Matt Welch makes several interesting points in his "Why I Prefer French Health Care" (January) and even makes a reasonably good case that France's socialist system is preferable to the regulated bureaucratic system found in the U.S. Advocates of a single-payer approach undoubtedly will seize upon Welch's article as justification for the U.S. to adopt a similar model. But as Welch points out, France's tax burden is much heavier than ours. Were the U.S. to adopt a similar system, our tax burden would have to be even higher.
The U.S. spends $700 billion annually on the military. This is approximately 50 percent of the world total and represents $2,300 for every man, woman, and child in the U.S. France, on the other hand, spends $870 per citizen, which means $1,430 per person left over simply because it does not feel compelled to police the world.
I'd prefer a free market health care system and a more modest military. But given the choice, I too would prefer to spend generously at home rather than abroad. Unfortunately, the bipartisan consensus in Washington is to maintain America's global empire. The question now is whether to pile yet another massive burden on our economy at a time when two wars are already straining our ability to pay.
Paul J. Gessing
Matt Welch's article on the relative merits of what he labels France's "socialist" health care is long on anecdotal evidence but short on analysis of system incentives. The pay-per-visit compensation program used in France rewards providers who see patients with routine problems that can be easily treated, as with Welch's prescriptions for muscle relaxants and anti-fungal creams. Time spent with the doctor typically declines in systems that attenuate price signals, however, along with system capacity.
The U.S. system, with all of its moral hazard, adverse selection, and other flaws (many governmentally induced), does provide strong incentives to give high-quality care to those who are truly ill. It is in the treatment of those with cancer, heart disease, and other serious ailments that the U.S. system excels.
Does anyone doubt that Sen. Ted Kennedy would have rammed some Obamacare-style mandates through Congress if a shortage of doctors and hospitals took the lives of 15,000 elderly residents during a Boston heat wave? In France the director general for health care took the fall in 2003 after such a disaster in Paris, but doctors continue to vacation en masse during August while hospital capacity declines.
Why is a reason editor lecturing readers on the advantages of government intervention? Libertarian interest can be advanced only by those who oppose government meddling at every level. Matt Welch's panegyric on French health care fails to mention a crucial element relevant to his case: Unless Welch pays French taxes, he benefits at the expense of those who bear the economic burden. French law may allow Welch's parasitic conduct, but legality is a poor substitute for libertarian standards.
In an otherwise fair portrayal of the Congressional Budget Office (CBO), Peter Suderman repeats the common misconception that CBO is responsible for scoring tax bills ("The Gatekeeper," January). But there is a division of labor in congressional cost estimating. Estimates of the budgetary effects of proposed tax law changes are the responsibility of the Joint Committee on Taxation (JCT), a less well-known agency. It does not have an active website, and its estimates are not accompanied by methodological explanations. CBO reports but does not change JCT estimates. The CBO estimates of the various health reform proposals contain JCT estimates for the tax provisions. The estimates for capital gains tax cuts alluded to in the article likewise were the handiwork of the JCT.
Former Director, Congressional Budget Office
New York, NY