In France, the sicker you are, the more coverage you get. For people with one of 30 long-term and expensive illnesses — such as diabetes, mental illness and cancer — the government picks up 100 percent of their health care costs, including surgeries, therapies and drugs.
France has made an unusual guarantee that every cancer patient can get any drug, including the most expensive and even experimental ones that are still being tested, says Dr. Fabian Calvo, deputy director of France's National Cancer Institute. This kind of access is why the French — unlike Americans — say they are highly satisfied with their health care system, he says.
"It's a feeling of safety — that if you have a big problem, you could have access to the good therapy," Calvo says.
When compared with people in other countries, the French live longer and healthier lives. Rodwin says that's because good care starts at birth. There are months of paid job leave for mothers who work. New mothers get a child allowance. There are neighborhood health clinics for new mothers and their babies, home visits from nurses and subsidized day care.
The Cost Of Care
It's expensive to provide this kind of health care and social support. France's health care system is one of the most expensive in the world.
But it is not as expensive as the U.S. system, which is the world's most costly. The United States spends about twice as much as France on health care. In 2005, U.S. spending came to $6,400 per person. In France, it was $3,300.
To fund universal health care in France, workers are required to pay about 21 percent of their income into the national health care system. Employers pick up a little more than half of that. (French employers say these high taxes constrain their ability to hire more people.)
Americans don't pay as much in taxes. Nonetheless, they end up paying more for health care when one adds in the costs of buying insurance and the higher out-of-pocket expenses for medicine, doctors and hospitals.
The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.
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