# 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:** 3
**Author:** ![UDS](https://avatars.discourse-cdn.com/v4/letter/u/ecae2f/32.png) [@UDS](https://boards.straightdope.com/u/UDS)\ **Post date:** [August 6, 2010, 4:11am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/41 "2010-08-06T04:11:18Z")
> [@Tom\_Tildrum](#): > > > [@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. One might decide not to stay in France as well. You think they detain doctors at the border? Most countries _encourage_ younger doctors to travel; they get to see different ways of doing things, and to be exposed to a wider range of practice. It’s an advantage, when seeking a more senior position at home, to have practised abroad. ---
**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 6, 2010, 4:11am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/42 "2010-08-06T04:11:36Z")
> [@Stoneburg](#): > > > [@Kimmy\_Gibbler](#): > > > > 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. That’s OK. You were never that interested in encountering opposing ideas anyway. If you want to spin it as being underwhelmed by anyone’s intelligence, knock yourself out—it could not be a more transparent attempt to avoid backing up an argument you’re not prepared to make. I’m not especially interested in your so-called debates where you demand justifications and evidence from all your opponents (while at the same time insinuating that their failure to agree with you is evidence of an intellectual defect), yet you react with sneering and disdain the moment anyone asks you for the merest evidence to substantiate your own claims. ---
**Author:** ![Kobal2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kobal2/32/20_2.png) [@Kobal2](https://boards.straightdope.com/u/Kobal2)\ **Post date:** [August 6, 2010, 4:15am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/43 "2010-08-06T04:15:37Z")
> [@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? > > Actually all education is ‘free’ here, although one university recently decided they are going to start charging foreign medical students from outside Europe. FWIW, I’m not aware of any forced public doctoring system in place in France either, although doctors that wish to become specialists have to go through more education, which includes part-time internship at a teaching hospital for a few years. Which might be what **Sam** is talking about but it’s a training process, not a civic duty or cost saving measure. Generalists can go straight from diploma to private practice AFAIK. [QUOTE=Sam Stone] And also, France completely subsidizes education for doctors, which encourages more people to go into medicine, offsetting the lower wages. [/QUOTE] Yup, as we do most of education, but medicine in particular also comes with the “numerus clausus” : even if they pass all tests and finals, only a certain number of first year students will be selected to go on with their education, the rest will either have another go or have to move on (you can only do two first years). This to avoid swamping the market with fresh new doctors and keep doctor wages at an artificial high. The exact \*numerus \*varies from year to year, based on the number of doctors needed and practicing doctors retiring. It’s a bit unfair, frankly, but the doctor’s association would have a massive fit if there was any talk of changing that system. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 6, 2010, 6:42am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/44 "2010-08-06T06:42:56Z")
Sam Stone - I know you always turn a blind eye to this question but I’ll ask again; why don’t you clarify that you are not Canadian? > [@Quartz](#): > > 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. Do me a favour. The political origin was the Beveridge Report of December 1942, which itself was in part based on non-party political research from earlier that year. ---
**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 6, 2010, 8:32am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/45 "2010-08-06T08:32:59Z")
> [@sqweels](#): > > Sure beats being bankrupted by a mid-level injury or illness. Indeed. No big deal anyway, as those secondary insurances (that thus make you fully covered for anything) are cheap (I pay about 35€/mo). ---
**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, 9:36am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/46 "2010-08-06T09:36:10Z")
> [@PrettyVacant](#): > > Sam Stone - I know you always turn a blind eye to this question but I’ll ask again; why don’t you clarify that you are not Canadian? Why would I do that? I am Canadian. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 6, 2010, 9:49am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/47 "2010-08-06T09:49:33Z")
> [@Tom\_Tildrum](#): > > Does anyone know how much French doctors get paid? It’s not France, but it’s a neighboring country with a similar system (government managed health centers, though, although private centers can work via SS as well). Spanish doctors working exclusively for the public system get the highest salary level for government workers (it’s the same for all positions requiring a “bachelor’s”, which is the highest they can require; officially, PhDs for “public university professor” are “valued” but not “required”), with pluses for things like covering specific shifts, time in position, etc. As a starter salary it’s fabulous, but not something you’ll get rich on; it doesn’t grow a lot with time, so eventually other college graduates who started working under “training contracts” which pay less than minimum wage can catch up and surpass it (can, not necessarily will). Doctors working in private practice make more, but have less job security. ---
**Author:** ![Mops](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mops/32/16494_2.png) [@Mops](https://boards.straightdope.com/u/Mops)\ **Post date:** [August 6, 2010, 10:55am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/48 "2010-08-06T10:55:55Z")
> [@Tom\_Tildrum](#): > > Does anyone know how much French doctors get paid? No hard figures but a junior hospital doctor of my acquaintance told me lately that to go work in French hospitals was an attractive option for her peers as they had less inhumane hours and more pay than here in Germany. ---
**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 6, 2010, 11:09am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/49 "2010-08-06T11:09:48Z")
> [@Sam\_Stone](#): > > > [@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? > > 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. > > 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? > > 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. The government has a ton of leverage over doctors. They can scrap immigration quotas for doctors and allow lots more doctors into the country. The free market will do the rest in relation to doctors’ salaries. Even if asalaries fall a long way US doctors will still be earning more than doctors anywhere else. And why is scrapping drug patents a bad idea? It could save trillions of dollars. ---
**Author:** ![New\_Deal\_Democrat](https://avatars.discourse-cdn.com/v4/letter/n/9d8465/32.png) [@New\_Deal\_Democrat](https://boards.straightdope.com/u/New_Deal_Democrat)\ **Post date:** [August 6, 2010, 12:36pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/50 "2010-08-06T12:36:44Z")
> [@Ruminator](#): > > France’s universal health care is already broken. According to a Harris Interactive Poll released July 7, 2008 of ten developed countries, the American system was the least popular, and the French system was number 4 in popularity. “Majorities of all adults in France (70%) and Britain (59%) believe their health care systems are ‘the envy of the world’,” [News Articles - FindArticles](http://findarticles.com/p/articles/mi_m0EIN/is_2008_July_7/ai_n27890769/) According to the Organization of Economic Co-Operation (OECD) in 2006 per capita costs in U.S. dollars in the United States for health care was $6,714. In France it was $3,449. [http://secure.cihi.ca/cihiweb/en/media\_13nov2008\_fig2\_e.html](http://secure.cihi.ca/cihiweb/en/media_13nov2008_fig2_e.html) Nevertheless, “Nearly 45,000 annual deaths are associated with lack of health insurance [in the United States] according to a new study published [September 17, 2009] by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.” [http://www.harvardscience.harvard.edu/medicine-health/articles/new-study-finds-45000-deaths-annually-linked-lack-health-coverage](http://www.harvardscience.harvard.edu/medicine-health/articles/new-study-finds-45000-deaths-annually-linked-lack-health-coverage) ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [August 6, 2010, 1:56pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/51 "2010-08-06T13:56:02Z")
In anycase, their incentives system apparently works pretty well. According to the OECD, France has 3.4 doctors per thousand people versus 2.4 in the US ---
**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, 2:14pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/52 "2010-08-06T14:14:32Z")
> [@Kimmy\_Gibbler](#): > > > [@Stoneburg](#): > > > > 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. > > That’s OK. You were never that interested in encountering opposing ideas anyway. If you want to spin it as being underwhelmed by anyone’s intelligence, knock yourself out—it could not be a more transparent attempt to avoid backing up an argument you’re not prepared to make. > > I’m not especially interested in your so-called debates where you demand justifications and evidence from all your opponents (while at the same time insinuating that their failure to agree with you is evidence of an intellectual defect), yet you react with sneering and disdain the moment anyone asks you for the merest evidence to substantiate your own claims. I’m fine with you believing that. ---
**Author:** ![Ian\_D.Bergkamp](https://avatars.discourse-cdn.com/v4/letter/i/5f8ce5/32.png) [@Ian\_D.Bergkamp](https://boards.straightdope.com/u/Ian_D.Bergkamp)\ **Post date:** [August 6, 2010, 2:45pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/53 "2010-08-06T14:45:37Z")
A 2000 report by the World Health Organization ranked the French healthcare system the best in the world. A [2008 report](http://www.cato.org/pubs/pas/pa-613.pdf) by the Cato Institute does a pretty good job of analyzing that 2000 ranking, as well as providing an overall evaluation of the French system. The relevant discussion starts on page 7. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [August 6, 2010, 4:41pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/54 "2010-08-06T16:41:22Z")
[The World Health Organization's ranking of the world's health systems, by Rank](http://www.photius.com/rankings/healthranks.html) France is number one ,we are number 37. That should tell you something. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 6, 2010, 6:10pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/55 "2010-08-06T18:10:56Z")
While costing about 4% more GDP and covering only 2/3 of the population - deal! ---
**Author:** ![Ian\_D.Bergkamp](https://avatars.discourse-cdn.com/v4/letter/i/5f8ce5/32.png) [@Ian\_D.Bergkamp](https://boards.straightdope.com/u/Ian_D.Bergkamp)\ **Post date:** [August 6, 2010, 7:27pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/56 "2010-08-06T19:27:20Z")
> [@Tom\_Tildrum](#): > > Does anyone know how much French doctors get paid? According to page 9 of the aforementioned [Cato Institute report](http://www.cato.org/pubs/pas/pa-613.pdf), “The average French doctor earns just 40,000 Euros per year ($55,000), compared to $146,000 for primary care physicians and $271,000 for specialists in the United States.” The article further states that the disparity is partially offset by (1) government-funded tuition at French medical schools, and (2) a tort-averse French legal system that reduces the cost of malpractice insurance. ---
**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, 7:28pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/57 "2010-08-06T19:28:29Z")
> [@Dick\_Dastardly](#): > > The government has a ton of leverage over doctors. They can scrap immigration quotas for doctors and allow lots more doctors into the country. The free market will do the rest in relation to doctors’ salaries. Even if asalaries fall a long way US doctors will still be earning more than doctors anywhere else. I am all for that. However, I’m not sure if there are immigration quotas for doctors in the U.S, or if there are, whether they are low enough to be a significant barrier. My wife can go to the U.S. any time - American medical facilities routinely come to Canada to try to entice medical professionals to emigrate. To understand doctor’s salaries, you have to really dig into the minutae of how the markets function and whose interests are being served. For example, in some industries, high salaries are maintained by standards boards being set up which create insanely high GPA requirements for people to get into graduate programs. Sometimes residency requirements can be onerous, and are used as a mechanism to reduce the number of new entrants into a field. It may not even be a government restriction. Some of this is collusion between faculties and the industries that they are affiliated with. When I was in college, the most difficult faculty to get into was physiotherapy. You needed something like a 3.95 GPA to get accepted to the program. This despite the fact that physiotherapy is not one of the most intellectually taxing medical fields. But man, if you got in, the pay was sky-high. Also, don’t underestimate the lobbying power of the AMA or its ability to shape policy to its own ends. Regulatory capture is a big problem in the medical field. > [@](#): > > And why is scrapping drug patents a bad idea? It could save trillions of dollars. Because no company will invest a nickel in R&D if they can’t protect their investment through a patent. Getting a drug certified in the U.S. now costs around a billion dollars and takes on average more than a decade. Who would possibly invest money in that if, once the drug was certified, the price immediately collapsed to the generic price? Private companies in the U.S. invest about $70 billion per year in drug research. Remove patents, and that money goes away. And it won’t save trillions of dollars. The R&D still has to be done, and the money for that recouped. The net income of all the pharma manufacturers in the U.S. in 2006 was 110 billion dollars. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 6, 2010, 8:43pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/58 "2010-08-06T20:43:04Z")
> [@I'm Not Dennis Bergkamp](#): > > > [@Tom\_Tildrum](#): > > > > Does anyone know how much French doctors get paid? > > According to page 9 of the aforementioned [Cato Institute report](http://www.cato.org/pubs/pas/pa-613.pdf) _stops there_ LOL . . I feel sure there will be no agenda from that organisation. ---
**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, 8:50pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/59 "2010-08-06T20:50:46Z")
> [@Sam\_Stone](#): > > > [@Dick\_Dastardly](#): > > > > The government has a ton of leverage over doctors. They can scrap immigration quotas for doctors and allow lots more doctors into the country. The free market will do the rest in relation to doctors’ salaries. Even if asalaries fall a long way US doctors will still be earning more than doctors anywhere else. > > I am all for that. However, I’m not sure if there are immigration quotas for doctors in the U.S, or if there are, whether they are low enough to be a significant barrier. There are very few profession-specific immigration quotas in the U.S., and the few that do exist apply to very narrow categories of workers, none of which include doctors. Details [here.](http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=24b0a6c515083210VgnVCM100000082ca60aRCRD&vgnextchannel=24b0a6c515083210VgnVCM100000082ca60aRCRD) There is, however, a [special program (with a path to a green card)](http://www.uscis.gov/portal/site/uscis/menuitem.5af9bb95919f35e66f614176543f6d1a/?vgnextoid=e39718a1f8b73210VgnVCM100000082ca60aRCRD&vgnextchannel=a695a6c515083210VgnVCM100000082ca60aRCRD) to encourage foreign physicians to work in medically underserved areas. (No quota, and applicants who meet the criteria get to bypass the convoluted process of documenting that there are no qualified and available and willing U.S. workers for the position.) ---
**Author:** ![Ian\_D.Bergkamp](https://avatars.discourse-cdn.com/v4/letter/i/5f8ce5/32.png) [@Ian\_D.Bergkamp](https://boards.straightdope.com/u/Ian_D.Bergkamp)\ **Post date:** [August 6, 2010, 10:05pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/60 "2010-08-06T22:05:47Z")
> [@PrettyVacant](#): > > > [@I'm Not Dennis Bergkamp](#): > > > > According to page 9 of the aforementioned [Cato Institute report](http://www.cato.org/pubs/pas/pa-613.pdf) > > _stops there_ > > LOL . . I feel sure there will be no agenda from that organisation. Why? What bias do you think the Cato Institute has? I have no particular feeling about them one way or another, but my impression is that they’re generally well-respected on both sides of the aisle. And, of course, if you have competing data, I’d love to see it. [Previous page](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197.md?page=2) [Next page](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197.md?page=4)