Grand French Bargain For Health Care? 3rd Best, But Better Than Destruction

I know France very well, having lived there, East to West, North to South. There are a lot of good things about their health care system. There are also an awful lot of bad things. I know that the peverse effects of the very French Republican approach to public policy, health care specifically, is that when people pay for insurance, they maximise, as one would expect, according to economic theory. "I've paid for it - I might as well get as much as possible out of it". So France has most hypochondriacs, most over-prescription of drugs, most over-use. Similarly, allowing medicine to be a free liberal profession like any other mean there are far too may doctors in high revenue areas, and not enough in less glamourous ones, and just too many doctors, all in all. Misallocation of resources, waste. And all this means its specific health-fund, la SECU, is deeply in debt, as is country, as a whole, far more than Canada. And also, that introducing a modest user fee for seeing doctor has only discouraged low-income folk from visits, who probably need visits more, and had no effect on middle classes and upper classes. And were they to raise it high enough to discourage many, they would end up with worse health treatment, and later, too late, when conditions worse, and more complicated and costs more to fix. And I've already mentioned how some 5% don't have private "complementary" insurance to cover their 1/3 of costs, and they are of course the working poor, don't qualify under welfare etc., but too poor to buy insurance, and so try to save. Just as in USA. And then the number of insurance plans is so complicated that although fine for educated folk, ie. middle classes and up, generally, confusing for less-educated, generally working class, who buy "wrong" insurance for their situation. Etc..

But it is true that 2/3 - 1/3 funding system, State paying for 2/3 of expenses, you/your insurance paying other 1/3, COVERS EVERYTHING, TEETH, EYES, DRUGS, as well as doctor care. So while I consider French system less efficient than Cdn, more wasteful overhead and transaction costs, it does at least cover everything, as we promised we would, all parties, over the last century. I prefer Tom Kent's tax recovery of social benefits plan which would extend benefits to include everything, as we should, starting with children first, as most politically powerful opening move, being obvious moral imperative. This way, we retain the administrative efficiency of our system, while building it further.

But should that prove a hard sell, another option, 2nd or 3rd best in my view (best is increasing general taxation, corporate and individual - most efficient, most equitable - while extending benefits to cover everything) would be to propose a grand bargain: We will go to French System, ie. you, the citizen will have to pay for 1/3 of your non-hospital care (hospital still 100% State covered, as in France) but Govt will pay 2/3 of everything, in return.

I don't particularly see how this makes things cheaper, given the French example, more the opposite it seems to me, but since everyone is all het-up about co-payments and dedicated health taxes and the like, and there is some mystical delusion taking control that leads people to think private involvement will everything better, despite all evidence to the contrary, but "the problem is selling it to public", then one way would be to offer public this grand bargain, which would be great for middle and upper classes, and suck for working and lower classes and poor. But at least Govt could say it wasn't a simple case of making people pay out of their own pockets, but rather a way of extending needed additional services (eyes, teeth, drugs, etc.) to everyone, while finding a way to pay. That would probably fly.

But best is to keep our excellent system, expand it to cover everything, do best practices and encourage healthier lifestyles, and pay for it, most wisely, by increasing taxes on corporations and individuals. Figure out what you need, and then tax to need. That's smartest, and best. But if we ever get to the point that we absolutely are going to change things because elite opinion is in lockstep, despite public's rightful pushback, then the French Grand Bargain is better than simply going two-tier, or user fee, or cutting services.

Mais quant à moi, je dis : Vive le Canada! Vive son excellent système de santé! Vive les impôts!

"Taxes are the price we pay for civilised society." - Some Republican

PS. Subsequent to a couple of comments, I include the following in the main post:
I suggest all read the following CMA report on health systems, their strengths and weaknesses, to get some perspective, particularly the tables right at the end, re. $ vs. outcomes, and cost/debt and efficiency:
Background report on 5 European health systems (April 2009)

Also, shamelessly, I recommend my previous post re. point about geo-historical specificities and limits/opportunties to and for change:
Bless The Obama USA

My Denticare proposal, referenced above, also offers a good quick review of our health care history and future challenges and opportunities, with this proposal:

Now is the time to make this vote-winner a reality, by leveraging Canadian pro-Obama sentiments and Canadians' awareness & approval of the Democrats' desired "public health care option" to propose a similar "public dental care option", to cover the 40% of Canadians without dental insurance, and help the even greater number who struggle with the costs of profiteering insurance companies and "gourmand" dentists. (...) A public dental insurance option, modelled on the Obama plan, free for the poor, working- & lower-middle classes, subsidised on a sliding scale for all others, would save Canada a lot of money, reducing extreme costs of hospital emergency demands, and forcing dentists & insurers to be less "gourmand", and more efficient. It would also make Canadians healthier, happier and more productive.