Why I Prefer French Health Care

The U.S. system's deep flaws make socialism more tempting


By now I'm 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." It's not that I think it's either feasible or advisable for the United States to adopt a single-payer, government-dominated system. But it's 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 I've 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 wife's native France. On a personal level the comparison is no contest: I'll 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 (I'll 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 doctor's office has sent its third payment notice. By the time it's all sorted out, you've 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 you're done. If you need a doctor, it's 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. I've 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 it's 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 France's 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), you're 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 consumer's health care experience will probably be more pleasing in France.

What's more, none of these anecdotes scratches the surface of France's chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn't depend on your job, it doesn't depend on a health maintenance organization, and it doesn't depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it's like to be serially rejected by insurance companies even though you're perfectly healthy. It's 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 I've missed exactly three days of work due to illness. I don't smoke, I don't (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 world's capital of freelancers (Los Angeles), I couldn't 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 I'd had in France). Blue Cross rejected me too. There weren't many other options. Months later, an insurance broker told me I'd ruined my chances by failing to file a written appeal. "You're basically done in California," he said. "A rejection is like an arrest—if you don't contest it, you're guilty, and it's on your permanent record."

It wasn't 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 wouldn't 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. Don't 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 wouldn't have paid if I had controlled my own insurance policy.

I've 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 France's 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? It's a question I plan to ask my doctor this Christmas. In French.

Matt Welch is reason's editor in chief.

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  1. Welch is just shilling for Big Gaul.

  2. Pass the popcorn. The comments here ought to be fun! Watching the heads explode of those libertarians who are still wearing their fourteen year old’s clothing while clutching their Ayn Rand novels, is quite amusing…

    1. Not really, smart socialism could be better than dumb quasi socialism. Doesn’t say anything about free markets. Libertarians aren’t stupid liberals who think the status quo is free markets, and aren’t defending the status quo.

      1. No, but libertarians are like 14 year olds who have no fucking clue about how the business world really works or how this nation developed in the first place. There was never a capitalist paradise, and never will be, anymore than Communism ever existed anywhere.

        Plus, libertarians have no fucking clue that the economic ruling class has no interest in their theories to actually implement, but find libertarians useful to oppose positive social change that might otherwise undermine the power of the ruling class. That’s their–and your function. And that’s why they love it when you and your Ayn Rand friends fight moving to a system like France’s medical insurance system. It keeps them powerful and rich. And you are just a fucking stupid sap who went along with the program while you pray to your goddess Ayn Rand.

        1. How did the summer of 2003 work out for them?
          One of France’s worst problems is the rigidity and expense that comes with an extensive welfare state.
          I will pass on the welfare state each and every time.

          The power of the ruling class has MUCH more to fear in a capitalist system than in a socialist one. The imbeciles who pray to the God of Good Intentions know their place in society and stay there.

          1. Except France spends 40% less of its gross national income on medical insurance than we do.

            How did the summer of 2003 work out for those in Chicago, and other areas of the mid-west DD? Our system simply doesn’t keep track of those deaths. A beauty of private enterprise externalizing its losses and inefficiencies…

            1. Regulation has everything to do with higher costs in the U.S. For instance, this recent mammogram circus. It would be more economical for consumers to simply pay out of pocket for procedures like this, but most state governments and now the federal government is forcing insurance companies to cover them “for free”. Hence, costs go up for everyone.

              1. Yes, really… I need $1,000/month insurance to pay for my $100 per visit annual mammograms?


                Clear proof that the average American has NO FUCKING CLUE what medical treatments actually cost.

                If they did, they’d probably dump their insurance en masse.

          2. Dude, the US doesn’t even need heatwaves: 44,000 people in America die annually from a lack of health insurance.

            44,000. Annually.

            All over Europe, 37,451 Europeans died in a very severe heatwave in 2003.

            You can fix healthcare delivery, you can’t fix heatwaves.

            What’s your excuse?

    2. The thing is, what he likes about the french system could be accomplished by deregulating the american system. The need to see a doctor, government required, pharmacist can fill a prescription without a note from a doctor, government requirement, and on and on.

      this is similar to many of the other socialist medicine states.

      So in Obamacare utopia do you see congress pushing back against the doctors? not likely, with Obamacare we will get the worst of both worlds. Not something I want.

      1. Bingo! I have to see my doctor EVERY MONTH, to get a prescription, just because it is a heavily regulated drug. It would be 1/12 the cost if the doc could just give me yearly refills on a med I have to take (unless I want major back surgery).

    3. Hard to buck Ayn Rand when she’s right: America’s standard of living is higher than any country that has socialized medicine [Link]. Because fewer Americans suck on the welfare teat than others in the world our economic activity makes it possible for other countries to even have some sort of socialized medicine.

      When America coughs everyone else’s balls shake. If we ever get socialized medicine you will see all the “free” health care systems in the world collapse.

      Be careful what you wish for, Mitchell. I call you Mitchell because after reading the failed Karl Marx, I feel as if I know you quite well.

      1. GDP != standard of living

      2. GDP != standard of living

  3. MF, don’t hold your breath. There is a post about breast implants right above this one. Not many of us will make it past that one.

  4. The French are freeloading on medical advances made in our kinda-sorta-free market system.

    1. Bigtime.

      And Welch is really remiss for not mentioning that.

      1. Medical R&D spending is a trivial fraction of the whole. Nor do we spend THAT much more than most other nations (and we are not #1, either, per capita).

        We simply overpay for everything, and top it off with a healthy dose of out of control bureaucracy and market failures. Anyone who thinks our system is great probably hasn’t experienced anything outside the US other than a drunken night in Windsor or Iiajuana.

        1. You haven’t said anything new here. And you haven’t even addressed the point about innovation in any meaningful way.

          I for one am happy to live in a country where “early adopters” can finance beneficial, life-saving medical treatments which eventually work their way down to the masses, and later to your beloved social welfare states, where the now-vital treatments can be offered to patients at long last. Provided the government bureaucracy decides such treatments are “cost-effective”. (You didn’t think America was the only country with a harmful health bureaucracy, did you?)

          1. Move to Japan, then. They spend a higher fraction of their GDP on private medical research, and have more of the fancy gadgets than we do (per capita, of course).

            Clearly, there is no trade-off between innovation and universal coverage.

            1. Japan also has a denser population, its hard to get those expensive machines out into rural Utah where maybe 5 people might use them.

              While the U.S. market is where drug companies can actually recover the costs of developing drugs.

              1. Actually, Japan has a lot of rural areas, and quite an excess of fancy gadgets out there. What Japan doesn’t really have is something like our suburbs. It’s either really dense, or pretty sparse.

                Bragging that our system lets us be the ones to overpay for drugs is hardly a way to advocate for it.

                1. Apparently geography isn’t your strong suit. Rural and distance are two different things. Japan is a small country, a large percentage of the total population is close to highly developed areas despite being in rural areas. Not so, in America.

            2. you are right that we don’t spend as much as other countries on R&D and most pharmaceutical companies spend a majority on marketing old treatments, but that doesn’t change the fact that America has more medical innovation than any other country.

              1. Really? Have you noticed Big Pharma offshoring every R&D job it can to China and India this last decade, and especially the last two years?

                To the extent we still lead in medical R&D, it is largely because of our generous funding of NIH.

                1. It’s also partly the way FDA treats clinical trials as a make-work program for researchers in the USA. It’s not that there’s any law or even any rule against using results of foreign clinical testing. It’s just that FDA stands a good chance of rejecting them because “medicine is practiced differently here”, so drugs and devices (and maybe food additives, etc.) may not act the same here as there.

                  1. I’ll brag about “overpayment” all day if you define overpayment as not using a government created monopsony power to artificially depress prices and free riding on innovation by using generics.

                2. I’ve told you before, Chad. Where the R and D spending takes place is irrelevant. The fact of the matter is that if the us paid less, there would be a smaller market, thus less incentive to innovate. REGARDLESS OF WHERE THE INNOVATION OCCURS. DO YOU UNDERSTAND?

                  1. Bingo. European drug makers are also financing their R&D on the profits from the US. 50% of a drug’s profits come from the US alone, the other 50% come from the rest of the world combined. It doesn’t matter if it’s Merck or Novartis developing the drug.

        2. Something like 90% of the drugs in the world are developed by US companies.

          I for one am tired of subsidizing the rest of the world. Fuck them.

          1. Something like 90% of the TAXES in the US are PAID by PEOPLE MAKING OVER 200K.

            I just changed your original statement JB, but feel just as strongly.

            This country will continue its decline until the majority of people in this country actually pay for things. Their healthcare, their family’s education, etc. Beggars can’t be choosers.

            1. That’s the problem here. When voting (ostensibly) determines what government does, AND beggars are in the majority, then beggars ARE choosers.

              Zeus help us.

          2. Actually, 6 of the top 10 pharma companies are European, so I don’t believe your statistic.


  5. I completely agree. I’m not a fan of the government takeover of healthcare, but our system does have real problems. My attitude is that obama types care less about solving those problems than they do about taking over the economy. I would trust a conservative public option much more, but the republicans had 8 years to do something and they did nothing.

  6. An honest view at last, from someone who has actually experienced a different system. Thank you, Matt.

  7. OK, what’s next, an article by Nick & Veronique on why the stimulus is working? An article by Damon Root on the greatness of FDR? My god, after this anything is possible.

    1. Matt’s been humping the French system for years. (No pun intended, Mrs. Welch!)

  8. Doctor de Rugy to Emergency! Doctor de Rugy to Emergency, stat!!

  9. Mitchell: You seem to be under the confused impression that our current health care system has any significant similarity to a free market.

    1. Actually, you seem to be under the confused impression that your positions as a libertarian are only relevant to the ruling class who control our nation’s economy when you oppose any reform that actually helps people.

      1. Try rephrasing that in English.

      2. No, Mitchell, no one here is under the impression that libertarian views are relevant only to “the ruling class.” Except you. Nice try at writing coherently though, better luck next time.

        Also, libertarians indeed do support reforms that help people. We just reason that reforms that increase freedom will help people more than reforms that minimize freedom.

        1. Isn’t it wonderful that you can sit there and say libertarians support increased freedom when so many of you are more afraid of people having health insurance by the government than Dick Cheney torturing people. Just look at the voting records of most libertarians and see whether they vote for more Rs than Ds. Their choice among statists is quite revealing…

          The level of ignorance leveled at Welch for recognizing the obvious is a testament to the reliance on shallow libertarian ideology instead of ever checking out how the foreign nations operate their health insurance systems.

          I don’t give a rat’s ass whether something is public, private or whatever. But I do find from empirical understandings that most other nations that are civilized rely upon either not for profit insurance companies or government run insurance companies.

          None of you really want to engage Welch on that, because you live in a world of ideology.

          1. Mitchell – that was a joke right?

            1. Successful troll is successful. 🙂

              There are certainly some libertarians noobs who chant “freedom!”, but don’t understand it. Just as there are progressives and conservatives idiots who vote the way an actor or their pastor tells them to.

              People in all three camps can be and must be ignored if you want to have an honest debate about where we are, and where we ought to go.

              Matt provides an rational argument here, not for importing the French model, but against the status quo. No one disagrees that current American healthcare has many horrible flaws and the French system is better in many ways. However, a truly free market system with both employers and government de-coupled from healthcare would be an improvement on both systems.

              1. “Matt provides an rational argument here, not for importing the French model, but against the status quo. No one disagrees that current American healthcare has many horrible flaws and the French system is better in many ways. However, a truly free market system with both employers and government de-coupled from healthcare would be an improvement on both systems.”

                Best comment in thread.

                1. Except that the ultimate free market reform for health care would be indistinguishable from a protection racket. Again the libertarian ideology rests on a fantasy that free markets are perfect, something even people from rainbow unicorn land do not believe.
                  Health insurance is a public good that should be regulated and distributed in the manner that utilities and other market failure prone commodities are. Public Utility Districts survived the Enron market manipulations quite handily while those getting private utility service got brownouts and stratospheric bills.
                  Sadly, if you are some Randian or Paulista, you will not be able to read and understand this. Somalia is libertarian heaven.

                  1. On ya Dick. Food is also pretty essential and a public good (starving people just don’t contribute that much to society), so I guess you’ll be happy to get Obamafeed?

                    1. Ever heard about Food Stamps funded through US Dept of Agriculture…


          2. “…so many of you are more afraid of people having health insurance by the government than Dick Cheney torturing people. Just look at the voting records of most libertarians and see whether they vote for more Rs than Ds.”
            I’m pretty sure you’re wrong about that, buddy. Polling data please? Do you actually think less libertarians are against torture than against the public option, or are you joking? And I would love to see those voting records.

            “But I do find from empirical understandings that most other nations that are civilized rely upon either not for profit insurance companies or government run insurance companies.”

            Saying “other countries are doing it” is neither an argument that public healthcare is good, nor is it an argument that free market healthcare would be worse. If the U.S. was only allowed to advance itself with innovations that already existed in other countries, we wouldn’t be very advanced, would we?

            1. MF: master of make-me-up statistics. Where do you get this stuff? The only one living in a world of ideology is you. That is quite obvious by now.

          3. You “find from empirical understandings” that blah, blah …

            Well, I find that dependency on operational conditions can lead one to varying interpretations.

            The sentence above is just as equally devoid of meaning as yours but I thought I would throw that out there while we are using phrases usually found in post-graduate theses of no consequence.

            By the way, exactly who is the economic ruling class here in America?

  10. so, what do you specifically propose for America? Medicare for all? A 100% private system but with much more regulation to address the issue you brought up (like Switzerland) ?

    Pretty convenient for you to enjoy American capitalism and French socialized healthcare…but we can’t all do that

    1. I’d start with breaking the link between employment and health care, removing state barriers to insurance competition, rolling back various government mandates, breaking up some of the more unnecessary licensing rackets, freeing most pharmaceuticals to my side of the counter, and so on. The January issue is filled with good ideas; you should read it!

      1. Matt, I read the ideas – and they make sense. They basically call to make the US system more like the healthcare system in Mexico, which is (not on purpose, mind you) more libertarian.

      2. The solutions to health care are repeated over and over. They aren’t sinking in. How can interstate markets not make sense to people? Or the employment based relic? A country with this population, expansive geography, and baby boomer aging, we need the free markets more than ever. We need an MRI or CT kiosk on every corner. Maybe even create jobs. If you are over the age of 30, there is some part of your body that you would probably like to have examined with an MRI.

        Matt, you mentioned the higher taxes and welfare state in France, but you left out cultural differences and the upward mobility that exist here that doesn’t in France. It would be an impossible nightmare trying to replicate health care in France, Germany, England, or Canada. It doesn’t make a shit bit of difference how great it is or isn’t in France.

        The question is how in the hell do you get people to understand that we need a free market now more than ever because of these reasons. Reason helps, but …

        1. No, no, the market forces that provide us with cheap and plentiful food and ubiquitous shelter can’t provide us with inexpensive and quality health care. That’s unpossible.

          1. What we need is a government option in celluar service for more competition. Or, an employment based system. Yeah, I was gonna take that dream job I found, but they only offered T-mobile and Sprint. My shitty job offers AT&T and Verizon. Fuck it, employment based groceries. Hey did you hear about the specials they’re having on buds (oh no, wishful thinking) and Sierra Nevada at Publix. You should go by there on your way home. No, I can’t, I can only shop at Whole Foods and only organic because of the plan I have at work. WTf!

            1. ? You load sixteen tons, and what do you get?
              Another day older and deeper in debt.
              Saint Peter, don’t you call me, ’cause I can’t go;
              I owe my soul to the company store… ?

            2. Don’t forget housing.

              Why should i have to pay rent. Its more essential that HC.

              We need free government housing.
              That’ll make everything better.

              1. No, you should live in employer provided apartments.

          2. Market based forces that provide us with cheap and plentiful food? The punchline to that joke goes like this: “Helllllllllooooo subsidies to agribusiness.”

        2. Or the employment based relic?

          I’ve heard that people are scared of “losing their current coverage” by going from employer to individual coverage. Which makes no sense to me, since my employer has changed plans 3 times in the last 3 years.

          The only benefit I can see from employer-based coverage is that it provides a form of guaranteed issue for those with preexisting conditions. That could be replicated (actually, improved) by having a government-run plan that would charge above-market but not crippling rates to otherwise uninsurable customers. It would still have to be subsidized, but I’m ok with welfare for those who actually need it.

          1. Yeah, the employment based system has worn out its usefulness or imposition rather. People change jobs frequently. Furthermore, see above comment for the ridiculousness of having any product and/or service attached to employment.

            How about neither an employer-based model or government-based model. A free market model. It’s doubtful most Americans don’t want to help the helpless or needy, but the clueless…. There are plenty ideas out there for addressing the needs of such without the crap being legislated currently.

            1. Boehner put up a substitute bill before the Democrats passed their health care takeover. It would have been a huge boost for free market health care.

              1. Well, there have been quite a few alternatives floating around besides what they are pushing now. It looks as if that ship has sailed. Perhaps the Republicans should have mentioned health care during one of the Wheel of Fortune debates during the primaries. It’s all a circus and mainly about power. The Dems have to pass “anything” to have a chance at holding the majority in the Senate and maybe the House. If Congress and Obama went on break for a few years, the economy and health care could very well get healthier on their own. Then again, what would they congratulate each other for – vacationing?

                1. McCain was strongly in favor of leveling the tax field by taxing employer-provided coverage, which would have been a good start.

                  1. Sure, but the point was that Democrats are the public’s champions of health care. There wasn’t a mention of healthcare during the Republican primaries. McCain was a horrible pick for Republicans. It was truly a perfect storm. Besides,when you ask people why they are voting for a candidate and 90% of the time the answer is, “I hate Bush,” McCain could have said he was going to give every American a 50% tax cut and promise to personally pay of the national debt. Republicans in Congress suck every bit as much as Democrats, but the combination of Obama and Congress is a nightmare.

          2. There’s no such thing in a free market as a large group of consumers who are willing to pay for a product but aren’t getting it.

            1. A free market requires a willing seller and a willing buyer, if the buy wants X for 5 dollars, but is only willing to take $10, how can there be a sale?

        3. Are you crazy…95% of this nation`s wealth is in the hands of top 5% of the population and the wages has stagnated for a decade and you are talking about upward mobility

        4. Are you crazy…95% of this nation`s wealth is in the hands of top 5% of the population and the wages has stagnated for a decade and you are talking about upward mobility

        5. Are you crazy…95% of this nation`s wealth is in the hands of top 5% of the population and the wages has stagnated for a decade and you are talking about upward mobility

      3. It’s a real pitty we didn’t do all that when the so-called “conservatives” controlled the congress and the white house. By doing nothing the GOP is now getting what it deserves and people like us are taking the collateral damage.

        1. The conservatives decided to defend Medicare and make health care about abortion. Brilliant. Perhaps if people become more informed, they could make the upcoming elections less about R’s and D’s and more about replacing the shitbags that have been running Congress for decades. How about Kennedy giving up his seat after 47 years? Kudos.How about if we elect officials and Presidents who have had jobs?

          1. Don’t forget they support guaranteed issue which would completely muck up the insurance markets, causing massive adverse selection without subsidies and individual mandates.

        2. The conservative under Bush did do HC reform.

          Unfortunately the reform was to create a huge new entitlement – prescription drug coverage.
          It was worse than nothing it encouraged the progs to push for a complete takeover of medical care.

      4. Oh come on, Matt. Just face it. You’d be fine with the French system. You said it already. Why backtrack now with the bullshit your friends in the arrested development movement known as business libertarians are pushing?

        1. Biking to work is an improvement over walking, but driving a car is the best. Just because the French system may be better than the status quo does not mean it is better than other alternatives.

        2. He said the French system is better than our current system, not that he’d “be fine with it.”

      5. I know exactly how you can reduce costs. It’s got nothing to do with what you just highlighted, unfortunated. And you won’t like it. All other developed countries ban (or severely restrict) prescription drug advertising to the general public.
        I don’t have the numbers handy, but just look at the amount of ads for drugs on US TV. For a European it’s incredible, literally, to see them.
        Banning them helps prevent over-consumption (ads do make people consume, that’s kind of the point …), and prevent drug companies from spending dozens of billions on ad space.
        Some here might object to it on ideological grounds — after all the first amdt protects the right to be forced to watch ED ads at dinner time — but the facts stand: it would lower drug costs tremendously.

        1. Evidence, pls.

          1. Most of the drug ads I see here in Canada are ads of cough syrups, allergy meds and those very minor illnesses.

      6. Breaking the link between employment and health care will cause an uproar by some. The better way to do it is to make all health expenditures tax deductible. That way people can keep their employment-linked coverage (though it really won’t be an advantage any longer).

        1. ” That way people can keep their employment-linked coverage (though it really won’t be an advantage any longer).”

          Uh, no. You’re missing the point. Employers, especially big ones, have more leverage with the insurers to get more affordable rates.

          An individual seeking insurance has no leverage, thus is more likely to be quoted irrationally exorbitant premiums, or be denied insurance altogether.

          Tax deductibility isn’t going to help, especially if you can’t afford the premiums in the first place.

      7. It all sounds nice; possibly better that what is in place at the moment.

        How do you see such a system handling people who are priced out of the health care market?

        There are a lot of negative impacts that society in general bears when people can’t affford basic health maintenance or catastrophic coverage.

      8. Should employers be forced to abolish their health benefits (statist solution) or should we eliminate the tax subsidies to level the playing field, leaving the option open for employers to provide coverage if they still want to (free-market solution)?

        1. You are totally clueless. We have Single Payer System in Canada and private companies do offer supplemental health benefits to employees.

  11. this reminds me of limousine liberals living in rent controlled apartments crying for affordable housing

    can’t have it both ways

    unless, i guess, you marry a french woman

  12. Re: Matt Welch,

    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 I’d had in France). Blue Cross rejected me too. There weren’t many other options. Months later, an insurance broker told me I’d ruined my chances by failing to file a written appeal. “You’re basically done in California,” he said. “A rejection is like an arrest?if you don’t contest it, you’re guilty, and it’s on your permanent record.”

    This is the first time I have heard that a service provider rejects a customer on the base of a grading system a la eBay… That tells me that the market is clearly rigged, since in a free market, SOMEONE is willing to accept you as a client – may cost you more if you represent a higher risk, but you would be covered.

    My family and I did not have full coverage insurance where I used to live. We had catastrophic. The doctors we visited charged us market-level prices, whenever we needed a checkup. When I was hospitalized with a kidney stone, I only paid my co-pay and deductible, but my follow ups I paid out of pocket. How much? Around $50.00 per visit.

    This is in Mexico, where there’s no artificially-placed third-party payment system. Private doctors compete for your business. There is no artificial cap on how many doctors graduate, except their grades (The Mexican Medical Association does NOT have the power to cap the number of doctors that graduate.)

    Some people say that Mexico does not count in a comparison because it is a shithole. NOT when it comes to medical care, only when it comes to defending your life from armed thugs and the police.

    Oh, there IS the public option – it’s bad, but it IS a true option: You can always see a private doctor, cheaply, without having to have insurance of ANY kind. There are Clinics that give you membership discounts, like Costco. You cannot do that in the US because the States will prosecute you.

    An example: An anatomical (i.e. 3-D) ultrasound scan for my first born, done in Mexico, cost me $100.00. The VERY SAME SCAN, done in California, on an outside-the-net place, cost me $1,050.00. Same equipment. Same procedure. Big difference: The Mexican lab is competing agaisnt many other such places. Here in California, you have to be “licensed.”

    There IS more freedom in Mexico regarding healthcare than in the US. Costs are much, much lower, thanks to a truly free market. I expect the snide comments regarding Mexico…. now.

    1. i like Mexico. despite a horrible government. good place, good people.

      1. I need to thank them for the authentic Mexican food, like Taco Bell. They can keep the chihuahuas though.

    2. The VERY SAME SCAN, done in California, on an outside-the-net place, cost me $1,050.00. Same equipment. Same procedure. Big difference: The Mexican lab is competing agaisnt many other such places. Here in California, you have to be “licensed.”

      Oh, bullshit. There are a lot of things that go into cost besides the licensing. Since most clinics depend on insurance and medicare payments, which are negotiated at a percent discount, undiscounted prices are higher. Also, labor and insurance costs are substantially higher in California, not to mention other fixed costs like office space. About the only cost the two locations would share is the price of the machine.

      1. You did not put your attention on the fact that there’s more competition in Mexico.

        Since most clinics depend on insurance and medicare payments, which are negotiated at a percent discount, undiscounted prices are higher.

        Oh, those poor babies – in fact, they can easily reject ANY insurance or medical payments and lower their prices. Unfortunately, they would quickly feel the wrath of our A.G. The-State-Is-Me Brown.

        1. Well, yes, there’s more competition in Mexico. When people pay out of pocket, they’re more sensitive to prices than when a third party pays. The insurers get much better prices than you do as an individual. And, no, a medical group does not have to take insurance or medicare payments, but these compose the majority of medical payments, and they would be putting themselves out of business with such a policy.

          The professional payment for a gyn ultrasound read varies from about $35-80. For everything, an insurance company would pay between $70 and $220, not dramatically worse than you paid in Mexico. You’re getting shafted because you’re not an insurance company.

          1. good job backing up his argument!

            1. Oh, I agree the problem is lack of competition. I just think that this is due more to the face that providers compete for business from 3rd party payers, not from individual healtcare seekers. Licensing is not the major contributor, and does not account for a signficant fraction of the 10x difference in costs between the US and Mexico in this example.

              1. Oh, I agree the problem is lack of competition. I just think that this is due more to the face that providers compete for business from 3rd party payers, not from individual healthcare seekers. Licensing is not the major contributor, and does not account for a significant fraction of the 10x difference in costs between the US and Mexico in this example.

                Except that in the U.S. licensing a medical device requires a “certificate of necessity.” The government decides if your town “needs” another CAT scanner, and if adding one would result in competition with existing facilities, the answer is “No.”

                1. California is not a CoN state, so again, you’ll have to look elsewhere to find the cost difference Old Mexican mentions. Not that CoN isn’t a pain in the ass, though.

                  1. Yess, I’m sure the CAT scan would end up costing more in CA than in MEX even after eliminating all of the restraint of trade issues. But, I suspect the price difference would be more in line with the price differences on other goods and services. Unless I’m mistaken that’s a multiple more on the order of 3-5 rather than ten.

              2. It’s not the cost of the licensing. It’s the cost of the lack of competition created by the licensing. So what’s your argument?

          2. The insurers get much better prices than you do as an individual.

            It depends on whether the doctor is “in network” or not. If you see a doctor out of network, the provider can pretty much charge whatever they want, because in most cases the state mandates that the insurer HAS to cover it.

            If you pay directly, however, many providers, knowing there’s no insurance company they can easily rip off, will be more reasonable about rates.

            1. My wife was getting a treatment not usually covered by insurance. The doctor’s office presented us the bill. We reminded them we had insurance. They checked again and said, oh, you do have insurance. Charged us a co-pay. We went on on our merry way.

              Got the explanation of benefits a few weeks later. The doctor’s office charged the insurance company roughly twice what they would have charged us had we paid cash. So cash is king, as always.

      2. “About the only cost the two locations would share is the price of the machine. ”

        Not true. I was listening to a report on the radio the other day. GE sells its MRI machines, to use one example, to Japan for SUBSTANTIALLY less than they would to a hospital in the US.

        I can’t quite remember what the difference in cost was, but I remember getting angry about it.

        1. Found it. Right here.

          Professor GERARD ANDERSON (Health Policy and Management, Johns Hopkins University): I’m talking about the MRI machine. When you go and you buy it from Siemens or General Electric or any of the manufacturers, you will be paying about twice as much in the United States for the exact same machine.

          JOFFE-WALT: Japan sets the price they pay for MRIs super low. And so to get into the Japanese market, the manufacturers lower their prices. They charge more here in the U.S. because we will pay more. How come? Well, I called a number of American hospitals and doctors and I got basically two reactions. The first and most popular: a shrug. We could never get those prices. That’s just how it is. And the second: some were surprised. Just like that radiologist getting his first MRI. Health care prices even to them are something of a mystery.


          If GE and Siemens can make a profit selling MRI machines to Japan for half the price, why can’t they do it here as well?

    3. Of course you like the Mexican system, because you are one of the very small minority which gets the good care. Meanwhile, sixty percent get really crappy public care, and most of the rest get virtually nothing other than what they can pay for with a few pesos or beg for at clinics.

      Sounds like the libertarian dream to me!

      1. Yes, because in a libertarian world the U.S. economy would be like Mexico’s.

    4. I totally agree with your assessment of Mexico. Healthcare is cheaper because of the free market and the doctors are comparable to American doctors.
      Most people that live in border towns go across for this very reason…there is no bullsh*t to deal with like their is in America.
      I also think despite the government being crooked as hell it is still less crooked than our government. The whole licensing scam that exists in America is a big reason why.

  13. This “libertarian heresy” shouldn’t be news to anyone who’s been reading this blog for awhile.

    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.

    Then why don’t we try it, instead of surrendering to massively higher taxes and by intractable economic laws, rationed goods and services?

    1. I don’t believe Matt was advocating we go with the French method, but he was just pointing out that we either need to go with one method or the other, because this shit in the middle really sucks.

      The preffered method being more compeition of course

      1. I must admit that a friend of mine made a good point on this issue, which is that the Democratic reforms are pro-competition, in a way. Insurance companies will become more “boring” and will have to compete more on value-added service. Entire teams of insurance employees, who currently work on denying claims and applications, will have to be relocated to another area of the business or fired.

        Of course, there will be a loss of innovation and costs will keep going up, but at least the insurance companies will face the competitive forces of the Choose Your Health Plan Web Page.

        1. if the public option isn’t denying people, then they are charging higher rates. The PO will fail unless it cheats the system or plays by the norms of the other insurance players

          1. The “public option” will succeed the same way as Florida’s “public option” in property insurance does, by being bailed out from time to time with money from general revenues.

      2. … the preferred method of his employer being more competition. Matt’s preference for juicy, somebody-else-pays-for-it medical care is too much of an opiate for even him, the self-described least-qualified-libertarian on the staff, to resist.

  14. i always said, the only 2 solutions to healthcare are 100% socialized, or 100% free market

    we have neither, and the “reform” going through congress isn’t gonna help

    1. Seconded.

  15. Of course Mr. Welch loves it when he receives low-cost health care in France. He isn’t paying the fucking taxes to subsidize it!

    I rejoin this with two lovely poor health care stories of my own. I had a shoulder injury and broken collar bone. It took me over 9 months to even get an x-ray, with the first 3 months being in such extreme pain I had to have my roommate help me dress (he loved that). By the time they took the x-ray, the bone had healed itself, which explains why it pops out of my shoulder at random intervals now.

    A year and a half later, I fucked up my ankle at work (swollen to just under the size of a basketball), on a Friday. I was told to come back to the clinic on Monday, when I was given crutches, and told to come back in a week for an x-ray. No cast, no splints, nothing. I ended up having to improvise those with bandages I bought at Wal-mart.

    My employer and health care provider for both of those incidents? The U.S. Army.

    1. Au contraire, Kyle Roberts! My wife earns most of her income in France, and we are more than duly taxed in both countries, thank you very much.

      1. and we love it!!!

      2. Fair enough. I’ll retract that part then. But the American socialized system horror stories I’ll keep.

        1. And I’m sorry for your horror stories; sound horrible. May your bones heal nicely.

    2. What makes you think he isn’t paying any taxes to his lovely French overlords? He used to.

    3. My employer and health care provider for both of those incidents? The U.S. Army.

      Having been treated by the military healthcare system and also that of the Veterans Administration, I can readily believe that. Government medical employees generally make the same salary each month regardless of how many patients they treat, so there is no incentive at all to do amy more than just what little they can get by with. Nor do they have to worry much about being fired or sued for malpractice. In fact, that’s true of most government institutions.

      1. Osama bin Laden is the only one who actually seems to fire government employees.

        1. That was awful and funny at the same time. Good stuff.

    4. Geez man, your in the army. Take a fucking salt tablet. Chicks dig scars.

  16. I expect the snide comments regarding Mexico…. now.

    You neglected to include a preemptive “Shut the fuck up, LoneWacko.” Although, our xenophobic friend has been missing in action for a while now. Maybe his mom took away his internet access.

    1. He finally died by chocked on that silicone burrito he uses to pleasure himself.

      We all warned him, but, like high-flying Icarus, he doomed himself by gagging too close to the shit-smeared sun.

  17. Arguably off-topic:…..;Itemid=50

    And spot the dirt and mould on the roof above me, this is the view from my Hainan hospital bed. Fortunately I was not able to snap photos of the rat under my bed.

  18. Yeah, I must admit I got better, cheaper, and faster health care when living in Europe.

    But doctors didn’t get paid anyone near as much as they do here and there were no malpractice lawsuits. Basically, the costs were far, far lower.

  19. I’m a fierce opponent of Obamacare, but I don’t think pure free-marketers have acknowledged that health care is an incredibly imperfect market where costs are not known to consumers in advance, and medical providers and pharmaceuticals profit from doing a bad job and breeding reliance on their services and products. You can somewhat argue that government interference has contributed to the former (by employer-provided insurance obscuring costs) but medical fraud and price gauging are real issues that require regulation, especially because our lives are at stake. I take a radical laissez-faire stance on almost every industry except for healthcare, but would be open to hear alternate views.

    1. Re: Hobo Chang Ba,

      I’m a fierce opponent of Obamacare, but I don’t think pure free-marketers have acknowledged that health care is an incredibly imperfect market where costs are not known to consumers in advance[…]

      There’s no free market system for health care in the US. The Third party payment system is NOT a creation of the free market but a creature of convoluted tax regulations.

      1. Of course, I’m totally aware. I think in most areas it should be far more free market than it is and more individual-oriented vs. employer-oriented – and available from any state, thus removing the need to reapply for insurance. Insurance should be more focused on catastrophic and the difference should go into some sort of perpetual health savings account that covers minor procedures, prescriptions and doctor visits.

        However, medical corruption and fraud is a huge issue that the market can’t really solve. Unfortunately, our choice is between heavier regulation and disclosure laws or more costly malpractice lawsuits after the fact. If my doctor is getting bribed by a pharmaceutical company to prescribe drugs we might not need in return for favors, I see that as a violation of my rights. We rely on doctors for life-affecting advice in a field we have little knowledge in the first place, much less access to perfect information upon which we can “choose” which medicines to take. While we can “shop” for doctors to a degree, it doesn’t do you much good if you are the person who dies from a misprescribed drug or develops long term effects from taking one you didn’t need. Doctors also profit from making us do procedures we don’t need, defensive medicine or not.

        I generally don’t like regulation for it’s high inefficiency and cost on the workforce. But the medical industry is naturally inefficient by profiting from reliance or doing a mediocre job. At the same time, malpractice lawsuit reform looks away from violations of individual rights and acts of fraud.

        There’s no easy answer, but I generally think there needs to be more disclosure and anti-fraud regulations and less regulations in most other areas.

      2. And there never WILL BE a free market system…so it is utterly irrelevant if your fantasy would work or not.

        Are choices are a national system, or the insane public-private hybrid we have now…and the choice is obvious.

        1. This same tired old argument again, free markets will never get passed so we shouldn’t try to advocate them but rather surrender to the progressives.

          People said that about racial equality too. While we are at it, gays will never be accepted as married; so they should just shut up about not being second class citizens. Of course the war on drugs will never end either, so we should give the DEA all they want. And neither will the wars abroad, so we should all just be raging neo cons. Right Chad?

          1. Your advocating of a fantasy is what keeps us stuck in this absurd hybrid. You should start thinking about the real choices that we face.

            In any case, a “free market” for insurance cannot work, as it is riddled with serious market failures for which it has no answer.

            1. Just because you can’t understand the answers, doesn’t mean they don’t exist.

            2. What “market failures?” Have you seen these failures, or are they merely hypothetical and easily taken down by simple economics?

              1. Chad’s market failure he likes to cite is adverse selection, after posting elsewhere about how horrible it is people get turned down with pre existing conditions.

                If we had a real problem with adverse selection, such people would be the only people getting health insurance. That’s what adverse selection fucking means.

                Markets for him only don’t work in the context that they won’t force the rich and the young to subsidize the poor and the middle aged/old. And without an individual mandate his regulations forcing insurance companies to cover everything tangentially related to health care no matter how low cost can only result in adverse selection, because young healthy people don’t need all that stuff.

                Yes there is adverse selection in the current “markets”, largely because governments tell companies to disregard any information about people’s health and tell them who to cover, what to cover, and how much to charge. If you can’t charge sick people more than X times what you charge a healthy person, you have to charge the healthy person more; and they would be stupid to buy into such a system. So unless they get subsidized and use it or lose it from work, they don’t.

                He’s not talking about our “irrelevant fantasy”, but he won’t admit it unless pressed. Preferring to try and build up the strawman that free markets are the status quo so he can knock it down while pretending to be Mr. pragmatic enlightened progressive only concerned with the facts about what works.

                1. Oh, he’s also totally incapable of comprehending the notion that an insurance company should keep paying for your treatment for an existing condition even after you lose your job.

                  He’s like “No, no, it only makes sense to force someone completely unreleated to pay for your health care! Making the insurance company you actually paid money to pay for your treatment is like a totally wacky incomprehensible idea that would never work!”

              2. “Hello Mr. Heller. That’s a nice compound fracture you’ve got there. Do you want to pay what I ask, or do you want to wait a few days and do some comparison shopping? Shame about that jagged piece of bone sticking out of your leg.”

                Do you really think you’d be a cool-headed value-oriented shopper under the circumstances?

                That’s a market failure. People buy healthcare services under duress.

        2. Chad,
          Your post has nothing to do with anything I’m talking about – try reading it again and addressing the points. Anyway, all of my “free market” reforms I have proposed are completely within the bounds of reasonable electability and relatively cheap – interstate insurance markets, making individual purchase of health insurance tax-deductible and a tax-deductible health savings account that rolls over, combined with catastrophic insurance.

          Also, there are always more than two (or three) choices.

        3. Choad, shut the fuck up asshole.

    2. Imagine if employer-based health care was the exception rather than the rule. Do you think hospital rooms would cost less, or more? Here’s a hospital bill from 1950. The inflation-adjusted cost of having a baby was around $800 at the time, with a 5 night stay. Today it would cost over $5000 and you’d be lucky to stay 2 nights.

      People used to pay out of pocket and got a damn good value for their money. Insurance was reserved for unexpected events only.

      1. Today it would cost [to have a baby] over $5000 and you’d be lucky to stay 2 nights.

        That’s about right. It cost me around $5200.00 for my second born, here in lovely California…

        1. If you can’t afford that, you can’t afford children.

          1. But having all the children you want and paid for by other people is a human right!

        2. Try $10,000 – $15,000 for the average delivery.


          My neice’s delivery in TN a couple of years ago cost $18,000 because of some minor complications.

    3. Of course, fraud is something that most libertarians support regulation against anyway. A doctor advising you need a surgery that she or he or it knows is completely unnecessary counts as fraud.

  20. You are right. It can be more convenient in a system that covers almost everything and with little hassle.
    When I was in grad. school in Wisconsin, we were under the State-run HMO Wisconsin and it seemed to run pretty smoothly and covered dental as well. Since Madison is the state capitol, and this HMO covers mainly state employees as well as students in the UW system, they had a large pool of healthy kids and the legislators live in that city and use that HMO so there were big incentives to keep it running smoothly and there are only 200K people that live there and only half (just a guess) are on this system.

    In New Orleans where I am now, I can often get a doctor’s appointment the same day or within two days for bad back pains, etc. and some of the medicine’s you mention I could probably get a scrip. called in over the phone the same day. I do have to schedule my physicals weeks or months in advance.

    In what other area would you have businesses turning down customers? This probably reflects the fact that they are not allowed to operate as an insurance company is supposed to and cover their risks. Each state requires a different set of mandates and limits abilities of companies to charge proper rates or to limit coverage. If you don’t have cheap insurance for young healthy people, it drives up costs so you either let the companies have limited policies that younger people can afford (free market) or you force the younger people to pay high rates to support the older folks which is the direction we are heading. In both cases it is govt. policy driving the results. If you compare auto, life, homeowner’s and flood insurance, you have more problems getting decent coverage at affordable prices in the more highly regulated ones like homeowner’s particularly in Louisiana where the govt. drove out all the smaller companies even before Katrina. The only one that is cheap and anyone can get is the flood which is completely federal (just like healthcare in France) but then the cost we actually pay for flood insurance is so low that everyone else in the country subsidizes our flood insurance. This is more expensive now than pre-2005 but is still cheap for what you get and has all kinds of people 100 feet below sea-level grandfathered in. Now where did my copy of Ayn Rand go …….?

  21. Are you telling me that in France, one can get muscle relaxants from a pharmacist without seeing a doctor? Somehow, I doubt that you can just pick up a bottle of Xanax or Valium in France so easily…

  22. yah! matt welch gets to feel those contrarian oates…yippie…

    but i do remember my 3rd year of med school at an NHS in the UK — and while i enjoyed england and those lovely northwestern nurses — it’s not a healthcare system i’d wish on us. for the simple fact that most of us, if we had to deal with something comparable, would say to our providers: you want me to wait how long?! i have to do what?! why can’t i? and how long is that going to take?! well who do i have to call?

    and finally it would end with some variation of…why can’t we just do it the way we used to? freakin’ obama.

    and probably…everything was perfect til’ those goddamn hippies ruined everything with that collectivist sheit!

    1. Exactly. For anyone who promotes the Euro or Canadian model, they need to accept the fact that we would have to become France, England, Germany, or Canada. Of course, it seems like our wise overlords in Washington are pushing us in that direction. Sweet, I have “free” health care, but I didn’t want to be a coal miner like my Pa. I wanted to change jobs twenty times, go back to school for 5 different degrees, and end up producing porn in California. Fuck it – back to mine with my Pa and Grandpa.

    2. Big difference between the NHS – a nationalized health system (um, which is what it means) in which the doctors are all state employees and the hospitals all state property, and the French system, which is essentially just single-payer.

  23. Here’s why what Welsh just wrote is foolish:

    He basically doesn’t have to pay for the socialism he likes. We do, through higher drug prices.

    1. I pay both for the higher drug prices (some of which I bought just today, for my daughter), and for the socialism (through my family’s French taxes, which fund all kinds of things we *don’t* have access to).

  24. I honestly believe a true single-payer system (Europeans-style) would be better than this horribly bastardized system of crony capitalism that we have now. It would of course be worse than a true free market, but it would be better than the current system. Of course, the Dems don’t have the balls to do this. They just want to add another massive layer of bureaucracy on our already sucky system. Thus, they will make it even worse!

    1. +1

      The French are also famous for having pretty efficient government. Most of the other single payers are not nearly as efficeient.

  25. What we have here is a hybrid. Those simply work the worst. Unlike a homogenous system (all free-market or all socialist), you have two forces fighting each other. It’s like having a WWE match in your living room-stuff is gonna get messed up (yes, I know wrestling is fake but I make my point). Pick one or the other. This is one case where you can’t have you cake and eat it too.

    1. How about the following system:
      1) Automatic health insurance for claims over $50,000 per year per citizen
      2) Below $50,000 you’re on your own
      3) All health expenses tax deductible: complete parity with group insurance through employer

      1. 90% of people would be bankrupted by a $50,000 bill…especially with one that probably correlates with lost income as well.

        1. Which has nothing to do with whether or not a market is working, you’re advocating welfare not government intervention in the name of a market failure. Nice to see you admit you’re really just about redistribution of wealth and all the other arguments are just distractions.

          While you of course assume a static world, where current medical prices have nothing to do with horrible incentives of our mixed system.

          I also pointed out the government plan advocated here in,

          Which at the very least does attempt to deal with the problem. But if executed truthfully, a big if considering the poor incentives of government, it won’t include massive wealth transfers to buy off voters/special interests or enact progressive equal outcomes utopia. Hence why it receives little discussion other than at the CATO institute. Because in the end health reform isn’t about whether government or markets can run the system better, it is about wealth redistribution.

          1. As I have said many times:

            Health insurance, paid for by anyone, is a market failure. You can always “fix” the market failure by eliminating the insurance. To the extent that you neuter insurance, you “fix” the market failures to the same degree.

            Your plan eliminates almost all insurance, and therefore eliminates most of the market failures. It also exposes huge numbers of people to insane risks, however…defeating the purpose of the insurance in the first place.

        2. “90% of people would be bankrupted by a $50,000 bill”

          This is laughable considering new cars cost $30,000+.

          Buying a new car must bankrupt most people then.

          1. Don’t confuse Chad with facts Josh.

            He also doesn’t understand market failures, on the one hand complaining sick people can’t get covered and on the other ranting about adverse selection; I’m sorry but those two positions are mutually exclusive. While as Hazel pointed out there have been many free market alternatives posted here, but he doesn’t understand them either.

            Next up on news channel 8, adverse selection in the used car market where only high quality cars are sold and no one can unload a lemon. Should the used car market be socialized, Chad will debate…

            While if Chad even read the article he would have come across this paragraph
            “Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings?say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime?roughly $4 million in total.”

            And of course Mr. Facts understands that employers don’t really pay their contribution, its just another form of wages. That could cover quite a few 49,000 dollar treatments. Assuming of course that such treatments would actually cost that much if our system wasn’t so distorted. There’s a lot of money lying around in the additional cost of more comprehensive insurance plans and “employer contributions”.

            That’s beside the point though, I’m not a fan of the mandate; and private markets will sort out what level of coverage people are willing to pay for based upon what it costs. Maybe the number should be 20 or 30k. Pointing out that some people can’t afford to pay 49k does not mean a market isn’t working.

            Hence Chad isn’t concerned about market failures, he’s really just about “spreading the wealth around”; disguised in pseudo-economics to convince the gullible to believe him. His arguments stink, so he has to convince people he is somehow smarter and better than his opponents so they won’t notice. It’s the only way he can justify micromanaging vast swaths of their lives.

          2. Indeed, and only the top 2% of the population actually holds a mortgage.

            Havn’t you seen all the slave hovels dotting the landscape? Truly an eyesore.

            1. But Hazel, people actually have to pay their mortgage. No one should have to pay for a place to live, housing is a human right! OH, THE HUMANITY!

              1. Or should I say that no one should eww profit from people’s needs for housing, especially not evil middlemen like bankers who provide no value added; siphoning money away from homebuyers and construction workers.

          3. You can choose a cheaper car. Many diseases and injuries don’t offer the luxury of having an inexpensive treatment.

            You really are a moron.

          4. Hospitals, doctors and radiologists typically don’t give you years to pay off huge debts, or consolidate the bills.

            I had to declare bankruptcy from multiple medical bills for me and my spouse that were not covered by insurance and that I had no prayer at the time of paying on at all.

    2. The French system is not entirely public, by far. Without going into the technicalities, the *insurance* system is mostly public, it covers roughly 100% of chronic and catastrophic conditions (and 100% of “pre-existing conditions”, no questions asked), and 65% of everything else. You can buy complementary coverage from private insurers.

      The medical providers are mostly private. Pharmacies are private, most doctors by far are self-employed. Hospitals are a mix of public and private, teaching hospitals are mostly public — med school is paid for by the government.

      What makes the system work is that you get both government protection *and* a free market. Not a completely free one, but most certainly a much freeer one than if your only choice is an HMO. At no point are you forced into a shitty health decision because of lack of choice.

      For instance, while the government sets the price for doctors’ pricing, they can opt out under certain circumstance; or entirely but then they don’t get covered by the public insurance. But then your complementary private insurance can pick up the tab, if they choose to cover that. If the nearby public hospital sucks, there is always a private clinic, and they’re usually covered by the insurance system.

      In most cases though, your doctor is on the standard pricing; they compete on service. Imagine that?

      1. So the government dictates the doctor’s wages and if a doctor don’t like it he gets ostracized from the system to suffer the wills of private insurers?


        1. Yes that is the downside. There are always trade offs.

  26. Matt should make sure to mention that his story is anecdotal, and any other anecdotal story about how great French health care could probably be balanced with plenty of stories about how horrible the same services are. But let’s look at some specifics-…..re_system/

    National health insurance in France stands upon two grand historical bargains — the first with doctors and a second with insurers.

    Doctors only agreed to participate in compulsory health insurance if the law protected a patient’s choice of practitioner and guaranteed physicians’ control over medical decision-making. Given their current frustrations, America’s doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement.

    French legislators also overcame insurance industry resistance by permitting the nation’s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by S?curit? Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.

    What I don’t agree with in Matt’s story is his bit about getting prescription drugs. I recently changed my high-blod pressure meds. I went to the Doctor for my appointment, he wrote the prescription and had it faxed to my local Walgreens. I picked it up later that night. The receipt broke down what my insurance paid and what the costs were with and without insurance. How is this so complicated?

    Anecdotal evidence isn’t something to build an argument from. But numbers are. According to Health Quality Indicators in December, it showed the five-year survival rate for breast cancer to be 90% in the United States compared with 83% in France and 81% in OECD countries as a whole. American men had a 65% survival rate for colorectal cancer, compared with 57% for the same cancer in France and 57% for the OECD as a whole.

    I am all about making it cheaper and more efficient, but I don’t think that paying 50% of my income to the government will achieve the goals in question, which is currently what happens in France.

    1. When you consider the occult cost of of employer-provided health insurance, your costs are probably higher than you suspect. At my last job, we got the numbers for our health insurance costs and I calculated that I was being “taxed” at over 40% with a net take-home of $37,000.

      Because health insurance costs plateau at a certain level, this functions as a kind of regressive tax. Most people don’t think of it, however, since they never see the money on their paystubs.

      1. A fair point DBN. I agree that the “tax” that we don’t see through our employer is ridiculous. I think the first part of healthcare “reform” should be for employers to come clean about how much they subsidize your insurance costs. I can imagine this might stimulate a different type of debate.

        I don’t want either the government or my employer making my health care payments, because then they get to decide whether my suffering is “worth treating” or not.

        1. The Wyden-Bennett bill would force employers to make a direct payment to the government for the cost of your health insurance, which would then apply the money to a health insurance plan of your choice, and put the balance in a HSA. This would go on for a few years until people decide whether they prefer the higher compensation or the group insurance.

          The bill would have been a mess but it was better than what we’re getting now.

    2. What about mortality rates? I care more about avoiding death from cancer than I do surviving a long time with it.

      1. Except for skin cancer and some lucky situations with respect to colon and breast cancer, not many people “survive” cancer in the sense that they die of something else many decades later. Most people do eventually die from the cancer, when it comes back. But that could be years to decades later — and that’s the point. What is an extra decade of life worth to you? Time to see the children go from grade school to college? And please if you’re under 40 get back to me with that answer when you’re over 40, and have some genuine appreciation for mortality.

      2. That was an exceptionally stupid comment Chad, even for you.

      3. WTF Really?
        Surviving cancer == not dieing from it.

        What’s the mortality rate? easy:
        Mortality rate = (1 – Survival Rate)

      4. Mortality Rate R=1 exactly.

  27. I suppose the problem opponents of governent health care have is that there is no example of a free market approach to compare it to. There truly is nothing free in our system. The AMA defines who is a Doctor, the FDA what drugs we can take the State governments which insurance system we have to choose from. Who knows what an amazing system might develop without the interference of Government. The only thing we can know is that the Federal Government is sure to screw it up even more.

    1. Plastic surgery and Lasik are HC areas with free market dynamics.

      Both have lower prices long term and more care options.

      1. Josh is right about those niches, but I agree with Will in that there are no examples of first world countries with truly–system wide–free market healthcare that we can point to and say “let’s do it like they do!”

        Mexico would be a decent example in some respects, but their big problems in other areas (rule of law, corruption, poverty etc.) makes people sneer at them before they even hear about the state of their healthcare market.

  28. Compares Opponents of Health Care Reform to Supporters of Slavery:

    (war is peace, etc.)…..upporters/

    1. FTA:

      Senate Majority Leader Harry Reid took his GOP-blasting rhetoric to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago.

      Now which party was that again?

      1. Oooh! Can we spell D-e-m-o-c-r-a-t, boys and girls?

  29. Any libertarians want to compare the cost of the French, British, etc. systems with America’s current costs? We spend more than 40% at the least than they do. If the Brits have any problems, it may have to do with funding overall, than with the sort of rationing we do–and at least they can console themselves that the rationing they do costs them less in money than ours does.

    Oh wait. I forgot. We’re only supposed talk ideology here. You know, kind of like in the old days of American Stalinism when any thought of practicality was confined to “praxis” version of philosophy…

    1. How insightful. I heard we spend more on NFL football season tickets than the French and British.

    2. My friend’s daughter lives in England and pays for additional insurance so she doesn’t have to wait months for an appointment and also to associate with what I was told is a “better class of people”.

      Wouldn’t that happen in the US? So your taxes go up and you still have to buy insurance.

      1. Again, if you’re spending half what we spend, that is what happens in such a system.

        You and I would both rather be in Medicare and have a Medigap than the monies we pay now. I’m in the private sector. I know what these things cost, and I know what my folks on Medicare pay.

        1. None of the libertarians here are arguing for the status quo dumbass.

          1. The point is to build up the straw man that we are so they can easily knock it down, failing that they say “free markets will never happen” so we should just give up and side with them because anything else is just being a corporate tool. Despite the fact that virtually any plan that passes is going to benefit the entrenched special interests at the expense of the population at large, because that is how government bureaucracy works. Maybe the government plan will benefit different special interests and hide those costs better, but it is still there. At least with the current reform plan young people and rich people are going to take it up the rear, and possibly old people but they have a powerful lobby. Young people have been robbed for generations to pay for SS and Medicaid.

            1. My bad I meant Medicare.

      2. My daughter goes to school in London and you register with a doctor in your neighborhood. “GP practice could decline you – for example, if live outside of the GP’s surgery area.” Better class of people? “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.”

    3. Some of that is because they use price controls to free-ride on US profits (which spur innovation that otherwise wouldn’t exist), and some is due to the morass of third-party payments that are not remotely based on free markets. Again, pointing out that the US system sucks is not evidence that government control is the answer.

      1. No, what we fund is the profits of BigPharma. And if you look at government funding of research on a year by year basis and compare it to private funding of research, what one finds more often than not is that the government is doing the foundational sorts of research, and to take the home metaphor further, BigPharma is putting in the window shades.

        Most other nations that again are civilized have tight controls and drive hard bargains with BigPharma. We don’t. That’s because they own our Congress and we have too many voices of propaganda bandying about “free enterprise”. Foolishness.

        1. Mitchell,”That’s because they own our Congress” May I add lock, stock, and barrel.
          “The industry fought, and won, a nine-year legal battle to keep congressional investigators from the General Accounting Office from seeing the industry’s complete R&D records. (See Section IV) Congress can subpoena the records but has failed to do so. That might owe to the fact that in 1999-2000 the drug industry spent $262 million on federal lobbying, campaign contributions and ads for candidates thinly disguised as “issue” ads. (See accompanying report, “The Other Drug War: Big Pharma’s 625 Washington Lobbyists”)”

          1. When you start taking one of Big Pharma’s drugs for your raging Herpes, I hope you eat a big hypocrite sandwich.

    4. Cost growth in OECD countries is remarkably similar, with a few outliers; over the period 1990-2007, seven OECD countries had inflation-adjusted cost growth numbers faster than that of the U.S., and one of them was the U.K., with France not too far behind.

      That is, the long view is that all these countries are headed for the same fiscal cataclysm we are, just at differing rates.

      1. “That is, the long view is that all these countries are headed for the same fiscal cataclysm we are, just at differing rates.”

        But they’re also starting from spending a lower % of GDP.

  30. Matt, what I don’t really get about your article here is that you’ve basically said that in France the price-system is actually more direct with people paying most of their basic procedures out-of-pocket, and that there is arguably more competition in France (and others have argued for Mexico, I see – though I don’t know anything about that)… And yet you proceed to consider their system “more socialist” than the US.

    Ultimately some of this breaks down to bad definitions and a poor general understanding of “socialism” itself. The question ultimately comes down to whether or not individuals, rather than a central authority of any kind are primarily in charge of their own medical decisions.

    As I – and many others – have argued countless times, in the US, it is largely the central authority which controls prices, payment, supply of medical goods & doctors, and what care is even allowable.

    The only difference is that the US does this more indirectly through regulation & mandates… Oh, the joys of Corporatism.

    But in either case, how is it that we’re considering France a “more” socialized system if people have more individual choice and the price system is actually functioning as it should (comparatively)?

    1. Sean — Consumers pay directly, but at prices that can’t possibly come anywhere near covering the cost of the treatment delivered. The socialism comes in robbing Peter to pay Jean-Paul. (And also in capping medical-industry salaries, and promoting a top-down culture of medical provision, and so on.)

      1. Ok, but this isn’t substantially different than the US in philosophical terms… We just use “private” insurance to act as a 3rd party payer to cover most of the costs. Obviously there are problems with this method as you discuss, but it’s just as top down, and considering the myriad mandates that government has imposed on the insurance world dictating the types of plans allowable – and the protection of their industry through restrictions on competition (interstate/international, obviously)… I fail to see how it’s any less “socialized” in the broader sense of the term.

        Granted, again, we could talk about the relative differences between fabian socialism and the fascist/corporatist varieties, but it’s really two sides of the same coin isn’t it? Government can control the supply of goods by “owning” all of them, or by mandating what private “owners” do. Either way, it’s still central control……… And last I checked, that isn’t a long-term solution.

        1. Matt’s not advocating a French system. He’s pointing out that our system isn’t really so free market, or desirable.

          In certain ways, as you point out, France incorporates more “capitalism” – at least by having patients pay out of pocket for more things than ours does.

          The interesting thing is that these low-level daily type medical expenses seem to be the MOSt free makret part of France’s system, and the LEAST free market part of ours.

          We have co-pays for checkups and prescriptions drugs. Which is indistinguishable from a subsidy when it’s provided by an employer, and the employer is induced to provide the insurance by a tax break.

          France subsidizes it’s drugs directly, and we fuck around with the tax code and the insurance mandates. Is our system really more “free market”?

          1. How many drugs does France develop?

            Nearly zero. So whatever system they have it doesn’t do much for innovation.

            1. I’m sorry to say JB but you’re an ignorant twit.


            2. Why yes, France (and virtually *every* developed nation) has some hand in drug & procedure development. So you may very likely be taking JB too literally Nixar.

              The real, important point, is where the bulk of the medical innovation comes from – and France doesn’t generally make the list:

              First, here’s Tyler Cowen in the NY Times on the topic.

              Second… I bring you the top 10 medical innovations & country(ies) of development:

              10 Most Important Recent Medical Innovations

              Sorry to say, France isn’t on the list. However, in 8 out of the 10, the United States is.

              1. Yup, according to the 2004 report about the US healthcare system made for the then US president who didn’t want to change a thing about said system — apart from giving hundreds of billions of dollars of tax payer money no strings attached to drug manufacturers.

                Anyway, we have a few things going here, such as the first face transplant.

              2. “10 Most Important Recent Medical Innovations”

                a) That would be far more persuasive if there weren’t so many countries on there with socialized medicine. Kinda negates your argument.

                b) How many of the US inventions came from NIH funding, ie, socialized funding, rather than the mighty hand of commerce?

                If France is lacking in medical discoveries, I suspect that may be due to general cultural issues, rather than the healthcare system. I mean, the country simply isn’t known as a hotbed of invention and entrepreneurialism.

        2. The main difference is that the socialized systems takes from the “have mores” and uses it to subsidize the “haves” and “have nots”. The Third party system expects the “have mores” “haves” and “have nots” to all pay based on their physical condition, not their financial condition.

          1. You forgot a bunch of steps in between… Like where the socialist systems have no way to rationally calculate resource distribution and thus waste or misallocate great amounts of wealth, and where the politicians skim a significant portion of money off the top – yet obfuscate that because almost no one is capable of actually seeing where their specific tax-monies are going, and also where the incentives for innovation, development and production disappear………..

            In short, you’ve forgotten the whole part of socialism being one of negative returns and tyranny rather than growth & freedom.

            That said, don’t misunderstand this point: the US system is every bit as socialist as anywhere else – we just didn’t do it the same way, largely because we didn’t have to, as most European nations did following the complete destruction they experienced during WWII.

      2. And btw: consumers paying directly (even if their payments are subsidized, a la food stamps) is still far preferable to 3rd party payers.

        Ultimately this has to come back down to the distribution of knowledge & economic calculation. Frace appears to make that more viable than the US simply by getting the consumer more involved – even if it’s ultimately not any more permanently sustainable.

      3. “The socialism comes in robbing Peter to pay Jean-Paul. (And also in capping medical-industry salaries”

        How much does medical school cost in France? Not having such ginormous loans to pay off would, I think, sugar the pill of lower salaries.

  31. Oh… Also, I feel compelled to point out the repeated riots and other issues that the French government endures each time they try to limit costs………. I mean, you do realize that the system there is no more solvent and no more economically sustainable than ours. Much less so if you get rid of the US’ contributions to medical technology (which will be happening soon enough, it looks like).

    1. Also, pray there aren’t any heatwaves in August, or thousands of people will die needlessly in hospitals.

      1. Yeah because our system doesn’t let people die needlessly from weather conditions. Just ask the residents of New Orleans.

        1. You’re comparing Katrina to a heat wave?

          Not even in the same ballpark. If a Katrina sized hurricane hit, say, the banlieus in France the body count would dwarf Katrina’s.

        2. A bunch of dumb fucking trash decide to live below sea-level in an area prone to hurricanes?

          Fuck them. I hope God sends a category 5 and drowns them all. I’m tired of paying for their lifestyle choices.

          1. I’m sure where you live isn’t naturally prone to any natural disasters whatsoever, right?

      2. As opposed to the thousands of Americans who die every year because of lack of healthcare.

        The French have a definite advantage. It’s easier to install A/C than to fix our clusterfuck of a system.

  32. You are comparing France to Kaiser? No wonder its better. If you want me to believe you, pick a real health care provider.

  33. Always looking for something for nothing. Except people like me, who are going to be paying for lazy liberals along with myself. If you think you are going to get something for nothing with monstrosity they have in the Senate, I have news for you.

  34. That’s all well and good, but something tells me that, Heaven forbid, if you or your wife were stricken with cancer and needed surgery, you wouldn’t be hopping on the first AirBus to Paris if you could find any way to arrange to be treated here in the US.

    1. I bet they would, to hide the fact that they have cancer which would drive up their premiums or get them kicked out of the policy.

  35. 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 (I’ll 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 doctor’s office has sent its third payment notice. By the time it’s all sorted out, you’ve 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 you’re done. If you need a doctor, it’s 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. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe ?300 for any one procedure.

    I find this remarkably dishonest. On the one hand Welch counts the cost of the prescription, the doctors visit and what his insurance company paid. Comparing it to just the cost of the prescription in France. Nevermind the cost of the visit and how much was paid via subsidies…that Welch free rides on since he lives here and doesn’t pay taxes in France.

    And it’s 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.

    Two questions come to mind:

    1. What would the Kaiser doctor(s) have done if the wife went back and noted the lumps were growing?

    2. What would the French doctor have done if he had done the first exam?

    The two situations are not the same so comparing outcomes, doctor’s recommendations, etc. is rather dishonest.

    What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine….

    Matt you dumbass, both the U.S. and France have private/public systems. Its just that the French do it better.

    Christ, get a clue.

  36. How does interstate competition help? Wouldn’t it favor the big companies who can conform to the differing regulations across different states?

    1. Much less than the current system.

      If insurers were competing across state lines you would be able to choose a plan that better fits your specific health care needs/wants or is cheaper, regardless of which state it was in. Currently, you must choose from a limited cartel of options all basically forced to offer the same services for essentially the same rates. This is where big companies really win – because they have a captive customer base and have only a few competitors to deal with at most. More competition may very well still favor “big” companies, but it gives the smaller guys more opportunity to actually compete provided that along with interstate competition, we stop mandating what gets covered.

      1. Its ironic that the feds can ban growing weed in your back yard, for your own consumption based on regulating interstate commerce.

        Yet they can also ban interstate commerce in insurance.

      2. Your insurer would relocate to the Northern Mariana Islands. And when you have complaints, you are perfectly free to visit them at their HQ

    2. The interstate competition implies that you could buy an insurance plan that didn’t conform to your state’s regulations, and still use it in your state. Thereby rendering the state regulations moot.

      1. And then you have a race to the bottom where all insurance companies move to the least demanding state. If we believe in decentralized government and federalism, then states should be able to say what kind of insurance they wish to have sold in their state and how to balance free markets with people being taken advantage of when buying a very complex product with lots of small print.

        1. Should states get to say what kind of cars we can buy too? Coming up next, Massachusetts rids itself of clunkers; it is only legal to buy Porsches. Or maybe just SUVs with four wheel drive, because everyone needs to be able to cart tons of stuff around off road in style. If we let young people buy cheap used compacts to drive to work, there won’t be a big enough market to drive down SUV prices for the average 40 yr old soccer mom! We have the interstate commerce clause for a reason.

          There’s nothing wrong with oversight to make sure people aren’t being outright defrauded, but it’s hard to say that someone is being defrauded because their state doesn’t mandate coverage for birth control, routine checkups, gym memberships and alcoholism treatment.

          Nor is it as “race to the bottom” to be able to buy a policy that isn’t community rated or that has some other restriction on underwriting.

          People don’t routinely by products that screw them, and every state has an incentive to prosecute outright fraud and trickery.

          The fallacy you are committing is assuming that all these state regulations are merely trying to protect the consumer from the big bad company, rather than a means to outsource wealth redistribution to the private sector while buying off various special interest groups.

          Almost every other form of insurance is sold across state lines.

          1. Exactly right.

            Why shouldn’t the consumer be allowed to choose a policy that doesn’t cover mammograms under 50?

            Anyway, if I want to sign a contract with someone in another state saying that if X happens he will pay me Y, why is it my state government’s business to stop that transaction?

            Talk about protecting people from themselves. We’re allowed to drink and smoke across state lines, buy buying insurance! *gasp* NEVER! The horrible, horrible, squalor and sinful temptation one could be led into by those LOW RATES! Buying insurance, it’s just like SHOOTING CRACK I tell you! People need the government to control this behavior, FOR THEIR OWN GOOD!

        2. Why is it that economic ignoramuses always use the term “race to the bottom”, when talking about liberty?

          Are they all really that retarded? There’s almost never a “race to the bottom” where actual freedom & competition is concerned because the companies don’t get to make the rules… Their customers do! The race is for who can give their customers the best deal at the cheapest price, but the deal has to be good. Companies competing in a free enterprise system compete FOR your business! That’s it… The only way they can actively do otherwise and still “profit” is by using government power to force you to pay them. Which conveniently, is exactly what they do now.

        3. Fuck federalism. State governments should not be able to infringe on individual freedom any more than the federal government.

    3. Dormant Interstate Commerce Clause FTW!

  37. I am in need of some help. Why exactly does the french system for example work better than the American. Better access for less cost? Is this some refutation of the law of supply and demand? How do they work their socialist majic? Is there a special government machine that produces desired services at a cheaper cost? What is the mechanism that will allow this to happen? Can the socialists be so dopey as to think that insurance companies are really so profitable that by eliminating such unjust profits our problems are solved? Can Matt Welch, MNG, Tony or the New Mexican explain this? Thanks.

    1. Instead of being a concern troll, Joe, why don’t you read the works of Ure Reinhardt, who has done detailed comparisons of the various systems. Or Arnold Relman, who used to be editor of the New England School of Medicine’s journal? Or maybe David Himmelstein, from Harvard’s medical school?

      You’ll find that your theories don’t work too well in real life in terms of which type of system really keeps down costs, and provides universal coverage–and where the wait times are far less than the propagandists want you to believe.

      1. Please go buy a clue.

        US health care expenditures and innovation subsidize a good portion of the world’s health care.

        Any study that doesn’t factor those in is full of shit…just like you.

        1. “US health care expenditures and innovation subsidize a good portion of the world’s health care.”

          So you’re willing to pay for the French? And not US citizens? People in the US go bankrupt over their medical expenses while the French can have the best healthcare in the world, have 30 days of holidays, travel all over the world. And you are paying for their luxury?


      2. You didn’t answer my question. How does it work?

        1. The same way Wal-Mart is able to dictate prices to their suppliers. Unlike Wal-Mart though (when you don’t like the choice or the price, you can go to another retailer), Healthcare Insurers (the retailer) and Healtcare Providers (the suppliers) have no incentive to get the best choice for the lowest price. Because both know that you will pay any price to get your life back. And you are forced to stick with the retailer anyway because no other retailer doesn’t want you anymore as a “customer”: you’ve become damaged goods.

  38. Matt Welch demonstrates a stunning level of ignorance:

    Both France and the U.S. have mixed public/private systems. The French just seem to be doing it better in terms of contraining costs.

    As for his anecdotes I find them rather lame. In the prescription one he compares the following U.S. costs:

    Doctor’s visit
    Insurance companies payments

    To the French cost of:


    No kidding one is lower than the other.

    And never mind that Welch is essentially free loading off the French system. He lives here in the U.S. and pays taxes, but goes to France to get much of his health care and not pay the taxes there. Truely and ugly American.

    1. Actually he pays French taxes too. Matt Welch is a beautiful American.

    2. Cost of a doctor’s visit in France: ?22

      That’s WITHOUT insurance. With standard insurance you get reimbursed ~?14. With complementary insurance, all but ?1.

      Yup, ?22 *without insurance*. Without any subsidy. You can hope in a jet, come here, go to the doctor, pay ?22.

  39. refused to cover pregnancies or childbirths at any price

    Oh for God’s sake. Of course, why would you insure against something actually try to do. Do you have car insurance at a demolition derby? Do you have insurance for oil changes, replacing tires, and other items that routinely wear out? No and no.

    Really dude, get a freaking clue. Learn what insurance is. Here is a hint it isn’t the current health insulation we currently have.

    Or TL;DR–Matt Welch the sometimes libertarian…but only when it doesn’t cost him too much.

    1. You’re right on, Steve. Insurance, and the overuse of it, is just as much a part of the problem as government intervention. Go to the doctor whenever you get a sniffle and slap that insurance card down. One size fits all. What in the hell does insurance have to do with child birth? If you want to have a child, save some money. Think about the carbon footprint that little bastard is gonna have – breathing in and out all the time. The next thing we’ll have is college tuition insurance, just in case.

      I had a customer service representative for satellite television trying to sell me a $5.99 per month maintenance plan so that “in the event” I need a service call, it would cost me $29.99 instead of $49.99. What imbecile would do that? It’s pervasive and rampant. Instead of a warranty and standing behind products, now we have extended warranties.

    2. I didn’t find anything un-libertarian in Welch’s piece. He says the French system is better than the current U.S. hybrid, but he doesn’t say it would be better than an actual free market.

  40. Au contraire, Kyle Roberts! My wife earns most of her income in France, and we are more than duly taxed in both countries, thank you very much.

    Really? You pay taxes in France too? I doubt it. Your wife isn’t the free loader, you are.

  41. Does your wife have a reasonably attractive and unmarried younger sister?

  42. An intriguing post and an enjoyable discussion.

    I’ve been wondering whether some new purely free market options can be launched to reduce insurance costs and save lives without putting new cost burdens on taxpayers.
    Appreciate comments/responses on the questions below —

    1. Is it possible for individuals who adhere to healthy lifestyles to self-organize and negotiate group health insurance rates?

    Adherence to healthier lifestyles could yield enormous savings for insurors and for the health care system in general.

    An immediate question would be how insurors might confirm adherence to healthy life habits. Part of the answer could be a contractual agreement to post online diet/exercise diaries (e.g. semiprivate Facebook postings shared with friends), uploaded photos, and agreement to (rare) spot checks by the insurance companies.

    Do any legal/regulatory barriers keep people who adopt healthier diets and habits from self-organizing to purchase affordable health care policies on a group basis?

    2. Can Safeway-style group health insurance innovations extend beyond employees to include committed customers?

    Safeway’s plan, as recently reported on NPR, delivers big rebates to each employee whose health checkups confirm that they have dropped weight (or kept weight off) to ensure a body mass index below 30.
    Whole Foods, Safeway, and other firms might expand access to their employee group health policies to include qualifying, loyal customers. In doing so, the grocery chains could expand market share by bringing better coverage to now-uninsured or under-insured individuals and families who qualify.

    The amount of the savings offered could be linked to patterns of frequent (healthful) shopping, low Body Mass Index, and commitments to keep diaries of exercise as per #1 above).

    3. Can the discounted health policies offered by some universities to their traditional alumni (e.g. Tufts University’s group policy) be extended as well to new kinds of alumni markets, such as graduates of distance learning courses?

    For example, individuals and households that complete a (fee-paid) online Tufts course on healthy living habits might become eligible for entry to a high deductible group health insurance plan.

    The extent of their annual cost-savings in premiums could hinge again on digitally documenting adherence to the insuror’s ietary/exercise guidelines.

    4. If US health care further buckles under the weight of its dysfunctions, can overseas solutions reach large numbers of people here?
    Already, as noted in some of the comments, health tourism is becoming a vibrant industry for Mexico, India, Eastern Europe, Brazil, and other locations. Tata (among many others) has begun offering remote consultations and radiology services.

    Hard-pressed insurance companies in the US are reported to be actively looking into ways of encouraging their customers to access overseas healthcare solutions.

    Conversely, overseas insurors might be in a good position to offer affordable health care policies — with a blend of onshore partnerships for urgent care, and offshore health care provision for what are now very expensive, non-urgent surgeries.

    Such offshore insurance solutions might prove to be especially in expenses in cases where they could target low-risk groups that made dietary and lifestyle changes like those in 1-3 above.

    Hopefully, by virtue of their offshore domiciles, they would not be as constricted by any archaic, cost-boosting regulations such as North American insurance companies now face when writing group policies in some US states.

    What do you think?


    Mark Frazier
    @openworld (twitter)

  43. Ok, I stopped reading after the first six paragraphs. What is the authoring comparing his experience in France to? He never paid more than 300 Euro (that’s about $450) for any procedure. Jesus. I nor the mother of my children (worked so as to emphasize she’s given birth, 4 days in the hospital) have never paid more than $30 for anything. Ever. This author paid $450 or so for what, x-rays? an ear examination? Are you serious? Maybe minor oral surgery, which, is not what’s being debatted here friend. Our dental system, sucks, agreed on that front. But we’re not debatting dental care reform. This whole paragraph was meaningless and did not to advance the cause for gov’t run healthcare other than confirm for me what I’ve always known and seen in other countries.

    Doctor visits. In France, 3 day wait, here, 5. Oh my God, what a better

    Ok, what the hell is wrong with this guy’s getting Rx? I’ve never had to go through the nonsense he talks about. My doc calls the pharmacy, I go pick it up (when my refills expire, which is usually one a year, at worst). I have an annual check up and adjust everything at that time. I mean, seriously. And besides, in some instances, you should have to see a doc before getting your meds.

    This author was comparing some freak experience in the US to an experience in France that doesn’t hold a candle to what I’ve had here in the US since I was a kid, and I’m by no means well off. Rather than convince me of otherwise, this piece only served to reinforce my beliefs.

  44. Welch is definitely right that the French system is better (all things considered) than America’s bastardized hybrid system. The US system is first in the world for some people, but a soulkilling headache for a lot more.

    I think mostly this could be addressed through market reforms, though.

    1. I meant to add that Welch’s argument from anecdotes is a really shitty form of journalism as well.

      1. Well, I know this guy who finds argument from anecdotes highly persuasive.

  45. The socialism comes in robbing Peter to pay Jean-Paul.


    An American expat friend of mine, married to a French woman and living in Paris, was bragging about their “free” health care – minutes after complaining that he paid 65 percent of his income in taxes.

  46. Matt, I do want to congratulate you on bucking the party line. It is very rare to see a libertarian deviate from its ideology.

    Our system is a mess, and needs radical overhaul. After Obamacare passes, we will go from having the most right-wing health care system on earth to having….the most right-wing health care system on earth. It will still suck.

    1. Matt Welch’s article is akin to a Jewish libertarian living in Nazi Germany singing the praises of Stalinism. Pointing out the fact that Stalinism is better for Jews than Nazism doesn’t necessarily equal a ringing endorsement of Stalinism.

      BTW, our current health care system isn’t “the most right-wing health care system on earth”, it’s the brainchild of the various special interests that render our government as functional as 18th Century, pre-partition Poland. Seeing as Democrats are just as beholden to their own puppeteers as the Republicans are, don’t expect to see the “change” you were duped into believing…

      1. Joe, other than violating Godwin’s Rule, your analogy is wrong.

        Welch lived in France and lived with the system, and it worked for him. You’re saying he is akin to talking about Stalin’s system while living in Germany.

        Watch those analogies, brother.

        1. Its not a Godwin if it is an accurate analogy. He’s not drawing some moral equivalence between socialized medicine and Hitler.

          To make a similar analogy without Hitler, its like a feminist saying she would rather live in pre women’s suffrage America than live in present Saudi Arabia. She’d probably still rather live in a society that respects women as equals.

          Of course Chad would have told her in that women’s suffrage would never happen so she shouldn’t fight for it.

    2. Chad, you do realize that you’re by far the most ideological hack most of us have ever encountered right?

      1. He is pro life and better on economics than the average progressive, but thats not saying much. He was willing a while back to cut corporate tax rates a bit and favored a carbon tax over cap and trade shenanigans. At least I believe so, and I hope that maybe he realizes that corporations only pass costs of taxation on to customers and that their employer contributions are really just another form of wages.

        There are much worse than him around. I just wish he would be a little more honest about his ideology and desire for wealth redistribution, rather than try to hide his ideology behind fallacious economic arguments. At least I haven’t seem him touting the public option as “choice and competition”.

        1. I’ve seen a lot as bad as that.

  47. I have devised a cunning plan to get universal health care in the United States:

    First, we’ll declare war on France.

    Then, and this is the tricky part, **WE** will surrender to them before they surrender to us – the timing will be critical, because the window we’ll have to surrender will probably be quite small.

    If we time it right, we get socialized health care for all. French food may be a deal killer, though – I guess we can’t have everything.

  48. Dear Matt, you are probably the reason that Reason is a worthless rag.

  49. Dear Matt, you are probably the reason that Reason is a worthless rag.

  50. well, kinda hard to relate to this mamma’s boy’s description of health care.
    so when whiny Welch didn’t really need any help (except maybe a massage plus happy ending or a suck on mommy’s tit), France was good to him (no surprise). Now that he’s older & might actually have health problems, he prefers the American providers. What a f’n wuss…oh, and by the way the way did anyone not know that Welch’s wife was French? Cause he’ll repeat it for you if you want. Apparently it’s the one big hoot of his life.

  51. Welch, the problem with your point of view is you’re looking at the American system from its worst possible aspect, which is in its cost, its convenience, and in its treatment of minor ailments and routine wellness. Without doubt, the annoyance of getting a throat infection taken care of, or getting your allergy meds covered, is a giant pain in the ass.

    But so what? Honestly, this is trivial stuff in your lifetime of taking care of your body and health. When you reach an age at which serious illness becomes possible, you’ll realize these are trivial burdens. It’s like the burden of having to fill your car with gas in order to drive it.

    If you look at the American system from the important and life-critical end, as in what happens to you when you are really sick or badly injured — then things really turn around. Then you’re looking at the system where it really shines.

    A few anecdotes of my own, then: my 10-year-old daughter had a skiing accident in the mountains of Southern California, just like the one that killed Natasha Richardson up north a few months ago, because Toronto decided air ambulances were a wasteful extravaganza for the small use they got. But here in the evil ol’ expensive US, there was an air ambulance standing by, no doubt sucking up the precious health-care dollars of twentysomethings who just wanted a prescription for penicillin for the sore throat, dammit. That chopper was landing on a mountain road and then transporting my daughter to the trauma ER — 90 minutes drive down the mountain — in less than 15 minutes. What’s daughter’s life worth? A lot more than the $2,500 I paid for that flight.

    A good friend of mine, in his 50s, recently came home from work with a terrible headache. His wife convinced him to go to the ER. They had a CAT scan machine standing by, driving up the cost of ER care, so that college students who come in for a broken toe are charged $50 for a handful of asiprin and $500 for a simple X-ray — outrageous!

    But that CAT machine, “wastefully” located in a local hospital (and not “efficiently” at some regional center), diagnosed a brain bleed in my friend from a previously-unknown AVM. Since the local hospital lacked top-notch brain surgeons he was airlifted within the hour to UCLA Medical Center, where a superb neurosurgeon sealed off the bleed and saved his life without any lasting damage at all.

    Then finally there’s my partner, who was diagnosed with breast cancer three years ago. In this wasteful United States, we have some really cutting edge biotech. In her case, a company in San Francisco, which makes “obscene” profits I am sure, in order to be able to hire the best PhD biochemists in the world, sequences the DNA of breast cancers and tells you whether you need chemotherapy or not. She did not.

    I don’t know if you know this or not, but chemotherapy makes you very sick. Not to mention it can have permanent effects on your heart, liver, and mental function. What’s it worth for a 44 year old to avoid mild brain damage as part of the price of cancer treatment? A lot more than the $3,000 we paid.

    So if you look at it from the end where the medical rubber really hits the road — where lives are actually saved — and not from the fairly trivial side of keeping yourself in tip-top pristine smelling like roses condition, you would see the American system at its best. And I should say it’s not just anecdotes. Plenty of people have shown that the cold statistics tell the same story. Your outcome for serious disease in Europe is statistically similar to the United States circa 1975.

    Your point of view seems fairly typical of young and healthy people, who have had no real experience with serious disease, and who can’t understand where all the money goes. You will understand, someday, when you’re one of those on whom the money is spent. You could get a jump on that now by talking more seriously to folks over 50.

    In some ways you can make an analogy with American education, which suffers similarly. We have awful primary and high-school education, which is why we end up way down the list on international student scores. But our graduate educational system is second to none, leads the world. It’s similar in medicine. Our routine care is awful, frustrating, expensive, stupid. It’s our life-critical care that is top-notch, second to none.

    What you say about the pain of having insurance tied to a job is right on, of course. Believe me I know, and even better than you do: my partner cannot stop working, even briefly, because no one will sell individual medical insurance at any price to a cancer survivor. She is locked in to a job with medical benefits until she qualifies for Medicare. But as you know very well, that is a direct result of Congress interfering with the market by making health-care premiums tax-free for employers, but not employees. That is a failure of government, and a rather spectacular one at that. Only deranged hyperoptimists believe that the cure for one fantastically awful government screw-up is to give yet more power and responsibility to government. Might as well think that if a doctor misses the spots on your X-ray and you get cancer, the right thing to do is go back to the same doctor and ask him to treat the cancer.

    1. Carl,”because Toronto decided air ambulances were a wasteful extravaganza for the small use they got.” The accident took place in Quebec and Natasha Richardson refused medical care. It is quite possible her death could have been prevented but it was her choice to take a chance.

    2. “But as you know very well, that is a direct result of Congress interfering with the market by making health-care premiums tax-free for employers, but not employees.”

      So you think if the tax law was different any insurance company would be willing to insure your wife? The employer tax break status and the group it creates is the only reason your wife can get insurance of any kind.

      1. No she could have kept her private insurance throughout her working years, *gasp* paying premiums out of the wages she earned to *gasp* a company of her choice.

        That said I think Carl and Matt would probably agree on the best solution. Although buying prescription meds over the counter really doesn’t depend on whether or not a system is socialized.

        I’m not sure that the 50 bucks an asprin is going directly to funding the top notch care, we could have that good care and cheap asprin if we followed a free market system. Its more likely it costs that much because the 30somethings with subsidized comprehensive insurance from work have no incentive to dispute such a ridiculous cost. Or because government forces charity on hospitals via EMTALA, and doesn’t pay the full costs and delays payment for Medicare and Medicaid patients. The latter being much worse than the cost shifting from the uninsured.

      2. “The employer tax break status and the group it creates is the only reason your wife can get insurance of any kind.” This statement nails it on the head. The truth is insurance companies do everything they can to deny coverage and they sure as hell are not going to become benevolent when they are just up against the individual.

        1. They deny coverage because the state mandates that they charge lower rates to high risk people.

          It is the universal effect of price controls throuough history. Cap the price of milk, and dairy farmers will stop producing it – because they would go out of business if they keep selling at a loss. Cap the price of insurance for high risk individuals, and insurance companies will stop selling it – because they will lose money otherwise.

          Always and everywhere, price controls cause shortages.

          Remove the price controls, allow insurance companies to charge high-risk individuals more, and they will start catering to them.

          1. We can agree that they determine what is high risk and perhaps you can agree that it does not always make sense. Companies are already allowed to charge high-risk additional fees but more to the problem they can exclude certain pre-existing conditions. How are they to receive medical care if not for government regulation or single payer service?

            1. The employer tax status is not the only reason that woman had coverage, if she had been able to buy an individual policy without paying vastly more than the employer policy she would have coverage not dependent on her job.

              If she dropped coverage and then got cancer she might have trouble finding a new policy, but assuming she/her husband has been steadily employed long enough and earning enough to continue to pay the policy’s premiums she would still be covered. From the story that assumption seems reasonable.

              While there is a reputation effect for dropping customers, people will switch companies if they see that going on; and the government is around to enforce contracts. I guess auto insurers only pay claims because people get it from their employer and their employer goes to bat for them, oh wait…

              How much incentive does an employer have to go to bat for one employee anyway? Could the lack of alternative choices possibly be the reason why companies can get away with dropping coverage while insurance commissioners are too busy setting prices?

              We don’t live in a static world, you can’t just assume current prices and problems with our mixed system would exist in a free market without making an argument about why they would. We don’t see these problems in areas where insurance is competitive, and there are logical arguments about why those problems wouldn’t arise under such a system.

              It’s really not that hard to understand once you open your mind to something beside progressive orthodoxy.

              1. Tim, “While there is a reputation effect for dropping customers”. (I am guessing you are joking) “We don’t see these problems in areas where insurance is competitive” The question begs why? Well, perhaps it is because they have many people in a group and the percentages work in favor for large groups. How will this work with individual coverage? It won’t.

                1. Auto insurance isn’t sold to groups, it’s sold to individuals and families. Your boss doesn’t give you auto coverage. If one of those companies started screwing people over, people would stop buying it. It’s not in the little Gecko’s interest to shaft customers; because soon he won’t have any since people can go to other auto insurance providers.

                  The only place we see some of these problems is where insurers have captive markets, i.e. health insurance. People can either buy an expensive individual plan while sacrificing a good portion of their wages, or take whatever their employer gives them. How do you not understand this?

                  The current health insurance system is not competitive. If it was, people wouldn’t buy from companies that routinely shaft customers.

            2. Why shouldn’t insurance companies be allowed to exclude pre-existing conditions?

              You can’t buy insurance on a car that is already damanged and expect the auto insurance company to fix it up for you.

              If these is anything that needs to be fixed, it’s the fact somehow insurance companies are allowed to stop paying for treatments for existing conditions. Or rather, that you’re expected to keep paying premiums, AFTER you already have cancer. IMO, we could fix the majority of the “pre-existing” conditions issue, by forcing previous employment-based insurance companies to keep paying for “existing” ones.

              1. Hazel,”we could fix the majority of the “pre-existing” conditions issue, by forcing previous employment-based insurance companies to keep paying for “existing” ones.” I know that you must never have owned a business but that would be a logistical nightmare for any size company. Surely, you don’t mean that your employer would continue to pay a percentage of your health care after you are no longer employed. Cobra is the solution most people use as gap insurance and it is a nightmare and expensive.

                1. No, she means that insurance companies you paid premiums into to pay for you if you got cancer don’t get to stop paying for them because your boss switched providers or you switched jobs. She’s not talking about what the employer does at all, try actually reading and thinking about what she wrote; I know that’s something foreign to you.

                  “If these is anything that needs to be fixed, it’s the fact somehow insurance companies are allowed to stop paying for treatments for existing conditions.”

                  Where the fuck in there does it say anything about an employer continuing to “contribute” to your health care costs after you switch jobs?

                  It would be like if you switched auto insurance companies and they got to stop paying the entire cost of the accident that happened on their watch.

                  Do you have an education? Or critical reading skills? You consistently misinterpret what we say and don’t understand what you are talking about.

                  1. Tim,”She’s not talking about what the employer does at all, try actually reading and thinking about what she wrote; I know that’s something foreign to you”. Perhaps comprehension is your problem. Hazel, does not seem (and neither do you) to know that your employer is paying a percentage of your healthcare. When you leave a company you receive certificate of creditable coverage and some protection under the Health Insurance Portability and Accountability Act but the fact remains you are no longer in the pool and your costs and share rise dramatically. The fact insurance companies dump you when you become costly is the main issue that leads me to vote for public insurance.

  52. Welch’s wife: “Can you cool it with the ‘my wife is French shit,’ ca commence a etre un peu degradant pour moi”
    Welch: “yeah but you’re French and you’re my wife..I just love hearing that.”
    Welch’s wife (actually closer than him to being a ‘real’ journalist): “bon, tu fais chier maintenant, I’m not you’re prop, how many of your friends with Asian, African, South American wives saoulent les gens avec ca comme toi?”
    Welch: “Je sais mais I married a FRENCH woman”
    Wife: “Vas te faire foutre, pauvre connard, le canape t’attend”

  53. It’s increasingly clear that the central problem with the US healthcare system is employment-based insurance.

    Most of the problems you’ve described are in one way or another a product of that system. Either through the bureaucratic opacity that presents to the patent, or by the way third party payment incentivizes cost inflation.

  54. Dude, I don’t know what place you’re going to for a doctor’s visit in the US. I’ve had insurance my whole life and if I’ve needed muscle relaxants, fungal creme and an inhaler for either myself or my children. In all 3 instances I saw a doctor THAT same day. No wait…when I threw my back out, I saw the doctor the next day for muscle relaxants. And I don’t know what part of the US you’re in for paying your bills either. I paid an office visit co-pay and that was it, but that is bc I only go to preferred providers on my plan, which is almost every doctor in our city. My experiences are not unique either.
    I have heard it is hard to get insurance, but next time try I got health insurance in between jobs much cheaper than cobra.

  55. Got a new idea …

    How is it that states are able to prevent one from buying insurance across state lines?

    Couldn’t you simply collect the bills and send them to the insurance company and get paid directly by them? If the insurance company isn’t paying the hospital, but YOU directly, how can the state prevent you from taking out a policy, or getting paid by them?

    1. “How is it that states are able to prevent one from buying insurance across state lines?”

      Sounds nice and simple right? But maybe it’ll turn out like credit cards, where the cards all move to the state with the loosest regulations, then they jack the interest rates up, etc.

  56. OH wait…better things about France–45% payroll tax.Income tax of up to 50%, 5% tax on food and 20% vat on items….does that make your cheap office visit worth it? AND a 35 hour work week, but they say that isn’t working bc people are cheating and working more w/out pay. Those pesky hard workers.

    1. For the included benefits, that looks like a bargain to me.

      IMO France does not get enough respect in the industries that companies there excel in. (Like munitions sales)

    2. “Income tax of up to 50%”

      What was America’s top tax rate in the 1950s?

  57. I am so sick of arguing with dumb ass conservatives about this issue. Too much right wing fascist radio in your lives. Government is good for you. It is not out there to? control you. It’s just trying to make our lives a little easier. Taxes are necessary. I hate to pay them too but that’s the price you pay for the commons. If you don’t like this arrangement, move to Somalia. No rules, no regulations, no government pure freedom

    1. War is peace.

    2. Wow, a boring troll. How novel.

      1. You Right wing idiots are so desperate to block people from having health insurance? they resort to this crap? Fuck you!!! You stupid right wing idiots!!!!! You don’t even know why you’re opposing this thing!!! Government takeover!!??? So What??? Take it over government!!! I NEED health care!! I am uninsured!!! If I get sick, I’m fucked!! And there’s 40 million others!! I HATE Libertarians! this is personal!!

        1. Shorter Penny Lane: “I want you to buy me stuff!”

        2. This is not a right wing website douchebag. Go back to Daily Kos and talk about how you want the government to wipe your ass for you as well (because you might get paper cuts if done improperly).

        3. Well, considering I HATE socialists, I suppose we’re even.

          Fortunately, we libertraians own more guns.

        4. d’oh.
          I suspect sarcasm/troll, but if not,

          Libertarians Right Wingers/Republicans/Conservatives

          Read more until you figure out the differences. If you look at most 2D political position graphs libertarians are more “up”, than left or right.

          1. I had a greater than, less than between libertarian and Right… guess it got filtered.

            libertarians != Right wingers etc…

    3. All government, all the time, in every hole.

      I would love to see that 2 foot government-issue razor-blade dildo shoved up your ass.

    4. Step 1: Learn that we’re not conservatives here and you’re talking out of your ass.

      Step 2: Learn what the word “fascist” means before using it.

      Step 3: Learn that Somalia has a shitload of government in that it is essentially a kleptocracy where you have no right to own property and very little protection of even your life itself – whereas government routinely seizes the products of your labor and agents of that government routinely murder & rape regular citizens.

      That is, last I checked, the *opposite* of “pure freedom”.

      Also, special bonus step: Quit using Beatles song titles as your handle. It’s incredibly lame.

      1. Fuck you, you fascist pig!!!!! Learn what true freedom and love is you fucking retard. You can start by putting Atlas Shrugged down and picking up real books like Communist Manifesto and A people history of the US. Or you can buy a one way ticket to a third world country so you live out your libertarian fantasies. Fucking Douche bag.

        1. I have read both, thanks. I’d steak a rather large wager that volume of books I’ve read in my life exceeds yours by a multiple of 10, including, and possibly most especially on history… Zinn’s book is one of the weaker ones of that list.

          Oh… And I’ve traveled all over the world, including to the developing parts of it.

          Try again, troll.

        2. hmm… *stake*

          Also… Again… Learn what the word “fascist” means. Then realize it is literally the opposite of what libertarianism is about. Also realize that it’s really fucking close to what communism is about.

          Here, let me help educate you:

          Nolan Chart

  58. As I interpret Welch’s argument, moving towards a single payer system in this country can be compared to amputating a gangrenous leg: Amputation is surely superior to having gangrene, but that’s not a statement about the value of having a healthy leg in the first place (clearly preferable in my mind).

    I, for one, would prefer to have a healthy and functioning market system in place in this country, as opposed to the gangrenous mess of government meddling we have now.

  59. Milton Friedman had some pretty interesting ideas on all this fifty years ago on “Capitalism and Freedom”. To him, the main problem is federal licensure instead of just certification for the practice of medicine. He claimed it would drive down prices because only the extremeley rich would go to the “cadalac” doctors for everything and that most would go somewhere cheaper for the stuff that takes less skill and is less dangerous.

    1. Fiscal Meth, one cultural observation or question: Are you under 30?

      “Cadalac” is actually “Cadillac”. It refers to an American originated automobile and was seen, back in the late 1950s and 1960s, as the premium, best made car. To say something was the “Cadillac” of something was to give it the highest compliment.

      Your misspelling of the term and putting it in quotes is one of those cultural barometers where people lose the original meaning of a term over time. I’m not saying you are ignorant, however. I am saying you are probably too young to have simply recalled the original meaning of the term Milton Friedman may have used orally and your attempt to reconstruct it for understanding.

      As Spock would say in Star Trek, “Fascinating.”

      1. Way to use an ad hominem in a poorly conceived attempt to undermine a paraphrase of Friedman’s arguments.

        Is this what’s left of the American Left? Sloganeering, Brownshirts and empty posturing?

  60. This really is to late to comment on, but…

    The thing about health insurance, is that there is not enough risk and unknown to make it sensible. In the long term I can make a statistical guess as to if you will crash a car.

    But I can do a genetic test and look for patterns, and probably tell exacly how much care you will need. That means what I charge isn’t a broad insurance, its a specific will my covering your minor ailments be worth enough $$ to me.

    1. ALL insurance ultimatly makes money that way. By definition, they calculate the expected cost of illness for a particular group of people, and then they break that down into average monthly payments, and charge you slightly more than that.
      The only difference is that now they can track more risk factors, and hence break down the risk pool into more variations and charge them different rates.

      All insurance basically makes money off of people’s risk adversion – you trade off an uncertainty (risk of cancer) for a guarenteed loss (monethly insurance premium). And you’re willing to pay a little more for the guarenteed loss than your average probable loss otherwise.

      1. What? Someone who understands what insurance is? She’s dangerous. 90% of people don’t know how insurance works, thats why even the Republicans support crap like guaranteed issue and comprehensive policies.

  61. Libertarianism: Fuck you go die you poor piece shit
    Socialism: Everybody takes care of each other resulting in better and longer lives

    Which one would you choose?

    1. Ah yes, that tried and true socialism under which, in case after case, everybody ends up taking care of eachother resulting in better and longer lives. You’re silly dude.

    2. Yep, those are the real arguments too, not just stupid strawmen that a intellectual infant came up with because he didn’t understand what the adults were saying…

      La Muerte is truly a knowledgeable, intelligent & unfailingly honest individual.

    3. This kind of socialism works in Amish and other strongly religious societies, which value work highly and have very effective societal countermeasures against freeriding.

      Everyone else is better with self-interest.

      In my country, 41 years of socialism led to the fact that Penicilin was hard to get (in 1989). Pre-socialism Czechoslovakia used to be one of the most developed countries in the world, btw…

    4. This kind of socialism works in Amish and other strongly religious societies, which value work highly and have very effective societal countermeasures against freeriding.

      Everyone else is better with self-interest.

      In my country, 41 years of socialism led to the fact that Penicilin was hard to get (in 1989). Pre-socialism Czechoslovakia used to be one of the most developed countries in the world, btw…

    5. They also hold hand and sing songs amid fields of endlessly blooming flowers. Or so I’ve heard.

  62. Matt Welch,repent for your sins or I will cast thee into the pit of hell!!!!!!

  63. In korea most people have sensible healthcare (called “citizen healthcare insurance” or something like that, loosely translated), and Matt Welch’s experience is typical for them. Getting medicine from the pharmacy (you get a free yogurt drink sometimes) and visiting doctors can be routine stuff.

    On the other hand, they have to pay for SOME things out of their own pocket. A homeless man without a penny can’t barge into a hospital and receive dozen services. Hospitals can reject you in some instance, and (apparently) even kick you out if you can’t make payments. That’s potentially a downside in that healthcare format.

    Here in US, we pay for almost everything. My pharmacist friends often marvel how seniors can buy pills that cost 100 bucks for about 4 bucks. Guess who pays for remaining 96? Some people hoard boxes and boxes of medicine that they never use. Medicare gave my grandmother who passed out momentarily a brand new wheelchair, even though no one asked for it, and she walks by herself just fine.

    You need to take insurance out of some equation, which (as I understand) was the libertarian position from the very beginning. IF you want more government involvement, then you have to expect them to say NO on certain instances. But I don’t have much confidence in the American government to do so. I don’t see them effectively controlling doctor’s wages, hours, and other costs, because election years – those things are pesky. The unions, consumer advocates, and other special interests will come into play. This is a country that pays fully salary to suspected pedohpile teachers in a “rubber room” to do nothing.

  64. There’s also the wussy-factor to consider when surrendering to the (post-Waterloo) French…

  65. Question: I understand that in France, Denmark and other socialist European countries, people pay high taxes but benefit from generous government programs. The question: In these countries, do the higher income earners / higher tax payers also benefit from the generous programs? – or are they ‘means tested’ out of the programs like in America?

    1. The programs benefits to everyone.
      At the beginning of the financial crisis, there was even some ruckus because French financial advisors (or whatever the title was) who were working, and who were really well paid, in London were able to receive a good amount of money from the French state once they were fired.
      An example : the fees for public university is very low (compared to the USA), and it’s true for the poor and the rich (for those who are wondering : the best French universities are indeed public).

  66. Janie,

    They are universalist, which means it does not matter whether you are rich or poor. Means tested is how the US often does its government programs, and that is why they are so….mean.

    Robert Kuttner, in his book, “The Economic Illusion” (1988), had the best explanation of why universalist programs work most efficiently and best when compared to means tested programs (not all the time, but most of the time).

    Amazing that we finally have someone actually asking empirical questions here…Thank you Janie.

    1. Have you ever heard of the concept of moral hazard? Is it not a problem to say to people: we guarantee you a place to live, food to eat and healthcare. All you have to do is breathe. Won’t you, on the margins, encourage dependancy where none would have existed without the incentive?

      1. If you had the choice between
        a/ not working and living a shitty life, without being able to afford anything
        b/ working, living a better life and being able to affort hobbies, making gifts to family and friends, going out
        What would you choose ?
        I’m quite sure you would choose b/, just like everybody else.

  67. Interesting article. While I may not agree that socialism is anymore attractive due to the flaws in the current US health industry, I can say I agree that most of your points need to be addressed by whatever system is in place when the dust settles on this issue.

    I’m hardcore free market, and I believe there are strengths and weaknesses to our current system, things that are idiosyncratic to the U.S., that should be utilized. The sad part is I’m not seeing any of that happening. I even wrote about it in my blog, sent letters with my ideas to my Senators, etc. I’m just not sure what else to do.

  68. Let me see if I understand your argument:

    The single-payer, third-party socialized French system (which is going bankrupt) is preferrable to the multi-payor, third-party socialist Americam system (which is going bankrupt) for low-severity care. Okay, I’ll except it, but so what? Is there a better solution available? Why are we presented with this false choice between different versions of socialized medicine?

  69. The reason countries like France can afford such health care systems is because they are not heavily populated and have first world economies that can afford them.

    The U.S. has a sinking first world economy and too large of a population to afford Obamacare as it is currently proposed.

    The alternative is to allow regional state co-ops to provide health care for individuals that do not have or can afford private-for-profit health coverage.

    There are already such local co-ops in existence. In San Diego County for instance, the cities of Oceanside, Carlsbad, and Vista operate Tri-City Medical Center.

    We pragmatic liberal libertarians are not opposed to government providing those essential goods and services that the private sector cannot provide at a reasonable cost, as efficiently, or not at all, and health care is an essential service that is not always available at an affordable cost when provided by the private sector.

    1. “The alternative is to allow regional state co-ops to provide health care for individuals that do not have or can afford private-for-profit health coverage.”

      Not a bad idea, but in a dysfunctional state like California that already has to deal with illegal immigration (state population roughly matches Canada’s entire population) and other bad spending, a statewide co-op might just bankrupt the place (I already take advantage of poor man’s obamacare programs in LA).

      Ideally a government sponsored healthcare should only fully cover the poorest of the poor. Or they should cover everyone, but expect them to pay some things out of their own pocket to keep cost down. America will probably fail on both counts. Medicare is already costing us a pretty penny. This economic crisis was caused by lax lending policy that was meant to boost home ownership to the poor and minorities.

      Our government loves to give and spend in the name of social justice, and most of the population (300 mil, ten times the size of Canada) have a bloated sense of entitlement. We’re spending a ton on two wars, defense, stimulus, public education, welfare, etc. 50 states (many of them big enough to be a country unto themselves) spend all on their own, and other smaller countries probably don’t have to deal with such things.

      You don’t have to be right winger to predict that, Obamacare will end up costing us much more than original projections, cover more (unneccesary) things, and ultimately fail to end the perennial “only the rich gets the best healthcare” whines.

    2. Medicaid already covers most real poor people, like half the uninsured earn over 50k; while one can buy some really affordable plans in states where such plans are legal. The rest are temporarily between jobs or illegal aliens/new immigrants. I don’t want to kick em out, but I don’t feel particularly obligated to pay for their health care. Unfortunately the price controls on Medicaid are so harsh that many doctors don’t participate, and it still gets routinely defrauded.

      Medicaid is already part state part federal, and if we have any such welfare programs they should be administered by states or municipalities, because such entities are easy to leave if they screw stuff up, are more responsive to the people they serve, can serve as laboratories of democracy providing examples to imitate or avoid, and benefit from regulatory competition that will drive them to provide such programs that really are public goods but with waste squeezed out.

      Pragmatic libertarians support government providing goods the market can’t provide due to real market failures, providing that associated government failures don’t make things worse. For example there might be social costs to people doing drugs, but nowhere near as much as the costs of prohibition in destroyed lives and wasted money. Markets don’t fail though because some people can’t afford shit, and the current reforms aren’t directed at those truly poor people anyways. They are designed to buy off middle aged middle class voters at the expense of the rich and the young because the rich don’t have enough money. They might “screw” old people too, but that assumes that old people are actually entitled to all that Medicare spending a significant portion of which they didn’t pay for, their children did.

      Medicare should at the very least be heavily means tested, and the only reason that some here rant about “universality” is because it allows them to hide welfare as an ever increasing middle class entitlement and use it to buy votes. Real poor people hardly vote, and there aren’t a lot of them. There a lots of irresponsible members of the middle class that manage to pull down 40-60k plus but still screw up; having kids too early and buying tons of crap they don’t need with equity stripped from their homes.

      Living isn’t that expensive, having a big house with a white picket fence, an SUV, regular vacations, cable television, eating out, having kids etc is. I don’t claim to be a penny pincher, but I don’t run around with my hand out either. A reasonable public goods case exists to help out people who “fall through the cracks” so they don’t starve and can turn their lives around, but you can’t help them out so much as to make them dependent parasites; and if you help out people who could live responsibly and support themselves you aren’t paying for them to get health care and go to school, you are paying for them to buy a fucking SUV and flat screen T.V. with the money the didn’t have to spend taking care of themselves. Not that SUVs and TVs are bad, but they aren’t human rights; at least not yet.

    3. Perhaps I should also note that the private sector “doesn’t” provide this currently because the private sector barely exists in health care. Over 50% is already paid directly by the government and most of the rest by insurers who have enough mandates & limitations, as well as a captive customer base due to restricted competition, that it’s literally a cartel.

      What this has done is completely sever the single most important aspect of a free market: The Price System.

      Without functioning prices being decided voluntarily by consumers & producers, there is no information… And all the problems Hayek pointed out with communism apply perfectly to our centralized health care system.

      The market will do just fine if it actually *is* a market, rather than some centrally controlled top-down “system”.

    4. That’s a good one. I agree with regards to the population as the reason why insurance in French have a better system compare to United States

    5. That’s a good one. I agree with regards to the population as the reason why insurance in French have a better system compare to United States

  70. It’s interesting he uses Kaiser Permanente an HMO notorious for rationing as his anecdotal example of the US system.

    Kaiser is also often trotted out as a paradime for health care on NPR. It’s safe to do because most NPRbots woudl never research an issue for themselves.

  71. Assuming the French system is better when you take everything into account(it is clearly less expensive); I don’t see us getting there. The current bills in Congress will increase the the costs of health care not lower them. We will never cut cut Medicare by 462 billion dollars to help pay for that. The same people supporting it, criticized Bush less then a year ago for looking to cut Medicare by less then half of that. If you want to lower the cost of health care, having a government run insurance company competiting against private insurance companies will not work. Especially with new regulations for covering prexisting conditions. While I would like to see health care covering more people, we are going to end up with a bigger mess then we already have.

  72. Oh to be old in Paris in the summer…i.e. dead from the heat when all the emergency services go on vacations

  73. And is France’s system finacially stable or is it’s liablities adding up just like our entitlements here? Its easy to make a perfect medical system if you don’t mind trillions in unfunded liabilities. The answer is to get government and lawyers out of medicine and cost and wait times will be greatly reduced.

    1. “And is France’s system finacially stable or is it’s liablities adding up just like our entitlements here?”

      What part of “they spend a lower % of GDP than we do on healthcare” are you having a problem with?

      Clearly, if we could halve our healthcare spending tomorrow, by switching to a French-style system, we’d have quite a bit of room for costs to expand before we again reached the current levels.

      Even so, I don’t believe France’s healthcare spending is increasing at the rate ours is, either.

  74. Ok, Matt Welch. I was just wondering that if you pay taxes in the US and you are filling jointly here, are you receiving any double taxation relief? I could not help wonder if their is more to the “My wife earns most of her income in France, and we are more than duly taxed in both countries”. Btw, so far I have learned being a Libertarian means never having to follow what you preach.

  75. Man, this debate is dizzying. All I know, being a crazy caribou lover from Canada, is that I can’t get 222 aspirin in America.

    If you get migraines THOSE babies do the trick. Ironic given that most major pharma companies are from the States.

    As for the France, Canada – whatever – public health thing. Comparing at this point is well, pointless. America has to do what fits its personality.

    I see his point, at the end of the day it’s THERE. It may not be free, but it’s a perk millions of people like. Then there’s the whole compassion paradigm and a civilized society takes care of its sick thing. Yeah, sacrifice is made to quality but it’s hard to detect how much. Moreover, innovation, or lack thereof, is equally tricky. France, Italy, Germany and Canada, for example, still make medical breakthroughs.

    Yet Canada has the least MRI, catscans, etc. per capita than most in the OECD. It’s all so confusing.

    Is health, in the end, the role of the state or citizens or both? Once long ago, it was community based, churches, doctors, etc. Now all things run through the government. That’s not good.

  76. Just make sure to never get cancer or heart disease or grow older than 80.

  77. So exactly how does a typical French person get an appointment with one of the “best breast surgeons in the country?”

    1. Get a referral from her doctor.

      If Americans had experienced healthcare in Europe or Canada, they’d string up their representatives for lying to them for so many years.

      Never have I seen so many people opposed to something they completely misunderstand.

      1. Well, it’s a known fact that the streets of European cities are littered with the bodies of the dead and dying, that mothers die in childbirth while languishing in wait lines. Also, rabid voles.

  78. YES!!!!!!!!!!! Lived within the Canadian system for five years. Bliss!
    Self-employed here for 25 years. Horror!

  79. Matt Welch,

    In other words, you’ve got yours, fuck the rest of us. Including my deaf daughter who can’t get coverage.

    Fuck off.

  80. You realize what a slimy, self-serving bastard you seem to be, I hope?

  81. Mr. Welch has given America what it so desperately needs. The simple solution to America’s healthcare woes is presented here for your benefit:


  82. Ah. Those wonderful laws of “supply and demand in the free market will define the best product for the lowest price”.

    Ever had to plead Wal-Mart, and fill out hundreds of pages with personal details (and don’t you dare to misspell your name or forget your acne at 14), just to become a customer?

  83. Wow. Another reason (no pun intended) to stop supporting the Reason Foundation.

    You receive quality health care, little wait time, etc., but are against American’s having the same?

    There are many reasons to oppose the current health care plan, but there is little reason to oppose helping to insure the current un-insured population.

    Why should I support a Foundation that has a man – who receives high quality health care – blasting a plan to let American’s receive high quality health care?

    Forget it Reason Foundation. I’m done.

  84. The hypocrisy of this is breathtaking. You take all of the benefits of a socialized medical system, leaching off the people who pay for it, then pat yourself on the back for choosing not to live there.

    Pretty easy to choose to live here when you can steal their benefits. The fact that you would choose to get care from a socialized system while working to stop the rest of us from having the same freedom is nothing short of vile.

  85. Here’s why I want some sort of public option/universal health coverage/single payer, whatever we want to call it. I had a son born with a birth defect called CDH, short story a hole in his diaphragm where his bowels and parts of his stomach and spleen passed through and landed on his developing left lung while in the womb. I won’t go through all the crappy details, suffice it to say it took two years to get him right. I had insurance through work and then the state (PA) chipped in with the SCHIP program.

    So my kid is 4 now, about to turn 5. Other than half a left lung and a little on the low weight side he is healthy as any other kid. Given today’s corporate HMO environment he doesn’t stand a chance in hell of getting any coverage once he leaves our protective nest.

    Maybe he’ll qualify for some sort of state coverage but I doubt it. Once he turned three he was removed from the SCHIP program because he was too healthy. I have no problem with that, they were a godsend during the tough times. But there is no state or federal program I know of that’ll cover him now.

    And what employer is going to want to hire him, though he has no adverse or lingering effects from his condition some health insurance bean counter will red flag him for sure and push the company premiums out the roof.

    So I am all for universal coverage.

  86. I don’t really see the “socialist” in your description of the French health care system. You describe paying the doctor immediately in cash for your treatment, which frankly looks more like a transparent free market transaction than what we have here in America. The government isn’t paying for it as in the Canadian system (or US Medicare) and I don’t believe French doctors are government employees as they are in the British system. I know it’s trendy in some quarters to assume “French” is synonymous with “socialist” but where’s the socialism in paying your doctor for your health care?

  87. You’re like someone who steals packets of ketchup from McDonald’s so he doesn’t have to buy any at the store.

  88. So the libertarian solution seems to be deregulate and let people buy their own services and insurance.

    Two problems

    First – what do we do about people who can’t afford insurance or care? Do we just let people die or suffer because they are poor?

    Second (and more important) – genetic information is going to bring down the insurance model if everyone isn’t required to have it. Once people know they have genetic disposition for say breast cancer then they’ll get insurance. If they are genetically extremely healthy then they wont. Killing the whole idea of insurance. More and more people will have to bear the full costs of the genetic lottery. Putting them at major disadvantage to the rest of the population.

  89. Perhaps the French think more clearly in some areas. I cannot imagine something like this being worked out so simply in the US. We just have too many confused selfish whores in charge of everything.

  90. Americans will get what they have always gotten—exactly the kind of health care system they DESERVE.

  91. Reading over these comments, and the “pull it out of your ass” solutions that are really “Just So” stories, one is reminded of the Churchill quote:

    “You can always count on Americans to do the right thing – after they’ve tried everything else.”

    Here we have Conservative/Libertarian business interests slowly being forced to compromise, and realize that their original intents have left Americans in the lurch so many times that they their previous arguments are no longer taken seriously.

    It’s a study in cognitive dissonance. They won’t give up on the “Don’t Tread On Me!” narrative, so they have to keep devising unproven schemes that make the situation even more complicated, and costly.

    The reason why the current health care bill is not stronger, and what we actually need (a single payer system) is because of the business lobby that Libertarians/Conservatives are front for. We’ve seen this kind of Conservative hard selling for years. How many times are you going to drop the ball before you leave the court?

    The failures of right wing politics, of which Libertarianism is an outgrowth, are so numerous that it’s shocking that the American people still buy into this bullshit.

    I’m also reminded of another quote by Republican strategist Ron Bonjean that effectively sums up the psychology of the people on this site: “Americans would elect a ham sandwich for president if it would promise them jobs and a higher income.”

    Libertarians/Conservative are the ones who insist on complicating the issue, and allow their Think Tanks to confuse the public, resist the proposals, and then complain that Democrats are giving us something worse, when they’ve offered nothing at all. Hell, they refuse to even have the discussion.

    Personally, I believe that a single payer system is inevitable, and it will eventually be implemented. Unfortunately, for the time being, due to sites like this, and a host of other Think Tank propaganda machines, we aren’t getting what we need.

    So, please, spare us the righteous indignation. You’re apart of the problem.

  92. Matt, I usually agree with you. However, you are not doing justice to the US system. You start by talking about finding a doctor in your network. Well, that is one choice of health insurance, but it certainly isn’t mine or many others. I have traditional, individual health insurance. We have no wait for a doctor unless we want a specific doctor who is on vacation or busy on that day. We got same day service on Christmas Eve, and New Years Eve (not a great health holiday for the family). We pay 100 percent until our deductible is met than insurance kicks in. I had surgery which I disclosed shortly before getting accepted into my individual health plan. Your version sounds like a different planet from the one I live in – then again LA and Minneapolis are pretty much different planets…

  93. One more thing. Can you ask your French doctor how many Nobel Prizes in Medicine France has in the past 30 years? How many life saving devices or drugs have been developed in France? How much of the quality care that is provided in social medicine countries are complements of the free market system in the US?

  94. One more thing. Can you ask your French doctor how many Nobel Prizes in Medicine France has in the past 30 years? How many life saving devices or drugs have been developed in France? How much of the quality care that is provided in social medicine countries are complements of the free market system in the US?

  95. Yes, the number of Nobel Prizes in medicine magically trumps as person’s inability to benefit from those innovations.

    It’s like listening to Pro Castro Cubans herald the country’s literacy rate, when the average citizen can’t do much with the skill.

    If you’re bankrupt, or dying due to a lack of health coverage, who won what and for why is generally of little consequence to you.

    Again, this seems to be a common obsession with Libertarians. They care more about GDP, than what the GDP is benefiting the public.

    And many of you wonder why you’re mocked for posing as “enlightened” teenagers.

    The average Libertarians grasp of nuance is so incredibly poor that I can only assume that for many of them a chip is missing.

  96. Hello,

    First of all, I apologize for not having read all the comments (480 and mounting), so I will not comment anything past. Just my personal experience: I am born french, live in France, and came to this state.

    I am making more than twice the median family income, so I don’t expect the state to wipe my ass. I am probably what you would call a liberal by your standard, but by the standard of my country, I am rather a centrist.

    Here are a few of my observations:
    1) I never was afraid to enter an ER in France, here I had always second thought.
    2) The price for anything in France are the same for everybody, then the social security would pay between 66% and 95%, and the remaining would be paid by your additional health insurance, and if any left, by you. But the price is exactly the same for everybody.
    3) I had need for a dentist, because I could not have the regular employee, but could get a student one, the price was 500$, later I got to enter a employer plan the cost at the same dentist then was 350$, and a month later, I got a better plan though my wife and then it was charged 250$…
    YES, you read it well: the same doctor, the same patient, the same problem, 3 different prices….
    Are you kidding me?

    4) we entered the ER the other day (bad luck first of january), my wife being covered by her plan, and my plan, nobody in the hospital (register, cashier, accounting department) could tell us which plan to use, they did not had a clue.
    I entered another hospital 9 month before for a broken toe, nobody could tell me what it was going to cost me…

    I thought that real free market implies that you have full knowledge of the options , the price, real choice.
    I am sorry, but I don’t see that.
    What I see, is that insurance companies do whatever they want, the doctor/hospital charge you in a not-random way, but very obscure.

    I rather stick t a system where cost are clear, reimbursement are clear.

    PLUS, we in France (and Europe) are real team-player: the minimum coverage is for everybody, we don’t want anyone dying or being sick uselessly (specially when the cure was invented 200 years ago).

    You can go to church every sunday, but if you allow people to die in your country by lack of solidarity. I advise you to read again the bible new testament, and you’ll know that you are not going to make it in heaven. (it’s gonna be hot, be prepared)

  97. There is a reason why it’s called COBRA…venomous snakes; and they have the audacity to call it health “care.”

  98. I have practiced medicine for 25 years and I agree with most of your observations. We do not have a free market in health care in the US. The 1990’s HMO movement was supposed to get ride of the doctor greed but all the government mandates prevented cost contaiment because American patients have unrealistic expectations for care without paying much more than a co-payment. Further socializing medicine is going to make things worse and threatens the good things about our system. I doubt French doctors worry much about what happens when a doctor gets a nuisance lawsuit–years, attorney charges (way beyond mine) only to have the suit droped-sorry Doc.The best solution for quality, total coverage and cost contaiment is the free market. Mackey outlines the arguement unforntunately no body cares and few Americans seem to believe in free market solutions–so on to socialism American style. I wonder whose going to do all the innovation-India or China?

  99. Look, some 37 other countries are getting universal health care and paying about 30 to 40% less than we are while still posting better longevity. I’d gladly split the difference and pay a 10% surtax to pay for R&D. We’d still be saving 20%!

  100. You guys can argue all you wan’t, the bottom line is that even I have better health care hire in Croatia where me and my wife live for the past 6 years even dough we also have the US health insurance as the gov. employee. I totally agree with Matt Welch. And I can insure you that France Health care system is the best in the world for average Joe’s Jane’s.
    I pay 198 kn approx. $40 for Croatian Health Care and about $16 for supplemental insurance. The best part is that my wife is covered under my plane as well. In last than 5 years I have two major surgeries, and numerous specialists visits and didn’t have to pay a dime. As of last year we don’t even have to pay co-payment, supplemental cover that. And that is Croatian health care, dude, not even close to France Health Care as Croatia lack of doctors and some equipment so you have to wait. Obama’s scaled down health care is not good any more. If US people want a good health care, France system is the best for them, but they have to take it whole or nothing.

    People of the US do not allow deliberate misinformation being sent to you by Republican parties, medical and drug companies lobbyist. They kill the bill before was even out. Obama’s mistake was, not providing detailed bill, where people would see more clearly where the money would come from and that no one would be undercut, for example, If you would ask me, and if everyone would be covered under my new bill of the universal health care, then you, the retiree, will no longer need the Medicare or you the poor people will no longer need the Medicaid, so how can someone say that new bill will cut the Medicare or Medicaid.
    It is a shame that country as the USA among all the developed nations in 21st century still have 45.000.000 uninsured citizen..

  101. Of Course you think France is better, You dealt with Kaiser. Horriawful.

  102. Sorry, I didn’t have time to read every comment here, so I’m hoping someone bothered to point out that France does not have a socialized medical system. Not even close. England is pretty close. On a website like this one, dedicated to a particular political/economic philosophy, people should really have a better sense of what the word ‘socialism’ means. Disappointing, to be sure.

  103. France’s health care systems sounds wonderful to me. I believe that everyone should be covered period, here in the USA, but we all know that will NEVER happen in a zillion years.

  104. Matches my personal experience exactly. Watching this catastrophe unfold frightens me. I doubt my country’s healthcare will ever reach France’s quality and efficiency.

  105. I can no longer trust Reason’s analysis any longer after reading this editorial. What anti-freedom nonsense. My subscription is cancelled.

  106. You admit its good and works, but still insist its wrong.
    Why are you writing for something that calls itself ‘Reason’?

  107. And is France’s system finacially stable or is it’s liablities adding up just like our entitlements here? Its easy to make a perfect medical system if you don’t mind trillions in unfunded liabilities. The answer is to get government and lawyers out of medicine and cost and wait times will be greatly reduced.

  108. I wonder how much tax Matt really pays in France.

    “Whatever the nationality, a person whose tax domicile in France is taxable on its worldwide income. People not living in France are subject to limited tax on their income from French sources only.”

    Are you and your wife tax domiciled in France? Is most of her income considered “French sourced” (I am imagining they pay CA correspondents via a subsidiary possibly.) At the very least you have sheltered your income from French taxes…though it must suck to pay US taxes on your global income without much recourse.

    Sorry to have to get personal like this, but I am in similar situation where Taiwan offers me excellent cheap care but I only have to pay taxes on Taiwan income…which our company can easily limit. Its a sweet deal.

  109. Also, I am really interested to find out why foreign care can be so cheap compared to the USA. Is it the system? Is it free riding? Is it lawyers?

    I will say, that in Taiwan, you have to doctor shop, because the quality is very uneven. If you get bad advice or the guy wants to cut you open without even an X-ray (true story) there are no lawyers to get a payment.

    But I do think US healthcare is a bit too expensive…dental hygienist cleans my kids teeth, dentist reviews X-ray for 5 seconds…214 dollars….

    1. It is a combination of:

      1) when you have fewer payers (or one big payor like the government), they can drive prices down… For example in Australia we have public subsidised drugs, as well as non-subsidised drugs. Naturally subsidised drugs are used more. To get subsidised you have to PROVE your drug is better than any older drugs… so for example less side effects that reduces further health costs, or more efficacious. So drug companies that just release a different version at a higher price, can’t get subsidised, unless they accept the price of the older drugs (why pay more if it isn’t better – who cares if it is “new”). As a result in Australia we dispense roughly 2% of the worlds drugs to patients, but pay only 1-1.2% (depending on the type of drug) for that 2% (so we are paying roughly half what other countries are paying). You could see this as free loading, but pharmaceutical companies know they are ripping off Americans (who pay way too much), so they sell their drugs (and still profitably – just not as much) to Australians at those prices. By the way, I work in marketing in the pharmaceutical industry… that’s how I know this stuff.

      2) Your lawyers, and your attitude to medicine needing a 100% guarantee makes medicine so expensive in the US. In the US, doctors are so scared of being sued for misdiagnosing (or even missing something a patient didn’t present with), that they routinely test just about everything, and scan for everything – just in case. As you note yourself, a simple teeth clean has a big bill because you have a dentist reading X-rays (which he/she does so he/she can check for any “hidden” issues, so he/she wont get sued in the future.

      Our solution in Australia – you get regular check ups, and YOU are responsible for asking for extra investigations for anything that may be hidden/not obvious. If you get X-rays once a year or so, you should pick up any hidden issues. Personally I wouldn’t want to be X-rayed that often – it is a radiation dose.

      In Australia, where the general public expects a high standard of care and gets it, we are not so quick to blame doctors and try and sue them out of business if something goes wrong. We will sue them for obvious negligence, or where it should have been reasonable for them to notice something (not for some hidden thing that would only be picked up with extra tests that add cost to everyone but only benefit the tiniest % of people that issues are picked up in – to us that is malpractice – testing everyone just to avoid being sued by the few).

      We also accept that medicine is not an exact science, it involves two human beings and a human body that is not like very other body, and hence circumstances mean that sometimes, even with the best effort and knowledge a good or great doctor will miss something, and as long as they have acted with a duty of care, they shouldn’t have their lives ruined so a lawyer can make 40% and a patient can “exact revenge” on a doctor who is offering their services in good faith. It is a cultural thing.

      Note your very statement – there are no lawyers to get a payment – in Australia we don’t think of lawyers when we think of medicine… in fact we see lawyers as a problem to good and affordable medicine generally… but there is a place for them when something does truly warrant it, they aren’t a primary consideration.

      By the way, I wouldn’t be comparing Taiwan to the US… why do yo guys always pick countries that have no chance of stacking up… how about the Britains, Canadas and Australias which culturally and socially are more comparable??

      This isn’t the whole answer, but it is part of the answer, and the most obvious explanations for why Americans are over serviced when they see doctors/dentists etc and hence pay too much for simple things and also overcharged for drugs and new medical technologies… in the end, in America, the drug company that is best at lobbying your insurer will get their drug on the insurers formulary, regardless if it is worth your insurer and hence YOU paying for that “new fancy drug” (the insurer never really pays for it, cause they make profits, they are passing on the costs in premiums and co-payments) AND the lawyers have scared the medical community into testing everyone all the time, just in case – which is poor medicine as it over services, exposes people to unnecessary tests and increases the cost for everyone to benefit the few that get picked up – I don’t know about you, but THAT sounds like socialism to me, and in the worst way, because it is hidden and sold as a free market!?

      Again – this is not a dig or attack, I just see Americans fed bull crap that alternative systems either don’t work, cost too much in taxes, provide sub-standard care or ruin the economy… and I understand why you’d reject those options… but perhaps if you guys knew there are decent systems out there in affluent and far from socialist countries you’d have a different view of all this.



    2. That is scary to hear about their it though. I believe yes, insurance in US is a bit expensive.

  110. My only point is that if you take the Bible straight, as I’m sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won’t get the full deal by just doing regular skill english reading for those books. In other words, there’s more to the books of the Bible than most will ever grasp. I’m not concerned that Mr. Crumb will go to hell or anything crazy like that! It’s just that he, like many types of religionists, seems to take it literally, take it straight…the Bible’s books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on…the Bible’s books were written by people with very different mindsets

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  112. Great piece…

    But why does it have to be France as the comparison?

    Other than the obvious fear mongering effect – Americans don’t in any way want to be associated with the French (despite the fact the French helped America become America from British colony). Of course being British is the villain again thanks to BP… You Americans are very good at black and white, good vs evil… there are so many shades of grey you miss!!??

    Anyway – on those shades of grey – why not compare to the Australian or even British or Canadian system (I understand why the author didn’t – he was comparing his experience in France) – I mean why the debate is so selective.

    None of these three countries would be deemed as ‘socialist” as France in terms of domestic of foreign policy… They all run government subsidised healthcare, and have very healthy economies.

    In fact as an Australian I’d happily compare the Australian economy to any other economy in the developed world right now (yeah we are smaller – but that means we SHOULDN’T be able to weather these financial storms so well – or afford any form of socialised healthcare, the bigger the economy/population the better for funding public health options).

    Yet all the things the author described apply to the Australian experience.

    My drugs cost at least half what they do in the US, healthcare standards are some of the highest in the world. We have a mixed private and public system.

    It works well.

    In fact, we are worried about Obama’s healthcare reforms, because it is well recognised that the US citizen subsidises the rest of the world by paying so much for drugs and new healthcare technology… if you guys stop paying too much, then the drug companies will come to us asking for more!!

    And that is what I don’t get. As Americans you guys get ripped off, yet you’d prefer that to any concept of a public health option… it is beyond logic for us in other countries.

    Also unlike the US, Australian citizens do NOT have to pay tax on their earnings to the Australian government if they are not residing in Australia (if you are even a US resident – not even citizen – you pay tax on any earnings world wide). The reasoning is in Australia that taxes are for services provided, so if you don’t currently live here, you are getting those services, so you don’t have to pay. But even then, if you come home to Australia, you can get access to public healthcare.

    So like the author, I have friends that live in LA, and after one of them had an accident, it was cheaper for him to fly back to Sydney and get treated here, plus he got a better standard of care (faster access to services and more services compared to what his US health insurance would cover). After his treatment he flew back to the US. Irony being of course, Australia hadn’t taxed him that year, the US continued to (as he is a resident), even though the US government which collected the taxes provided no services to him whilst he was in Australia… that isn’t a free market or democracy if you ask me… but income tax is another issue completely.

    Personally I think America is amazing, and this isn’t an attack – I just wonder how many Americans know that there are alternative systems that are not socialist basket case economies? When you are told the alternative to what you have will mean financial ruin, I can understand why you don’t embrace it, but there are so many examples of countries that have systems that support a free market, have a high standard of living and still have public health options (and a fair taxation system).

    My 2 cents to all this.



  113. There needs to be a dual system, one like the NHS that should attend to those that need life saving health care and another base on private health care that can get less serious medical conditions dealt with in a more reasonable amount of time.

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  115. healthcare should be made cheaper and available to more people than at the moment.

  116. I’m not sure whether health care is cheaper elsewhere, it may just be that it is of a different standard. Don’t get me wrong, I’d rather have the free NHS if I’m ill and skint than nothing, but that doesn’t mean that its necessarily the best standard. Lots of people are now going private or supplementing their treatment with paid for complementary therapies such as massage and reflexology or even hopi ear candling now adays in the UK.

  117. Is it possible to be a libertarian who thinks CanadaCare is a better system? I’ve been thinking this over, and if the central tenant of libertarianism is equal opportunity, then is it possible that guaranteeing health is a part of that? Quite frankly, for-profit health care is inefficient. It gauges on prices precisely because its for-profit. Perhaps a government that is limited in all aspects but health care might be a healthy alternative.

  118. I’m not too sure whether having a cheaper health care system is less cost to us in the long run – its an opportunity cost question really….

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  125. I’m not sure whether health care is cheaper elsewhere, it may just be that it is of a different standard.

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  128. it’s interesting to see the views from someone who has experienced both french and american health care systems first hand. great article!

  129. The french health care is great for everybody living there. We haven’t a health care that’s like the french apart from the tricare insurance for our troops.

  130. The French healthcare system is as good as any.

  131. I think French healthcare is good as opposed to Serbian. We can just hope to achieve that standard. But I also think we’re going to the right direction.

  132. I think that we are going in the wrong direction with most foreign affairs.

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