# What is the argument against French healthcare? **URL:** \ **Category:** Great Debates\ **Created:** [August 4, 2010, 10:20pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197 "2010-08-04T22:20:50Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Drum\_God](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/drum_god/32/44_2.png) [@Drum\_God](https://boards.straightdope.com/u/Drum_God)\ **Post date:** [August 5, 2010, 5:03pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/21 "2010-08-05T17:03:45Z")
> [@Stoneburg](#): > > > [@Rand\_Rover](#): > > > > What’s your evidence for this proposition? > > Basically, it’s OK to let Americans get sick and/or die, because we make money off them. My guess is that people would be unhappy about this if they knew enough to understand it. I doubt that people would be unhappy about this. The reasoning is that it’s the undesirable people who get sick and die. Not me. Not my family. It’s always the other guy. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 5, 2010, 5:48pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/22 "2010-08-05T17:48:17Z")
The weird thing I never get about this argument when it’s discussed in the USA is no one sees a family timeline beyond themselves or, at a push, this generation - like the family has always been and will always be middle class and employed and never likely to trigger an exclusion clause. Go back two generations - was your family wealthy then? What happens to your great-grandchildren - you’re willing to take a gamble on the well-being of your great-grandchildren? I and my family are thankful for the voting decisions taken in 1945 by my grandparents and great-grandparents because without them throwing Churchill out of office in that particular election, we might not have UHC now. The hospitals are that generations true monument, not the memorial stone with all the names on. My family were all real working poor at that time, middle-class now and God only knows in 40-50 years time. The thing is UHC never goes away, it will always take care of your family - even those you’ll never know. ---
**Author:** ![Khaki\_Campbell](https://avatars.discourse-cdn.com/v4/letter/k/9de053/32.png) [@Khaki\_Campbell](https://boards.straightdope.com/u/Khaki_Campbell)\ **Post date:** [August 5, 2010, 7:07pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/23 "2010-08-05T19:07:49Z")
The French system is not the panacea. At all. You still have to subscribe to a secondary insurance (a “mutuelle”) if you want to enjoy certain care (especially dentistry and eye stuff). In the best case, the State healthcare pays you back 2/3 of the cost. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [August 5, 2010, 7:19pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/24 "2010-08-05T19:19:23Z")
> [@PrettyVacant](#): > > Healthcare in every developed country is in almost identical positions, but somehow universal healthcare survives and electorates around the world never, ever consider changing. Well, they must know something, mustn’t they? ---
**Author:** ![sqweels](https://avatars.discourse-cdn.com/v4/letter/s/f19dbf/32.png) [@sqweels](https://boards.straightdope.com/u/sqweels)\ **Post date:** [August 5, 2010, 7:25pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/25 "2010-08-05T19:25:18Z")
> [@Khaki\_Campbell](#): > > The French system is not the panacea. At all. You still have to subscribe to a secondary insurance (a “mutuelle”) if you want to enjoy certain care (especially dentistry and eye stuff). In the best case, the State healthcare pays you back 2/3 of the cost. Sure beats being bankrupted by a mid-level injury or illness. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [August 5, 2010, 7:51pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/26 "2010-08-05T19:51:14Z")
France spends a little over 11% of its GDP on health care. Significantly higher than most other countries with socialized health care. France’s health care is a hybrid system. There is a public insurance plan, but the delivery of health care is private as it is in the U.S. This is in contrast to the NHS in Britain, in which the government manages health care delivery. It would be very difficult to transition U.S. health care to the French model. For example, one reason costs are held in check in France is that doctors only make about twice the national average income, as opposed to the U.S., where they make five times the national income. To support the low-paying model for doctors, France does two things - it greatly insulates doctors from legal liability, both because the French are less litigious than Americans, and also because the government limits tort liability for doctors. And also, France completely subsidizes education for doctors, which encourages more people to go into medicine, offsetting the lower wages. Also, France limits demand somewhat by forcing patients to pay part of their regular medical bills. France’s public health insurance only covers 70% of the cost of doctor consultations and most dentistry, for example. Drugs are covered in a range between 35% and 100%, depending on the drug and the diagnosis. It’s not clear either that all of France’s medical expenses show up in the GDP stats. For example, is the free education for Doctors covered in the health care stats? Or does that show up under education? Doctors are also paid extra because France subsidizes most of their social security - a benefit amounting to almost 40% of their pay. Is that counted as a health care cost, or sunk into the cost of social security? Also, the tort protection given to doctors is a form of social subsidy passed on to the population, which would not count in the health care statistics. France also allows doctors who have served more than 4 years in a hospital to open up private practice and charge whatever they want, so there’s a completely private system operating in parallel which may be offloading costs from the public system. France can get away with paying doctors on average 2X the national income because of these other factors which increase the supply of doctors to compensate for the lower pay. The U.S. could not do this for doctors who are already working, as they have already paid for their education. Such a huge cut in pay would result in massive dislocation and a huge shortage of doctors. The only way the U.S. could do this would be to phase in such a system over a period of many years - for example, creating a new class of ‘public doctor’ that people could volunteer for, getting their education paid for in exchange for mandatory service in hospitals at low pay for a number of years (similar to the training model in the U.S. military for skilled trades like pilots). The U.S. would also have to shelter all doctors from almost all torts as France does, because it would not be feasible (or probably constitutional) to protect some doctors and not others. So the French model is not easily transportable to the U.S., but it does have some good features compared to other health systems which could be phased in over time should the U.S. move to a public health model. ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [August 5, 2010, 7:58pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/27 "2010-08-05T19:58:12Z")
Here are a couple of [interesting](http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/) [articles](http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/051709dnbusfrance.40cc221.html) about the French health care system. ---
**Author:** ![SteveG1](https://avatars.discourse-cdn.com/v4/letter/s/bb73d2/32.png) [@SteveG1](https://boards.straightdope.com/u/SteveG1)\ **Post date:** [August 5, 2010, 8:01pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/28 "2010-08-05T20:01:48Z")
> [@Wesley\_Clark](#): > > France spends half what we do per capita on health care. They spend about $3400 per person vs. our $7000+ per person per year. … At the end of the day France has a superior health system that costs half what ours does. So why shouldn’t we implement it? This. If it makes sense and it works, we should do it. Unless it’s from the evil and brutal and very scary French :eek: ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [August 5, 2010, 8:12pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/29 "2010-08-05T20:12:23Z")
> [@PrettyVacant](#): > > Healthcare in every developed country is in almost identical positions, but somehow universal healthcare survives and electorates around the world never, ever consider changing. That’s just not true. Canada is slowly transitioning away from single payer to a parallel system that contains both private and public elements. We’ve always had a small amount of private health care, but it grows each year as the burden on the public system continues to strain budgets. 30% of our health care spending is now completely private, and 75% of services are delivered by privately owned companies. 65% of Canadians have supplementary health insurance to cover services not paid for by the government. Not only that, but our one-payer system has been successfully challenged in court. The Supreme Court of Canada ruled that Canadians who face long waiting lists in Quebec must be allowed to seek private services. This is still being appealed, but if it is upheld it could open the door to a large variety of private health care services in Quebec. ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [August 5, 2010, 8:23pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/30 "2010-08-05T20:23:25Z")
> [@Sam\_Stone](#): > > > [@PrettyVacant](#): > > > > Healthcare in every developed country is in almost identical positions, but somehow universal healthcare survives and electorates around the world never, ever consider changing. > > That’s just not true. Canada is slowly transitioning away from single payer to a parallel system that contains both private and public elements. We’ve always had a small amount of private health care, but it grows each year as the burden on the public system continues to strain budgets. > > 30% of our health care spending is now completely private, and 75% of services are delivered by privately owned companies. 65% of Canadians have supplementary health insurance to cover services not paid for by the government. > > Not only that, but our one-payer system has been successfully challenged in court. The Supreme Court of Canada ruled that Canadians who face long waiting lists in Quebec must be allowed to seek private services. This is still being appealed, but if it is upheld it could open the door to a large variety of private health care services in Quebec. Err…the post you responded to said Universal Healthcare was never reversed. Not Single payer, which seems to be what your responding to. France has Universal Healthcare, but not Single payer. I seriously doubt there’s a trend in Canada to move away from universal coverage. ---
**Author:** ![Kimmy\_Gibbler](https://avatars.discourse-cdn.com/v4/letter/k/bbe5ce/32.png) [@Kimmy\_Gibbler](https://boards.straightdope.com/u/Kimmy_Gibbler)\ **Post date:** [August 5, 2010, 8:38pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/31 "2010-08-05T20:38:46Z")
> [@Stoneburg](#): > > > [@Rand\_Rover](#): > > > > [QUOTE=Stoneburg] > > 2. France is usually at the top, or near the top, in international comparisons of healthcare > > What’s your evidence for this proposition? I figured this was a fairly well known fact, but what sort of evidence would you accept? [/QUOTE] Let’s start with, say, “any,” chief. Do you have _any_ evidence for this claim? ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [August 5, 2010, 9:34pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/32 "2010-08-05T21:34:59Z")
> [@Kimmy\_Gibbler](#): > > > [@Stoneburg](#): > > > > I figured this was a fairly well known fact, but what sort of evidence would you accept? > > Let’s start with, say, “any,” chief. Do you have _any_ evidence for this claim? Let’s start with you saying what sort of cite you would find satisfactory. 'Cause you know, it’s not my first time on this forum, and I don’t feel like giving you 200 cites and you saying “Mjeh, not good enough”. Or you could find some cite that supports what you believe to be true. Or just say what you think. Either way works. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [August 5, 2010, 10:57pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/33 "2010-08-05T22:57:38Z")
> [@PrettyVacant](#): > > I and my family are thankful for the voting decisions taken in 1945 by my grandparents and great-grandparents because without them throwing Churchill out of office in that particular election, we might not have UHC now. Don’t thank them. The government during the war - headed by Churchill, if you recall - was working on it. The father of the NHS, the publisher of the White Paper in 1944, was actually the Tory MP Henry Willink. Wiki article [here](http://en.wikipedia.org/wiki/History_of_the_National_Health_Service_(England)#Birth_of_the_National_Health_Service). ---
**Author:** ![Dick\_Dastardly](https://avatars.discourse-cdn.com/v4/letter/d/c4cdca/32.png) [@Dick\_Dastardly](https://boards.straightdope.com/u/Dick_Dastardly)\ **Post date:** [August 5, 2010, 11:31pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/34 "2010-08-05T23:31:59Z")
> [@Sam\_Stone](#): > > France spends a little over 11% of its GDP on health care. Significantly higher than most other countries with socialized health care. > > France’s health care is a hybrid system. There is a public insurance plan, but the delivery of health care is private as it is in the U.S. This is in contrast to the NHS in Britain, in which the government manages health care delivery. > > It would be very difficult to transition U.S. health care to the French model. For example, one reason costs are held in check in France is that doctors only make about twice the national average income, as opposed to the U.S., where they make five times the national income. > > To support the low-paying model for doctors, France does two things - it greatly insulates doctors from legal liability, both because the French are less litigious than Americans, and also because the government limits tort liability for doctors. And also, France completely subsidizes education for doctors, which encourages more people to go into medicine, offsetting the lower wages. > > Also, France limits demand somewhat by forcing patients to pay part of their regular medical bills. France’s public health insurance only covers 70% of the cost of doctor consultations and most dentistry, for example. Drugs are covered in a range between 35% and 100%, depending on the drug and the diagnosis. > > It’s not clear either that all of France’s medical expenses show up in the GDP stats. For example, is the free education for Doctors covered in the health care stats? Or does that show up under education? Doctors are also paid extra because France subsidizes most of their social security - a benefit amounting to almost 40% of their pay. Is that counted as a health care cost, or sunk into the cost of social security? Also, the tort protection given to doctors is a form of social subsidy passed on to the population, which would not count in the health care statistics. > > France also allows doctors who have served more than 4 years in a hospital to open up private practice and charge whatever they want, so there’s a completely private system operating in parallel which may be offloading costs from the public system. > > France can get away with paying doctors on average 2X the national income because of these other factors which increase the supply of doctors to compensate for the lower pay. The U.S. could not do this for doctors who are already working, as they have already paid for their education. Such a huge cut in pay would result in massive dislocation and a huge shortage of doctors. The only way the U.S. could do this would be to phase in such a system over a period of many years - for example, creating a new class of ‘public doctor’ that people could volunteer for, getting their education paid for in exchange for mandatory service in hospitals at low pay for a number of years (similar to the training model in the U.S. military for skilled trades like pilots). The U.S. would also have to shelter all doctors from almost all torts as France does, because it would not be feasible (or probably constitutional) to protect some doctors and not others. > > So the French model is not easily transportable to the U.S., but it does have some good features compared to other health systems which could be phased in over time should the U.S. move to a public health model. I don’t see why doctors should have their salaries protected just because they spent a lot of money on their education. If the markets show us that they’re uncompetitive with foreign doctors, surely you wouldn’t be advocating that they should be subsidised or protected by government regulation of markets? Surely there’s some kind of deadweight loss to the economy involved in employing people in restricted and regulated employment markets? The US could open up its healthcare system to the benefits and joys of the free market. We could allow foreign doctors to emigrate to the US in large numbers, stop all the restrictions which protect US doctors’ jobs. We could allow US patients to take advantage of far cheaper operations abroad. We could scrap patents on pharmaceuticals and fund all the r and d directly via the government instead of via the pharma companies. ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [August 6, 2010, 1:18am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/35 "2010-08-06T01:18:16Z")
> [@Kimmy\_Gibbler](#): > > > [@Stoneburg](#): > > > > I figured this was a fairly well known fact, but what sort of evidence would you accept? > > Let’s start with, say, “any,” chief. Do you have _any_ evidence for this claim? Actually I’d like to change my previous responses to this: If you’re not aware of French healthcare being considered among the best, you don’t have enough knowledge on the subject for me to be interested in discussing it with you. I’m not your tutor and judging by your tone you’d be a reluctant student anyway. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [August 6, 2010, 1:19am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/36 "2010-08-06T01:19:16Z")
> [@Dick\_Dastardly](#): > > I don’t see why doctors should have their salaries protected just because they spent a lot of money on their education. I didn’t say anything about ‘protecting’ doctor’s salaries. The point is that the government has no leverage over doctors who already have been educated. In France, my understanding is that the free education comes with conditions - that doctors agree to work in hospitals for X number of years at the government pay scale before being allowed into unlimited public practice. Just as a person who signs up for flight training in the military must agree to X number of years of pilot duty at military pay scales before being allowed to quit and take, say, a high paying airline job. How exactly are you going to force current doctors, some of whom are carrying hundreds of thousands of dollars in school debt, to take a 3/5 cut in pay? How about the ones who no longer have any debt, but certainly paid their hundreds of thousands for their education? What are you going to do if you cut doctor’s pay and they decide to leave the country and set up shop in some health care haven, or simply quit doctoring? > [@](#): > > If the markets show us that they’re uncompetitive with foreign doctors, surely you wouldn’t be advocating that they should be subsidised or protected by government regulation of markets? Of course not, which is why it’s a good thing I never said anything of the sort, or even anything resembling anything of the sort. > [@](#): > > Surely there’s some kind of deadweight loss to the economy involved in employing people in restricted and regulated employment markets? Sure. And I think there’s a case to be made that the AMA works to restrict entry into the medical field to keep up the salaries of doctors. It would be interesting to look at medical standards in other countries to see if they do things differently. Are residency conditions and educational requirements the same all over? > [@](#): > > The US could open up its healthcare system to the benefits and joys of the free market. We could allow foreign doctors to emigrate to the US in large numbers, stop all the restrictions which protect US doctors’ jobs. We could allow US patients to take advantage of far cheaper operations abroad. Absolutely. These are all good ideas. > [@](#): > > We could scrap patents on pharmaceuticals and fund all the r and d directly via the government instead of via the pharma companies. Whoa. That came out of left field. Crazy idea. ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [August 6, 2010, 1:29am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/37 "2010-08-06T01:29:36Z")
Doctor education is ‘free’ here as well (Sweden), and there is no obligation to work after you get it either. And I don’t see any need for such an obligation. If you spend 6-12 years getting an education, isn’t it reasonable to assume that you intend to work in that field? Actually all education is ‘free’ here, although one university recently decided they are going to start charging foreign medical students from outside Europe. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 6, 2010, 1:43am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/38 "2010-08-06T01:43:51Z")
> [@Khaki\_Campbell](#): > > The French system is not the panacea. At all. You still have to subscribe to a secondary insurance (a “mutuelle”) if you want to enjoy certain care (especially dentistry and eye stuff). In the best case, the State healthcare pays you back 2/3 of the cost. Meh. Canada’s system doesn’t cover dental care but it is far superior to ours. I’ll take only getting 2/3 of my dental work covered over having my chemotherapy rescinded mid-cycle because the insurance company found out I had acne as a teenager and labeled it a pre-existing condition. ---
**Author:** ![Eva\_Luna](https://avatars.discourse-cdn.com/v4/letter/e/e495f1/32.png) [@Eva\_Luna](https://boards.straightdope.com/u/Eva_Luna)\ **Post date:** [August 6, 2010, 2:04am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/39 "2010-08-06T02:04:36Z")
> [@Sam\_Stone](#): > > The point is that the government has no leverage over doctors who already have been educated. In France, my understanding is that the free education comes with conditions - that doctors agree to work in hospitals for X number of years at the government pay scale before being allowed into unlimited public practice. Just as a person who signs up for flight training in the military must agree to X number of years of pilot duty at military pay scales before being allowed to quit and take, say, a high paying airline job. > > How exactly are you going to force current doctors, some of whom are carrying hundreds of thousands of dollars in school debt, to take a 3/5 cut in pay? [There’s already precedent for forgiving student loans for people who choose public service jobs.](http://studentaid.ed.gov/students/attachments/siteresources/PSLF_QAs_final_02%2012%2010.pdf) I don’t see any reason the same concept couldn’t apply to doctors. (On a voluntary basis, of course.) ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [August 6, 2010, 3:10am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/40 "2010-08-06T03:10:51Z")
> [@Stoneburg](#): > > Doctor education is ‘free’ here as well (Sweden), and there is no obligation to work after you get it either. And I don’t see any need for such an obligation. If you spend 6-12 years getting an education, isn’t it reasonable to assume that you intend to work in that field? But one might decide not to stay in Sweden to do so. [Previous page](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197.md?page=1) [Next page](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197.md?page=3)