by Mitch Kokai
Senior Political Analyst, John Locke Foundation
Forgive my plucking a comment from the obscurity of Twitter to make an example of, but it is a useful one. In an exchange about health-care policy, a professor of political science at a major American university asked a familiar question: Why is it that some Americans apparently believe that the United States is incapable of managing a single-payer health-care system like France’s?
You’ll see the problem there.
The fact is that nobody actually knows whether France or the United States is capable of managing a single-payer health-care system, because neither country has single-payer health care. Not many countries do.
France’s health-care system is different from the U.S. system in important ways, but it is in other ways quite similar: It is based on insurance. As in the Swiss system and the original version of the Affordable Care Act regime, that insurance is compulsory. Patients pay for their health care and then are reimbursed — but not for the full amount — by their insurers. The French generally have to consult with a general practitioner before being referred to a specialist, they must pay lab fees, etc. About a quarter of the hospitals are for-profit and the rest are either private nonprofits or public. There is an extensive system of subsidies and price controls. What the French do not have — and what almost none of the countries of Western Europe and few countries around the world have — is single-payer, a public-monopoly model of health care found in the United Kingdom, Canada, Norway, the United Arab Emirates, and a few other countries.
There is much to admire in European governance and much that Americans — conservative and progressive both — could learn from the successes of Western Europe and the Nordic countries in particular. It also is the case, I’m afraid, that a great deal of American thinking about European governance is based on the experiences of tourists and business travelers.