Friday, February 08, 2008
Health care the French way
By Miriam Falco
Managing Editor Medical News

Ever since the 2008 presidential campaign shifted into high gear last year, CNN Medical News has been taking a closer look at some of the problems in our health-care system. In our documentary "Broken Government: Health Care -- Critical Condition," which made its debut last week, Chief Medical Correspondent Dr. Sanjay Gupta investigated problems with America's health care system. The program will be rebroadcast this weekend, Saturday and Sunday at 6 a.m. ET on CNN in the U.S.

The World Health Organization ranks France as having the No. 1 health-care system in the world. So last month I spent a couple of days in Paris, to catch a glimpse of how French health care works. This certainly doesn't make me an expert. But it was a very interesting experience.

Everybody in France has to have health insurance. If you can't afford it, the government helps you pay for it. If you lose your job, you don't lose your health insurance. (watch video)

I focused on the costs of having a baby in France, as an example of how it's covered by health insurance.

Dr. Laurent Mandelbrot heads the obstetrics department at Louis Mourier Hospital in Colombes, a suburb of Paris. He explained to me that in France, all prenatal care from the fifth month of pregnancy until the baby is 1 month old is free. New moms also stay in the hospital for at least four days, long enough to learn how to take care of their baby, get used to breastfeeding, get some rest. Mandelbrot says this allows doctors to detect problems early, when they might be resolved. "If people don't have access to care and it's too late (to catch a problem), that costs a lot more and it's just a terrible cost in terms of sick babies and maternal complications," Mandelbrot said.

I also met a social worker at the same hospital, Elodie Cadier-Dervaux. Her main job is to help expectant moms navigate the system, to ensure that all her medical costs are taken care of. Another part of her job is to make sure the expectant mom is taking care of herself, getting proper nutrition, vitamins etc.

Knowing that families in the U.S. can fall into serious debt if their baby is very ill at birth and their insurance doesn't cover as much as they thought it would, I wanted to get an idea of how much a family in France might pay in a similar situation.

When I met the director of France's national health insurance organization, Frederic Van Roekeghem, I gave him a hypothetical scenario: Baby is born with a serious problem, perhaps a heart defect. Baby needs surgery and has to spend a month in a neonatal intensive care unit, how much would that cost? Van Roekeghem told me the total costs would be about 30,000 to 40,000 Euros - but the parents would only pay 18 Euros. Even without doing the math (18 Euros = approx. $26), I knew that was a very low amount, but I asked him again because I thought I had misheard his answer. I think it amused him, but he repeated - 18 Euros.

It's hard to imagine that France's system could be duplicated in the U.S. - it's costly and people do pay a lot for it - approximately 21 percent of their salary goes to their version of social security, which includes mandatory health insurance, supplemental health insurance and retirement benefits. But judging by the folks I met in France, having access to health care for everyone is something they don't want to do without.

Do you think our health care system needs to be fixed? Do you think everyone in the U.S. should/must have health insurance?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.
Voluntary participation in health insurance is a failing policy. Too many are uncovered and those covered are at the mercy of a poorly regulated industry focused only on profit. On the other hand, if private industry can move a package more efficiently than the US postal service; do we really want the government in charge of our health care. Health care dollars need to go to health care not to private or public bureaucracy.
Internet and the ease of communicating with people in other countries really paints an interesting picture. Most of my relatives claim the health care in countries like France or Canada is far behind that of the US. That for all important medicine they come to the US because their country can't take care of it, or that they have to wait six months or a year or more for basic dental care. Yet when I talk to friends living in such countries, they tend to adore their system and think the system of the USA is broken and far inferior.

I think it is rather important to look at facts as this does. I don't know if a system like the one France has could work in the USA, but I do think it's about time we start treating medical care as a necessity and not as a luxury. I keep hearing people supporting the way things are in the USA claim how we're the number one country, yet the people of these other countries love their medical systems, and the USA ranks below many of them.

I think it's time for people in our country to stop taking the notion that our country is number one in all things as simple patriotism, and start examining real ways for us to catch up. Perhaps at one time we were the leading example of freedom, or of health care, and of social progress, but I am afraid that time is passed and we are now falling behind some of our allies even regarding something as essential as health care. Should we do something similar to France? I don't know that, but I do know things have to change and they need to change sooner rather than later.
I think that the French system would be great. How do they handle preventive care? How do they handle emergency care, Orthopedics, Hospital care for routine illnesses and for serious conditions such as Cancer? I would like to know more about the French Health Care system.

The 21% tax, is that in addition to their income tax? What is the total percentage of pay the French citizens pay in taxes?
All of these percentages are approximate.

In the US, Social Security cost 15% (7.5% paid by employee and 7.5% paid by employer) for most people. Or about 4.2% of GDP.

In the US, the cost of Medical spending is about 15% to 20% of GDP.

So the US spends over 25% of our GDP and still has 47 million uninsured.

Maybe we should hire the French to run our system and save enough money to balance the Federal budget at the same time.
The government is not responsible for peoples health, that is an individual responsibility. The government should be responsible for providing good quality affordable health cover though.
People must be held accountable for their weight, smoking, alcohol and drug abuse. Healthy living is not a mystery. Loose weight and moderate your living style.
I notice that the French Couple had a total insurable bill and out of pocket costs of less than half by far of that of the American couple's total insurable bill and out of pocket costs.

Until the run away costs are addressed any reform is impossible.

What if we bought health instead of disease or injury by the area we live, work or go to school. Suppose contracts were let for total care (HMO, socialized medicine or what ever you want to call it), with an important twist.

Suppose the health care contractor, whether an insurance company or HMO provider or an association (like Secure Horizons in CA) of providers; recieved bonuses for performance such that they would count on recieving say a 25% bonus if they met expected standards to be profitable while haveing a goal of shooting for the moon.

Wouldn't market forces drive down costs and improve care both esthetically and morbidically. Certainly it would cure a lot of fraud that is in our current system.


Lemuel C Bray
How do you explain all industrialized countries in the world, except for the US, having national healthcare? If it's so bad, why aren't those countries abandoning their system?

If Vice President Cheney can benefit from a single-payer, government-run healthcare plan (for his ticker), why can't all Americans benefit from the same?
if the french model is true then it's cost seems very low, health care for all seems good until you look at it in the mirror 21% of your paycheck going to (reiterment& health care) that leave how much for state local and federal. most americans would bail on that idea. hey maybe each state could look after their own citizen; they would be in a better position to control cost than any private citizen.
Can you tell us 1. Is health insurance in France a for-profit endeavor? 2. Does the governtment set any price caps on the cost - either on the procedures or on the cost of insurance?
I recently saw the piece on the Health Care problem in the U.
I am a american living in Germany, I was born and raised in the U.S. spent time in the military, after leaving the military returned to my home state of MN, and went back to school at this time I got sick with a lung infection. I went to the Doctor and was treated, recieved a prescription for anti-biotics and one was 75.00 dollars this was for 20 tablets.
Now when in germany for 1 precription you pay 5 euros, if you need to see a doctor you pay 10euros a quarter. I have had some minor surgeries, and this was all paid for by my health insurance. The german system is like so if 1 family memeber is working the whole family is fully covered. Medications for childlren are free or extremely reduced in cost.
The medical care I recieved in the U.S. when I lived there is wonderful, but if you do not have a very good job and I meam Very you just cannot afford it.
I am a Nurse Practitioner in an Emergency department in South Texas. I see first hand the poor choices we, as a society, have made and are making for our health care. I wonder, if you added up all the money we pay for taxes that end up supporting our health care system if a system like in France would really cost any more? I would also like to submit that the old saying "a stitch in time saves nine" is a concept we should take into consideration in regard to many issues. It must be made cheaper to purchase unprocessed food than processed, we must make our communities walkable, we must encourage our children to eat fruits, vegetables, and whole grains. TV advertising of unhealthy products aimed at children must be made illegal. NP
Our healthcare system is indeed broken. At best it is a patchwork system with large cracks to fall through. The care available is very good, but the access to it is the problem. It is to the breaking point where it will have to be seriously addressed because we have reached a critical mass where many people are finding they simply cannot afford to pay for access to healthcare. At an absolute minimum, healthcare should be affordable and not lead to bankruptcy or other financial disasters. The problem now is that too many people (i.e pharma companies, insurance companies, hospitals, providers, medical device companies) are making money off of others health problems that there is resistance to fully address what needs to be done. In addition, our elected officials are, for the most part, immune to the problems most of the population experiences because of their generous healthcare benefits.
Health care must be mandatory. I know many people claiming they can't afford health insurance but manage to buy large screen digital TV's, new cars every three years. full option cable / satellite TV programing, etc. Why buy health insurance if you can go th=o the ER for nothing and let the rest of us pay for it?? it is a question of priorities.
I have been living in France since '98 and originally am from Pennsylvania.
I can attest to the excellent health care coverage in this country from emergency room care (fractured arm requiring surgery and pins) to having a baby. With the birth of my son, after my insurance had reimbursed me, I only paid 450 euros. Considering that I had a c-section, was hospitalized for 6 days and had a private room in a clinic with odting mid-wives, I consider that to be a pretty good deal for having a healthy boy.
I had routine health check ups and sonograms - don't think that because it was cheap, the doctors overlooked important steps...
The French system is not antiquated or lacking anything that you might find in the US.
For the past few years, I have been wanting to move back home. The only thing stopping me - lack of health care coverage. I have gotten so used to this system, I am spoiled.
It is ironic that the "so called" world power has a terribly screwed healthcare system. At one extreme people do not have healthcare insurance. On the other, the ones with the insurance if even get sutures for a minor cut end up spending thousands of dollars out of pocket. Even the people with healthcare insurance avoid going to the doctors to avert the possibility of being presented with bills for "unheard of" services. The politicians promise healthcare to everyone but will the copay or out of pocket expenses for surgeries and medicines be afordable by a man earning an average wage of the US?

Prices for basic services in the hospitals are exhorbitant, why?? A single sterile gauze pad does not cost a hundred dollars, then what is the root cause for the charges that are slapped at a common man? After assistance by insurance payments why an American spends years together paying medical bills in installments for just an Ultrasound for example? We need a leader that understand the real situation and make decisions to fix the root cause. The actions may involve upsetting insurance or pharma companies but this needs to be done.

How ironic it is that billions of dollars are being spent on health care research where the mass cannot even afford the right of basic yearly physical exam. What if someone asks where the billion dollars of tax money goes? The bitter truth is that it placates the desire of most of today's the researchers to get the most money to institutions, to be the first one in a rat race to publish poorly thought out animal research with no potential for being translated into clinic.

United States the so called super power is breaking down from within, it will fall apart one day. We need a revolution for our healthy and happy future.
An additional thought if I may. The primary problem with healthcare in the U.S. is our perspective of it. We currently view healthcare as a for-profit venture whereby a persons health problem is a commodity - a profit center- and someone wants to make money from the illness. Healthcare is actually not a commodity, but more like a utility (electricity or water) or a social service (police or fire department). It is not a choice of whether we will use healthcare, but when will we use healthcare. Since it is a utility-like entity it must be regulated as such to ensure affordable access to all people. We have no choice on using healthcare, we will all use it at some point. It is a basic civic function no different than the fire department or water service.
I went through 7 months of my first pregnancy in southern France. I found the care to be excellent, very thorough, but most importantly, reasonable in terms of cost. I remember paying less than 30 euros for some of my regular appointments. It was shocking to compare costs once I returned to the States, where my epidural alone cost at least $1,200.
Most of my relatives claim the health care in countries like France or Canada is far behind that of the US. That for all important medicine they come to the US because their country can't take care of it, or that they have to wait six months or a year or more for basic dental care. I live in Saskatchewan, Canada. The birthplace for universal health care in North America.

I don't think anybody is waiting 6 months for dental care in Canada as dental care is completely private. Wait times for certain procedures like hip replacements can be excessive in Canada. Part of the reason the system was underfunded in the 90's when Canada put its fiscal house in order by dramatically reducing government spending. The system is just beginning to recover.

There are some areas of care where the wait times get so long that people do head to the US for private care. In my social circle it is rare because most people are adequately served by the current system. I've been through two lung surgeries and received emergency care on a number of occasions. I've had nothing but positive experiences.

It seems as though some people automatically associate anything government run with inefficient bureaucracy. While I think that there is definitely truth to this there are exceptions to the rule. Universal health care in Canada is inherently less complicated than private care. You don't have be approved for coverage, businesses don't share the cost, there are no HMO's or complicated rules about what is covered and what is not. No one has to take legal action against an insurance company.

Lets assume that a private hospital ran 25% more efficient in the actual delivery of care than a public hospital. The public system would still be much cheaper because it is simpler, it has less to do and less to process. I believe this is why health care in the US costs 40-80% more per person than in countries with universal health care.

I wouldn't hold Canada up has the golden standard. Our system could use some reform. I'd look to France, Germany or Japan first.
It seems that all industrialized countries (including some not-so-advanced, like India) have a better healthcare system than the US. I'm getting really tired of "capitalism" - everything is slanted toward the good of "business" instead of toward people! Why should health coverage come thru my employer? I would love to have a system like France's.
I live in Massachusetts with the mandated health insurance. It is not working for the people I'm talking to. First the premiums MUST go down. The wrong people are judging what individuals can afford. Premiums are very high. Some one making 40-50K, with a mortgage/rent,auto payments, children, child in college,etc, can't afford health insurance premiums, much less food, gas and heating fuel! AND, if we don't get the insurance we lose our tax credit because we have to submit our insurance verification when we file taxes this year. Premiums MUST be lowered before the mandates can be made, as Sen Obama has suggested. Romney did my state NO service. Don't let it happen nationwide.
We do have socialized healthcare, but only at the end stage. City hospitals can't refuse the uninsured. So the uninsured or underinsured - the majority - only get coverage when it's gotten as expensive as it can get; and when their complaints are most likely to take them out of the tax-paying workforce for good. A cent of prevention would be worth a million dollars of cure.
OK so European health systems aren't perfect but people do not worry that they might not be able to afford the care they need when they get ill. I for one was born 3 months premature, my care surely cost a lot of money, as did the later orthopedic surgeries. Had my family lived in the US they would not have been able to afford it all even with insurance, in Europe it did not cost them anything. I really do not understand why people in America are so against a health care system like Europe. Just because it is mandatory, because it is state run? If you earn over a certain amount you can get private insurance and you can buy additional insurance if you wish. You get good care. It is rediculous to have people pay fines for not having insurance like in MA. If you can't afford it no matter what you earn, the state should step in. The problem are the insurance companies, they charge too much for the care they provide, that should be regulated. What is wrong with paying higher taxes if you actually can get the care you need and it wont bankrupt you? I'm sure all those people so against "socialized medicine" (it is not it is socially responsible)will change their minds if they ever are in a situation where they lose all they have worked for because of bills for health care or if they ever fall ill in Europe and experience the care there for which they will not even receive a bill.
America is a free country where we make our own choices and take care of ourselves. Let's keep it that way. I don't want to go to work and have my taxes pay for someone else's health insurance. If they want it, they should have to pay for it, just like I do mine.

Everyone likes the French system until they realize the French economy is a disaster because of their social overspending. Let them keep that. I prefer greater freedom and a strong economy. If there are things we can do to make insurance more affordable, let's do those things. But no socialism.
Insurance companies add ZERO value to the health equation between you and your doctor. In fact, they profit from their existence. I'm all for private industry, but that makes no sense at all. Should we have food insurance, clothes insurance, school insurance? We are paying more and getting less than the rest of the world. AND, many people in this country are suffering. It makes this country a less competitive place to do business.
Healthcare should be treated as a fundamental right. The doctors and the insurance companies in the USA have a strangle hold on heathcare, and the free marketeers argue that the State should have no responsibility towards healthcare. People, even the rich are afraid to be sick and this is not good for the super power.
According to the OECD statistics for 2005, the US pays the largest share of its GDP for health care.

1. US - 15.3%
2. Switzerland - 11.4%
3. France - 11.1 %
4. Germany - 10.7 %
5. Canada - 9.8 %

At the same time, indicators such as life expectancy or infant mortality in the US are similar to a threshold country. (For instance, life expectancy in Cuba is higher than in the US.)

As a foreign national living in the US, I am shocked how expensive, inefficient and inhumane the health care system is in this country. Pure market economy might be apt to some areas, but it blatantly fails when it comes to health care.
I am a general surgeon and I think our medical system is a travesty and a disgrace as the richest and most powerful nation in the world. Nobody should live in fear regarding the loss of their livelihoods due to a medical catastrophe, yet so many do. That is not real 'freedom'! Furthermore, caring for human beings under the profit motive just doesn't mix well. Their are way too many conflicts of interest. It is in the interest of insurance companies to deny care in order to improve the balance sheet and enhance profits. Also, it is in the interest of physicians to offer more procedures to increase profits. As a physician and surgeon, I chose medicine to aid the sick and assist in the healing process. I believe most physicians chose medicine for the same reason. Without a doubt, I favor universal health care, even a one payor system. I would rather deal with the inefficiencies than watch people live in fear regarding the expenses of medical bills. This is not socialism. Rather it is a culture willing to care for its society equally without judging who should and shouldn't get health care. We all should. Eliminate the health insurance companies, eliminate the malpractice industrustry, eliminate the fear among patients and providers alike, and restore the specialness of the doctor-patient relationship!
One of the reasons that socialized medicine works is that it is NOT for profit. Not unlike our public education system, police & firefighters here in America, socialized medicine means that there is not a billion dollar corporation at the top taking profits from the sick & elderly. That means a great proportion of money spent on healthcare goes to the patient.

I was raised in Canada and now live in the USA and I would be thrilled if we adopted a universal healthcare system.
I just want insurance to be separated from employment. As things now stand, a person with even a minor pre-existing health condition finds it impractical to be self-employed because insurers won't insure him or her. For some people the only way to get insurance is to work a job, even though the economy would benefit more if the person were an entrepreneur, for instance. I thought that the idea of insurance was that the pooled money from a large number of subscribers was supposed to pay for the sickness of the few who get sick. If insurance companies have the option of turning away whomever they want, for whatever reason they want, uh, isn't something wrong with this picture? The word 'racket' comes to mind.
"Approximately 21 percent of their salary goes to their version of social security, which includes mandatory health insurance, supplemental health insurance and retirement benefits." (per this blog) Having worked in France, Germany and Great Britain I would be thrilled with the French and German health care and retirement system. The 21% covers health care (for the whole family), social security benefits and retirement benefits. They are not concerned about retirement and old age and their 401k, they worry where to go on one of their next vacations during the year. They don't have to save up for old age - they know they will be taken care of - yes - by their government through their past tax burden. Also realize that most of their other taxes,i.e. road taxes, property taxes, etc. are covered by sales taxes. It's a different system and I am not sure it would work here in the US, unless it could be state funded - not federally funded. I would not recommend the British system.
Hasn't anyone grasped the fact that the government, using history as a guideline, has never run a truly, cheap(essentially tax payers are paying for "free" health care), effective program? Also, what makes McDonald's want to develop a better hamburger than Wendy's or Burger King? COMPETITION! Competition drives down costs, leads to innovation and an overall increase in quality. These are the fundamental ideas behind Hayek, Friedman etc. and have been tried and proven to be effective throughout history. Once one agency has a monopoly over the industry, there is no longer incentivization for them to innovate and put forth a cheap, quality good or service. This is so basic. Wake up people!
As long as we live in a society where a complicated issue like health care is reduced to 30 second ad spots paid for by HMO's and drug companies, our citizenry will never do what is for it's own good. Because we are consistently misinformed by corporations making billions selling us bad health care and excessive drugs.

"Follow the money" they said about Watergate. And it's good advice here too. The bottom line is, lobbyists and political donations are based on .... the BOTTOM LINE. Not what's good for the country. Not what is fiscally responsible. Not your health and well-being...

Honestly, the best interest of citizens, for the pursuit of their "life, liberty and happiness" is to have good health. Without it -- what is "happiness"? What is "liberty"? And the best health care, is free health care, that doesn't damage you financially while you recuperate physically and mentally.

Unfortunately, the best interest for corporations is to make as much money as possible, while smiling and pretending that what they do is good for YOU.

Ask the tobacco companies. Ask Erin Brockovich. Remember Love Canal. Nothing will change until we realize that the profit motive is the BIGGEST THREAT to to our health, and to affordable health care for all. And like monkeys in a cage for an addictive drug study, we will keep pulling those voting levers, the ones that slick advertisements by HMO's and drug companies, keep telling us to pull.
The French (European) system of entitlements goes against the grain of American culture; for the most part we don't think health care is a "right", and thus don't believe the government "must" provide it. But health care is a necessity that everyone will use. And costs continue to escalate at ridiculous rates, to the detriment of all -- individuals and businesses (driving up the total cost of hiring a person and thus driving down the ability to hire.)

I think we as a nation should rethink how it's best to handle health care. But the cure will not be simple. Issues not addressed in this article, but which heavily affect the cost of healthcare are lawsuits and costs of being a doctor:
1. Lawsuits - are people allowed to sue, for what, are damages limited?
2. What is the cost of being a doctor: liability insurance for lawsuits; school loans: in many parts of Europe school is paid for by the state, and thus new doctors do not owe huge loans for their education.

These areas are puzzle pieces that don't seem to fit the way we've laid them out now. But if we define what we want and why, we should be able to create a system that works for the U.S. and helps us compete on the global market -- which provides health care.
One of the best incentives we could provide for US businesses is to take away or vastly reduce their health care costs. Health care is the major expense of hiring a worker. If businesses didn't have to pay any or as much for it, they would be more likely to hire US workers and regular employees rather than contractors. That's the best stimulus package we could offer to keep good jobs in the US.
The national health care in foreign countries like France is definitely something we need to be modelling. We as voters need to vote into office someone who will take definitive action toward a workable national health care plan. Other countries already have in place working plans for their citizens so this is not new territory to be discovered. All we have to do is study which country we want to model after or take parts of various countries' plans and make one uniquely suitable for our country. We need to make health care change a top priority. As a home health care nurse I see people falling through the cracks more and more. There is less coverage at a higher price for fewer people. This needs immediate attention and drastic measures.
The US spends more than any other comparable country on health care, has generally far worse outcomes than those same countries and the situation is getting worse. Having insurance companies profit from "health" care dollars is a travesty. The premiums keep rising, adding to the cost and the benefits are reduced leading to worse outcomes as treatment is deferred or is suboptimal.

America DOES have great care available-- arguably the best in the world, and certainly better than most of the above referenced countries, but it is available to only a few and of course there are 47 million who have no access unless it is an emergency. What we don't want is the same thing that most of the socialized medical systems have, which is an even greater number of overworked and underpaid doctors and nurses with, acceptable, but not outstanding health care delivery.
There are solutions to this and I hope the US does NOT kill the fabulous innovations that make this potentially the best system in the world-- we need to support and make the best in care available to all. It is cheaper than not doing so.
I think of access to health care from a public health perspective. With discussions of the inevitable outbreak of a virulent pandemic flu or the concerns of bioterrorism, the lack of health care access delays the detection of such outbreaks within the community. Hospital emergency rooms are already unable to meet current demands so how do we expect them to meet the surge capacity of such extraordinary events. We desparately need a national health care strategy that makes health care coverage a strategic imperative.
Yes, cheap medical would be nice. Speaking from experience, my son has a heart defect and required open-heart surgery at 3 months old. We had insurance and still had to sell our new vehicles, but it was worth it. I wouldn't trade what happened for anything, even a national health-plan. I was able to choose what surgeon to take my son to and was able to interview him before hand. I could got to whichever facility I chose and if I went out of state volunteer programs are in place to provide flights free of charge.

I would not change anything that happened. I agree that it is about priorities. Have a great day
I work in public health and absolutely believe that universal care should be a right, not a priviledge.

However I also do not believe people in this country would be willing to pay the tax rates required to fund such a program.

The article quotes the social security tax in France at 21%, including health insurance, supplemental health insurance, and retirement.

According to in this country we are paying 7.65% total for social security (old age survivors and disability plus Medicare).

That's 21% in France, 7.65% in the US. What would happen if someone tried to TRIPLE social security tax in this country in order to fund universal coverage?
I am a Canadian living in US for 8 years now. I have 2 health insurances from my and my husband's employers. We pay atleast 27 thousand dollars combined for our insurances most of which covered by our employers but I am scard to go to doctors office or for any tests, because I know I will be getting multiple bills for each visit I make. Even after having 2 insurances most of the services we use are not covered and we have to pay most of it ourselves, because most of it fall under deductibles and deductible are very high now. So I feel I am paying so much for insurances to cover ourselve for something serious. I also hear horror stories about coverage in the event of serious illness.
I don't know if it is because I never paid any medical bills or received any medical bill while living in Canada that it bothers me so much.
I feel it is creating enormous stress in my life just to follow up on the bills, apealing to insurance companies and finally making claims to flexible spending plan. Keeping track of all the receipts and paper work is taking a lot of my precious time and energy because being a mother of 4 kids and having a full time job, I don't need unnecessary stress in my life.
I think having a universal healthcare system without any conditions and right to education are the fundamental rights for any developped country like USA. And I don't see why citizens of this great country do not demand these rights from their elected governments.
I never appretiated Canadian healthcare system so much, until I moved to US and Canadians should be proud of the system.
Anonymous said:

According to in this country we are paying 7.65% total for social security (old age survivors and disability plus Medicare).

That's 21% in France, 7.65% in the US. What would happen if someone tried to TRIPLE social security tax in this country in order to fund universal coverage?

Actually, current costs of Medicare and Social Security are 18.2% (you pay half and your employer pays half). So now we're only looking at a 3% difference. Combine that with the fact that - after those costs - you still have to pay for health insurance in the US, and the after-insurance costs are far higher than the ones in France or other similar countries, and then what do you have?

The cost to add another person onto my (fairly decent) insurance is about $300/mo. Figure that for the average wage-earner... no, above-average... making $50K per year, that's an extra 7%... money that's still being paid, if not by you than by your employer. That puts the true cost for the American (and arguably inferior-resulting) system at a whopping 25%, a lot higher than France's 21% -- and we still pay more for services, do more paperwork, etc., than those under the French system.

Maybe its time for a change?
"Anonymous said:

According to in this country we are paying 7.65% total for social security (old age survivors and disability plus Medicare).

That's 21% in France, 7.65% in the US. What would happen if someone tried to TRIPLE social security tax in this country in order to fund universal coverage?

Actually, current costs of Medicare and Social Security are 18.2% (you pay half and your employer pays half). So now we're only looking at a 3% difference. Combine that with the fact that - after those costs - you still have to pay for health insurance in the US, and the after-insurance costs are far higher than the ones in France or other similar countries, and then what do you have?"

I am the particular "Anonymous" who wrote the post you quoted. And of course I am aware that what we pay is only half the story, that our employers pay the other half.

But consider that there are millions of people who don't have employer-based insurance. They either have none or they pay it themselves.

Among the employers who don't offer insurance, most say that forcing them to offer it will lead to massive layoffs, because they can't afford it.

Even if you proposed *only* increasing by 3% the employer contribution (so that we equal the rate paid in France) we're still *only* covering those who have employer-based insurance. That is very far from universal coverage. And you can bet that employers would balk at a 3% increase in their contribution, just as regular citizens would balk at a 3% increase in the SS/Medicare tax rate.
We require insurance for cars. Why not for people?

One problem is that many people are unemployed, so how would they (or their non-existent employer) pay for insurance? In reality, even uninsured people DO get medical care through programs like medicaid, and veterans can get it at the VA hospitals. But the waiting lines are horrendous and this care is seen as somewhat second-rate compared to "fully in sured" care.

The French make a good point about prevention; for example keeping the mother and baby in the hospital for four days. In the US healthcare for the poor is reactive, not preventive.

I think a reasonable first step toward health care for everyone is to require all employers to pay for health insurance, and regardless of whether an employee is full-time or not. When I worked in Texas as a single individual my health insurance was less than 300 dollars a month, paid by my employer and I was part-time. This is what all the fuss is about, three hundred per month? Considering that the minimum wage is woefully behind economic reality, employers should be required to pay for this. It would also be an incentive to work (for those who need an incentive) because you would begin to actually get some rewards in return for working. And if the price of a fast food burger goes up by a dime to pay for it, so be it. It is fair. Workers without benefits are basically paying for the health insurance of those with insurance because it is priced into the products and services THEY create! Those who are not employed would still be without insurance but it would be a start.
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