poisonwood's Diaryland Diary

Date: Aug. 08, 2009 . Time: 2:11 p.m.

cold Entry:

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cold

Current temperature in Kent at 2PM: 68 degrees. Is there no chance for temperatures somewhere between 68 and 95?

2:11 p.m. - Aug. 08, 2009

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French health care

On French health care.

Some of the quotes I thought were most interesting

Wow, they didn't even used to have co-pays?

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses.


I found the fact doctors could prescribe *any* drug amazing. I guess that's how conditioned I am to the idea that drugs are super-expensive and you can't just use them without regard to cost.

Patients can choose their own doctors, and -- unlike the U.S., where private health insurers can have a say -- doctors can prescribe any therapy or drug without approval of the national health insurance.


I also found it interesting that most people subscribe to supplemental private insurance. Maybe a hybrid model isn't such a bad idea. This is somewhat consistent of what my relatives in Ireland do. The wealthier ones have additional private health coverage (and tend to get better care as a result, though this article doesn't indicate this is the case in France.)

Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.


$30 for a consultation! I can't imagine that passing in the US. Amazing. Free med school is an interesting idea. I think doctor's fees are basically justified by the education and money required to becomes a doctor in the US. However, if med school was free, that would be completely different. No doubt, with lower salaries, the quality of doctors would drop, but you don't need to be a genius to be many types of doctors.

The quasi-monopoly of Assurance Maladie makes it the country's largest buyer of medical services. That gives it clout to keep the fees charged by doctors low. About 90% of general practitioners in France have an agreement with Assurance Maladie specifying that they can't charge more than €22 (about $32) for a consultation. For house calls they can add €3.50 to the bill. By comparison, under Medicare, doctors are paid $91.97 for a first visit and $124.97 for a moderately complex consultation, according to the American College of Physicians. In France, "If you are in medical care for the money, you'd better change jobs," says Marc Lanfranchi, a general practitioner from Nancy, an eastern town. On the other hand, medical school is paid for by the government, and malpractice insurance is much cheaper.


Preferred care in France?

In 2004, France introduced a system under which patients must select a "preferred" general practitioner who then sends them onward to specialists when necessary. Under that policy -- similar to one used by many private U.S. health-care plans -- France's national health insurance reimburses only 30% of the bill, instead of the standard 70%, if patients consult a doctor other than the one they chose.

8:53 a.m. - Aug. 07, 2009

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insurance rant

Becca linked to an article about a woman who was annoyed at having to pay largely out of pocked when she had a baby. Lately, I've been thinking a lot about the difference between insurance and a health care plan. Insurance, per google's definitions, is either "promise of reimbursement in the case of loss" or "A means of indemnity against occurrence of a uncertain event" or " form of risk management primarily used to hedge against the risk of a contingent loss." In other words, it's money you pay to someone in case you have a problem with your health. It's not a system where you give someone $10 a month to pay your $100 monthly health bills. You give someone $10 a month to pay your $5 a month health bills in case they become $100. If they're already $100, the health care company is going to want at least $105 a month and perhaps $200 a month if initially high bills imply a higher risk of increase.

Anyway, what health insurance company in their right mind would pay to "insure" a married childless 25 year old woman against the risk of pregnancy? It doesn't make any sense. Let's assume 50% of privately insured couples between 25 and 35 will have a baby in that time period. Either everyone can pay $10000 for those babies, or the 50% that have the babies can pay $20000. I'm not sure the former method necessarily makes more sense than the latter.

Next, the author says, "After several years in Europe—where coverage was, as goes the cliché, comprehensive and nearly free . . . ." Coverage in Europe is *not* free. Everyone pays for it with extremely high taxes. And perhaps that's right and reasonable. However, calling it free is ridiculous. In fact, I would say anyone who moves to Europe for a few years to have a baby or other expensive health care events is ripping off their fellow citizens, since they skipped paying the taxes their entire lives that pay for this stuff.

It seems like people should form cooperatives to negotiate better deals with insurance companies. These cooperatives could be extended the same rights as employers. I know my employer re-negotiates our healthcare every year, and my payments haven't gone up at all in the last 3 years despite constant benefits as we've grown larger and our bargaining power has increased. Negotiating to become a member of a cooperative would be interesting since the cooperatives would obviously want to seek out young healthy members. Anyway, some kind of negotiating power is obviously needed.

Society should probably bear the cost of childbirth, and that's how employee-based health care works. A company has a mix of old and young, single and married, so only a few people are having children at a time. Everyone pays for it. However, an individual planning imminently to have a child railing against an insurance company for not wanting to pay for it is silly. Insurance companies are for-profit establishments. I read so often about people complaining about not being able to find "insurance" for existing problems or complaints. Insurance is protection against future catastrophe, and that's why you have to buy it when you're healthy or else expect to at least pay for your existing complaints. Let's not blame the insurance company. Blame the government for not mandating coverage, perhaps.

Also, the writer says she shows up at the hospital thinking she's covered. Apparently they had to search for a company with maternity coverage - and they didn't check what the limit was? My insurance comes with a little book explaining what my benefits are. It's 30 pages with large writing and really not all that complicated. Some things are covered; other's aren't. I'm surprised this clearly articulate journalist shouldn't figure it out.

8:20 a.m. - Aug. 06, 2009

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