Tag Archives: Medicare for All

French Medicare-for-All System Provides Better Care at Half the Price

If you’re like most people, your head is probably swimming with claims and counter claims, unintelligble lingo, political doubletalk, and mind boggling statistics regarding health care reform. It all serves to distract us from the simplest way to assess various potential health care systems, which is by looking at  countries that already have them.

Conservatives like to produce dire warnings based on the British NHS, which does have a fair amount of rationing. (They don’t mention that 73 percent of Brits nonetheless said they had confidence in their health care system, as compared with 56 percent of Americans, according to a Gallup poll last year.) These same conservatives avoid looking at the very best national health systems, which manage to deliver superior care at dramatically lower cost.

Here’s a very simple run down on the French health care system, often thought to be the best of them all. Much of this information comes from a recent interview published recently in the New York Times with Victor G. Rodwin, a professor of health policy and management at NYU’s Wagner School of Public Service and an expert on international health care systems.

1. There is no explicit health care rationing in the French system, and access to care is generally excellent. The quality of health care provided in France was ranked first by the World Health Organization and in other recent studies.

2.  The model is something very close to a Medicare-for-All system–only better. As Rodwin describes it: “It’s not government run but government financed. Like Medicare and Social Security, it is funded by compulsory payroll taxes with some income tax contributions. But doctors work predominantly in private, office-based, fee-for-service practices, and there is a mix of public and private hospitals. The main difference from Medicare is that the entire resident population is covered and the benefit package is more generous.”

3. France  has preserved a role for insurance, although it is nonprofit and heavily regulated. The French buy supplemental insurance, like the Medigap policies bought by many Medicare enrollees, to cover copays and additional services–though they don’t need it for much.

4. The French drive a hard bargain with drug companies, so they pay a lot less for their drugs than we do. As summarized in a report prepared for Democrats on the House Oversight Committee in 2001: “The French pricing system allows pharmaceutical companies to sell their products at any price. However, if these companies want the national health care system to reimburse patients for the cost of the drug, the companies must agree to a lower, negotiated price. These negotiated prices and reimbursement rates paid by the healthcare system are based on the therapeutic value of the drug and the price of the drug in other countries. The French pricing system results in brand name drug prices that are an average of 45% lower than prices in the United States.” A more recent study put the figure at 48 percent lower.

5. The French system is one of the more expensive in Europe and, as the Wall Street Journal takes pleasure in reporting, there is controversy about rising costs. Yet according to OECD data from 2007, the per capita cost is still half that of the U.S. system, and the percent of GDP spent on health care is about 30 percent lower–11 percent as compared with our 16 percent.

If you’re not convinced yet, think about this: Doctors in France still make house calls.

DoctorFrance

We Geezers Got Our Single-Payer Plan. Now Go Get Your Own.

I’ve written many times about  how Americans have been set up for a fake intergenerational conflict over supposedly scarce health care resources. The purpose of this phony competition is to distract us from the fact that the resources wouldn’t be so scarce to begin with if we reduced the profits of the insurance and drug industries.

It’s an old bait and switch tactic, and the mainstream media have fallen for it hook, line, and sinker. So instead of talking about greedy pharmaceutical companies that gouge people for drugs they need to survive, or greedy insurance companies that let people die to keep up their share prices, we’re all talking about the greedy old farts on Medicare who don’t want their services cut to pay for younger people’s insurance.

The latest take on all of this, as described in over the weekend in the New York Times, pits the old (over 65) against the not-so-old (50-64). The article focuses on the conflict within AARP, which has spent several decades hitting people up for membership the day after their 50th birthdays, and now includes members from both these warring age groups:

Its 40 million members are split about evenly between those who have access to Medicare, the federal government’s health program for the elderly, and those who are too young to be eligible for such benefits. The younger members, or those between the ages of 50 and 64, sometimes face terrible choices in the private insurance market, with age and declining health status making premiums high and benefits poor. But members 65 and older get among the most secure medical benefits in the country, and many are in no mood to share.

So this is what it’s come to, in the American health care system: Sickly 60-year-olds just trying to hold out until they can get their Medicare cards. Cranky old folks hoarding their Medicare benefits against the encroaching middle-aged mob. People eyeing each other suspiciously across the 65-year age divide, fearing and resenting one another.

Do you think people of different generations look at each other this way in Paris? Or in London, or Dusseldorf, or Adelaide, or Kyoto, or Ottawa? Of course they don’t. That’s because in those countries, EVERYONE HAS MEDICARE. In most of them, everyone has Medicare that’s better than our Medicare. They all carry around the same little card in their wallets–the one that shows their membership in their country’s national health service. And you know what they have to do to get that  card? They have to be BORN. That’s it. No age restrictions. No waiting periods. No physicals or tests or worries about pre-existing conditions. And no premiums to pay.  

I am more than sympathetic toward the plight of people in their 50s and early 60s. I know my own body started to give me trouble at about 55, and I don’t know what I would have done if I hadn’t had a job with health insurance. I’ve recently written about how the Baucus plan screws people in that age group by permitting insurance companies to discriminate against them. But the solution to these problems isn’t cutting Medicare benefits for people over 65–it’s giving Medicare benefits to people under 65. If everyone loves Medicare, and everybody’s just waiting and hoping and biding their time until they can sign up, why not let them do it now?

Some proponents of an incremental approach have actually suggested just this–opening up Medicare to ages 50 through 65, with some financial contribution from enrollees. And many single-payer advocates, myself included, have simply called for “Medicare for All.” Since single-payer health care systems deliver better care for 20 to 40 percent less money, there would be no need to cut services to any generation.

So as a member of the over-65 crowd and a card-carrying Medicare recipient, here’s what I have to say to younger Americans: We’ve got our single-payer plan. Go get your own. And since we’re not into intergenerational warfare,we will help you.Remember, we’re all in this together.