Owl75 Wrote:OK so I googled the French plan and it is too complex for a simple explanation here.
One very French feature I noticed: spa stays are covered! (ok there is a 30% co-pay).
As someone who has actually used the French health care system, perhaps I can cut through some of the complexities. A couple of general observations.
1. Before I had my experience with the French system, I though it was a good model to emulate. When I had the experience, I thought to myself, "You've been in favor of this system from afar, now let's see how much you like it up close and personal." After having the experience, I am 1000 times as convinced as I was before that it is the way to go.
2. The system is not exactly what people think it is, certianly not what Michael Moore thinks it is, and there are some reasons why it might not work here, but I'd still love to see us try it. It is not a socialized system. There is no national health service, unlike Canada or UK. It's basically an insurance-based, free-market system where consumers are free to choose. Conceptually, it is as if a socialized medicine system (like Canada) and a fee-for-care system (like the US) were allowed to operate side-by-side. Another comparison might be our education system where we have free public schools alongside private schools where you can pay to send your kids.
There is a system of "free" care. The health care it affords seems to be okay, but the creature comforts and delivery environment that accompany it are not what Americans are used to (this is why I think it might be hard to implement in the US). It has been subject to very strict cost controls, which means the care is pretty basic, with anything outside the basic health care envelope subject to quotas and queues. The government spends about $3400 per person per year, to give you an idea of the cost controls; this element has come under considerable criticism, and there was a movement to increase government spending significantly, but Sarkozy has made it clear that he is not going in that direction, and his election seems to confirm that the country agrees with him. Without demonstrating an inability to pay, nothing is actually "free." As in your example, everything comes with a co-pay, starting in about the $40-50 range for an office visit. Also as your example suggests, there is considerable emphasis on preventive care and homeopathic and other alternative treatments. A lot of the basic care is handled by paraprofessionals, particularly on the free side.
The pay track works very much like the US system, only with a LOT less paperwork. One characteristic of the French system is much lower administrative costs than in the US. Another is a different approach to malpractice. Both these factors lead to significant cost reductions. You can purchase insurance to cover your expenses on the pay side. Employers typically provide health insurance (in a country with universal health coverage, no less) because if you get sick or injured they want you back at work, not stuck waiting in a queue. The insuarnce is cheaper because of the lower costs as noted above, because even if you have insurance you tend to go to the free system for things like tetanus shots and amoxycillin prescriptions and save the pay side for elective treatments, and because the government provides a catastrophic illness umbrella coverage for everyone (thereby eliminating a lot of the concerns that inusurers have here regarding preexisting conditions). The free side kind of works as a gatekeeper for the pay side, but you can buy insurance which lets you go directly to the pay side for everything (it is a bit more expensive than the normal process where the pay side is secondary). That's my perspective, now I'll try to explain how the system worked for me.
My mother and I made what was supposed to be a quick trip to Paris, that got extended when my mom fell and broke her hip on the Sunday evening before we were scheduled to fly back on Monday. She was picked up by an ambulance operated by the fire department, and taken to the emergency room in a "free" hospital. I would describe the hospital in terms I once heard used to describe Ben Taub, if you're in a life-or-death situation it's where you want to go, but as soon as you know you're going to live you want to get out as quickly as possible. She received outstanding emergency room care, and I was required to complete far less paperwork than would have been required of me in a simliar situation in the US, something I found particularly surprising since we were foreigners. She was scheduled for surgery the next morning. The ugly side of the free system reared its head on Monday, when she was prepped for surgery and taken down three times, only to be brought back up each time when some patient with higher priority came in. I began to realize very quickly what was going to happen, and I started working to get her out to the pay system. We were able to move her to a pay hospital on Tuesday, and she had the surgery Wednesday morning. The two weeks in the pay hospital were the best medical experience, by far, that either she or I can ever recall having. The surgery was a complete success, and six years later she has no problems. The recovery/rehab procedures were very aggressive. Upon her return to the states, my brother had enrolled her in a six week post-op program. After she was there two days, the facility called and told him to come get her, as she was already further along in recovery than they would have her in six weeks. Basically, they juice you up and tell you to walk, and if it hurts they juice you some more and tell you to walk. The anasthesiologist controls the morphine levels, and for that reason both the anasthesiologist and the surgeon make daily rounds throughout the recovery.
French docs aren't starving, at least not those who work on the pay side. The surgeon drove a 450SEL and lived in an condo where the cheapest unit was 800,000 Euros. The anasthesiologist was a 50-something woman, and in two weeks of visiting my mom, I saw easily $20,000 worth of clothes on that woman. You can test this for yourself. Docs are coming to the US from all over the world because they can make more money here than at home; look at the directory in any medical office building. While you're at it, see how many of them appear to be from France; I'm guessing you won't find many.
I got my mom in and out of two hospitals, with major surgery and two weeks of rehab, for less paperwork than it would take here if I went to a local emergency room to get an amoxycillin prescription for a sinus infection. At both of the French hospitals, comparable in size to what you'd find in major cities in the US, the back office staff consisted of a social worker (to evaluate ability to pay) and three or four clerks/bookkeepers. The savings on paperwork is immense. The nursing care was comparable to what you'd find in the US in the free hospital, but on the pay side it was several orders of magnitue more responsive than anything I've ever seen here. Both hospitals were in older buildings, but very clean. Neither hospital seemed to have quite as much glitzy, high-tech stuff as you see here. In a US hospital, the cat scan machine has touch-screen controls, whereas in France it has toggle switches; both work just fine. My mom's fovorite part was that every afternoon about 3:30, they came around with a wine and cheese cart for everyone. The food was amazing. There was a much greater emphasis on making the hospital stay a pleasant and enjoyable experience (you'd expect this of the French), and I'm guessing that translates into higher succes rates.
One of my business partners had the same surgery in the same time frame; his cost $40,000 in the US, while my mom's cost $13,000 in France. The hospital and the docs took Blue Cross.
I've likened the decision of whether to use the free side or the pay side to the decision faced by many in Houston, "Do I send my kid to Lamar or to Kinkaid." There are a lot of simliarities. If you're a patient, or visiting a friend or family member who is a patient, you would know very quickly whether you were in the free system or the pay system (by 3:30 at the latest, LOL). My mom is fond of saying, "I'm 85 years old, and if I ever need surgery again, I want to go back to that hospital in Paris."
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McCain/Republican Health Plan
