Wednesday, March 3, 2010

A better healthcare system (??) Part Deux

France's system has been called the best in the world. My previous blog described how France is attempting to meet the challenges of an aging population, and increasing medical costs the same way that all health care systems do...raising taxes and limiting services. The argument has been made that while flawed, France's system does work, and with vastly better outcomes. Furthermore, I illustrated the demographic and cultural differences that exist between the two countries, leading to an inherently unhealthier U.S. population, to which the argument was made that if people had access to healthcare in the U.S. that our general health would be improved. I intend to mitigate the first argument, and to expose the other arguments as being incorrect.

The statement was made that the income tax rate in France is less than what that person is paying in the U.S. in response to my assertion that France has had numerous health care tax increases since 1986. Income taxes are but one form of taxing the populace. Since 1985, when France first ran a deficit on it's healthcare program (which continues to this day), the following taxes have been implemented.

1986 -- Increase in health-care payroll taxes.
1988 -- Creation of a special tax on medication advertising to help fund health care.
1990 -- Introduction of the CSG, a new tax levied on all types of income to help fund health care.
1991 -- Increase in health-care taxes levied on payroll.
1993 -- Increase in CSG rate. Coverage of doctor consultation is reduced.
1996 -- Increase in health-care taxes. A new health-care tax is levied on private health-care plans
1999 -- New tax levied on drug makers when their revenue exceeds a pre-defined level.

These are just the tax increases. Increased out-of-pocket costs, reduced doctor reimbursements, increased bureaucracy (there are 43 various government agencies overseeing the French system) and facility closures are occurring at a faster and faster rate. So, while the French system may 'work' at this point in time, it's future viability is seriously in question (so much so that the prime minister stated in 2007 that the system is 'bankrupt'). Just how long can a 'bankrupt' system survive ? Not exactly a model to emulate going forward.

As far as having better outcomes, let's take a look at a few examples. SARS, a childhood respiratory disease,is a serious illness that can cause death. A full 14% of French babies that contract SARS die. The figure in the the U.S. is 0% statistically. Furthermore, 5.3 people in France vs 3.4 people in the U.S. per 100,000 people die of a particularly hard-to-treat cancer, stomach cancer. As far as cancer deaths overall, another "working" socialized medicine program that was held up as an example has the HIGHEST cancer death rate (the Netherlands). Better outcomes indeed. As far as prevention goes, (as an example), 91% of Americans are immunized by age one for measles as opposed to only 85% of French citizens. There are many more examples; space and time limits their inclusion.

The best that can be said is that France's system is beset by the same problems that affect all healthcare systems--cost. The difference is that the French people lead a healthier lifestyle (reflected in the fact that over 30% of Americans are obese, compared to less than 10% of French citizens). The argument was made that if the American people had access to health care that perhaps they would change their lifestyle to a healthier one. This argument falls flat on it's face for two reasons: #1 is EVERYONE in America has access to health care...just not access to the major financing mechanism for health care--insurance. A regular office visit in Nevada is around $85. Additionally, there are low-cost clinics, FREE clinics, Planned Parenthood and Quick Care centers for those that can't afford $85. #2-- the main cause of the health disparity between France and the U.S. is the obesity rate. From grade school (remember the food pyramid ?), television advertising (Healthy Choice meals, "get your 5 servings of vegetables in a V-8", yogurt, fiber, ad nauseum), support groups (weight watchers, jenny craig), gym and gym equipment advertising, food labels, laws against trans fats--we have been inundated with the perils of being obese. We don't need to go to the doctor to be told we're fat and need to quit smoking. It's all around us. Again, it is people's CHOICE to engage in these behaviors; a trip to the doctor won't magically change that. Additionally, disease management: hypertension, cholesterol, diabetes, etc. (all caused by obesity), requires the patient to take responsibility...a majority of hospital admittance is due to the failure of PATIENTS to manage their own diseases to the point where they have to go to the hospital. Where a trip to the doctor WILL help is in uncovering an unknown and non-apparent condition such as cancer. The U.S. already has among the best cancer survival rate in the industrialized world. Even then, a regular self breast exam in the shower will uncover more cases of breast cancer than mammograms and is free. Yet, the majority of women don't even do that...While doctor visits may be affordable (or free), what of catastrophic diseases (such as kidney failure for example) for people without an ability to finance it (i.e.through insurance)? The fact is, ANYONE can get dialysis if they need it...just ask UMC hospital in Nevada, which treats numerous ILLEGAL ALIENS to the tune of MILLIONS of dollars per year for free. The EMTALA act made that possible...passed in 1986, it made it illegal to deny care to someone based upon their ability to pay (or even citizenship).

As I said in my previous blog, it's always easier to point the finger of blame outward rather than in the mirror. However I think I'll close with a sentiment expressed by those in the know regarding health reform--You think health care is expensive now ? Just wait until it's free.

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