# 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:** 15\ **Page:** 4
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [August 7, 2010, 4:05am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/61 "2010-08-07T04:05:37Z")
Cato is a conservative/libertarian organization. They are not neutral and not particularly well respected. ---
**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 7, 2010, 4:28am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/62 "2010-08-07T04:28:03Z")
Correction: They’re not well respected by partisans who do not like their conclusions. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 7, 2010, 6:46am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/63 "2010-08-07T06:46:22Z")
I’m not interested in any statistical analysis from partisans on any side, it rather defeats the purpose and persuades no one other than those already convinced. C’mon, this is playground stuff. ---
**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 7, 2010, 8:20am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/64 "2010-08-07T08:20:22Z")
> [@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), “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. This figure is correct, however, it must be put in perspective with the average income level of other professions in France - of which docs are at the very top ([cite](http://www.insee.fr/fr/themes/tableau.asp?reg_id=0&ref_id=NATSEF04119), in French, INSEE study) Besides, it is not uncommon for private practitionners and specialists to earn double to triple that amount. I’ve never met a starving doctor 😉 ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [August 7, 2010, 8:21am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/65 "2010-08-07T08:21:13Z")
> [@Tom\_Tildrum](#): > > Does anyone know how much French doctors get paid? I don’t know, but for some previous thread about health care, I searched for this information, and though I don’t remember the figures, the income of french doctors is significantly lower than the income of american doctors (note though that they don’t pay for their education and training, and also that they don’t have much in the way of staff since they don’t have much in the way of paperwork. One secretary for two doctors where I go). Since you said “get paid” it let me suspect that you assume they’re paid by the government, so I’m going to mention that they’re paid by the patients (who are then reimbursed). A visit to my generalist costs me 22 euros. A home call costs maybe 10 euros more. That’s the basic payment reimbursed by the health care system and doctors have fiscal incentives to apply it. They can overcharge up to a given limit (rather high), but you won’t be reimbursed more than the 22 euros (I don’t remember what is the basic payment for specialists, but almost all of them overcharge, for instance). That’s one of the uses of complementary health insurances, reimbursing the difference (Again a note : most insurances here are non-profit, following a mutualist scheme). They can also opt out completely, charge whatever they want and you’re reimbursed nothing. Doctors doing that are really rare. Finally, the government isn’t _directly_ involved. France doesn’t have a system similar to the UK/Canada system. It’s more similar to the German healthcare model. Before the existence of UHC, there were a significant number of large companies, whole industrial branches, etc… that had developped an health insurance/retirement system for their workers, generally administrated by representants of the companies and of the unions. After WWII, this system was basically generalized. All workers have money taken out of their paycheck to fund healthcare and retirement, and the whole thing is administrated by representants of the unions/companies at a national level, not directly by the government. It fills in, however, for people not covered (people unemployed for more than two or three years, for instance). It also covered more than once the deficit of the “secu”, and obviously, since nothing can be made mandatory without a law, it has a final say about all issues, so it’s not like the healthcare system is independant of the government. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [August 7, 2010, 9:01am UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/66 "2010-08-07T09:01:50Z")
I should have read the whole thread before posting. I notice that\*\* Sam Stone \*\*had already answered, and his answer is more to the point. I would correct some points (doctors aren’t anymore as sheltered from tort and it begins to be a problem for instance for obstetricians, the cost of education aren’t included in the health care expenses but university education is paid for for everybody else, lawyers historians, etc…, some doctors are allowed to run a private practice _within the public hospital and using the hospital equipment_ in order to retain the top elements in the public sector and that’s what makes it peculiar, there’s actually currently a shortage, not an abundance, of doctors, especially in rural areas, because there’s an IMO idioticly low numerus clausus for medical studies (maybe one candidate out of 20 succeeds at the exam to join a medical school), but these are rather details and I mention them just for **Sam Stone** information. ---
**Author:** ![heatmiserfl](https://avatars.discourse-cdn.com/v4/letter/h/df705f/32.png) [@heatmiserfl](https://boards.straightdope.com/u/heatmiserfl)\ **Post date:** [August 7, 2010, 2:17pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/67 "2010-08-07T14:17:26Z")
> [@Wesley\_Clark](#): > > > [@G-SE](#): > > > > How about the fact that part of France’s health care system is basically “subsidized” by the U.S.'s spending in medical research. Although [this article](http://www.nytimes.com/2006/10/05/business/05scene.html?_r=1&bl&ex=1160452800&en=6737dbf98961a2a6&ei=5087%0A) is a couple years old, I doubt the general theme has changed. > > > > In fact, one the big arguments against universal health care in the US is that it will cut innovation & research. Hmmm… wonder where they got that idea? > > Europe lags in general in R&D, not sure why. It isn’t just medical R&D. > > In the US we spend about $90-100 billion a year in medical R&D. Of that, about 40% is funded by the public sector. Reading your article, it says the same thing. > > If our system were as efficient as France’s, we would save about $900 billion a year. So there would be more than enough money to invest heavily in R&D. > > In fact if we had France’s system we could have a great universal health care system, triple our medical research spending to $300 billion and pay for social security (about $600 billion/yr) all for the same cost of our current, flawed health care system, and still have $100 billion left over a year. > > So again, why don’t we have France’s system? A great universal health care system, triple the medical R&D and free social security checks for the same price as our current health care system. > Basically, claiming we should spend an extra trillion on wasteful, inefficient health care for an extra $20-40 billion in medical R&D isn’t persuasive. Just adding to the “US subsidizes world R&D”. France is obviously a smaller country but it still spends about half per capita on public biomedical R&D compared to the US. OTOH, I recall that France’s pharmaceutical companies (Sanofi-Aventis, for example) tend to use much more of their operating expenses on R&D than US companies. Plus, the French government gives companies a lot of tax breaks and other subsidizing incentives to spend more of their budget on R&D so maybe the difference is not so large. I should get a cite for this, I know. Maybe this one helps - [http://www.rand.org/pubs/documented\_briefings/2010/RAND\_DB590.sum.pdf](http://www.rand.org/pubs/documented_briefings/2010/RAND_DB590.sum.pdf) OTOOH, there’s a lot of private donations into US research that allows for much more freedom in spending. This supports innovation and high risk. I don’t know how much private donations goes to French research. Finally, I’d like to note that there is a general fear amongst US biomedical researchers that we may lose our place as the leader in biomedical research. I don’t know if this is actually true. ---
**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 7, 2010, 3:05pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/68 "2010-08-07T15:05:22Z")
I’ve heard a big part of why they set up in the US is because of how large and effective our higher education is. I don’t know the exact legality of it, but there are far more public higher universities to work with to get basic R&D from in the US. I have heard that is a big part of why R&D is set up here. Either way, I have also heard people worried that east asia will take the lead in biomedical R&D. Aside from east asia, I don’t know what other area would beat the US. ---
**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 7, 2010, 3:34pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/69 "2010-08-07T15:34:58Z")
> [@PrettyVacant](#): > > I’m not interested in any statistical analysis from partisans on any side, it rather defeats the purpose and persuades no one other than those already convinced. > > C’mon, this is playground stuff. _shrugs_ Seems to me the “playground stuff” is dismissing data because of perceptions about the political leanings of the source, rather than actually, say, examining the data or providing alternative data. It’s exactly the type of behavior that **Stoneburg** was predicting above and why he declined to provide sources until he could get agreement on which sources would be acceptable. As someone who trends to the left politically, I didn’t see any apparent flaws in the Cato Institute’s data, nor in their analysis of the WHO’s 2000 report. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [August 7, 2010, 4:17pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/70 "2010-08-07T16:17:53Z")
> [@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. I’d take that deal. The dental coverage on my private insurance costs $720/year for a $750 benefit. Wow, a $30 coverage per year! No vision coverage at all. ---
**Author:** ![heatmiserfl](https://avatars.discourse-cdn.com/v4/letter/h/df705f/32.png) [@heatmiserfl](https://boards.straightdope.com/u/heatmiserfl)\ **Post date:** [August 8, 2010, 12:49pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/71 "2010-08-08T12:49:11Z")
> [@Wesley\_Clark](#): > > Either way, I have also heard people worried that east asia will take the lead in biomedical R&D. Aside from east asia, I don’t know what other area would beat the US. Oh yeah. There’s two research institutes in China (Beijing and Shanghai, I think) that are specifically recruiting westerners, especially scientists from the US. Since we’ve had a funding SNAFU since 2003, they may be succeeding. ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2010, 5:09pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/72 "2010-08-08T17:09:45Z")
Pharmaceutical companies spend more in marketing than they do in R&D. Banning those stupid commercials might be a good place to start to cut costs, then we can tax Doctors who accept junkets to Hawaii to attend seminars funded by drug companies. Can’t they learn just as effectively in a Holiday Inn in Cleveland? ---
**Author:** ![DanBlather](https://avatars.discourse-cdn.com/v4/letter/d/f4b2a3/32.png) [@DanBlather](https://boards.straightdope.com/u/DanBlather)\ **Post date:** [August 8, 2010, 5:13pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/73 "2010-08-08T17:13:49Z")
[quote=“clairobscur, post:65, topic:549197”] > [@Tom\_Tildrum](#): > > the income of french doctors is significantly lower than the income of american doctors (note though that they don’t pay for their education and training, and also that they don’t have much in the way of staff since they don’t have much in the way of paperwork. One secretary for two doctors where I go). I got sick in Paris and went to see a doctor recommended by the hotel. He greeted me at the door, we talked a little in his little office, then went back to his examining room. No nurses, no staff of people dealing with insurance companies. It reminded me of the US 50 years ago. ---
**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 11, 2010, 5:25pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/74 "2010-08-11T17:25:32Z")
> [@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. 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. The amount of foreign doctors allowed into the US is clearly restricted. There’s definite protectionism of US doctors : [http://www.chowk.com/articles/4219](http://www.chowk.com/articles/4219) And I don’t have to be aware of anything except supply and demand when it comes to doctors’ salaries. And it would save trillions of dollars to let the government fund all r and d. A hundred billion a year by the estimates of actual economists who’ve written papers on the subject. > **[intellectual\_property\_2004\_09.pdf](https://cepr.net/documents/publications/intellectual_property_2004_09.pdf)** > > 78.12 KB ---
**Author:** ![Gregg64](https://avatars.discourse-cdn.com/v4/letter/g/9f8e36/32.png) [@Gregg64](https://boards.straightdope.com/u/Gregg64)\ **Post date:** [August 13, 2010, 10:25pm UTC](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197/75 "2010-08-13T22:25:31Z")
If nothing else, it won’t work for all diseases. If you get German Measles they surrender and you die from it. [Previous page](https://boards.straightdope.com/t/what-is-the-argument-against-french-healthcare/549197.md?page=3)