US Healthcare System Compared to France 1

US Healthcare System Compared to France

Teresa Calderon

Cal State University Channel Islands

US healthcare system compared to France 2

The American healthcare system has seen many changes over the last few years in an

attempt to have all Americans have access to a health insurance for themselves and their

families. The Affordable care act was an attempt to ensure that all American could have access

to an affordable health insurance for all individuals. Although we have seen that the system has

not been perfect the program did expand Medicaid for individuals who qualified, yet many

individuals have remained uninsured. One thing we ask ourselves is why America has not been

able to obtain a single payer health insurance for all its citizens when compared to other

countries in the word? Many European countries have a single payer system or public health

insurance system that is funded by the government yet insurance for many Americans is still not

attainable. In this paper I will compare our current health care system with the one of France who

according to a study (Bloomberg study 2013) was ranked number 19th in the world as having one

of the best healthcare systems while in the same study the U.S. was ranked last place.

In order for us to get a clear picture of our current healthcare system we must first see

what our past health care system was before the affordable healthcare act was enforced on

January 1st 2014. Before the affordable care act was signed into law, many individuals where

only able to obtain health insurance through one of the following ways: through their employers

if it was offered to them, if they where over the age of 65 or federally disabled and qualified for

Medicare, privately though a private insurance, or if they met the criteria for Medicaid (also

known as Medi-cal in California). Even if most Americans were able to pay for private insurance

the cost of it could vary and your cost could increase tremendously if you had what insurance

companies considered “pre-existing conditions”.

Our current healthcare system although, it is still not perfect, made some major changes

in our healthcare system to ensure more individuals where covered. But the question remains,
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what type of healthcare system do we actually have in the U.S? America today does not have

one sole system in place; from a market based to socialized health insurance compared to a

national health system placed in Great Britain, France, Spain, or other European counties. The

Affordable Care Act in 2010 has given a “shared responsibility” between the government and

employers; private insurances are regulated by state level. The affordable care act allowed

Medicaid expanded their eligibility guidelines and private insurance provide income-based

premiums for low income and middle class families. Where before the middle class had a

difficult time obtaining insurance either privately or through their employer the expansion of

such programs now it almost ensured that most individuals would have access to an affordable

health insurance. The ACA (Affordable Care Act) not only made health care more affordable to

some people but also mandated that all individuals have full health coverage that met Minimum

Essential Coverage or you could face a penalty at the end of the year if you and your family

where not ensured.

Our current American health care system is financed by the state and privately. Per the

International Profiles of Health Care System about 66% of Americans have private voluntary

health insurance, 55.4% are employer provided, 14.6% acquired health insurance directly from

companies, 16% are under Medicare, 19.5% are insured under Medicaid, and 4.5% are military

insurance.

Since the Affordable Care Act, its has requested health insurance to cover 10 of the

essentials needed: ambulatory patient services, emergency services, hospitalizations, maternity

and newborn care, mental health, substance use disorder treatment, prescription drugs,

rehabilitation services and devices, laboratory services, preventive and chronic disease

management, and pediatric services. Unfortunately, the range and extent of services covered are
US healthcare system compared to France 4

determined by each state. A preferred provider organization, or PPO plan, is a type of managed

care organization that has a list of preferred providers who are paid according to their agreement

to a discounted fee. This plans has some limited coverage and with higher expenses to a plan

member if they go with a provider out side of network. A health maintenance organization, of

HMO plan, is a managed care organization that provides comprehensive medial care for a

predetermined annual fee per enrollee. Under the HMO plan, the members have a list of

providers they can only see; they do not have the option of out of network services. All services

will require a preauthorization for services, which needs to be initiated by their primary care

physician.

Another health plan provide is Medicaid, a joint federal-state program of health insurance

for low income and those below poverty level. Elderly Americans also have a choice between

Medicare, a federal program of health insurance with certain disabilities or with end stage renal

disease. A higher option of Medicare, Medicare Advance, or Part C, is when a Medicare enrollee

receives all health care services through a managed care plan. Most plans have a cost sharing

with the enrollee- copays, out of pocket expenses and high deductibles. The affordable care act

provided a tax-advance health savings account for those who could not pay the monthly

premiums, but these premiums are later collect back at the time the member files for taxes. All

insurance plans have a negotiated agreement with providers and facilities for payment.

Although our health care system has made many improvements the last few years to ensure that

more people are covered under an affordable insurance there are still many things are not perfect

about it. In Washington DC health coverage is still a hot topic as people continue to demand

some changes but the current administration wants to see most of what the affordable care act

disappear without given the American people an alternative or a single payer health care system
US Healthcare System Compared to France 5

as there is in other parts of the world, France is one of the places where healthcare is available to

all individuals and ensures everyone has access to that healthcare system.

In France the healthcare system is completely under the supervision of the French

government and defines the general orientation of the healthcare policy. In the documentary

Sicko by Michael Moore, it stated in France medical care is provided by the needs and the pay

by needs. Health care and college is free, therefore about 4,500 medical students graduate each

year. The health insurance program is in place based on incomes and the premiums are based on

salaries; the government determines the entire rate. France has about 65% public hospitals and

35% private and they all work well together.

Compared to the American healthcare system, the French health care system is financed

64% by employer and employee, 16% national earmarked income tax, 12% from alcohol and

tobacco taxes, 12% from pharmaceuticals, 6% from other branches and 2% from state subsides;

per the International Profiles of Health Care.

Medical care is not only free but also unlimited in France. Like the US, all preventative

services, outpatient services, hospitalizations, specialist and diagnostic and laboratory services

are covered but there is no restrictions on how long or how many consultations you need. In the

documentary, they mentioned that the more pre-existing conditions you have, the more medical

care they provide for you, and they do not use it against you. Besides from just citizens, visitors

are covered for emergency services only. The cost sharing are copays, balance from billing in

specialty and primary providers. In France there are no deductibles, about 8.8% are cost sharing

and they are from visions or dental services.

The American health care system is far from being perfect and free for all. The health

care system in America is focusing on the wrong idea of what it should be. The insurance and
US healthcare system compared to France 6

government is more focus on what they profit will be rather than what is best for the patient and

their medical needs. Still in this day the hospital are “dumping” patients and making it difficult

for patients to get services they need. Like in the documentary by Michael Moore, the

government set funds for volunteers to get health expenses covered yet they make are making it

so difficult to meet guidelines and are denied because they were “not under our payroll”.

Working in the healthcare system, is hard to see how medical services that are needed to

treat a patient properly; are denied by insurance plans because they “ do not meet criteria” or are

“experimental”. Some services or medications are to prevent chronic problems or to help treat

some diseases or infections. If we want to have better health care in America, insurances need to

stop having a mindset of having to make a profit and being selfish. Much like the France

healthcare, they offer unlimited sick time; unlike the US after three sick days the employer needs

a doctor note. The Affordable Care Act is a start to make our healthcare better; perhaps insurance

companies should be the same price for all. No matter what pre-exiting conditions the member

has or how much they use it. These are the barriers that members have to access the healthcare

they need. Another solution our healthcare system can improve is by having all insurances pay

the same amount to the providers or hospitals to avoid not accepting certain insurances. The

insurances are more focus on keeping revenue and making a profit, just like Lena, in the

documentary stated, they need to keep a 10% denial and they give bonuses to those who have a

higher denial rate. In the insurance eyes, all paid claims are “medical losses”. I hope the

healthcare system improves over the years, and just like France and other countries we all need

to look out for each other’s wellbeing.

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