France

More Health Care Comparisons Between France and the U.S.

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Am I crazy for preferring to consume health care in France rather than in the United States? If so, I am joined in mania with the Competitive Enterprise Institute's Hans Bader, who has also dabbled in the stuff care of a French wife. From a piece Bader wrote about health care legislation three weeks back:

The bill will also increase taxes to "European levels of taxation," while failing to provide European-style universal coverage.  It will vastly increase the costs of our health care system, rather than reducing it to European levels.   It reinforces foolish restrictions on national competition in health insurance, which do not exist in Europe.

And you cannot get sued for such behavior in my country!

Doctors afraid of being wrongly sued for malpractice despite providing good quality care order unnecessary tests (or defensive medicine), which wastes at least $200 billion annually.  That's nearly as much money as France spends on health-care for all its citizens.  The bill does nothing to reduce such costs, ignoring lessons from Europe.  (Many European countries have specialized health courts, rather than American-style jury trials, to cut lawyers' bills, speedily compensate the injured, and prevent American-style baseless lawsuits against doctors.)

In European countries like France, doctors don't need to be paid as much, because competing professions, like lawyers, are paid less.  European law is generally much more conservative than American law when it comes to lawsuits, including lawsuits against doctors.  Punitive damages are generally forbidden, and lawsuits are discouraged by making unsuccessful plaintiffs pay the other side's legal bills.

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  1. “In European countries like France, doctors don’t need to be paid as much, because competing professions, like lawyers, are paid less. European law is generally much more conservative than American law when it comes to lawsuits, including lawsuits against doctors. Punitive damages are generally forbidden, and lawsuits are discouraged by making unsuccessful plaintiffs pay the other side’s legal bills.”

    Apparently European trial lawyers don’t own their own political party and hoards of useful idiots like their American counterparts.

    1. That paragraph jumped out at me, too. Congress is full of lawyers. Therefore, no legislation will EVER make life harder for the law profession.

    2. Yes, I zeroed in on that very quickly as well John.

      I see no problem with the elimination of most punitive damages, unless performing surgery under the influence of an intoxicant and causing harm, either temporary damage inconsistent with accepted iatrogenic injury or permanent damage, for example.

      Loser pays would be the single biggest deterrent against frivolous suits IMHO as well caps on say, attorney’s fees under a Medicare like system as a part of TORT reform. But that would cut into the attorneys’ fees, thus jeopardizing their wealth and political influence.

      Say, constitutionally speaking, one has the right to an lawyer, correct? Where is the public option for defraying costs of legal assistance? Oh, that’s right, the Public Defender’s office (which rarely inspires confidence in the accused).

      Hey, if I have a right to a lawyer, I deserve the best! Even if it is on someone elses dime! Just like health care, right? Right?!!

      I would like to see the trial lawyers assn. get a taste of what they wish on the rest of us doctors. Why can’t we have a program like Medicare/Caid for legal services; we can call it LegalCare and LegalAid. Let them have my ungodly malpractice insurance (120k/yr, which would decrease with award caps and less frivolous cases filed). Let them see how efficient slow pay beauracratic third payer(s) systems are in their practices.

      I am familiar with enough lawyers personally and on H & R to know legal is not an easy profession, but C’MON!

      1. Loser pays would destroy any chance the “little guy” ever had of bringing suit. Wouldn’t be worth the risk.

        1. I’m not sure that’s entirely true, though it’s a valid concern. How does it work in practice in the UK, which I believe does operate under a loser-pays system?

          1. Based entirely on anecdotes, I’m pretty sure that in Canada it is quite difficult to bring a malpractice suit.

            But that’s only from a couple of people I know personally and I have to consider the possibility that they were so wrapped up in their own suffering that they could see things objectively.

        2. What I would think is valid is to actually enforce Rule 11 of the Federal Rules of Civil Procedure and bring sanctions when the situation requires them. Its current use is far too narrow and limited.

          For disclosure, I’m an attorney. Never been near a court room in my career (I’m a transactional corporate lawyer. I negotiate contracts and deal with the SEC for a living). Firm does no malpractice work that I know of (and anything we did do would be on the side of the insurance companies)

        3. I disagree Andrew. If a patient has a legitimate case of medical negligence/malpractice, even if they are the “little guy”, it will see the inside of a courtroom.

          Or a deposition and settlement at the very least. Bad cases deserve to be resolved, but those cases need separated from cases where the outcome was regretful, even mortal, but fell within accepted medical practice and physician discretion.

          1. One thing that comes to mind is to ask why litigation has gotten so insanely expensive. If the little guy could sue the big guy without having to spend insane amounts of money, that would help.

            Rule 11 and other sanctions wouldn’t hurt, nor would judges who had the balls to reject ridiculous discovery requests, motions, and other needlessly delaying and cost-adding gimmicks.

      2. Mon dieu, Groovus! You pay $120k/year in malpractice insurance? I knew it was expensive, but that’s outrageous.

        Given what we know of the current form of the senate bill, would that premium change dramatically once the magical new health-care system kicks in?

    3. “European law is generally much more conservative than American law when it comes to lawsuits….” Wrong. They have an “industry” called
      Libel Tourism in England and it has nothing to do with visiting Buck House. http://www.opendemocracy.net/a…..litigation

  2. What’s with the moire? You guys can’t find decent clip art anymore?

  3. The key is not in the “socialism” vs “private” but in various demographic issues mentioned, such as doctor pay, number of doctors per capita, less legal hassles, etc. OB’s in this Country have to pay $100,000 or so for malpractice insurance; there’s no way they can deliver a baby as cheaply as a French M.D. regardless of the payer system

    1. Yeah, that “specialized health court” had a nice ring to it.

  4. The idiocy of current health care legislation doesn’t suggest France’s health care system is better than the current one in the United States , nor does your singular experience (you’re famous and all) or Hans’. The current legislation is about a political victory, and more importantly, a new entitled voting block.

    A single-payer would be better than the mess they are putting together now. Nevertheless, with our geography, culture, population, and economy, a single-payer isn’t even feasible. And it would lead to an economic nightmare, in the same direction as medicare.

    With the aging boomers, we need a CT and MRI kiosk on every block, more innovation, and more technology. Not to mention health care providers. Thus, we need the free market.

  5. “The bill does nothing to reduce such costs, ignoring lessons from Europe. (Many European countries have specialized health courts, rather than American-style jury trials, to cut lawyers’ bills, speedily compensate the injured, and prevent American-style baseless lawsuits against doctors.)”

    The bill can’t override the Seventh Amendment to the United States Constitution, which guarantees the right to a jury trial in common law suits exceeding $100 in controversy. While the Seventh Amendment hasn’t been incorporated against the states as substantive due process, most state constitutions also preserve the right to jury trial in significant disputes. I’m not so sure that the Supreme Court would ever uphold an act of congress invalidating state constitutions for an important class of common law cases. As for the creation of a “federal health court,” Congress would have to state, unambiguously, that it intended to enact exclusive preemption of all health care law in the United States, which would never fly politically.

    While I’m not a fan of federal health care overhaul in the first place, it does seem odd to read libertarian condemnation of state jury trials in favor of federalized administrative courts.

    Still, whatever floats Reason’s boat: hundred flowers, hundred schools of thought, etc.

    1. A link/excerpt is not an endorsement. I for one am not crazy about capping doctor pay and not having civil redress through the court system.

      1. You’re absolutely right it doesn’t. My apologies for reading what sounds like an endorsement of one of the worst aspects of European centralization of decisionmaking in the hands of the better sort of people as an actual endorsement.

        Since this is the internetz, that isn’t meant to read as snarky as it sounds. I got to enjoy Soviet health care and found it to be not bad for an acute but serious digestive disease. And while I’d say so if asked, that doesn’t mean I endorse the Soviet government that made my easy.

        Touche!

    2. This is a good point. Instead, perhaps the medical malpractice statutes could be tightened up to require a higher standard of proof, more detailed pleadings, etc.

      1. With a universal system of some sort, the awards against doctors would go down. Damages would go down against OB/GYNs because 60 years worth of medical bills would be taken out of the equation. While pain and suffering is still loopy, the comparison between Europe and the US is more complicated than let on.

        1. The damages (i.e. cost of continuing care for 60 years) would still exist – their cost would simply be shifted from the shoulders of the negligent health care provider to society as a whole. So not only do you remove a disincentive to malpractice, but you propose that society should share the costs of individual provider’s liabilities.

          1. You’re assuming that the costs are actually close to the damages. Society may compensate for loss of income, possibly for corrective medical procedures, but society isn’t going to pay for nebulous crap like “emotional distress”, much less punitive damages. And the more objective types of damages are not what generally cause controversy.

            Punitive damages are particularly problematic, since there’s a financial incentive to go after them whether or not the act was deserving of actual punishment (rather than the less judgmental step of making an injured party whole), and since they are using a lower standard of evidence than the other punitive system (ie, criminal).

            Punitive damages should not be paid to the plaintiff or his lawyers, for starters. If someone has a karmic debt, it’s to the universe (ie, should be payable through community service, loss of license, and other sanctions that generally wouldn’t incentive abuse of the courts). Making the plaintiff whole is the purpose of compensatory damages.

  6. America and Europe are on different evolutionary branches. Socialized health care in America is like putting wings on whales.

  7. There’s a point on the fascist/socialist econo-continuum where markets are monkeywrenched in a worse way for consumers than they would be if things got “worse.” That point is exactly where we’re headed via insurance reform and cap-and-trade and the bailouts and…everything.

    The best we can hope for is that there’s an evil conspiracy to fuck shit up on purpose. Then at least there’s an end to it. We’re still in the “Steal underpants” phase. There might not be a Step 2.

    1. Simpatico.

  8. Well, all that tort reform and “specialized health courts” sounds awfully good until the pesky 6th amendment gets in the way. Some of you guys sound exactly like liberals complaining about the constitution getting in the way of assault rifle bans and the like. Matt Welch thankfully clears the air regarding his views in his comment @ 4:56. I find it very hypocritical for libertarian-leaning conservatives to suddenly support massive redistribution of the separate powers’ roles when it conveniently benefits a consistently conservative group (doctors) to the detriment of consistent lefties (trial lawyers). Disclaimer: I’m a trial lawyer, and a libertarian.

    1. I meant to say the seventh amendment, which guarantees the right to a civil jury trial. Read what you will into that mistake about my abilities as a trial lawyer . . . 😉

      1. Nothing wrong with not taking one’s self to seriously Drew. At least you corrected yourself, and quickly to boot.

        Granted I went on a bit of a rant upthread, and I personally don’t see a problem with “specialized health courts”. There is family court, juvie court, etc. As long as it is a civil trial with merit before a jury, fine. My objection is the Trial Lawyers Assn. and it’s influence over Congress (both D’s and R’s) and the money it contributes to campaigns (also both, but decidedly more to D’s). Since it is lawyers writing the rules, it naturally (and I believe disproportionately) benefits those in the practice of trial law.

        My argument essentially is health care is not a right. However, legal representation is (criminal only, not civil cases); it doesn’t seem a stretch to me for the folks that believe HC is a right and that it demands even MORE government intervention (redistribution) that the same consideration can be extended to legal expenses and services, including civil. With similar restrictions on earnings ala Medicare/Caid complete with the maddening paperwork. I already referenced my malpractice premium upthread. Lower premiums for me is lower cost passed on to patients.

        I wonder how trial lawyers would like to deal with a legal insurance industry?

        1. “I wonder how trial lawyers would like to deal with a legal insurance industry?”

          A clear payer that can’t go bankrupt and was governed by openly stated federal rules sounds great to me.

        2. “I wonder how trial lawyers would like to deal with a legal insurance industry?”

          A clear payer that can’t go bankrupt and was governed by openly stated federal rules sounds great to me.

  9. I am joined in mania with the Competitive Enterprise Institute’s Hans Bader, who has also dabbled in the stuff care of a French wife.

    Does not compute.

    1. The phrasing is odd.

      Hans and Matt both have French wives and therefore can, and do, receive health care in France.

  10. Can’t be said any better than this.

    http://www.salon.com/news/opinion/camille_paglia/

    The U.S. is gigantic; many of our states are bigger than whole European nations. The bureaucracy required to institute and manage a nationalized health system here would be Byzantine beyond belief and would vampirically absorb whatever savings Obama thinks could be made. And the transition period would be a nightmare of red tape and mammoth screw-ups, which we can ill afford with a faltering economy.

    1. I’ve tried to make this point before.

      Furthermore due to the homogeneity, cultural if not entirely racial, of most European countries, medical care becomes a one size fits all proposition. To the extent there are racial and ethnic minorities outside the norm they tend not to befit as much from social services.

      With the on NPR the other day concerning the different health care needs of blacks (not to mention women) the mind boggles when one considers how the Al Sharptons, not to mention the David Dukeses, will react once those difference needs are being considered by federal bureaucrats.

      1. Sorry: “With the story on NPR the other day…”

        Carry on.

      2. Dammit!

        “befit” s/b “benefit”

        1. Kind of racist of you to leave out the superior infant mortality rates of Mexican women ,even though they typically get less prenatal care. Gonna out breed whitey.

          I’ve made the point many a time myself. It’s akin to suggesting the Euros adopt our system of the collegiate football BCS – the transformation in culture alone would be ridiculous to consider.

    2. B-B-B-But Matt Welch went to France and got some pain medecine without any hassle! And the doctors gave his kids lollipops! Surely they have a better system than ours?

      Seriously Matt, anecdotal evidence is pointless for this discussion.

  11. I want to socialize my health care costs too, to have everybody else pay for them.

    It should work great until everybody else gets the same idea.

  12. Could a jurisdiction outlaw malpractice insurance? It wouldn’t be worth as many people’s (and lawyers’) whiles to sue.

    1. Sure it would, until they put all the doctors out of business.

    2. This is one step: “Three years after Texas capped noneconomic damages in medical malpractice suits, plaintiffs’ attorneys and the medical industry are reporting a sharp drop in med-mal lawsuits. … healthcare lawsuits and a $250,000 cap on awards against doctors.” My children attended three different private schools at the time this matter was voted on and It was so interesting to see the bumper stickers on cars. Vote no: lawyers wives or vote yes: doctors wives. Golf club memberships lessened for the lawyers!

  13. So, Mr. Welch, the point you’re trying to make is that our beloved government can fuck up socialism as well as capitalism?

  14. I just read the older article in which Matt praises the French health system. I am not entirely sure how their systems works but I read sometime ago that it is similiar to our German system. It is FAR from perfect and I fully believe that if I need the best treatment money can buy I will be better off in the US. But I also believe that for the great mass of treatments that need to handled daily our system is superior. It has been badly reformed by the last government and will be re-reformed by the new government so I will explain the “old” system.

    Breaks down like this:
    Jobs over 400?/month are required to pay into the social system: 50% employee / 50% employer (I reckon the employer-payment just shifts the wage). As a an employee you can choose from like over 300 state-funded insurance companies which differ not only in premiums but in “additional” care” (very exhaustive “basic care” is granted to everyone by them). Depending on the insurance company premium rates go from 11-15% of your monthly wage, so there is incencitive to choose a cheaper one.
    High-paying jobs are not required to use the state system. While they may stay in the system most choose a private insurance company. Those usually cost more, are some-what restrictive in what customers they accept (had psychotherapy in the last 15 years? off you go!) but are able to pay doctors MUCH more.
    Doctors are somewhat bitten in their respective bums by the system. Since the state-funded insurance companies only have so-much money each month doctors accepting those patients (which are most of them – you can still opt to only take privately-insured patients) practically work for free a quarter of the month. Doctors complain a lot about that and are right to do so. There needs to some change there.

    STILL: with all those nasty state-interference NO German has to worry about not getting coverage or waiting months for treatment. Privately-insured patients may get an appointment faster than others but for most doctors it’s not like 5 days vs 5 weeks but more like 5 days vs 2 weeks. That’s not too bad.

    Our system has problems adapting to longer life-spans and higher treatment costs. I hope the new government will install some more market mechanisms in the whole system (like privatizing all the state-insurers but require them to accept anyone for a basic coverage plan AND less regulation on pharmaceuticals). I have been to the US a couple of times and I absolutely love many of the economic liberties you enjoy (I still am “libertarian-leaning”) BUT if there is a single market that needs some regulation it’s the health care market. I find it unacceptable that just because you have genetic dispositions, bad luck (accidents), etc. you can’t get affordable medical treatment. There will be aholes that abuse the system to charge your pocket for their bad lifestyle. Still – I find that more acceptable than the other option.

    Fire away.

  15. I’m starting to see a pattern of libertarians freeloading off the French taxpayer.

    1. Marlock, Being a Libertarian means never having to say your sorry. Hum, I mean do what I say and not what I do. Cue “Love Story” music.

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