Health Care – UK, France, US: Krugman and Me

Health Care Terror 


These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming. 

"National healthcare: Breeding ground for terror?" read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism. 

While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens. 

I say conscience, because the health care issue is, most of all, about morality. 

That’s what we learn from the overwhelming response to Michael Moore’s "Sicko." Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn’t focus only on self-interest. They should also appeal to Americans’ sense of decency and humanity. 

What outrages people who see "Sicko" is the sheer cruelty and injustice of the American health care system — sick people who can’t pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn’t a participant in her mother’s health plan won’t treat her, hard-working Americans driven into humiliating poverty by medical bills. 

"Sicko" is a powerful call to action — but don’t count the defenders of the status quo out. History shows that they’re very good at fending off reform by finding new ways to scare us. 

These scare tactics have often included over-the-top claims about the dangers of government insurance. "Sicko" plays part of a recording Ronald Reagan once made for the American Medical Association, warning that a proposed program of health insurance for the elderly — the program now known as Medicare — would lead to totalitarianism. 

Right now, by the way, Medicare — which did enormous good, without leading to a dictatorship — is being undermined by privatization. 

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care. 

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result — but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here. 

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even Britain, which spends only about 40 percent as much per person as we do. 

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American — and much better than that of uninsured Americans, many of whom never receive needed care at all. 

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There’s a scene in "Sicko" in which expatriate Americans in Paris praise the French system. According to the hard data they’re not romanticizing. It really is that good. 

All of which raises the question Mr. Moore asks at the beginning of "Sicko": who are we? 

"We have always known that heedless self-interest was bad morals; we know now that it is bad economics." So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money. 

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can’t overcome those forces here, there’s not much hope for America’s future.

James Mauch <> wrote:

Kathleen, you’ve experienced both France and UK’s healthcare.What’s your take on them? 


My Experience – The NHS and France


I agree that this is a moral issue, first of all. It can’t be right for people to work all their lives, then lose whatever they have earned  because they fall ill. Or not to be treated because they have no money.   When I read Dickens, I used to think how appalling life used to be in the 19th century.  And it was the same in the US.  How lucky, I used to innocently believe, that we are more enlightened now. 

I also  agree that French medical care is excellent.  In France, you choose any doctor you want, go to a specialist without being referred by your GP (which is not the case here in the UK), and have access to all the best that technology has to offer, although you might have to travel a little to get to it. The best eye clinic is in Lyon.  The best heart center is in St. Laurent du Var.  But it is first-rate.    On the other hand, the doctors and staff tend to be French.

This can be a problem for Brits and Americans, who tend to expect a reasonable bedside manner from doctors and nurses.  They will be sadly disappointed. It doesn’t seem to be in the training manual.

A few years ago, my husband had to go to the hospital with a heart malfunction.  It was just before the May holidays, of which there are many in France, and he didn’t get out for two weeks. Long week-ends kept cropping up, during which nothing was accomplished.  Nurses stood talking in corridors, ignoring patients, and when they did deign to enter his room, were unsympathetic and unfriendly. Mind you, there was a language problem, here.  And this is one person’s experience.

Bernard had to cool his heels waiting for the medical staff to come back from holidays to take care of the problem so he could leave.   And the hospital in Frejus  is not quite as pleasant as the rehab center in Hyeres!!  However, the diagnosis was right on, the solution, when it came, excellent. It was all free.  An incompatible bedside manner is a small price to pay. 

When you have a joint replacement or other orthopedic operation in France, you are automatically sent for six weeks of rehab. Where I lived in the south of France, the nearest clinic would have been on the beach at Hyeres, east of Toulon.   Here, you have scenic walks to help you get better, good French meals elegantly served, and wine to match.  After my Achilles tendon was repaired here in the UK, I got no rehab at all. 

I have found the UK system less flexible, and less user-friendly. In fact, it’s ponderous and slow.  My husband’s son, a doctor in London, says that when he has seriously ill patients, with a life-threatening cancer, for example,  he has to send them to the emergency room to be seen.  The  system will take too long. When I asked him if money was the answer, he said no.  The system is antiquated and needs to be re-organized. 

On the other hand, when I recently experienced shortness of breath I was sent to the Quick-Response Chest Pain clinic to be evaluated within 3 days.   I have to wait 4 to 6 weeks for an angiogram, but if I were in danger of a heart attack it would be sooner. 

Patients over 65 don’t pay a cent for prescriptions, and they don’t in France, either.

In France, you keep your own medical records.  You have a copy of your x-rays and MRI’s, your blood tests, your prescriptions.  So if you don’t keep them, no one does.  The French like to know their test results and like being in charge of them.  It is the opposite here in the UK.,  All records  go into the computer.  Any doctor you see in any part of the UK will see those records, so there is a background built up.  However, you will be told the results only  if there is a problem, unless you ask. As I am a poor keeper of records, this suits me just fine. 


An American friend of mine was bicycling through France a few years ago. In Normandy, he lost control of his bike, hit a tree, and managed to break his ankle.  He got back to his "pension", where the landlady called for an ambulance.  He was taken to emergency, treated, kept for a few days, and released, with good wishes of the staff.  He was not asked to pay a cent. Maybe memories of the war are particularly vivid in Normandy, but we were both impressed.   

While there are those who abuse the systems  and over-use them, both in the UK and in France, they are  there for whoever needs them. 

I’d have to say, though, Vive La France. Sort of wish I’d been in France for my tendon repair.  Still, I can’t complain.  I walk without pain for the first time in years. .