THE FRENCH SYSTEM

Tim Worstall thinks that Krugman misrepresents it. Excerpts:

Funding via taxation means precisely that, that general revenue is raised and then fed through the normal political process to pay for the health system. This has, certainly from the UK experience, two effects: constituencies of Ministers do seem to get bright shiny new hospitals and the minutiae of treatments become national political events. Three weeks ago the UK was convulsed over whether one particular woman who had had her operation for a broken shoulder delayed eight times, including visits to her from a Cabinet Minister and the Leader of the Opposition. Perhaps not all that sensible a system.

Compulsory insurance is how, for example, the French system works. Deductions are made from wages and sent to a specific fund which then runs the health system, in large part by-passing the grandstanding and pork barrels of the elected politicians.....

Now as we all know, prediction is very difficult, especially about the future, so I offer this only tentatively, but I think that Krugman will come up with a system that is a single provider, single payer one. Note that the VA (which is both) is regarded as lean and efficient, that competition is regarded as bad (I'm willing to believe that at times and in places this can be so but not in the provision of a service like health care), and that personal choice leads to higher costs. To put it crudely, that he will propose a system whereby we pay taxes and then get back the treatment that the bureaucracy thinks we should have. Essentially the UK's National Health System. That is, one of the very few rich world ones that is truly awful. The current target (amongst the 1600 that govern this centrally managed system) is that no one will wait more than 6 months for an operation, and Tony Blair recently boasted about how few there are waiting longer than this. (Note that even Ted at CT doesn't think this is a good idea.)

This is where I think the bait and switch will come in, for he has, as above, rightly praised the French system. Yet the French system is not a single payer system at all. The compulsory insurance element collected through pay packets pays for only a portion of treatment costs (35-65% on prescriptions, 70% in general, except in some exceptional circumstances like cancer treatment). There are myriad private insurers who offer a variety of plans to cover the un-reimbursed costs and sometimes the extra costs that can be charged over the prixe fixe. One could with a straight face actually state that this is less generous than the current Medicare and Medicaid systems in the US. Anyone want to try and get the AARP behind the idea that the old geezers should be paying 65% of their Viagra prescriptions and 30% of the cost of their GP visit?

The second thing is that it is not a single provider system. There are indeed publicly owned hospitals, as there are non-profit or charitable ones, as well as profit seeking private providers. All patients have complete freedom to seek treatment from whomever they wish, so certainly an amount of personal choice there.

What worries me is that the Professor will point to a decent system, that of France, and use it to propose a terrible system, that of the UK.





AUSTRALIAN PUBLIC SYSTEM FAILS THE MENTALLY ILL

Australia's health system is still failing the mentally ill, a leading mental health specialist says. After 12 years of national mental health reform, gaps remained in the system, said Professor Ian Hickie of the Mental Health Council of Australia. Writing in the latest Medical Journal of Australia (MJA), Prof Hickie, who is also executive director of the Brain and Mind Institute at the University of Sydney, said governments were not providing enough funding for acute care and suicidal patients. "The mental health community reports little progress in implementing its key priorities, such as expanded early intervention programs, co-management of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings," Prof Hickie said in the MJA report. "We propose new national targets for reducing the social and economic costs of poor mental health."

He said the targets included increased access to effective care and reduced suicide rates. Prof Hickie said in 2003, people aged between 25 and 49 accounted for 56 per cent of all suicides in Australia, while the rate was 31.1 per cent for men aged 25 to 29. He said any new funding for mental health care was welcome, but $110 million over four years represented only 10 per cent of the federal government investment that was needed with a similar level from the states.

Australian Medical Association (AMA) federal president Bill Glasson said federal and state governments were uncoordinated in providing sufficient care, especially for acute patients. "It's an area of medical care that has been totally neglected, the acute sector particularly," Dr Glasson told AAP. "What they have to make sure they do is set up appropriate care facilities for treating the mentally ill. "We are lacking beds, we are lacking facilities."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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