Advocates of socialized medicine, their claims for Canadian health care having been repeatedly exposed as wildly inaccurate, are now promoting a new single-payer paradise: France. Economist’s View links to a typical example of this in the Boston Globe

The WHO rated [the French system] the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country’s population.

As with similar claims made for Canadian health care, this is misleading. As David Gratzer points out, French health care providers are not quite as “responsive? as the passage suggests:

During an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died.

As to the “health and longevity of the country’s population,? Frenchmen with prostate cancer might disagree:

The survival rate for prostate cancer is 81.2 percent here [in the United States], yet 61.7 percent in France.

And French health care isn’t cheap. The Globe piece makes a passing reference to its high cost, but fails to discuss the financial crisis outlined in The Guardian

A government commission has warned that without fundamental reforms France’s national health service … will collapse within the next 15 years.

The French government made an effort to institute some of the “fundamental reforms? recommended by the commission, but its health employees were not amused:

Doctors and hospital staff on Thursday marched on the Health Ministry in Paris, accusing the government of planning to privatise medical care.

And then there’s that “best in the world? designation. As David Hogberg has pointed out, the WHO ranking includes:

… not only outcomes like how well a health-care system cures disease, but also something called ‘fairness in financing.’

This dubious standard deliberately stacks the deck in favor of government-run health care systems. When it is removed, the ranking changes dramatically.

So, once again, the evangelists of socialized medicine are trying to pass off a sow’s ear as a silk purse. Aucune vente.

Comments 21

  1. John Hurley wrote:

    Don’t know much about the WHO ranking scale but if you do simple comparison of infant mortality rates, life expectancy etc, America does significantly worse than France and many other countries worldwide – nearly all of them poorer in GDP per head terms.

    Re costs, 15% of American GDP goes to health – around twice the proportion of other developed countries – and yet the greatest worry of a very significant % of American citizens is falling ill and not having the health insurance to cover it.

    I encountered a friendly Texan, first generation immigrant from Pakistan, and his son on an underground platform in London recently. He too didn’t think much of ‘socialised’ societies and complained about the lack of ‘opportunity’ in a ‘stagnant’ economy such as the British one (news to me and I’m sure to many of the 400,000 French young people living and working in the London area). His counterpoint: his brother who had moved to America a generation ago had trained to become a gastroenterologist and cleared ‘$2 million’ a year.

    Posted 13 Aug 2007 at 3:14 pm
  2. Catron wrote:

    If you do simple comparison of infant mortality rates, life expectancy etc, America does significantly worse …

    That’s a commonly deployed (and increasingly tired) talking point, but those stats aren’t very useful. This paper explains why.

    Posted 13 Aug 2007 at 3:28 pm
  3. Morris Berg wrote:

    Dave: you disparage infant mortality and other statistics that tend to make us look bad.

    But other than profits and wait times, on what objective scale would you judge our health system to even be in the top 10? Or . . . would you make the argument that NONE are valid measures of comparison.

    For the record: even if your argument against the veracity of such measures carries any nugget of truth (because of reporting discrepancies, etc), all of the arguments in that weak “paper” operate at their weakest in countries such as France and U.K.

    Besides, there are more comprehensive studies that make use of multiple outcomes and metrics, showing that the poor in U.K. are much better served (on a number of health metrics) than even wealthy Americans . . . at 40% of the cost.

    Nice try Dave, but you ought to adress Mr. Hurley’s point rather than just citing to Hodgberg’s lame paper for the 527th time (nah nah nah . . . I can’t hear you . . . no such thing as life expectancy . . . lah lah lah = is not an argument).

    Posted 13 Aug 2007 at 4:02 pm
  4. Catron wrote:

    nah nah nah . . . I can’t hear you . . .

    Isn’t this the very tactic you’re using, Morris? I mean, you haven’t provided any substantive rebuttal for Hogberg’s points, have you now?

    Posted 13 Aug 2007 at 4:07 pm
  5. Marc Brown wrote:

    Your argument tends to break down on the question of access – it is indisputable that there is great dispairty in access to high quality healthcare in the US. This is particularly trie of primary care, and the work done in prevention and detection, and management of chronic conditions.

    Tomorrow, I can walk into my primary physicians’ practice and see a doctor. I can book an appointment in 48 hours and avoid any wait. If I’m prescribed drugs, all it costs is about $12, regardless of the drug, and many get the drugs free. This access applies to all UK citizens. Ask anyone if they’d trade for your system and boy would they laugh.

    Posted 13 Aug 2007 at 4:51 pm
  6. Morris Berg wrote:

    Psst: I’m neurochemist who retired and became an attorney [not a Plaintiff's lawyer either], so I know stats and I know arguments, Dave.

    Nice try but answer my question first . . . don’t switch the burden. I don’t have to “refute” Hogberg’s paper point by point. Mr. Hurley’s point is one that you refuse to address, ostenbsibly because these numbers can’t be trusted. But the WHO rankings are far beyond Hogberg’s “learned” analysis, so you can address his point without relying on those metrics disparaged by your fellow Dave. These numbers are not critical to the validity of the premise of his argument(s): namely that healthcare is better elsewhere.

    Re: Hogberg

    He is basically arguing the obvious: that these are broad metrics. I have argued elsewhere that these numbers actually reflect public health as much as anything else (i.e. give me some cash and I could do much to increase the numbers of some of the very worse sub-Saharan countries without hiring one bloody doctor). Regardless, the comparisons b/w U.S. healthcare and the Western European countries are the one’s with the fewest problems and the strongest statistical power.

    That wasn’t hard now was it?

    Posted 13 Aug 2007 at 4:52 pm
  7. Catron wrote:

    It is indisputable that there is great disparity in access to high quality healthcare in the US.

    Actually, MArc, that point is quite disputable. The whole access meme is based on the myth that coverage equals care. And, BTW, much of the “prevention” talking point is undermined by this.

    Posted 13 Aug 2007 at 5:48 pm
  8. Catron wrote:

    These numbers are not critical to the validity of the premise of his argument(s): namely that healthcare is better elsewhere.

    Actually, Morrs, if you go back to his original comment, his conclusion does indeed depend on the validity of those data. If they aren’t valid, his comment nothing more than a gratuitous assertion.

    Posted 13 Aug 2007 at 8:57 pm
  9. Matt wrote:

    So what metrics do you use Catron? Which ones are valid in your opinion to judge the quality of healthcare and why are they any more valid than those you denigrate?

    Posted 13 Aug 2007 at 9:34 pm
  10. Catron wrote:

    Unfortunately, there really is no international standard for the collection of such information. Both the WHO and the OECD admit that their data aren’t “internationally comparable.? Moreover, they don’t verify the data they receive from various countries. So, propaganda from Cuba (or whatever worker paradise you prefer) is reported “as read.?

    Posted 14 Aug 2007 at 6:41 am
  11. Matt wrote:

    So in other words, you don’t have any metrics. Don’t you get tired of constantly being the critic? You say everyone else’s info is wrong, but provide nothing to bolster your own claims.

    Posted 14 Aug 2007 at 7:52 am
  12. Catron wrote:

    You’re not paying attention, Matt. If you will take the time to read (and actually think about) the post, you will see that I have provided links supporting my positions.

    Posted 14 Aug 2007 at 8:17 am
  13. Morris Berg wrote:

    Youor position is that there is no way to compare.

    So in that case I will just assert that U.S. health care scores a ten on my suckiness metric (10 being suckiest), and other developed countries score between 3s and 6s.

    Disprove it. Show me any factor where the U.S. is less sucky? If you have no factors, you can’t so I guess that is not fair.

    What I’ll do then is offer you the chance to show that American health care is less sucky.

    Go . . . I’ll be waiting. Any metric? Can you offer one where we are top 10 that doesn’t fall victim to the exact same post-modernist (“there is no abstarct truth”) BS that you keep spouting.

    This is getting ridiculous. You’re backed into a logical corner where you either have to put up or admit that you just don’t think comparing health care on any metric – outcome, financial, etc. – across nations is possible.

    This is just an obstructionist/absurdist position if I’ve ever seen one, akin to “you can’t prove to me that sky is not really red and you and I just don’t perceive it the same.”

    Do you honestly think health care in the U.S. is “better” in any measurable sense than elsewhere and if so, how? If you can not answer this (and don’t just point to something you’ve written that no one else can understand . . . explain yourself) then you ought to be relegated to complete irrelevance because you are clearly not a serious policy wonk . . . you’re an ideological hack. I am sorry but this is just ridiculous.

    Posted 14 Aug 2007 at 12:01 pm
  14. Matt wrote:

    Actually, Catron, I’ve read everything you’ve posted. And you’ve given us no objective metrics by which you believe healthcare could/should be measured between different nations. You just criticize everyone else’s.

    The only substantive position I’ve ever seen you take with regard to improving healthcare was that Medicare/Medicaid should raise reimbursement rates, and we should make the tax credits for health insurance higher. No explanation of how any of this is paid for, of course. Oh yeah, I nearly forgot, insurance lobbyists also should get to set the value of cases. That’s your other “libertarian” reform. Pretty light stuff.

    What was it Teddy Roosevelt said about the critic? I think he was talking to you.

    Posted 14 Aug 2007 at 2:19 pm
  15. Catron wrote:

    Youor position is that there is no way to compare.

    No, Morris, my point about Hurley’s comment was that life expectancy and infant mortality don’t prove anything about U.S. health care. I also explained why. You have yet to give me a sensible reason (or any credible stats) to change my position.

    Posted 14 Aug 2007 at 3:04 pm
  16. Catron wrote:

    You’ve given us no objective metrics … You just criticize everyone else’s.

    Matt, my goal is to show that most critics of U.S. health care use invalid metrics to support their claims. Since THEY are making the claims, it is up to THEM to provide proof. It isn’t my responsibility to do their (or your) research.

    Posted 14 Aug 2007 at 3:15 pm
  17. Matt wrote:

    I get your goal. Yet if you’re a constant critic with no real solutions, much less better options for measurement, eventually you get tuned out.

    So you’ve proven that all these measurements are wrong or ill conceived. And. . . ? What’s next? You’ve done the easy part, so where do we go from here?

    Posted 14 Aug 2007 at 3:25 pm
  18. Morris Berg wrote:

    We get it. You want to poke holes in every metric because none of them are up to par. It is indeed true that no one “suckiness” metric exists. It is also true that there is no step-by-step causal analysis showing tobacco causes lung cancer in any case. The point is that U.S. healthcare “sucks” on damn near every metric by a large enough degree that when you factor in cost (subject to different but fewer and lesser confounds) our system scores a 10 on the SUCKINESS inefficiency coefficient. Other systems are not without their suckiness, but just because each of the individual variables you quibble with do not themselves constitute the perfect metric for comparison . . . it is the collective power of the consistent suckiness across multiple measures that shows that our system does indeed SUCK lemons.

    On a side note, you CAN actually compare these numbers within the same group/system over time to avoid many of the confounds of which you and other Dave often speak, and what we see is that healthcare is getting much costlier yet not much more effective.


    On the Catron coefficient of SUCKINESS scale, how would you rate our healthcare with that of the UK, Canada, Germany, Switzerland, Japan, and France for example?

    Do you think our system is better?

    Would you be willing to make the claim that our “system” is really pretty-darn-not-sucky?

    [We will ignore the fact that it is metaphysically impossible for you to statistically compare the US with other countries . . . eventhough there are some populations where the confounds can be minimized and controlled to get statistically significant/powerful variables for cross-cultural and cross-nation analysis.]

    Posted 14 Aug 2007 at 3:44 pm
  19. Catron wrote:

    How would you rate our healthcare with that of the UK, Canada, Germany, Switzerland, Japan, and France for example?

    All, including ours, are in need of repair. I think deregulation and some free market reforms would help all of them.

    Do you think our system is better?

    Yep. I think it’s far better than it gets credit for being. And I think it’s better than most other countries.

    Posted 14 Aug 2007 at 4:00 pm
  20. Morris Berg wrote:

    It is not cheaper, so how is it better?

    What value do we the patient/consumer “get” for the value we put into it?

    You just have a hunch? Just don’t agree with the anecdotal evidence otherwise? Don’t agree with the various outcomes-based measures that show you’d be better getting procedure x or disease y elsewhere? Is it a conspiracy of socialists who have no financial motive but just want to control everyone and limit their freedom?

    Basically, why do you think that?

    Metric or hunch? What other systems have you worked in?

    Posted 14 Aug 2007 at 4:48 pm
  21. Marc Brown wrote:

    ‘The whole access meme is based on the myth that coverage equals care.’

    OK, first things first – what do you put as the extent of primary healthcare coverage in the US (and how much of that is state funded)?

    The next question: what is the proof that primary coverage is a waste of time and money?

    And let’s have some personal info – what is your access to primary healthcare?

    Posted 15 Aug 2007 at 4:45 pm

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