : money is where the risk is. Our Intensive care services are amazing, however basic depts are not that great.

prestadige 13y ago

My suspicion is that both health care systems are unsustainable because of rising geriatric care costs. To counter this we'll be forced to navigate the minefields of legal euthanasia and life extension technologies.

rwissmann 13y ago

This. All this hate for the European health care systems is just misguided and ignorant. Health care delivery is one of the few sectors of the economy that the US is not world class in (despite having the best medical research). We all have our national pride and there are real philosophical difference on how to organize societies - and these differences matter. Being smart however includes the ability to sometimes ignore one's ego, compare solutions based on their merit, and learn from each other where possible.

danmaz74 13y ago
All this hate for the European health care systems is just misguided and ignorant Not really... a part of it is misguided and ignorant; the other part is highly informed and very well guided.. towards ever increasing profits.

beilabs 13y ago

My father passed away from cancer, he was given 3 months to live. I often believe he received a sub-standard level of care and wonder would things have been different if he lived in a country like France. Work hard and pay high taxes all your life. Your country should take care of you when you need it the most.

ck2 13y ago

The US will never have humane health care like France as long as we are locked into the insurance driven model. And that fate has pretty much been sealed now for the next few generations, maybe even hundreds of years. There are now many millions of people in the US that will never have health care under the insurance model because of the medicaid gap caused by the loophole the supreme court made and the states that refused medicaid expansion.

fuckpig 13y ago

Flogging the old "European socialism is the best" dead horse again, I see. Comparing radically different countries always yields good results, right? It's important to also note the French are bankrupt and have massive internal problems. It's great they shifted all of their effort into health care. It will make a nice epitaph.

DanielBMarkham 13y ago

As an American, I've been reading these kinds of articles for decades: country X has awesome attribute Y, why can't we have it? Best I can figure, country X also has these undesirable attributes A, B, and C. The premise here is that you can pick and choose various best features of wildly divergent societies and then combine them, like eating at a buffet bar. I do not believe this premise is valid. If you want socialized French-style medicine, then you also get national strikes that shut everything down, Mediterranean time reckoning, really bad enviornments for startups, and so on. That doesn't make the effort worth abandoning. American healthcare is broken and it has remained broken through major political turmoil designed, presumably, to fix it. Just at some point, you have to decide for yourself whether or not you want to form political opinions based on how emotionally moved you can be from listening to just part of the story, or whether diving deeper is worth it for you. I applaud the French system's strengths and the efforts to improve our own. I'm just not sure how much here is useful. There's much more to this than "But if we could only just expand Medicaid!"

michaelochurch 13y ago
If you want socialized French-style medicine, then you also get national strikes that shut everything down, Mediterranean time reckoning, really bad enviornments for startups, and so on. That's ridiculous. All the European countries have healthcare systems that are far more civilized than ours. Not all of them have those problems. Also, it's not that Europe is a bad environment for startups. It's that Silicon Valley (for all its defects) is the best environment for startups in the world, and there's a power law distribution. (Whatever #2 is, it's not even close.) The US minus Silicon Valley is no better than Europe in terms of supporting entrepreneurs.

ThePhysicist 13y ago

I think you could call this article the (North) European way of cancer treatment, since overall the healthcare systems and standards are pretty comparable in most of European countries (with the exception of some new member states and a few southern countries). In fact, as a EU citizen your public health insurance card will even cover treatment in other member states in some cases, although "health tourism" is in general not possible (http://en.m.wikipedia.org/wiki/European_Health_Insurance_Card http://en.m.wikipedia.org/wiki/European_Health_Insurance_Car...). Personally I lived in Paris for three years and always tried to go back to Germany to see a doctor (which rarely happens) since I perceived the hygienic standards at hospitals and private practices to be a bit lower than in Germany, but maybe I'm a bit biased there as a German ;)

michaelochurch 13y ago

After all, people come from the all over the world for treatment at Sloan Kettering. This is one of those claims that has to be attacked. Day after day, I hear people defend our horrible healthcare system by claiming that people on the "global rich list" still come "to the US" for healthcare. That was true in the 1980s. Not now. No one who knows anything thinks highly of our healthcare system in general. Even if you have insurance, the quality of care is inferior to what many countries have for free. What is true is that very wealthy people (for whom money is no issue) travel to specific doctors for treatment, especially when getting an experimental procedure. If that doctor's at Sloan Kettering, they go to New York. If she's in Paris, they go to France. If she's at Hopkins, they go to Baltimore. If that doctor's in London under NHS, they go to the UK. No one comes "to the US"; some people come to specific specialists. Anyway, if you're an average American-- little wealth, no connections, unable to afford treatments insurance won't cover-- you're probably not going to be able to get appointments with those specialists no matter what. The U.S. insurance-dominated healthcare system is a world-class embarrassment. It's the first sign that we're no longer a first world country.

hartator 13y ago

Am I the only one who doubt that this is the truth? I am living in both Paris and the US. It's not what I have experienced. In Paris, one of my friend has been hit by a motorcycle. The motorcycle run away. She hits the ground and nobody cares. She was disoriented with weird bubble on the skull. I call the french 911, they send the firehouse department who came for finally asking me to go get my car to get her to the hospital. When she can walk, they don't have to take her. I mean WTF?. I took her to the hospital, lot of homeless people, cold waiting room. We wait for 2 hours for her to be taking care of and after that we wait for another 4 hours. The hospital staff were making fun of her because she can't remember her first name and a lot of stuff because of the disorientation (She is pretty so maybe they wanted to take advantage of the situation or something, wtf). Duh? They finally say the scanner didn't revealed anything and send us home. Actually she had blood in her skull and suffer from permanent brain damage now. I mean WTF? Yeah we've paid something like 7 euros I guess, but what's the point if it's for getting treatments from the middle ages? In opposite, one of my friend got in a car accident in Austin. They wanted to run away, they were DUI but finally get caught. He get to the hospital by an ambulance. Duh? And I finally join him in the hospital. Wahoo, this is day and night. The hospital have scanners or IRMs in every rooms and he has been take of right away. Someone was checking on him every 15 minutes or so. Plenty of devices with computers (duh!) and electronic devices (duh!). And the hospital food was not that bad (for hospital food I mean)! Everything clean and warm, people professional. He didn't get to pay anything because of good coverage.

Luc 13y ago
Anecdotes. Duh?
- hartator 13y ago
  The original article is an anecdote too.
lepouet 13y ago
one of the little flaws of our system ( i'm french) is that all being free a lot of people go to the emergency when a simple visit to the doctor would suffice, this mean emergency rooms are often surcharged and nurses have to prioritize who can see a doctor first and long waiting time when you are not in a critical condition. I have been in a motorcycle accident, the "fire house departement" ( we call them that but they do 90% medical emergency, they are trained for that ) arrived promptly, i had to wait 1h as i was not in a critical condition but i had all the treatment and analyses you say you had in dallas. And i live in a small country town. The only other thing who feel real in your account is that the hospital might feel old ( walls, paint, etc. ). Your friend might not tell you everything or he had a very bad exeptionnal experience who is not representative.

radovanb 13y ago

Great video on why US health care costs are so high: http://www.youtube.com/watch?v=qSjGouBmo0M http://www.youtube.com/watch?v=qSjGouBmo0M

vasilipupkin 13y ago

http://www.worldlifeexpectancy.com/cause-of-death/all-cancers/by-country/ http://www.worldlifeexpectancy.com/cause-of-death/all-cancer... US has better cancer survival rates than France

agarden 13y ago
This is getting to the point. The question I had at the end of the article was, would her father have survived if he had stayed in New York to be treated? But I think that chart is ranking cancer deaths per 100,000 people in the general population. Death rate of people who have been diagnosed with cancer would be much more informative.
- vasilipupkin 13y ago
  I don't have the link, but I think it's somewhat established that US cancer survival rates ( of those who have been diagnosed ) are better than in Europe
- lilsunnybee 13y ago
  Survival rate for pancreatic cancer, especially stage IV, is very low regardless of being in the US or elsewhere: http://www.cancer.org/cancer/pancreaticcancer/overviewguide/pancreatic-cancer-overview-survival-rates http://www.cancer.org/cancer/pancreaticcancer/overviewguide/...

Fizzadar 13y ago

I'm glad to see this on the HN homepage, it's about time americans started questioning why their insurance/healthcare system is focussed on money and not health.

cognivore 13y ago

This is apples to oranges. The French system is designed to provide medical care. The American system is designed to make money.

nickpp 13y ago

One advantage Western Eropean health car has that is not very often talked about is the brain drain from Eastern Europe. Countless well prepared doctors from countries like Bulgaria and Romania leave to work and live in France, UK or Germany. They are happy with the higher standar of life and better income in the west. However their education is subsidized by the East with the losses never recouped. Without those doctors, the health care in Western Europe would be significantly worse, kind like how Silicon Valley would be without immigrants.

DanBC 13y ago
There is a similar problem with nurses being recruited from other poorer places. Another problem is that clinicians make mistakes, and those mistakes kill people, and the risks of those mistakes rise with Whatever national language as a second language.

joesmo 13y ago

A similar system in the US would allow millions to stop being dependent on their jobs for health insurance and possibly not accept the horrible working conditions they have here simply to avoid dying uncared for in a hospital. We can't possibly have that here however. "Capitalism" (meaning oligarchy / monopoly based market control to Americans) must be applied dogmatically to everything, regardless of outcome.