Le illusion

by Russ Roberts on August 21, 2009

in Health

Sara Paretsky, in an article in the NYT entitled Le Treatment, described an emergency room in France and observes that rude bureaucrats in the French health system are worth putting up with, given the price:

Meanwhile, my husband’s heart and lungs were examined inside and out. He and his cellmate were both suffering from pneumonia, not heart attacks. They were given antibiotics.

At 2 a.m., when we were discharged, I offered my MasterCard to the surly gatekeeper. He said they would send us a bill. The doctor apologized for having to bill us, but we were not citizens, after all.

Six months later, the bill arrived. For X-rays, an EKG, 10 hours in the emergency room, a doctor, a cardiologist, technicians, nurses, drugs and even the surly gatekeeper, we were required to pay $220. I might put up with a lot of ugly bureaucrats for that.

That’s how the article ends. A bargain at twice the price. She seems not to realize that her $220 payment may not cover the full cost of le treatment and that the difference is made up by the taxpayers of France. Nothing like an expensive lunch masquerading as a cheap one thanks to the forced donations of others.

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Anonymous August 21, 2009 at 3:20 pm

She explicitly states that she’s not covered because she doesn’t have an EU passport. If you’re not a citizen, you’re not covered. On top of that, most healthcare in france is actually privatized, the state has a form of public insurance that covers most of the costs. The public insurance is the same umbrella that covers old age pensions and welfare.

Personally, I think the differences are cultural and are not directly related to differences in the healthcare systems. I get the same treatment when I go to restaurants or stores in France, and I speak decent French!

Sam Grove August 21, 2009 at 4:34 pm

That does not mean that the treatment was not subsidized, it likely was.
One of the problems with government provision of services is that their true costs cannot be known, so when evaluating what should be charged for various services, the only way to compare would be with a non-subsidized system. As France doesn’t have that, there is no possible comparison to be made.

Also, there usually is no charge for being in an emergency room. It’s actually a waiting room. Nobody charges you for having to wait for services.

So they had to wait nearly ten hours for treatment.

I took my daughter, before we adopted her, to the emergency room at the county hospital. We only had to wait six hours.

Anonymous August 21, 2009 at 6:04 pm

Of course it doesn’t mean that the treatment wasn’t subsidized, I was merely pointing out an issue in the original logic that I didn’t accept. It also doesn’t mean they waited 10 hours for treatment. They were in the ER for 10 hours. During that time they had a battery of tests done. Similarly, your daughter waiting 6 hours in an emergency room and comparing it to the 10 hour wait at this french hospital is not a fair comparison as there are so many permutations that could effect the wait time not the least of which are different reasons for being there in the first place. As a Canadian, I’ve been in and out of ERs anywhere from 45 minutes to 12 hours. That alone cannot be used to fairly judge our system (though many other valid statistics can).

Also, France does have a non-subsidized system. They do elective procedures for foreigners of countries with high wait times or poor healthcare systems (read: Africa) all the time. There are virtually no waiting lists for medical procedures in France.

For citizens, the French system is more akin to American Medicare covering 70% of the procedure for the entire population, leaving the rest to be covered by the user/private insurance except in extreme cases. ‘Extreme’ is their case is expensive cancer/rare treatments and being below a certain poverty threshold. There are many other issues with the system, not the least of which is high income taxes and corporate taxes that take a lot from hard working doctors.

I’d like to point out that I’m not defending Universal/Socialized medicine, the French system, etc. I agree with Russ’ base beliefs, but I’m a little annoyed at the fact that he immediately called the hospital worker a bureaucrat when it’s quite possible that it was merely a nurse trying to keep panicky relatives out of the way of the medical staff doing their jobs. The French also have a certain bluntness that many foreigners take as rude. My ideal system would be a Hayekian setup, including removing most restrictions on licensing/patents/distorting tax breaks, etc. Unfortunately, there are few modern examples in the real world of such a system.

Sam Grove August 21, 2009 at 6:14 pm

I stand corrected.

I can compare appointment wait times at Kaiser vs the county system, as I have had ample experience with both.

Kaiser: typical wait 15-30 minutes.

County clinic: minimum of 45 minutes and typically 60-90 minutes

kingstu August 21, 2009 at 3:43 pm

100% of Medicare patients like free money which accounts for the high satisfaction surveys.

Anonymous August 21, 2009 at 4:52 pm

There is no such thing as “Free money”, but retarded parasitic seniors are not known for their intelligence.

Anonymous August 21, 2009 at 6:09 pm

“but retarded parasitic seniors are not known for their intelligence”

It’s people like you that made it take a lot longer for people like me to believe in free markets.

Anonymous August 22, 2009 at 4:19 am

“It’s people like you that made it take a lot longer for people like me to believe in free markets.”

Just asking, but doesn’t that say more about you than it does about Arrowsmith or free markets?

Arrowsmith is free to believe and speak as he pleases, free markets aren’t effected by his opinion. Free markets are free markets, and are logical and rational.

What took you so long, Hylarides? You aren’t comfortable with some of the customers in the store, so you hate the store? Ooooh that is sensible.

Anonymous August 22, 2009 at 7:16 pm

“Just asking, but doesn’t that say more about you than it does about Arrowsmith or free markets?”

I was implying that ArrowSmith is a jerk or at the very least childish. My experiences wrt free markets were otherwise both growing up and up until very recently, which is why it took me “so long.” If having not been a total free marketer at some point in my life says something about me, it says that I learned from experience. Milton Friedman was a Keynsian at one point, don’t forget.

People that convinced me were those like Hayek’s writings or more recently Milton Friedman. They didn’t blame those on welfare, they blamed the system for putting them on welfare. They’re all being rational for accepting something that is given to them. They’d just have figured something else out if they had no other choice. Hayek and Friedman articulately explained why these programs were bad, why markets are best, or why the price system is so important. Yes, Medicare for the elderly does help many people, but at what cost? What if it wasn’t there? They actually had answers.

“Arrowsmith is free to believe and speak as he pleases, free markets aren’t effected by his opinion. Free markets are free markets, and are logical and rational.”

Simply calling seniors “parasites” and “retarded” doesn’t help the cause at all. Of course he is free to say what he pleases, but it’s not going to convince others. Most socialists aren’t trying to destroy the world, they’re simply ignorant and misguided. They’re focusing on intents instead of results of whatever they’re trying to accomplish. I admit I was among them. If capitalists keep calling me a leech, a goodie goodie, or whatever I’d still be among them.

“What took you so long, Hylarides?”

Out of curiosity, I picked up some books and found some videos of an opposing view. It started to make sense rather quickly. It wasn’t long before I started to see the mismanagement and the distortions that happen when an organization with a monopoly on power creates. It became so easy to poke holes in the arguments of big government.

“You aren’t comfortable with some of the customers in the store, so you hate the store? Ooooh that is sensible.”

If you wanted a quiet restaurant, would you go to a place that always had loud and drunk people? :-) I think that is an interesting, but poor analogy. I think universal healthcare, welfare, protectionist policies are all good ideas, but they just don’t work in practice. Even if protectionism worked, you’re only hurting somebody else in another country to prop up somebody in your own. I became an individualist. I no longer identify myself with any patriotism. To do so would take credit for the work of others.

Anonymous August 22, 2009 at 4:23 am

I know you for a staunch defender of freedom. Consider the fact that fear plays a big part in many of the elderly’s transformation into thumb suckers.

Fear overrides their intellect, and then there are the many of the elderly that grew up socialist and are now more than willing to spend your money, fear or no, they believe they are entitled to you.

Anonymous August 22, 2009 at 4:26 am

True. Honorable is the senior citizen who doesn’t give into his fear and remains a staunch defender of free markets.

Anonymous August 22, 2009 at 4:32 pm

Old age is something you prepare for in youth. It is understandably frightening when the government suggests that at the last minute they are going to cancel your plans. You cannot go back and live your life over.

Medicare is just another unjust government scheme with no possible just solution.

Currently older seniors get more out of Medicare than they put in, but the tide is turning with the baby boomers. The attitude in the future will not be an appetite for free money, but instead a justified desperate struggle to reclaim as much of their vaporized lost earnings as possible–not unlike the panic of the Madoff victims, but on an immensely grander scale. I think the latter attitude will be a much more difficult force for reform to overcome.

Dallas Weaver August 21, 2009 at 11:25 pm

An EKG machine is just a 12 channel analog input device with some software. That can be done on one chip and then a chip to convert the output to USB or ethernt for input into a laptop. Actually, my i-phone has the capacity to make a long term recording EKG as a minor AP. X rays with digital readouts also don’t use any film and are very cheap per photo with about the same resolution as one of the modern day digital SLR with a similar cost per photo. The bed + room area is similar to motel 6 standards in terms of area, if it was built without all our red tape, special electrical fittings, 1200ºF silver solder on O2 pipes, davis bacon act construction labor costs, etc.

That means that the $220 was mainly for labor and perhaps they don’t believe that their MD’s are worth 3 times as much other professionals like Ph.D scientists.

Perhaps they can provide the surly service (low labor cost) for $220. They don’t even have to use a back room army to do the accounting and billing and another army to make sure there is not too much cheating.

Ken August 24, 2009 at 1:33 am

Once upon a time, I too believed that MD’s earned significantly higher incomes than PhDs in hard sciences. That was probably true then, but I seriously doubt it is today. I hear anecdotal evidence from some physicians that a good number of their younger colleagues are leaving medicine for other higher paid an less bureaucratic professions. I know for a fact that 8th year surgical residents in a highly rated Boston medical center are paid salaries that wouldn’t put them i the top 25% of all US families.

Anonymous August 22, 2009 at 12:02 am

Ms. Paretsky should stick to writing mystery novels. She certainly doesn’t understand economics. Or medicine: the ER over-tested her husband for his pneumonia (a chest exam and an X-ray are all that’s needed) and gave inappropriate therapy (If he had bacterial pneumonia, one administration of antibiotic is insufficient. If he had viral pneumonia (the most likely diagnosis), then he needed no antibiotics at all.

So, the Paretskys dealt with surly staff, inappropriate testing, delayed diagnosis, and inappropriate treatment at one-tenth the charge of a US hospital ER. Doesn’t sound like a bargain to me.

Anonymous August 22, 2009 at 7:28 am

There’s no illusion. On average a French citizen spends almost half as much as a US citizen for health insurance. And NONE of them are ever bankrupted or lose their homes do to medical care cost. What liberty for the French citizen not having to worry about health care cost. Very smart indeed.

Anonymous August 22, 2009 at 4:38 pm

“And NONE of them are ever bankrupted or lose their homes do to medical care cost.”

What difference does it make WHY someone goes bankrupt? Didn’t anyone ever tell you money is fungible? Give a bankrupt Frenchman back all is past health care taxes with interest, and he might just be able to get himself out of bankruptcy.

Anonymous August 23, 2009 at 11:19 pm

You expect him to know the word fungible?

Carine August 25, 2009 at 9:01 pm

I thought you might be interesting by this article by Guy Sorman, who happens to be French and knows what he is talking about:
“Paying for Le Treatment – Nothing is free—certainly not French health care” – http://www.city-journal.org/2009/eon0824gs.html

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