Recently, a quite well-written diary by a fellow French kossack, French Imp, explained to Daily Kos how the French health care delivery system works. Aside from explaining post-war developments in our health care system here in France, the spirit of the diarist's thesis was the even our excellent French public health care system was the product of a long series of incremental improvements, ending only recently, in 1999.
Many kossacks, especially those inclined to celebrate the Democrat's recent achievement of a modest set of health care reforms, took encouragement from French Imp's celebration of French health-care incrementalism.
Unfortunately, his characterization of our health care progress here in France is largely false.
Not so much in the facts, though there were a number of factual errors in his presentation, mostly minor. No, the falsehoods come from errors of context, a context which, when evaluated, both completely undermines the case that current reforms in the US are an adequate start, and which underlines just how far behind the US health care system is relative to all other industrialized nations in providing good quality and timely health care to all of its citizens.
French Imp's thesis was simple: during the war of 1939-1945, conservative Gaullists and progressive Communists, resistance allies, agreed a framework for post-war development, including the broad outline of a social welfare state, including universal health care. Immediately following the war, the health care part of that system was put into place, know today as the Sécurité Sociale or Sécu for short. Further and further refinements and expansions of that system were to continue until 1999, when the final improvement was in place, (a law essentially ensuring health-care providers would receive state re-imbursement for treating indigent foreigners, on French soil legally or not). A celebration of incrementalism that any American could take heart in, even if greatly disappointed by the Health Insurance Industry Subsidies act of 2010.
The problem, of course, is that this story is largely false. Virtually every French citizen had guaranteed equal access to insured health care in 1945.
To see why there are large contextual holes in the "incrementalist" story, one need dial the clock back to before the war. In fact, you have to go back a couple of wars, as the first moves in France towards state provision of universal coverage happened in 1893, when a law established state subsidies for medical treatment of the poor. This law was itself a formalization and expansion of a more general law passed on Frimaire 7, Year 5 (27 november 1796 on non-revolutionary calendar). This framework would arguably have its US equivalent in Medicaid, which passed nearly 70 years later.
Further laws formalizing care for infants and for the elderly followed shortly thereafter (1904 and 1905), as well as workplace accident coverage (1898). This was a time of great progress in France, with the Socialist Jean Jaurès, in alliance with the left-radical (center-left in today's terms) Emile Combes, getting much done to make France a more social, secular and equal place. So, well before the Great War of 1914-1918, France had a public health care system whose state component was structure much like America's is today, over 80 years after the end of that war.
Of course, progress always moves forward and further improvements to the health care system were coming. In 1928 and 1930, state requirement of employer-provided health insurance, including maternity and disability insurance, is extended to all employees, including employees of the State, agricultural workers, farmers, miners, et c. Already at the time, there was talk of making the State be a monopoly provider of this insurance, i.e., make it a single-payer system, but the system of private insurers then in place was left in place. In other words, the health care reform bill currently being negotiated in conference in the US House and Senate will give Americans essentially the same structure of health-care delivery as France had in 1930.
During the war, of course, as with many other things, this whole edifice crumbled, and would need to be rebuilt as a priority following the end of that war, which is where the diary everyone here enjoyed the other day picked things up. But, what needs to be understood is that there already existed a health-care system prior to the war, and that, with the establishment of the Sécu in October of 1945. This establishment was not the first step towards universal, equal access to health care in France, but rather, the first step in making the system essentially single-payer. Access was already largely universal, greatly regulated and generously subsidized.
All the incremental change which was to follow were simply rationalizations of the system, bringing into the single-payer State system parts of the population which, though already largely covered, were covered under independent organizations, including farmers and agricultural workers, state workers, independent artisans and so forth.
So, when taking heart in how even the greatest health care delivery system, France, got to Universal Coverage in incremental steps over a long period of time, please note that Universal coverage here was largely achieved by 1930, and that the long process began in 1796.