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.
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.
Yet the ironic thing is that everyone in the US is paying for a healthcare system via taxes and they pay far more per capita than, say, the UK or Denmark (yes, US public health spending expenditures are higher despite not resulting in universal care). On top of that, they then pay a second (private) time to get any actual coverage unless they're disabled, old or young.
I believe the "problem" with the US system is the very idea that the private sector can manage and provide such essential services better than the government could. And at the same time run the services for profit, profitably. It's a capitalist fantasy. Its a successful power play by our deluded wealth. We have a sad state, this US of A, with our population completely brainwashed into accepting this absurd situation.
IANA economist, but as I see it, the problem is that healthcare is mostly a captive market, i.e. not having it when you need it is not an option. With such an inelastic demand and relatively high entry barriers for providers (making competition scarce), it's expected that prices skyrocket. So socialized healthcare is a big win for the people and a big loss for the moneymakers.
Living in another country with socialized helathcare, each time the situation in the USA is described, I'm really glad I don't live there.
Another issue is the lack of information. Most consumers in the healthcare industry rely on others (doctors, hospitals, pharmacists) to tell them what they need and the people giving advice having conflicting motives (helping the patient, making money).
Simply put, you don't make a business from treating sickness. When people are sick, they are least able to pay. Also, when one is sick, there is no incentive to insure him/her because it doesn't generate profit.
You're half right - the countries with the best standards of living in the world are the ones that have social services that are paid for by publicly owned oil profits, then other resource extraction profits, then taxes. Scandinavia and Canada are routinely the best. Another important feature of these countries is not a nationalised health service like the UK, but a guaranteed minimum standard insurance with a competitive market for provision. See http://www.oecdbetterlifeindex.org/.
Only Norway has a substantial amount of natural reserves in the Scandinavian countries, with Denmark a distant second.
Also, the healthcare system you talk about is the Swiss, the Scandinavian and Canadian systems do NOT have anything close to an insurer (except the State itself).
Re healthcare: I was talking about Scandinavian and Canadian systems. Government pays the cost but private companies provide the service. Contrasted to the UK where government provides the service.
I wish people would stop saying Scandinavia as though it were a country. It is not and the differences between the countries in Scandinavia are substantial. For instance:
Oil and gas: Norway has lots, Denmark a little, Sweden none.
Mineral resources: Sweden has lots, Norway has some, Denmark almost none.
Forestry: Sweden has lots, Norway has some but it's uneconomic because of the terrain, Denmark very little (except Christmas trees).
Hydropower: Norway has lots (98% of electricity), Sweden has some, Denmark almost none.
Land area:Sweden twice the size of the UK, Norway 60% bigger than UK, Denmark half the size of the UK.
I can't speak for Sweden and Denmark but here in Norway whilst private institutions provide services (X-rays, MRI, etc.) under contract to the state, the hospitals are nonetheless public institutions (barring a few, and as far as I can tell not very successful, private hospitals).
What does seem to unite the three Scandinavian countries is a general belief that we really are in it all together. When a rich owner of a chain of supermarkets started making a noise about moving to Switzerland because he was fed up of paying high taxes he was immediately told to " off then" not just by us poor peasants (of course there aren't many genuinely poor here) but also by other seriously rich people. It wasn't long before he was back here.
I don't think your theory is very good re: natural resources. Sure, some developed countries have a lot of natural resources, but most don't, include many associated with the highest standards of living and socialized care.
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
This is true but its worth noting that the Australian system has been moving towards the US version consistently for the past couple of decades. Private healthcare is common and seen in some circles as something not to be done without. Public services have been sold off and new infrastructure is privatised (telecommunications particularly). etc.
No. The US system is distinguished by healthcare insurance being tied to employment, and the absence of free options.
Australia has not been moving towards that model.
Private health care options have always been a significant part of the Australian healthcare system. In the current Australian settlement: (1) there is a catch-all system that's available to everyone; (2) if citizens want to chose a chosen private option, the government subsidises this.
There's a similar dynamic in school funding.
The result is that people can choose to funnel money towards the education and health system that's in addition to what they pay in their taxes. Their choice also reduces load on the free options. People spend money on health and education that would otherwise be spent on new cars or more ludicrous mortgages, and have done this through an exercise of freedom, rather than having had the government tell them what to do.
Australia is one of only a handful of countries with both solid education and health systems, yet a contained federal government debt situation.
I think you misunderstand my point. I'm not saying that Australia is exactly like the USA in this (yes, health care very sesnibly isn't provided by employers). But the 'dual' system you describe in both schooling and healthcare is definitely a step towards the american (privatised) way of doing things from a 'socialist' model (as exemplified in Australia by the Whitlam era approach). The simple test of the socialist model is if the poor don't get the same healthcare or educational opportunities as the rich. Australia has moved towards this and leans more in this direction than most other first-world countries. Whether this is a good thing or not is not my point (obviously you believe it is - I think there are arguments either way).
Privatisation of infrastructure (and a general lack of building new national infrastructure) is also a key sign that the system is not very 'socialist'
You appear determined to find a way to paint the recent history of Australian health reform as being somehow American. But it's not - it's its own thing.
The US system is a tangle of health systems provided by every level of government and charities. It's different state by state. There's a major veterans scheme. Some states have systems a bit like Medicare. The majority of people get their care through a employment tied insurance. It doesn't serve as an example of freedom, privatisation, variations in levels of care. It's just a big complicated mess.
I think it'd be more straightforward if you just stuck with 'less socialist' rather than trying overloading America as the standard for those qualities.
Not sure that Australia has evolved that way though. There was a recent reform to introduce means-testing to medicare. And the new hospital in Adelaide - 1.7 billion dollars, 120 extra beds.
OK. understand that you don't like my use of 'american' as the opposite to 'socialist' here. Simplifications like this can be difficult and probably will h healthcare we are less overtly 'like america: although still a ways from being strongly 'socialist' (in the Scandinavian sense)
That is probably because American isn't the opposite to socialist. The USA has many socialist aspects, it just doesn't like to think of them as socialist. Free education is socialist. Medicare for the elderly is socialist. The NFL has many aspects of socialism. The laws on state funded research being made available to the public are socialist. NASA is socialist.
This is true but the USA is still, of all first world countries, the one which takes the least socialist approach on many issues and this is the sense in which I use it as an example.
This risks being brutal, but you didn't have an email in your account details, and I left it a week so the forum would clear. I have tough but fond memories of being called out on things like this when I in my 20s. I think I'm well-intentioned.
Something that ribs me about the political culture in Australia: the intelligentsia will never miss an opportunity to claim their identity as being distinct, yet they judge themselves from a very American world-view. In this sense, the Australian identity is like a rebellious teenager - desperate to be making a break from mum and dad, but unaware how its rebellion is defined entirely by mum and dad's world-view.
You are welded to the (American) popular culture myth that American is an antonym for socialism. This is more important to you than the fact that it isn't. Even after we've discussed that there are better ways to express the idea, after you've gone through the pain of admitting you could have done this differently. You've then recanted, pulled back into your shell and defended your original expression. You won't grow if you do this.
It's not just you. But you can fix it. Turn off the television, blank your mind, read, travel, think, build your ideas on this foundation.
Yep, and as an Aussie I find it extremely worrying. I'm fine, I have private insurance, and my family and myself are not struggling financially. But that's not the case for some of my best friends and their families... And those are the people that are going to suffer.
Also, screw Translink. I still can't fathom why a 15% increase in price for a worse service makes sense. Sigh
I think you hit the nail on the head in 2 ways. First, s completely free market might work in healthcare, but what we have in America is so far from that, that most people don't even know what they are fighting for. Second, you do have much more freedom to move for tax purposes. The US demands its citizens everywhere to pay income tax, globally, even for 2 years after renouncing citizenship.
A potential downside to the world (maybe good for Americans) would be if changes in American healthcare reduces funding overall for drug research and development. I've always heard we fund most of R&D.
A completely free market in healthcare will absolutely not work. Insurance companies will drop everyone who has shown any form of uncommon illness - this is their natural incentive in the absence of regulation. Many serious and expensive illnesses are so rare that most insurance companies would severely curtail support towards these illnesses, with cheaper premiums and more customers as a result.
Libertarians are suffering from the same delusion that the communists did: In a world where humans are perfectly ethical towards each other and always put the public good ahead of their own interests, it will work perfectly. In the real world, it won't.
I'm having difficulty parsing your prediction. Are you saying that in a free market, nobody would offer insurance against the possibility of developing a rare, expensive medical problem? Or that once you've developed an expensive medical condition, you'll no longer be able to get insurance against it? Or something else?
Assume you were an insurance company executive and you wanted to maximize profit and you were indifferent to the plight of your customers. What would you do?
I'd release new products regularly, while increasing the insurance premiums of old products. Healthy people would just switch to the new product to avoid the price increase, but people with pre-existing conditions wouldn't be eligible so I could price-gouge them.
So you could get insurance against expensive medical conditions - but if you had to claim on that insurance, suddenly your premiums would start rising by 30% a year, and you would have no alternative because of your pre-existing condition.
The companies that didn't engage in this would then look expensive to healthy people and attractive to unhealthy people. And if the healthy (profitable) people leave and unhealthy (subsidized) people join, meaning premiums have to go up further, you could get a chain reaction putting them out of business.
So you could get insurance against expensive medical conditions - but if you had to claim on that insurance, suddenly your premiums would start rising by 30% a year, and you would have no alternative because of your pre-existing condition.
To bolster this example, I hear from my parents that this is more or less what's happened to insurance premiums in Switzerland since some idiot in government deregulated the insurance industry.
I think a free market insurance system would basically end up paying out lump sums for various illnesses and conditions. Hospitals would publish average price lists and then insurers would advertise and pay based on that.
Get lung cancer? Here take $200k courtesy of your insurance. Only going to cost you $150k? "No problem, glad you found a cheaper place. Buy a nice gift for your wife with the difference"
Pretty good insurance company to be able to offer a smaller premium when they have to cover the exact same costs on average when they have 10x the overheads of a company that pays lump sums.
Not to mention you are by necessity limited by the hospital and doctors on the insurance companies approved docs list. No thanks; they don't have my interests at heart.
Not to mention the very real incentive for such an insurance company to stop paying for "problem" clients with long ongoing illnesses.
If 25% of lung cancer cases cost less than $150,000 to treat, 50% cost less than $200,000 to treat, 75% cost less than $250,000 to treat, 99% cost less than $500,000 to treat and 99.999% cost less than $2,000,000 to treat, how much would the insurance company pay out for lung cancer?
There is no set cost for complex chronic diseases like cancer, so there is no way that could be published. No single case of cancer is exactly the same, and the course of it and how it responds to various treatments varies widely.
Sure it could. They would just have to categorize the major varieties etc. if you mean it wouldnt be 100% accurate well of course not as it is rough aggregate data. But it is very useful aggregate data.
The problem is that for the insurance to work optimally everyone have to chip in so that those that are healthy offset the cost of those that aren't.
In the US the young aren't getting insurance which is one of the reasons for the Offordable Healthcare Act. To force everyone to have an insurance so that economics become better.
Of course in reality the best possible system would be a single payer (tax based) healthcare system with some payment for usage but where no one can go bankrupt or be dropped or fall under the deadly pre-existing conditions clause.
Or a mandated private insurance like in Germany & Switzerland. Obamacare is one step of that way but it's so alien to US culture and have been so poorly implemented that on could fear for its future.
A completely free market in healthcare will absolutely not work.
It doesn't work because of other reasons. And libertarianism is quite irrelevant. A good economist can point out the flaws in economic markets...using economics. A marxist alternative is clearly from the wrong century and is irrelevant. The important point that govermnet semi-intervention is part of the problem is perfectly plausible. That is a different point than no co-operation is needed for a viable solution. People co-operate all of the time without the need for a "government solution". Try staring at people in the elevator or invading the personal space of someone on the NYC subway if you want to prove this point to yourself.
Of course, but then you're right back at where you started: Taxation.
Charities are much more common in the US than in Europe, because they cover services and treatments which are provided by the public sector in European countries. In the US, many of these services are based on voluntary donations and volunteering.
Of course, if the state is as corrupt as it is in the US, I understand the reluctance to pay more taxes. But in effect, charities do the same thing, except veiled by the fact that contributions are voluntary.
It works better for the corporations who benefit from the system with billions of revenues and who can afford to bribe (sorry, 'lobby') US politicians to perform as they please.
One difference between France and the UK is that doctors' salaries are much lower there. The French get more value for their healthcare spending than does the UK.
> I'm in the UK and we also have these same free public services.
You forgot the word "crappy" services. It's widely known that for life threatening conditions in the UK, the NHS has a wait list and you have to wait for your turn no matter what and that be months or sometimes more than a year. Sorry, but I want to have a system that allows me to pay more to get priority (or better treatments).
it is not enough to have a free public service, tho. I have no idea about the Uk, but Canada also has free public healthcare yet it is so quite worse than the french system that it feels like they are not in the same league, imho.
The UK system certainly has problems (long wait times, overcrowding etc.) but I think when it comes down to where I'd rather be if I had a life threatening illness, it would be here, not the US. The fact that I can receive a good level of health care without paying a penny (even for prescriptions) is worth the drawbacks that come with this kind of system. Also, I still have the option of paying to go private if I wish.
"in the States, you have to pay for your health like for any groceries."
In the US there is no functioning price mechanism. So, it it is quite unlike a trip to the super-marche. Your money disappears down a rabbit hole (insurance) for which there is very little practical choice; and the rest of it is like a giant "dark pattern" puzzle where all kinds games are played to milk out the most money. That is not to say introducing "market pricing" is the correct answer, in a naive sense, this is not correct. Because markets don't function with opportunistic negotions under duress and asymmetric information (ie, typical medical situations). So, the problems with healthcare are precisely this: money changes hands but it is part of a system that is neither here nor there. As such, its just a corrupt opaque and insider-exploited bit of social engineering. Of courese, that likely describes many of the alternatives. (Hence, tough choices and an unwillingness to do anything other than something well thought out and pragmatice.) At least EU countries have evolved a unique ecosystem over time that has developed it own internal logic. The US is a frakenstein system, and the more money we spend trying to "rationalize it" (buzzword of the 1990's?), the worse it gets...MBA type's and the hippocratic oath don't really mix.
> we don't think we are specially socialists (well, the French social party seldom wins the presidential elections).
Being French living abroad, your comment makes me smile.There's nothing but socialists in France, you just have right wing and left wing socialists but their economic and social policies are all very much converging except for some minor social issues about homosexuals and stuff like that. Liberals or should I rather say Libertarians do not exist at all in France so you have basically a single mindset in power. That's why France is known abroad as "La Petite Russie" (the small Russia).
> be nearly impossible for them to try an privatize a critical public service
and thats exactly why you end with shitty companies like SNCF and the former France Telecom who did not care about their users at all. Having competition does not solve all issues, but God, it can't be worse than State monopoly services.
About the political orientation, I do know that we are considered as a socialist country abroad, and even more in the States. I am just sharing what I have witnessed from inside. For instance, in the mind of most people, the left wing (PS, the "Socialist Party") is even considered to be right-wing-oriented. I think that French do no realize that they tend to think in a "leftier" way that the States (well, you could say that the US tend to think in a "rightier" way due to the Cold War).
> and thats exactly why you end with shitty companies like SNCF and the former France Telecom who did not care about their users at all. Having competition does not solve all issues, but God, it can't be worse than State monopoly services.
Some context for non-French: SNCF is the Société Nationale des Chemin de Fer (litteraly national railway company), that now manages most train traffic in France (but not the railways themselves, ironically); France Télécom (sometimes abbreviated FT) is the company which set up the infrastructure for land-line phones and started using it. Both SNCF and FT are public companies.
The statuses of SNCF and FT were logical at the time of their creation as it was an initiative of the state to build the infrastructure so that most people could benefit from it. However, this also meant that the companies had the monopole and, even when it was finally broken (legally speaking), they were considered as the "by-default" company so they still detain most of the market in their respective domains. Because of this, they were never really threatened by competition and evolve very slowly, leading to a degradation of the services they provide. Additionally, it is difficult to privatize those company because of social protests that raise whenever the topic is discussed.
You must have been extremely lucky, I have nothing but bad experiences with the SNCF and their employees through my years in France. This company is a joke.
Interestingly, the case about firemen not helping someone who didn't pay the out-of-county fire coverage fee also relates directly to health care. The reason they didn't help is because if someone was hurt fighting a fire they weren't supposed to be fighting, their health insurance wouldn't have covered it. If there had been universal health care, this would not have been an issue. Many screwed up incentives in the US result from lack of proper health coverage.
I'm no flag-waver, but I think it's important to point out that for 40+ years after WW2, it was an extensive (and expensive) US military budget which countered Soviet aggression. So when you talk about all these great social services, you have them in part because of a very expensive investment we made in the defense of western Europe, which freed you to spend money on these things.
The first many years after WW2 Europe spent rebuilding itself. America came out of the war with barely a scratch on its home territory. Although many American soldiers had died overseas no cities or industries were destroyed and almost no civilians died. In Europe, two generations had been decimated by the two consecutive wars, hundreds of major cities were destroyed, infrastructure was destroyed, businesses - well, entire industries, were destroyed. The iron curtain meant that trading partners in Eastern Europe were no longer accessible.
For America WW2 meant opening up it's trade with the war.
Let's not forget that Europe's welfare states were born in hardship.
> The first many years after WW2 Europe spent rebuilding itself.
The U.S chipped in quite a bit too. $15 billion, or $148 billion in today's dollars, which was almost 6% (!) of the U.S. GDP at the time. This was in addition to a previous $15 billion in aid before the Marshall Plan was enacted.
While indeed massive, the Marshall plan was handed out over 4 years so it was around 1.5 percent of US GDP. I dont think it made it impossible for the US to build public health care.
The French financial- and military contributions to the American Revolution were motivated almost entirely by a desire to contain the British and exact revenge for the loss of French North America. Financially that ended up being a very bad move for the (royal) French government, but don't imagine that they were inspired by fraternal feelings toward the American revolutionaries.
The american contribution to their own wealth was to not pay the debt they contracted to Louis XVI when France became a Republic (and they were right to do it for legal reason).
Le baron de Beaumarchais (famous writer and weapon smuggler) that lobbied the french monarchy for helping the US revolution was clearly doing it for the sake of freeing the people from monarchy (he was one of the philosoph supporting the strange idea that merit matters more than birth rights).
You should really read more. Especially 'le mariage de Figaro'
> The american contribution to their own wealth was to not pay the debt they contracted to Louis XVI when France became a Republic (and they were right to do it for legal reason).
According to a U.S. State Department history [1]: "In 1795, the United States was finally able to settle its debts with the French Government with the help of James Swan, an American banker who privately assumed French debts at a slightly higher interest rate. Swan then resold these debts at a profit on domestic U.S. markets. The United States no longer owed money to foreign governments, although it continued to owe money to private investors both in the United States and in Europe."
Granted, 1795 was a bit too late to help Louis XVI, who had lost his head two years before. Still, it was only 12 years after the peace treaty with Britain -- not too terrible for a brand-new nation, I'd say. And in any case, it'd be unconventional (to say the least) to try to blame the Americans for the French royal government's mismanagement of its financial affairs.
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> Le baron de Beaumarchais (famous writer and weapon smuggler) that lobbied the french monarchy for helping the US revolution was clearly doing it for the sake of freeing the people from monarchy (he was one of the philosoph supporting the strange idea that merit matters more than birth rights).
Nations aren't monoliths; their governments act in response to pressures from all sorts of different people who have all sorts of different opinions and motives.
(Example: When the U.S. entered WWII, the triggering event was the Japanese invasion of Pearl Harbor. But for months before that, and especially after the Nazi German invasion of the USSR in June 1941, a significant number of Americans had wanted the U.S. to enter the European war --- some to help the British, and some because they were Communists or sympathizers who wanted an immediate second front in Europe to take the pressure off the Soviet Union.)
In the rough French revolution context is basically the same as today:
* huge debts contracted by gvt;
* unfair repartition of the fiscality (the 1% wealthiest don't pay in proportion to their income);
* producers (the 10% wealthiest) are not able to produce anymore because fiscality is to high;
The convocation of "tiers etats" that triggered the revolution was about asking how to make the repartition of fiscality more fair.
the 1% wealthier said we don't care we don't pay and you can't change the system anyway because we make the rules and they "mouhahaha"ed
The remaining said, okay, are you losing your head (saracasm and irony)? and they said to the other europeans 1% (germans, brits, dutch, spanish)... Oh btw, we are not a kingdom anymore. As a result, we dont have anymore debts. Go fuck yourselves
The banks were pissed off and they said: WUT! Debts are to be honored, if people begin to think that money don't rule the world the world is doomed.
Thus the coalitions against France, battles (Valmy), Napoleon tricking Italia in Republic and then betraying them so that the bankers got another ennemy ...
I forgot the part where producers were also asking for the state to ensure a 'fair competition' based on merit and not birth.
Now, takes Forbes top 500 fortunes of the world and tell me how much people are not xth generation dynasty kids.
I love Bill Gates he has a lot of merit, one of which is being well borned.
We do have a meritocratic system, but this system is biased because he is mainly accessible through birth.
This is the definition of a society based on casts. We are regressing in the name of a so called "liberalism" that looks like the "communism" of Lenin : an implementation that contradict the purpose.
Our political systems are wrong implementations of good ideas. How can we repeatedly fail that much collectively?
And? Unless you're going to try to make the point that post-WWII American investment in Europe was done purely out of the goodness of the post-WWII American heart, I'm not sure where you are going with this.
> Unless you're going to try to make the point that post-WWII American investment in Europe was done purely out of the goodness of the post-WWII American heart, I'm not sure where you are going with this.
Not purely --- I would imagine that certainly American leaders had future markets in mind --- but there was definitely a large component of altruism, quite possibly more so than with the French support of the American revolutionaries in the late 1770s and early 1780s.
In the post-WWII era, the U.S. had nukes, as well as two broad oceans as moats. After the Japanese surrender we demobilized as fast as we could, in response to overwhelming domestic political pressure to "bring the boys home."
It might well have been feasible for us to have largely retreated to our own borders and leave the western Europeans to their fates at the hands of the Soviets. Instead, we spent billions, perhaps even trillions, to maintain forces in Europe to deter Soviet aggression and to try to help western Europe recover from the devastation of the war. (We offered Marshall-Plan aid to the Soviets and their vassal states as well, but the Soviets prevented those countries from accepting [1].)
Of course self-interest was part of the U.S. motivation. But there also was altruism, and generosity.
Other than in an abstract sense, what does the American Revolution have to do with the Postwar Reconstruction, some 170 years later? And how does that mute or counter the statement I made?
Perhaps you missed a key point: A universal healthcare system is less expensive than a privatized healthcare system. So, as much as I'm thankful for the protection from a possible soviet aggression and even more for the Marshal plan, it wasn't a lack of money that convinced the USA to have a private system. I think it was mainly a hate of anything "socialistic".
Less expensive on a per-patient basis, but more expensive as a government program, which would compete directly with defense spending and foreign aid. I don't disagree that there were cultural factors involved as well, as Americans have a predisposition towards certain ideas which resemble a notion of individual responsibility (for a certain definition.)
I would more talk about plan Marshall. Because France and UK had to build war jets, nuclear weapons, and air carriers on their own (and caravelle, and space rockets and Concord together).
The whole premise of social security in France after the war is that people with their basic needs unfulfilled voted for the nazis. So they decided that the State should provide some minimum services for everybody.
No, it was done in near- and long-term self-interest and strategic relationship building. Why would you assume I meant otherwise when I implied absolutely nothing about motive?
and all the other social groups humans form, in the order of priority being group size smallest to least.
Emotions are the definable channel to that "gene preserving" desire.
Everything we do in life is to achieve a certain emotional state (think about it). We don't want money. We want what it will mean to us (e.g. security, power, fun, freedom, etc.). We don't want a relationship, we want what it will mean to us (love, belonging, etc.).
Nature's calibrated human has his emotions correctly / optimally linked to spreading and preserving his and other humans' genes.
"Do you honestly believe everything humans do isn't done out of self interest?"
Yes, I do. I believe that I have personal experience of people doing thing detrimental to themselves, that they know are detrimental to themselves, that they do willingly. We are capable of overriding our emotional and physical reactions.
I suspect you have already decided on your conclusion, and will fit all evidence to that conclusion.
This is getting a bit off-topic, but go back in time 50 or 60 years: Ask the citizens of West Germany, Belgium, The Netherlands, Italy, (neutral) Austria, etc., whether Force de Frappe kept them from Soviet domination.
(Also ask whether the French would actually have used nuclear weapons to stop a Soviet non-nuclear attack on France. That's relevant because in a conventional war without U.S. forces, the Warsaw Pact forces could have rolled to the Channel in weeks if not days.)
No, it was NATO that served as the real deterrent to the Soviets. NATO was largely (and expensively) underwritten by the U.S. Le Grand Charles [de Gaulle] withdrew France from the NATO military alliance in the early 1960s. That freed up who knows how much in the way of French resources, with France still effectively still living under the protection provided by NATO.
Personal note: When I was a kid, my dad, a U.S. Air Force officer, was stationed in France; we lived "on the economy" in a little farm village, where my sisters and I went to the local schools and as a result were bilingual. We were upset when we thought we were going to have to move back to the U.S., and leave our friends, sooner than scheduled because of de Gaulle's announced intention to kick out U.S. forces. (As it turned out, that didn't happen until after our scheduled move back to the U.S.)
> Also ask whether the French would actually have used nuclear weapons to stop a Soviet non-nuclear attack on France
I dunno whether the French would have, but I know the Americans would have. It was US policy through much of the Cold War that conventional forces in Europe were only to be a "tripwire" to trigger a nuclear response, rather than a force strong enough to contain a Soviet attack on their own. This allowed the US and other NATO nations to economize on conventional arms and avoid having to conscript massive numbers of men.
I don't have any specific information about this, but somehow I doubt that the French atomic capability (Force de Frappe) would have been enough to destroy the USSR as a functioning society, in contrast to the U.S. nuclear arsenal, which was eminently capable of doing the job. The French nukes therefore would have had limited value as a deterrent against the Soviets.
Try this thought experiment:
First, recall the Soviets' ability to absorb fearful military punishment, as well as their willingness to act brutally in eastern- and central Europe during and after WW2; in East Germany in 1953; in Hungary in 1956; and in Czechoslovakia in 1968.
Second, imagine that in the 1950s or 1960s the Soviets had invaded Germany --- but also imagine that there was no effective NATO protection because (hypothetically) the U.S. had gone isolationist.
Third, assume that the Soviets had punched through Germany; reached the Rhine; and pushed through into France.
OK, now let's assume for the sake of argument that in response, the French had nuked the invading Soviet forces, but not the USSR homeland (for fear of provoking massive Soviet retaliation), using only small, tactical nukes.
It's not unreasonable to think that the Soviets would have responded in turn along much the same lines as they did in WWII --- but this time with their own nuclear weapons --- by obliterating the French armed forces, and probably a French city or three to make sure the message got through.
The French would (sensibly) have surrendered, of course. The Soviets then would have done much as they did in eastern Germany after WWII: They'd have carted off everything useful that they could, as war booty (euphemistically described as "reparations"). They probably would have shipped thousands of people off to slave-labor camps in the gulag, most of whom would not be seen nor heard from ever again. They'd have settled in to administer the ruined France as yet another impoverished Soviet vassal state under a Communist puppet government.
So France's nuclear Force de Frappe likely wasn't a real deterrent to the Soviets, but instead was merely anti-American and anti-British posturing by de Gaulle, safe behind what he knew would be the protective shield of NATO military power.
(Do de Gaulle's attitude and actions remind anyone else of what Hamid Karzai has been doing lately?)
Also ask whether the French would actually have used
nuclear weapons to stop a Soviet non-nuclear attack on
France.
From what I've read, during the cold war many countries developed short-range, small yield nuclear weapons. American examples are some of the most famous, like the Davy Crockett missile.
The thinking was, for the same reason France might not use nuclear weapons against a non-nuclear attack, the Soviets might not use large nuclear weapons against a small nuclear weapon attack.
When you compare the US and the French system, you don't get to just say "well, they did it why can't we?" as if that question exists in a vacuum. We have a defense program which is a massive government expenditure -- which pre-empts other government expenditures such as single-payer health care -- so a fair comparison would have to look at the fact that the French had a de facto defense subsidy.
If each country in Western Europe had been responsible for building up the kind of deterrent force which we were able to present, the calculus for a single-payer program would change. Certainly Force de Frappe was a strategic asset. Can you concede that without NATO (dominated by the US) the French investment in defense would have needed a drastic increase in order to fill that vacuum? If there were no NATO, at the least I think you can acknowledge that all of Germany would have been a Soviet client, putting France on a front line against the Warsaw Pact countries.
As mentioned in the article, the USA spends more per capita on healthcare than France, so it's not as if they're achieving this better service by being incredibly lavish with spending.
> France was at no risk whatsoever from the Soviet Union.
That's not the way it appeared at the time. Up until the mid-to late 1960s, it was entirely rational for Western leaders to conclude that the USSR wanted eventually to dominate all of Europe and even the Western Hemisphere. [1]
Yes. This comment is much smarter and better informed. I mean, it's not like you had things like this happening during that time: https://en.wikipedia.org/wiki/Prague_Spring
>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
Neither does most Americans with many of their socialized services. Very few people are protesting for disbanding of police fire or public education or highway infrastructure.
And what's even funnier is all the facebook and twitter post à la "That's it, I'm leaving France, going to live in the US" every time there is a new president elected or a new controversial law that is passed.
>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.
It's even worse when you consider one of the reasons why healthcare costs are so high in the US - people avoid getting early treatment because it costs so much. A vicous cycle. Whereas socialised healthcare can prevent a lot of illnesses in their early stages at a far lower cost, because people don't need to worry about going bankrupt after a doctors visit.
And that's just looking at the direct cost to the patient, completely ignoring the costs to society and the economy. Having to treat severely ill patients in late-stage scenarios where the patient is now out of work for months on end.
I still recall one story I heard during the Obamacare debate about a young father who died from a gum infection. His insurance had lapsed (unemployed) and he only had enough cash to pay for either painkillers or antibiotics, not both. He made the wrong choice unfortunately. This scenario does not exist where I'm from. Hell, I'm happy to pay for other people to get this kind of care. It still costs me less than the US system!
NB: Having personally had a serious abcess that needed root canal in the past (was abroad so couldn't get immediate treatment), I can't honestly blame him for taking the painkillers, it is astonishingly painful.
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.
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.
> France is a free country, by any sensible definition of the term.
haha. Funny comment. There are probably a thousands ways the US is more Free than France. Let's not start by checking all the administrative barriers to do ANYTHING in France. The US is certainly not an exemplary model for Freedom anymore, but trying to compare France and US in terms of Freedom is a lost battle.
There are also thousands of ways that France is more Free than the US. Which just goes to show only looking at ways that A is worse than B is a stupid (Edit: biased) way of comparing A and B.
EX: On September 11, 2001, the FBI had a list of 16 people deemed "no transport" because they "presented a specific known or suspected threat to aviation."[6]... In April 2007, the United States government "terrorist watch list" administered by the Terrorist Screening Center, which is managed principally by the FBI, contained 700,000 records.[15] A year later, the ACLU estimated the list to have grown to over 1,000,000 names and to be continually expanding. Note: There are no where near 1,000,000 known terrorists this is just name matching including known alias and including anyone close and well into the 90+% false positives.
Sure you can always find aspects where France is not acting as much a police state as the US (at least for now), but at the same since we are on Hacker News, let's talk about how difficult/painful it is to set up any kind of business in France and keep it alive and growing. There's a reason why most french entrepreneurs who are serious end up going abroad instead of staying in France.
Doesn't the US have barriers as well? If you look at the problems Tesla have selling cars in Texas, or the issues Uber have been having with taxi law, it would seem that the US is far from perfect in this regard either.
On the World Bank economic rankings of the easiest place to start a business, which is what Forbes have been using to bash France, France does score rather badly at 41st place, but the US is only at 20th place. Mind you, I am not sure if I should take these figures all that seriously. Rwanda is 9th, apparently, while being 53rd on ease of getting electricity.
It's not because the US is not perfect in that regard that it means it's not superior. We are not dealing with binary numbers here. Entrepreneurship freedom is usually way higher in the US than in France, but of course it depends on the States considered as well. But the trend is clear overall.
Why don't you read "about democracy in America" from Tocqueville ? It's more than 200 years old but it's very relevant even to this day to understand the differences in terms of culture between France and the US. And the culture shapes the laws and the aspects of Freedom.
I second Julie1 here, "When the citizen start to participate with their money, rather than their own self, the republic has been lost, taken away by the same politicians you are paying to write your laws and the militia you are paying for protection."
I don't like when people focus 1 specific aspect of a country. I've seen Canada and Scandinavia also mentioned in replies further below. You have to look at the country as a whole.
What people forget to mention is all the other less desirable traits of an economy. For example, I'm from Quebec, Canada and there are plenty of people that question the sustainability of our free health care with the aging population. There are tons of French people coming from France because they can't find a job over there.
> Canada and there are plenty of people that question the sustainability of our free health care with the aging population
Oh, the same questions should be asked in France as well, since the French Government needs to borrow 4 to 5 billions Euros on the market every few weeks to keep functioning. Of course it's not sustainable.
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.
As always you can always find anecdotes going both ways.
I am French and a public hospital actually forgot my father in a room for a week. He needed surgery, not urgently but in the meantime he had to be kept sedated. They kept him on morphine, fed him but he was not tracked as scheduled for surgery by their information system. And of course nurses kept telling us it was normal.
There is also a lot of abuse from this system, especially since the pharmaceutical lobby is quite powerful. They actually cover 30% of the cost of homeopathy! And when there was a H1N1 epidemy a few years back the French government ordered wice as many doses as the population of the country.
Comparing the cost of healthcare does not take other parameters into account. For instance obesity is not as much of an issue in France than it is in the US, and that helps decrease the overall cost of healthcare.
And of course, part of the reason is also that it is easy to keep prices down by having the State decide them instead of a free market. But the result is that some health professions are clearly underpaid. There were huge demonstrations of midwifes recently because of that, for instance.
But all in all I cannot deny that I still prefer our system to what exists in the US. As comments in this thread shows, it is not our system which is perfect, it is yours that looks terrible.
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.
The minor cuts and bruises is not the strong point of the French system. The solidarity principle applies mainly for serious diseases, like the example of the article.
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.
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.
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.
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)
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.
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.
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!"
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.
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.
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).
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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_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 ;)
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
> 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.
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
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.
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)
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)
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.
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".
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.
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...
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.
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.
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.
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.
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.