The Corp-Govt oligarchy is getting pretty embarrassing when Editor in Chief of Reason is calling for universal health care.
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Why I Prefer French Health Care
The U.S. systems deep flaws make socialism more tempting
Matt Welch from the January 2010 issue
Listen to Audio Version (MP3)
By now Im accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.
To put it plainly, when free marketers warn that Democratic health care initiatives will make us more like France, a big part of me says, I wish. Its not that I think its either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But its instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now Ive led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wifes native France. On a personal level the comparison is no contest: Ill take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (Ill conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctors office has sent its third payment notice. By the time its all sorted out, youve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.
In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and youre done. If you need a doctor, its not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. Ive had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe 300 for any one procedure.
And its not like the medical professionals in France are chopped liver. In the U.S., my wife had some lumps in her breast dismissed as harmless by a hurried, indifferent doctor at Kaiser Permanente. Eight months later, during our annual Christmas visit in Lyon, one of the best breast surgeons in the country detected that the lumps were growing and removed them.
We know that the horrific amount of third-party gobbledygook in America, the cost insensitivity, and the price randomness are all products of bad policies that market reforms could significantly improve. We know, too, that Frances low retail costs are subsidized by punitively high tax rates that will have to increase unless benefits are cut. If you are rich and sick (or a healthy doctor), youre likely better off here. But as long as the U.S. remains this ungainly public-private hybrid, with ever-tighter mandates producing ever-fewer consumer choices, the average consumers health care experience will probably be more pleasing in France.
Whats more, none of these anecdotes scratches the surface of Frances chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesnt depend on your job, it doesnt depend on a health maintenance organization, and it doesnt depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what its like to be serially rejected by insurance companies even though youre perfectly healthy. Its an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has the best health care in the world.
Since 1986 Ive missed exactly three days of work due to illness. I dont smoke, I dont (usually) do drugs or drink to excess, and I eat a pretty healthy diet. I have some back pain now and then from a protruding disc, but nothing too serious. And from 1998 to 2001, when I was a freelancer in the worlds capital of freelancers (Los Angeles), I couldnt get health insurance.
Kaiser rejected me because I had visited the doctor too many times in the 12 months preceding my application (I filled in the 3-5 times circle, to reflect the three routine and inexpensive check-ups Id had in France). Blue Cross rejected me too. There werent many other options. Months later, an insurance broker told me Id ruined my chances by failing to file a written appeal. Youre basically done in California, he said. A rejection is like an arrestif you dont contest it, youre guilty, and its on your permanent record.
It wasnt as if I wanted or needed to consume much health care then. I was in my early 30s, and I wanted to make sure a catastrophic illness or injury wouldnt bankrupt my family. When I finally found a freelance-journalist collective that allowed me and my wife to pay $212 a month to hedge against a car accident, it a) refused to cover pregnancies or childbirths at any price and b) hiked the monthly rate up to $357 after a year. One of the main attractions of moving from freelance status to a full-time job was the ability to affix a stable price on my health insurance.
This is the exact opposite of the direction in which we should be traveling in a global just-in-time economy, with its ideal of entrepreneurial workers breaking free of corporate command and zipping creatively from project to project. Dont even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldnt have paid if I had controlled my own insurance policy.
Ive now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of Frances worst problems is the rigidity and expense that comes with an extensive welfare state.
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? Its a question I plan to ask my doctor this Christmas. In French.
Matt Welch is reason's editor in chief.
------------------------------
Why I Prefer French Health Care
The U.S. systems deep flaws make socialism more tempting
Matt Welch from the January 2010 issue
Listen to Audio Version (MP3)
By now Im accustomed to being the only person in any given room with my particular set of cockamamie politics. But even within the more familiar confines of the libertarian movement, I am an awkward outlier on the topic of the day (and the topic of this issue of reason): health care.
To put it plainly, when free marketers warn that Democratic health care initiatives will make us more like France, a big part of me says, I wish. Its not that I think its either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But its instructive to confront the comparative advantages of one socialist system abroad to sharpen the arguments for more capitalism at home.
For a dozen years now Ive led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wifes native France. On a personal level the comparison is no contest: Ill take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.
Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (Ill conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctors office has sent its third payment notice. By the time its all sorted out, youve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.
In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and youre done. If you need a doctor, its not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. Ive had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe 300 for any one procedure.
And its not like the medical professionals in France are chopped liver. In the U.S., my wife had some lumps in her breast dismissed as harmless by a hurried, indifferent doctor at Kaiser Permanente. Eight months later, during our annual Christmas visit in Lyon, one of the best breast surgeons in the country detected that the lumps were growing and removed them.
We know that the horrific amount of third-party gobbledygook in America, the cost insensitivity, and the price randomness are all products of bad policies that market reforms could significantly improve. We know, too, that Frances low retail costs are subsidized by punitively high tax rates that will have to increase unless benefits are cut. If you are rich and sick (or a healthy doctor), youre likely better off here. But as long as the U.S. remains this ungainly public-private hybrid, with ever-tighter mandates producing ever-fewer consumer choices, the average consumers health care experience will probably be more pleasing in France.
Whats more, none of these anecdotes scratches the surface of Frances chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesnt depend on your job, it doesnt depend on a health maintenance organization, and it doesnt depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what its like to be serially rejected by insurance companies even though youre perfectly healthy. Its an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has the best health care in the world.
Since 1986 Ive missed exactly three days of work due to illness. I dont smoke, I dont (usually) do drugs or drink to excess, and I eat a pretty healthy diet. I have some back pain now and then from a protruding disc, but nothing too serious. And from 1998 to 2001, when I was a freelancer in the worlds capital of freelancers (Los Angeles), I couldnt get health insurance.
Kaiser rejected me because I had visited the doctor too many times in the 12 months preceding my application (I filled in the 3-5 times circle, to reflect the three routine and inexpensive check-ups Id had in France). Blue Cross rejected me too. There werent many other options. Months later, an insurance broker told me Id ruined my chances by failing to file a written appeal. Youre basically done in California, he said. A rejection is like an arrestif you dont contest it, youre guilty, and its on your permanent record.
It wasnt as if I wanted or needed to consume much health care then. I was in my early 30s, and I wanted to make sure a catastrophic illness or injury wouldnt bankrupt my family. When I finally found a freelance-journalist collective that allowed me and my wife to pay $212 a month to hedge against a car accident, it a) refused to cover pregnancies or childbirths at any price and b) hiked the monthly rate up to $357 after a year. One of the main attractions of moving from freelance status to a full-time job was the ability to affix a stable price on my health insurance.
This is the exact opposite of the direction in which we should be traveling in a global just-in-time economy, with its ideal of entrepreneurial workers breaking free of corporate command and zipping creatively from project to project. Dont even get me started on the Kafkaesque ordeal of switching jobs without taking any time off, yet going uncovered by anything except COBRA for nearly two months even though both employers used the same health insurance provider. That incident alone cost me thousands of dollars I wouldnt have paid if I had controlled my own insurance policy.
Ive now reached the age where I will better appreciate the premium skill level of American doctors and their high-quality equipment and techniques. And in a very real way my family has voted with its feet when it comes to choosing between the two countries. One of Frances worst problems is the rigidity and expense that comes with an extensive welfare state.
But as you look at the health care solutions discussed in this issue, ask yourself an honest question: Are we better off today, in terms of health policy, than we would have been had we acknowledged more loudly 15 years ago that the status quo is quite awful for a large number of Americans? Would we have been better off focusing less on waiting times in Britain, and more on waiting times in the USA? Its a question I plan to ask my doctor this Christmas. In French.
Matt Welch is reason's editor in chief.