Health Care Lessons From France Like the United States, France relies on both private and government insurance, with most people getting insurance through their employers. But in a ranking of 19 industrial nations, France is at the top of the list for health care quality, while the United States ranks last.

Health Care Lessons From France

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This is Day to Day. I'm Alex Cohen.


I'm Madeleine Brand. This month, we're taking a look at healthcare systems in Europe and how they compare with ours. Somehow, they're able to cover everyone at a fraction of what we spend on healthcare. Many U.S. experts are interested in the French system in particular. NPR's Joseph Shapiro explains why.

JOSEPH SHAPIRO: In 2000, the World Health Organization rated healthcare around the world. France came in first. The United States ranked 37th. And this year, two researchers at the London School of Hygiene and Tropical Medicine measured something called amenable mortality. Basically, it's a measure of death that could have been prevented with good healthcare. Again, France came in first. The United States was last. Now, some American experts, like historian Paul Dutton at Northern Arizona University, say there's a lot Americans can learn from the French. For starters, says Dutton, the French system is not what most Americans imagined.

Dr. PAUL DUTTON (History, Northern Arizona University; Author, "Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France"): Well, I think that Americans assumed that if it's in Europe, which France is, that it's socialized medicine. The French don't consider their system socialized. In fact, they detest socialized medicine. That's - for the French, that's the British. That's the Canadians. It's not the French system.

SHAPIRO: France, like the U.S., relies on both private insurance and government insurance. Also, just like in the States, people generally get their insurance through the place where they work. In France, everyone has healthcare. Unlike in Britain and Canada, there are no waiting lists to get elective surgery or see a specialist. Dutton wrote a book called "Differential Diagnosis," that compares the history of healthcare in the two countries. He says Americans, like the French, want pretty much the same thing, choice and more choice.

Dr. DUTTON: I found that the ideals that French and Americans held in terms of healthcare, specifically wanting choice of doctor, and doctors wanting really a lot of freedom of clinical decision making. Both peoples want a private physician and lots of choice within the hospital system.

SHAPIRO: Dutton says, the shared values come out of a shared history. Both countries are products of Enlightenment-era revolutions.

Dr. DUTTON: The French hold individual liberty and social equality very dear, right? Liberty, equality and fraternity, of course, the slogan of their revolution. And in this country, of course, we have similar ideals, individual liberty, social equality, equal chances for everyone.

SHAPIRO: But Dutton says the French have done a better job of protecting those values in healthcare. Here's how the French healthcare system works. The national insurance program is funded mostly by payroll and income taxes. Those payments go to several quasi-public insurance funds that then negotiate with medical unions to set doctors' fees. The government regulates most hospital fees. That's how France keeps cost down. When someone goes to see a doctor, the national insurance program pays 70 percent of the bill. Most of the other 30 percent gets picked up by supplemental private insurance, which almost everyone has. It's easily affordable, and much of it gets paid for by a place where you work. Victor Rodwin at New York University and the International Longevity Center studies the French healthcare system.

Dr. VICTOR G. RODWIN (Health Policy and Management, Robert F. Wagner School of Public Service, New York University): There are no uninsured in France.

SHAPIRO: Does anyone go broke over their personal healthcare costs?

Dr. RODWIN: Now that's completely unheard of. There is no case of anybody going broke over their health costs. In fact, the system is so designed that for the three or four or five percent of the patients who are the very sickest, those patients are exempted from their copayments to begin with. There are no deductibles.

SHAPIRO: That's another lesson from the French system. In France, the sicker you are, the more coverage you get. For people with one of 30 long-term and expensive illnesses, including diabetes, mental illness and cancer, the government picks up 100 percent of their healthcare costs for surgeries, therapies, even for the most expensive drugs. When compared to people in other countries, the French have long and healthy lives. Rodwin says that's because good care starts at birth.

Dr. RODWIN: When you are a new mother, you are very well taken care of in France. They take very good care of their mothers when they're pregnant. There's, of course, no problem of uninsured mothers. They get good prenatal care and they have house visitors. Nurses will come to the house and helped the mothers in the first week.

Ms. MARY LOU SARAZIN (American Citizen living in France): Are you ready? Are you ready?

SHAPIRO: On a recent spring morning, Mary Lou Sarazin, a young American mother married to French husband comes to a park with her baby daughter.

(Soundbite of baby)

SHAPIRO: Sarazin came to Paris to teach English. She'd tell her teenage students about life in the States.

Ms. SARAZIN: So, when I was explaining to them the concept of healthcare and health insurance. Oh, la, la, la, la, la. I mean, they was so shocked that if you were sick and you did not have health insurance, you could go bankrupt. To them, they made absolutely, positively no sense because America is seen as the greatest country in the world.

SHAPIRO: When her teaching job ended and her Visa expired, she returned to the U.S., and then was surprised to find herself among those 47 million Americans with no health insurance. She was pregnant and unemployed, and no insurer would sell her health insurance. So, she moved back to Paris to have the baby. In France, there's months of paid job leave for mothers who work. Johnson got a child allowance that went for things like buying diapers. She found the country provides healthcare and social support for new mothers in ways far beyond what she found at home.

Mr. JOHNSON: I mean, I love America, but when it comes to, like, the family unit, I just notice that France creates a system - like, there's something called Crush, which is like a daycare, which is very, very affordable. If she's ever sick, I can just take her to any doctor and be able to pay for her no problem.

SHAPIRO: So, by now, you're probably thinking, what does all this cost? France's healthcare system is one of the most expensive in the world. But the U.S. has the most expensive. Workers in France are requires to pay about 21 percent of their income in to the national healthcare system. Employers pick up a little more than half of that. And although Americans don't pay as much in taxes, they do end up paying more for healthcare, when you add in the cost of buying insurance and the higher out-of-pocket expenses for medicine, doctors and hospitals. So ,the French get more for less. But France, like all countries, faces rising costs to healthcare. And in a country that's so generous, it's even harder to get those expenses under control. The health system is running a deficit. So, in France, those benefits are being trimmed, and there will be more cuts to come. Joseph Shapiro, NPR News.

(Soundbite of album "Comme Si de Rien N'Etait")

COHEN: Later in the show, something else that's so typically French.

BRAND: Imagine this. What if First Lady Laura Bush, what if she cut a CD, a CD like this one, for instance, that contains lyrics comparing her love to street-grade heroin?

COHEN: Sounds crazy, but if you're a citizen of France, you're not imagining things. Pop singer, Carla Bruni is France's first lady. Her latest CD comes out today, and even Parisians are blushing.

Unidentified Woman: I sound conventional to say so, but it's immediately, like, oh, wow, oh, no, this is too much.

(Soundbite of album "Comme Si de Rien N'Etait")

COHEN: The music of Carla Bruni coming up on Day to Day.

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