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.
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