Arnold Kling  

Medicare, the U.S., and France

Tax-eaters... Arlo's Single Payer Plan...

Jonathan Cohn writes,

French universal health insurance works an awful lot like Medicare does in this country. And that's the great irony of how screwy the debate over health care has become in this country. Conservatives always talk about expanding choice, yet when it comes to the choices Americans prize most -- choice of doctor and hospital -- government-run health care actually delivers that choice better than private health insurance.

Last year, I scaled up the French population to our level, and then created the following table of medical expenditures:

CountryHealth Care Spending
$ billions

*with 300 million people

If Medicare were a country, it would already be way over the top in terms of health care spending. If we were to keep Medicare as it is and then introduce the French level of total spending then we would have to cut spending on the non-Medicare population by roughly 67 percent. Is that what Cohn is talking about? I doubt it. But I can never figure out what single-payer advocates are talking about, because they so often evade the basic issues of how it is supposed to operate.

I really want the advocates of single-payer health care to get into specifics about spending, taxes, methods for compensating health care providers, and all of the other mechanics that need to be worked out if the government is going to take over health care finance. It is irresponsible to just blithely say, "It works in Europe, so it can work here."

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COMMENTS (5 to date)
Viscus writes:

If you are so interested in the specifics of possible single-payer type proposals, why don't you do something constructive.

You design the best single-payer system you think can be designed. Obviously, the word "best" is somewhat problematic because what is "best" depends on our objectives, and our objectives are hetereogeneous. (Some people, for example, could care less about the healthcare of others as long as they have theirs. Other people care about those whose health conditions worsen due lack of access to preventative care -- even if those "other" people are not friends or family.) As you go about your design, make sure you are clear about your objectives, as well as why you think certain decisions are optimal.

Until you design your own single-payer system, I don't really see you as having standing for demanding that others produce a specific proposal.

Donut writes:

Couple of points:

1. Viscus - why should someone who does not advocate a particular position come up with workable models of that position before asking the advocates to do the same?

2. I think that Jonathan Cohn might be mistaken in saying that "doctor and hospital" is the most important choice, or at least the most important ECONOMIC choice that a patient makes. I sense (but don't have time to prove now, since I am at work) that the majority of a person's lifetime medical costs are accrued in the last year of their life. In the US, we often choose to make heroic attempts to stave off death - expensive procedure for elderly patients, costly cancer treatments, bypass surgeries, etc. Does a person in a European health care system have that choice? Can an 80 year old in France get a $250,000 surgery to add another year to their lives?

I don't know the answers, but I hope my question is important. Later, if I have time, I might try and research it.

spencer writes:

What would it do this calculation if you assumed that American doctors were paid the same as French doctors?

trumpetbob15 writes:

Something else that needs to be considered is quality of care, which is always difficult to quantify. For example, if I choose from 30 low quality doctors, do I really make a choice I wanted? What if I could only choose from the 3 doctors that I can afford, but they are all higher quality than the 30 of the previous example? Wouldn't I be better off having my choice from the 3 I could afford (out of however many doctors I couldn't afford) than having my pick from the all 30 of the worst doctors?

By the way, do the French actually get to pick their doctor? What happens if the doctor's office is full and won't see another patient? Here we could offer to pay more to make sure we are seen, but what could the French do?

rvman writes:

The difference between France and the US in the chart is $1 trillion. There are 800,000 US physicians. If you cut every physician's annual income by $100,000, you'd account for a grand total of 8% of the difference. If you took away all of their annual net, it would be about 16%. (The average US physician makes ~$200,000 per year.) The cost differences lie elsewhere. (Possibly in the fact that there are 3.6 office, admin, management, and finance people in health care per doctor explains some of the difference. This doesn't even count government bureaucracy - this is just in the businesses, according to BLS Statistics .)

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