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Yesterday, Tuesday, April 6, I had my second firsthand experience with the French healthcare system, and it was just as I had expected: efficient and cheap.
I walked into the Centre de Santé – Réaumur’s emergency health center at noon and was admitted within twenty minutes. Ten minutes later, I was meeting with the doctor. After a thorough exam, diagnosis, and prescription, I was sent up to the 7th floor to have blood work done, simply to “verify.” The total cost of the visit was €44, plus the additional €12 I paid at the pharmacy to fill two week-long prescriptions. If I had been covered by French national healthcare, la Securité Sociale, the total cost of the hospital visit would have been €0.
Though the term “bedside manner” is completely foreign to the French, the overall experience was pleasant, given the circumstances. The doctors could not have been more attentive, the hospital was clean, and the wait was negligible, as were the costs.
Nevertheless, I left skeptical, thinking, “it can’t be this good, what’s the catch?”
The French pride themselves on having a healthcare system that is just as I had expected: efficient and cheap – a system in which everyone pays and everyone benefits. However, just because everyone is paying doesn’t necessarily mean everything is paid for. Increasing drug costs, decreasing birthrates, and increasing unemployment have left the government with no other choice but to cut back or raise taxes.
Many citizens do not consider cutbacks such as minimizing hospital staff and shutting down healthcare clinics to be an option, for healthcare is a right that ought to be equally available to everyone, no matter where they live or what they earn. Because the French are historically unwilling to reform their cherished healthcare system, it is the tax system they consider reforming. “We must raise taxes… but mostly for the rich. We are in a crisis and we need to reform,” claims Philippe, a 75-year-old farmer living in the Provençe region of France who calls himself a “political moderate.”
The current French tax system deducts from individuals’ pay immediately, so that there is no need for an April 15th, “tax day.” Because of this, people often do not process how much they are really paying out to the government… or perhaps they just accept it. “[The tax rates are] really not as bad as most people think it is, but US tax rates don’t begin to compare,” claims Amy, a 23-year-old American living and working in Paris, privy to all of the costs and benefits of la sécurité sociale.
Le Parti Socialiste (Socialist Party), who – as of last month – gained a sweeping political majority in France’s regional elections, is now advocating a further increase in taxes in order to offset rising healthcare costs. Le Parti Socialiste is proposing an increase in the bouclier fiscal (~ tax limit), which currently states that “direct taxes paid by a taxpayer may not exceed 50% of taxpayer’s revenues” in Article 1 of the Internal Revenue Code.
While there is no doubting that the overall level of care and minimal costs are aspirational, the French universal healthcare system is not without its drawbacks. Just as the U.S. is currently suffering from a lack of sufficient, available healthcare and money, so is France. Though the French system offers many short-term and long-term benefits, it is clearly not without its short-term and long-term costs.
You mean to tell us you survived an encounter with Socialized – Single Payer – Government Run Health Care?!?
You Poor Poor Dear – having to endure such a horrendous experience.
“Though the French system offers many short-term and long-term benefits, it is clearly not without its short-term and long-term costs.”
Ain’t nothing free. You accept the the fact that the French pay taxes to support their health care system, yet seem alarmed they may have to increase those taxes to meet rising costs.
Americans decided long ago that everyone should receive health care, as no one can be denied emergency service at a hospital, and paramedic services are a governmental,taxpayer-funded, function. Our problem is, no one wants to pay for them util the instant they’re needed, and it doesn’t work that way. Not well, anyway, and not indefinitely.
I thought this was an interesting article. I wonder if a surgery center can deny treatment?
http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1539
I wonder if a surgery center can deny treatment?
If they are an emergency room set up to deal with life threatening emergencies, and if they accept Medicare or Medicaid, then no.
But if it’s a scheduled surgery center, and not an emergency room … I don’t think they have a legal responsibility to provide treatment, since it’s not their normal operations.
In 1984 i went to France to visit the Normandy beaches where many of our dear boys lost their lives on D-Day. While i was there, i had a severe appendicitis. My wife and the tour guide took me the hospital and i underwent an appendectomy. Stayed in the hospital for about a 5 days. The care was excellent and the doctors were efficient and carrying–really nothing bad i can say about that.
Besides leaving my phone number, my home address and my name on an information sheet, no one asked me to pay or do anything else. I returned home expecting a huge bill. What i got in the mail, about a month or so later, was a bill for the equivalent of $160. I honestly thought they made a mistake and that i stiffed them. But apparently, that was it, a hundred sixty dollars.
Rational Arguments » Why context is important // Apr 7, 2010 at 11:21 pm
[...] Ryan describes her experience with the French health care system. She’s shocked at how good it seemed: I walked into the [...]
I’d encourage people to read T.R. Reid’s book “The Healing of America”; he goes into detail about the French medical system. His book shows that the three fundamental points that enable most other developed countries to achieve better care than the US at lower costs are: 1. Basic health care is provided on a not-for-profit basis by insurance companies (they make their profits on supplementals); 2. There are uniform fee structures to keep costs under control, and 3. Health care is considered a basic need rather than a commodity.
Conservatives have fought these measures, claiming there is too much government control, but ironically in those countries that have implemented them (Japan is another example) there is much more decentralization and competition among providers. However, doctors, hospitals, pharmaceutical firms, and medical equipment manufacturers make smaller profits, so given the political power of these special-interest groups in this country it’s unlikely we would see these changes here in the US.
Randy MD, FACS
“Many citizens do not consider cutbacks such as minimizing hospital staff and shutting down healthcare clinics to be an option, for healthcare is a right that ought to be equally available to everyone, no matter where they live or what they earn.”
Pardon me while I surrender to a pet obsession, having had the frustrating discussion numerous times regarding whether health care is a right. As this quote illustrates, anytime you consider a “right” something which must be *provided* by government rather than preserved or protected by government, problems arise when there just isn’t enough money for government to do so.
As the health care debate and legislation enters the “fixing” stage, we’re actually in the enviable position of having a multitude of national examples to examine, to see what works well, what doesn’t, and what might be unintended consequences. It’s a good place to be, frankly, despite that it’s been bloody reaching this point.
The last I saw showed an average annual income of something like $60,000 for French doctors. A Frenchman I know whose sister is an MD in the greater Paris area confirmed that she makes about $50,000 per annum.
Now let’s try to get all of our $600,000 a year Scarsdale radiologists to accept a 90% paycut.
On ne peut que rire!!!
I also read that a typical MRI exam costs about $150 in France vs. $600 in the US. Why is this so?
The answer is that most Americans have some kind of Third Party Insurance, and NONE of the players in the system are incentivized to keep costs from rising (not the doctors, not the insurance companies, not the MRI center owners, not the patients who simply hand a magic insurance card and get most of the expenses paid.) With no rationing mechanism it will simply spiral and spiral and spiral up.
I fell off my bike in NYC last summer and scraped my face on the asphalt. I needed 4 stitches on my right cheek. I walked into the filthy emergency room of St. Vincent’s hospital, and like everyone else, was treated like shite by some of the rudest admissions staff you could have imagined, and I have gold-plated corporate health insurance. I walked out 3 hours later with a cleaned up boo-boo and 4 stitches. No x-rays or MRIs or anything fancy was done. A month later the bill/reconciliation came and the total thing came to $11,000, of which I only had to pay $200. I simply laughed out loud and went bwa-ha-ha, my poor insurer has to pay $10,800 for my four freakin’ stitches. (The biggest part of the bill, $8,000, was for some doc to actually do the stitches. Apparently, he was a plastic surgeon and got to charge $8k for what I think was a 12 minute procedure. Insane.)
Funny thing is, St. Vincent’s went bankrupt this week — again– and I think for good. Seems they can’t make a profit even charging $11K for four stitches.
There is no way any group of rational people would EVER devise a health care system like ours from scratch. I am quite conservative on many issues, but the US health care system is a national disgrace and a cancer which will continue to eat away our future productivity and prosperity from the inside.
As a dual citizen of France and America, I find it troubling that so many in the U.S. point to the French model of health care without having any true understanding of the costs.
The overall rate of social security and tax on the average wage in 2005 was 71.3% of gross salary, the highest of the OECD.
To begin with, the Employer taxes are prodigious at an official rate of 52% of the employee’s gross earnings. There are many different credits and exemptions however.
The OECD estimates that employer social security contribution in France amount to an average of around 35% of an employee’s salary.
Yet on top of those social charges are several other employer taxes: a “Training Tax” which starts at 0.55% of total payroll; a “Housing Tax” which is 0.45% of total payroll; a “Apprenticeship Tax” which equals 0.50% of total Payroll; a graduated “Salary Tax” for companies exempted from the VAT tax which can be as high as 13.6% on earnings above €14,295; there is also a “Company Car Tax”.
Thus, an employee whose true earnings are €100,000 will likely be receiving a “gross” salary of approximately €70,000. The employer burden is hidden from the employee.
The employee is then assessed 29.0% of gross salary for the a litany of “Social Charges”: 0.75% for “health/Sickness, 8.0% for the “Social Welfare Levy”, 2.4% for “Unemployment Benefit”, 6.75% for “Main Pension Benefit”, and 11.0% on the “Complementary Pension”.
So the 100,000 employee’s take-home pay is €49,700. (If you are self-employed, you will pay 45% of your net income in these “social taxes”). If you have any pension/benefit income you will pay 7.1% on that. If you have any investment income, rental income, or capital gains you will pay 12.1% in “social charges” tax on that too.
The employee then faces another host of taxes. Income tax is graduated with a top rate of 48.09% on all income above €69,783 and the code includes all employer-provided benefits (company car, hotel lodging for business purposes, meals, etc) in the calculation of taxable income. Capital gains, interest income and the like are taxed at 18% on top of the 12.1% you paid in social charges.
Our €100,000 employee, if single with no dependants, is now down to €35,304 having paid income tax.
Then, you face a property tax (taxe foncières) and a residence tax (taxe d’habitation). The owner of the property is liable for the taxe foncières. If you are an owner-occupier then you are liable for both taxes (this is unlikely to be the case because France has one of the lowest home ownership rates of all advanced nations).
After all that and a bevy of minor taxes, you can live. But you must pay a 19.6% VAT on everything you buy, although some food items are taxed at only 5.5%. If you want to drive a car, you should be prepared to pay for your gas or diesel two, three, or four times the price you would pay in America, depending upon the current level of petroleum tax which oscillates tremendously.
Should you have been able to save any money after all those taxes, they have an annual graduated “wealth tax” of up to 1.8% of your net worth.
And, if you have been truly refractory, managing to accumulate wealth over your lifetime, your heirs will be taxed royally too-up to 60%.
Isn’t amazing how little French health care costs?
France continues to be among the OECD countries whose tax rate is the highest. Taxes account for 45% of GDP against 37% on average of all OECD countries. The US now equals France in spending though its tax collections lag …at least so far.
“The current French tax system deducts from individuals’ pay immediately, so that there is no need for an April 15th, “tax day.””
You are obviously not much informed about French taxes.
The current French tax system deducts payroll taxes for individuals’ pay, and these payroll taxes only cover retirement, health and unemployment insurances. Regular income tax is paid independently.
Oldyale is factually correct on the various taxes (though I’d have to check the rates, which seem to me perhaps exaggerated), but this should of course be put into perspective: in the US, one typically has federal income tax, state income tax, sales tax, local property taxes, and so on.
However, Oldyale seems to imply that all this somehow goes into health care. In France, social security is not a government budget, but a separate budget, funded by its own taxes and with different appropriation bills — and the funds are actually managed by private entities (France has no social security administration – the various “caisses”, or funds, are operated under private law).
When it comes to health care, European countries have it so good. - Politics and Other Controversies -Democrats, Republicans, Libertarians, Conservatives, Liberals, Third Parties, Left-Wing, Right-Wing, Congress, President - Page 6 - City-Data Forum // Dec 19, 2010 at 8:31 am
[...] For more information on the level of reimbursement see Healthcare France FAQ more info Tough Choices for French Health Care | FrumForum In England you have to sign up on a list for healthcare and wait till your scheduled for an appt. [...]