Until recently, when the political left wanted to promote
universal health care, it would point to Canada as the example the
U.S. should follow. Now the left is touting France. In a recent
editorial, the New Republic stated “the
French, whose system the World Health Organization recently
declared the planet’s best, have more hospital beds [than
Americans]. They get more doctor visits, too, perhaps because their
access to physicians is nearly unfettered—a privilege even most
middle-class Americans surrendered with the spread of managed
care.” Apparently our great neighbor to the North has fallen out of
favor with the socialized-medicine crowd.
Changing poster boys is nothing new for the left. In their 1979
book Free to Choose, Milton and Rose Friedman
noted the increasing calamity that was the British health system:
“The British National Health Service has now been in operation more
than three decades, and the results are pretty conclusive. That, no
doubt, is why Canada has been replacing Britain as the example
pointed to.” In recent years, thanks in large part to conservative
and libertarian scholars, Canada’s single-payer system has also
been exposed as a mess. From hospital shortages to long wait times
for surgery, the problem has gotten so bad that, as the New
York Times recently reported, private clinics are now
springing up at the rate of one a week in Canada — even though
they may be illegal.
Since Canada no longer “proves” that government-run health care
is better than private care, the American left needs a new nation.
And why not France? After all, if you can just overlook the
trifling problems like the Muslim riots, nearly 10 percent
unemployment, and college students protesting a new law that would
allow employers to fire employees, France should serve as a great
example.
So thinks Paul Krugman, who, according to a recent news account,
predicted over the next 15 years, so-called
“health-care zombies” — strategies proven wrong that remain part
of the health-care debate — finally will fall away, leaving a
system like France’s. The employer-based system will collapse, he
said, replaced by a single-payer system similar to Medicare, with
government ownership of hospitals and an option to buy supplemental
coverage.
Krugman might want to do a bit more reading on the French system,
for if we were to become more like France, our system of
employer-provided coverage would not disappear. Although France
does have a public system of health care, according to an OECD
working paper, France has a “high rate of private
insurance coverage” because of “the preferential tax treatment of
employer-sponsored coverage.” Indeed, “roughly half of all [health
insurance] contracts are obtained through the workplace.” The
private insurance is used to pay for co-payments required by the
public system, and also to pay for goods and services that are
poorly covered by the public system such as dental and optical
care. Over 80 percent of Frenchman have private health insurance
(over 90 percent if one includes what the government subsidizes).
France also appears to have some of the same problems that
Canada does. Fausta’s Blog points to a number of BBC stories
about government cuts in health care funding are leading to
protests and strikes by doctors and other health-care workers.
And what about the WHO’s designation of France as the world’s
best health-care system? The basis for this is a measure called
“Overall Preformance” in a WHO 2000 report (see page 200). France is ranked first on this
measure, while the U.S. is ranked 37th, behind Colombia, Morocco,
Dominica and Costa Rica. I must have missed all of those news
stories about Americans flying to those countries for their
superior health care.
Overall performance is constructed using not only outcomes like how well a
health-care system cures disease, but also something called
“fairness in financing.” It is this factor that largely explains
the U.S.’s low ranking on overall performance. On fairness in
financing (see page 188 of the WHO report), the U.S. ranks 55th,
behind “fairer” countries like Bangladesh, Tanzania, and Cuba.
The standards that go into the fairness in financing
measure include progressivity — i.e., whether the rich pay more
into the health-care system (fair); whether some households incur
catastrophic payments (unfair); and whether equivalent households
make unequal health-care payments (unfair). Yet it’s questionable
if such standards are really fair. For example, is it fair for two
households with equivalent incomes to make equal payments if one
household consumes more medical services?
It’s pretty clear that such standards were designed to bias an
outcome in favor of government-run health-care systems. The WHO
report states that in health care, “government remains the prime
mover,” and its “key role is one of oversight and trusteeship — to
follow the advice of ‘row less and steer more.’” We further learn
that markets ration health care
by price, which means that who gets what goods and
services depends not only on how much those goods and services are
valued by people, but on who has the means to buy them. Priorities
are not set by anyone but emerge from the play of the market. As
indicated, this is almost the worst possible way to determine who
gets which health services.
Relying on the WHO report as sound research, as the
New
Republic did, is about as safe as a Renault Le Car in downtown
Paris last fall.
Now that the left is promoting France, it is probably only a
matter of time before it is discredited as an example of the ideal
health-care system. Where, then, will the supporters of
government-run health care turn to for a country with better health
care than the U.S.? Well, they can always try Colombia, Morocco,
Dominica or Costa Rica.
David Hogberg is a senior research analyst at the
Capital
Research Center. He also hosts his own website, Hog
Haven.
