July 9, 2007

The French secret

Why does the French health care system provide at least as good value at a cheaper price than ours? A big part of the answer appears to be that they just pay their doctors less:

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. ... Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation. But American-style compensation is rare. "There is an unspoken and undefined limit to what you can charge," says Dr. Paul Benfredj, a gastroenterologist in Paris.

Like soldiers, you reward them with glory (or at least respect) instead of money. That can work for for a long awhile, but if you let the genie out of the bottle (as the U.S. did many years ago with doctors and is probably doing with soldiers today by employing Blackwater mercenaries in Iraq at five times what they were making in the Army), it's awfully hard to start all over again.

My published articles are archived at iSteve.com -- Steve Sailer


Anonymous said...

Paying physicians less also means paying everyone else less. Since the physicians are at the top of the pecking order, if they make significantly less, that means that pharmacist, physical therapist, nurses, and everyone else has to make less.

I wonder how that also works in France. Maybe having a double digit unemployment rate also helps in lowering the pay scales.

Anonymous said...

We could probably get away with paying doctors less if we built more med schools and lowered med school admissions standards. They've been getting higher and higher, so we could set them back where they were 20 or 30 years ago and increase supply, lowering prices.


Anonymous said...

Ha ha you may not want to hear this, but you guys could import them

Anonymous said...

The NHS has long operated on the principle of underpaying its staff, especially the GPs. This has to some extent been rectified in recent years (New Labour having thrown money at the problem like it was going out of style), but its really only been the self-sacrificing public spirit of the sons and daughters of the upper middle class that has kept the socialist bulwark afloat so long. Oh, and the rich all having private healthcare insurance, anyway.

Anonymous said...

Steve Sailer: Why does the French health care system provide at least as good value at a cheaper price than ours?

You are kidding, right?

My brother-in-law almost died because of a misdiagnosis by a French doctor, while on vacation in France. [And, at the time, the doctor made a little "joke" to him about how the Americans waste so much money on medicine. Of course, the Frog didn't even bother to take an X-Ray.]

A week or so later, when his plane finally landed in the USA, my brother-in-law was immediately rushed off to emergency surgery, was on some industrial-strength IV antibiotics for about a month, and was off his feet for six or eight weeks.

All because some dickweed Frog MD didn't know his ass from a hole in the ground.

Anonymous said...

American doctors are very money-conscious. My doctor told me I had six months to live; I told him I couldnt pay his bill-he gave me another six months! :D

Anonymous said...

_some dickweed Frog_

Is it possible, even in theory, for the tyranny of the anecdote to end? "My brother X", therefore "Everyone X".

Sorry, chum, it just isn't true:


michael farris said...

anonymous 7:48,

I'll see your anecdote and raise you. A close relative of mine has almost died over the last year due to continued, repeated misdiagnosis by several US doctors (let's lowball it and say three) over several months (again, let's lowball it and say six).

So far US medicine is leading in the 'almost fatal misdiagnosis' race. Who'll win????

Anonymous said...

Stop the organized monopoly of American Doctors and their fees will drop too.

Anonymous said...

Steve --

I can't believe you missed the obvious.

Britain and France depend on importing low-paid, cheap, and Muslim doctors from Jordan and Iraq. Sometimes they like to blow stuff up, too.

That's a way to keep costs low, for a while. But dependence on low-cost immigrant labor is as Steyn says, a structural weakness.

Anonymous said...

This is absolute garbage. I can't believe Sailer is so easily duped by Michael Moore and his ilk.

Doctor's salaries are 5% of healthcare costs in America. If you get a $2000 MRI for example, the doctor collects about $100 of that. Or a $30,000 surgery, maybe $2,000 is the surgeon's fee.

You could double, triple, quadruple, or halve doctor's salaries in America, and it would have negligible effect on healthcare.

The biggest costs are the hospital fees, the salaries of support staff(each patient may have one doctor, but probably 10+ nurses, not to mention PT, OT, surgical techs, radiology techs, etc.), and drug costs.

Unknown said...

France subsidizes the hell out of education and childcare. No one would put up with American medical training without the possibility of affording quality childcare, private education, and university for their progeny. We don't care about glory because we can't afford to; French people don't have to make our high salaries because they don't have to pay directly for all the things Americans do to give their children a middle or upper middle class life.

Anonymous said...

As a resident physician, let me second Karen's response. The path to a medical career in the U.S. is far more arduous, starting with the requirement for separate undergraduate training and the accumulation of massive tuition debt up until the beginning of residency. Then add to that bitterness-inducing, brutal residency training and jealousy of the people in, e.g. I-banking, who work hard but not necessarily harder than we do and bring home exponentially more money. Many of us would balk at practicing medicine for French doctor wages.

Antioco Dascalon said...

I think some of this might have to do with a more traditional, more Catholic way of dealing with death. I would guess that more French people die at home than Americans and that they are more resigned to dying rather than placing slim hopes on some experimental procedure that would cost an arm and a leg (no pun intended) and increase the chances of survival only marginally.
Health care costs would drop dramatically if we accepted death more readily. But I don't think that "solution" is on the table.

Anonymous said...

So many of these examples point to one problem: the multitudes of problems the government creates when it tries to interfere with the free market.

Whether it's farm laborers or doctors, for example, immigration distorts the entire system. If the British NHS can get a Jordanian doctor for 80,000 pounds a year, why pay a native doc 110,000?

Anonymous said...

The path to becoming a doctor is costly, no doubt. But how much of that is really necessary? For instance, is the physics requirement for pre-med education relevant, or just another filter to raise physician salaries?

These requirements and restrictions can't all be getting us better doctors, but every single one does raise the cost of training one. In Israel, I've heard, one goes straight to medical school. Not that their system is great, but if we're feeling really radical, we could probably abolish the undergrad req of becoming a doctor. Tack on a year of classes to med school (pre-med school?), and it's functionally equivalent. Plus, you don't have a bunch of dull premed careerists flooding colleges anymore. You could do the same with law school, but we aren't exactly short of lawyers.

Possible Caveat - eliminating some of these barriers may reduce the salaries and prestige of the profession to the point where doctors become siginificantly worse. This seems pretty improbable though.

Anonymous said...

Prestige of Doctors? Derb on NRO made the point that in Heinlein's 1950's America, the social distance between doctors and cops was not that great. They were often living in the same neighborhoods.

As for NHS, Perry Como, Steyn put forth the stat the white males make up 43.5% of Britain's population. Yet only if memory serves, about 12% of doctors. So there is no noble sacrifice. The place runs on low-cost immigrant labor. That occasionally blows things up too. Shouting Allah! Allah!

France's attitude towards death? Yeah it's let the poor and old fend for themselves while we feel noble. During a recent heatwave about 15,000 elderly died because they had no air conditioning. While their children and grandchildren were at the beach.

Like all statist/socialist economies, France's is all about social stratification, complex hierarchies, and a de-facto nobility. I assume no one missed the significance of Mitterand's Mistress and his kids showing up at his funeral. That's something you'd expect from royalty. I'm sure Castro's mistresses will show up too when he dies.

That's the point of socialism: just another king-class. France's socialized medicine is part of that king-class. It's feel good but definitely not for the common man. I'm sure Arafat got first class care. Jacques on the street? Hardly.

Mike Courtman said...

Paying doctors less might work in France, because the languauge barrier is likely to deter French doctors from taking of overseas to search for better wages in English-speaking couuntries.

Doctors in New Zealand are quite poorly paid so many are disappearing to other English-speaking countries where wages are better - this is the main concern at present with our socialised system of medicine.

Part-charging certainly helps socialised medicine work better, as other-wise community medicial centres and hospitals are usually swamped with recent immigrants and the worried well (which is recently the case in the uk).

From what I've read, public health tends to be better value for money than private health but is less effective in some cases and tends to suffer more from labour shortages.

There certainly no ideal system, I guess its just a case of making the most of whatever system is already in place.

Anonymous said...

Possible Caveat - eliminating some of these barriers may reduce the salaries and prestige of the profession to the point where doctors become siginificantly worse. This seems pretty improbable though.

You've got it backwards. Prestige and high salaries are a consequence of quality, not the other way around. Some barriers are just pointless: the requirement for pre-med undergrad probably raises quality substantially, but a physics requirement?

Anonymous said...

As for NHS, Perry Como, Steyn put forth the stat the white males make up 43.5% of Britain's population. Yet only if memory serves, about 12% of doctors.

I said the sons and daughters of the upper middle class, not white males, in general.

Anonymous said...

The Catholic solution is to drop dead? No thanks. I'd rather be a ... you know the punchline, don't you?

Anonymous said...

There seems to be a certain amount of cobblers about the NHS on this site.
(1) Doctors are not the "Sons and daughters of the upper-middle class" in general. Of course, the children of doctors are over-represented, but UMC kids in general would rather go into finance or law. Plus, old bean, Britain has had a reasonably meritocratic education system for the last 60 years.Most doctors seem to have a lower-middle-class background.
(2) What's white males got to do with it? Sexes seem about equal at med school. The most over-represented group seem to be British Asians. I believe your premier medsoap includes a fairly realistic example. Or see the latest Dr Who when you get the chance for a believable current British med student.
(3) The NHS pays well enough to attract doctors from the Netherlands and similar countries.
(4) Jordanians and Iraquis are not significant. Most doctors from outside Europe come from India, where we cunningly set up the education system to meet our future shortages.
(5) Immigrant doctor worries: the UK can set whatever tests it wishes for doctors from outside Europe. Dutch and Scandinavian doctors are fine. But the EU does not allows us to impose any tests on doctors from the more backward parts of the EU. Dr Vlad Dracula has to be given preference over well-qualified Indians.
(6) You can't get some ops or medecines under the NHS, which can be quite nasty, but generally it seems OK. Right now there's an acute shortage of midwives.

Nice of you all to take an interest.

John of London

John of

Anonymous said...

Perry -- the objection still stands.

THE vast majority of NHS doctors (and nurses) are underpaid (and probably underskilled) Third World immigrants.

I fail to see how 12% or so of the Upper Classes (for which you've offered no evidence) somehow magically make the system "work" ...

Like most labor in Europe, it seems the European elites (politicos, media people, entertainers, finance people) wish to make all non-elite occupations cheap (and Third World). It's not just NHS, but most non-elite labor.

This of course has the dual purpose of diluting the angry-unionist class folks like the coal miners of yore into fractured Third World people at war with each other as much as with elites, and preventing upward mobility.

Anonymous said...

A Visitor:

"For instance, is the physics requirement for pre-med education relevant, or just another filter to raise physician salaries?"

Are you serious? Do you really think the basic understanding of physics provided by two terms of algebra-based college physics isn't relevant to the practice of medicine? A basic understanding of physics is crucial in higher-level classes in other sciences future physicians need to take, and it also has direct applications to medicine, obvious even to a layman. General physics covers optics, which is relevant to the workings of the human eye; it covers electricity/electromagnetism, which is relevant to the workings of the human nervous system as well as the workings (and limitations) of a host of diagnostic tools; it covers mechanics, which is relevant to traction; it covers fluid mechanics, which is crucial to an understanding of the workings of the heart, blood pressure, etc.

The idea that undergraduate physics classes are what cause physicians to have high salaries is contradicted by the comparatively low salaries of engineers, who have more rigorous academic requirements.

"In Israel, I've heard, one goes straight to medical school."

Do you have any links re the training of physicians in Israel? I find it hard to believe that Israeli physicians don't have the same undergraduate science requirements ours do. It's possible that these same courses are offered in a longer version of medical school rather than in a general college. From a quick Google search, it appears that Israeli medical school programs geared toward the training of U.S. and Canadian students have similar pre-requisites to American medical schools. I wasn't able to find an English version of a list of admissions requirements for Israeli medical students though.

Anonymous said...

America gets the best and brightest when it comes to doctors. This is one reason they want more money. The highest achievers go into law or medicine.

In other countries this in not always the case. The docs might be competent and experienced but they are not the guy you want removing the brain tumor.

France and the US have about the same life expectancy. When you take into consideration that everyone has health insuance in France then why is it not higher. The answer is that everyone gets mediocre care. Here they either get the best or the worst.

I would rather see a system where everyone got the best rather than lower my care to the French level.

C'est La Vie