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For French, US health debate hard to imagine

By Edward Cody
Washington Post / September 27, 2009

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MARSEILLE, France - When Jean-Louis Aloy could no longer walk comfortably among his olive trees in the hills above Marseille, he knew the time had come. Bowing to doctor’s orders, he checked in to a hospital for a long-delayed back operation.

Despite the prospect of an expensive two-week hospital stay, Aloy, 58, did not worry. France’s national health insurance, supplemented by a private policy for copayments, covered the entire bill - from doctor’s fees to medication to a private room with a view - and Aloy would not even know the total.

“All I have to do is fill out some papers and send them off to the insurance company,’’ he said during a smoke break on a sunny terrace in front of the hospital two days after the surgery.

France has long been proud of its national health insurance, part of a many-tentacled and costly social protection system designed to embrace almost everyone who is legally in the country. Most French people have grown up with the idea that the government is the ultimate guarantor of health care, even for people who cannot afford to pay. The concept has become so ingrained over the past half-century that it is an untouchable part of the political landscape, making the debate over President Obama’s proposals in Washington and the fading chances for a public option seem, in the words of the newspaper Le Monde, “altogether surreal.’’

But the fast-rising cost of drugs and medical care, particularly for the elderly in their final days, has raised the question of how long France can afford the health care it has come to expect. Seeking to beat back rising deficits, the government has reduced the reimbursement rate for many medicines and routine medical services, opening a growing market for private insurance policies, called mutuals, to cover the steadily increasing copayments.

Without abandoning the bedrock of health care for all, therefore, the French system has begun to evolve toward something resembling Medicare, the health insurance for older people in the United States, except that it covers people of all ages.

The shift is regarded as inevitable, specialists said, but increasingly it is raising the delicate question of how much the government will be forced to resort to even higher copayments in the years ahead.

Coverage policies have grown complicated as medical care and drugs become ever more sophisticated. In that atmosphere, fraud has grown. But despite the drawbacks, the outcome is relatively cost-effective in comparison with the situations in other industrialized nations, according to tracking by the Paris-based Organization for Economic Cooperation and Development.

France spent about $300 billion for the health needs of its 64 million people in 2007, the last year for which reliable statistics are available, the organization reported. That amounted to about 11 percent of gross domestic product for a system covering an estimated 99 percent of the population, well below what Americans pay for a system that leaves out tens of millions of people.

On a per capita basis, France also ranked well below the United States in health expenditures. It was eighth on the organization’s list, while the United States ranked at the top.

Despite the lower spending, French people have for years had a longer life expectancy than their counterparts in the United States, currently at 80.98 years compared with 78.11.

In the 30 years that followed World War II, the French paid steadily higher taxes for health care. They did not complain because their salaries were rising just as fast, but over the past two decades, growth slowed and health costs skyrocketed.

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