I grew up in the era when the specter of "socialized medicine" and not "having your own doctor" was enough to stop any conversation about what we now call single payer health care system. The emphasis was always on the lack of choice for the user of the system. All these many years later, critics still drag out the stock phrases "Well, look at England!" or "Look at Canada!" to try to end conversations about changing the health care system in the United States. My question is: "Why should we limit ourselves to talking only about the British or Canadian models? "
There are four main models of health care systems: Beveridge, Bismarck, National Health Insurance, and Out-of-Pocket. France, ranked as number 1 in health care by the World Health Organization (although their methodology and criteria have been criticized) is considered to be of the Bismarck variety. If you have a few moments I'd like to tell you a bit about our experiences with this model of single payer system.
Our first experience with the French healthcare system was in 1994, when I had a brief stay in a French hospital in Besançon on the river Doubs in the foothills of the Jura mountains. We had gone to take an intensive French language course for a month. What we remember most about the public hospital is that the large windows in the rooms were open, letting in a breeze. The rooms were modest-sized and had only 2 beds in them. They had cooks come in to prepare at least the dinner I had, which spread the most delightful scents. All this plus the patience of the doctors and nurses who had to struggle with my limited language skills as well as my physical ailment, left a very strong impression of the humanity and human scale of the medical system in France. This was in contrast to the people and the healthcare system that we knew as Kaiser Permanente. Even back then we knew we were lucky to have medical coverage which was partially paid for by my husband's employer.
Life went on. When we applied for a visa in 2003, one of the requirements was that we have our own medical insurance coverage. We had been without insurance since 1996 because even the COBRA type insurance was extremely high. So we found what we called catastrophic insurance. It was a catastrophe for the budget and it covered only the most severe medical issues, but it satisfied the French government requirement.
We moved permanently to France in 2005. Once here, we discovered that the French law required that we, now as real residents, enroll in the Couverture Maladie Universelle or CMU. At the appointed place and time we presented our birth certificates, copies translated into French, our certificate of marriage, and its French translation, proof of income, and the always requested electric or telephone bill to prove that we really had an address. We were never so glad to be required to do something. We waited a couple of months and we got a paper that said we were enrolled and that was that. In March 2006 we moved to this town, and took our change of address to the various governmental agencies that want to know. By May, we received, for the very first time, our Cartes Vitale, the green insurance cards that track your care and expenses in the healthcare system. That month we also got our first bill for our insurance coverage.
When you come from the US and are used to how our current health system is set up, it is a little strange. We are part of the system but, unlike regular citizens, not totally integrated into the system. There are a number of changes going on in the coverage of people that affects mostly the British who come to France to take advantage of the French healthcare system. What we do is pay back into the health system, that is, we pay for the trimester that has passed. The cost is based on a percentage of one's income. For this amount we have a generalist that we choose as "our" doctor, and a dentist, also of our choice. So now we pay less than we did for that catastrophic medical insurance in the US from 2003 to 2005 but have medical, dental, needed prescriptions, and also an allowance for glasses, and hearing aides. These fees are set by the government and the government pays 70% of the listed amount. We do not buy top-up insurance as it is called from any of the multitudinous insurance companies. I did the research and so far it is less expensive to just pay whatever the 30% is that is not covered by the healthcare system. For example, I broke a tooth a few months ago. Two visits to the dentist and fixing the tooth cost 106 euros which I paid by check. A week or so later the government reimbursed me 74.75 euros. (As a side note, we have noticed that the French as a society and culture are seriously insurance/assurance inclined. They take out insurance for everything. I guess we have not become very French yet!)
In terms of funding the French healthcare system I understand that the system is under scrutiny. As a consumer in the healthcare system, our contributions to the system are income tax, our health care payments which are really because we did not contribute to the system during our working lives (and we are not allowed to work here now). Then there is the equivalent of the property tax which is split 2 ways: tax foncière most closely resembles US property tax. The other part of the tax is habitation tax. This may have came into being because until quite recently in history France was a country of renters. Renters used local facilities just like the owners did and I think that's how the bureaucrats decided to make the tax more fair. The VAT is the general sales tax on things other than foodstuffs. My husband did the math once and found that in our situation, the tax burden in France is less than the total we had paid out for taxes (sales, property, income) and a limited health insurance policy in the US, but now we have what we consider to be good healthcare.
There is no doubt in my mind that for extraordinary surgical care, cutting edge procedures, and research, the US leads. But for the rest of us who just need everyday, wellness-oriented healthcare, perhaps a system based on the Bismarck model would better serve the US. It is a very important issue that we all care about. I have a sister who has only the catastrophic health insurance, another sister who would like to retire but who will lose her Kaiser coverage because her employer has reneged on coverage after retirement, and a young niece who is just beginning her life as an adult. Why is it that Americans must worry about getting and keeping healthcare coverage? That energy could be used much more productively.
My thanks to DrSteveB, DemfromCT, and nyceve for working very hard to educate us on a very complex subject. Here is a great page of useful links.