There is adiary getting a fair amount of attention due to Hillary Clinton’s latest attempt to obfuscate about Sanders’ approach to national healthcare. In reading the comments, I noticed a dearth of information and a fair amount of misunderstanding about how a system like what Sanders proposes might work.
In the interest of clearing up some confusion, here are some facts about an actual universal healthcare system out there in the real world. I used the French national health care system (la Sécu) for 28 years. I hope here to cut through the mis/disinformation about how such a system might work in the US. All the currency information is in euros. You can think “dollars”, as the buying power is about equivalent independently of exchange rate fluctuations.
1 La Sécu covers about 65% of the cost for doctor visits and medications.
2) It covers 100% of the cost of hospitalization in a public hospital. I don’t know what coverage it covers for private clinics.
3) It covers 100% for chronic diseases like diabetes, heart disease etc.
4) It covers eyeglasses if you want to wear national health glasses, which are not very stylish.
5) It covers dental care rather poorly.
6) Employees pay for la Sécu through a payroll tax, like our Social Security tax. In January 2007, the year I retired, I paid .85% on my gross salary and an additional 6.65% on my salary over €3798.45. The total was €233.43 that month. The steep increase for the amount above €3798.45 amounts to a graduated tax paid by higher wage brackets. My employer paid €1599.14
7) You can buy supplemental insurance from private, heavily regulated, insurers. I paid in January 2001, when I had 3 kids and a wife on supplemental €114.34 for it. It covered new glasses every year, the kids’ braces, dental and the 35% not covered by la Sécu. In January 2007, the year I retired the supplemental for the wife and me was €62.44. The cost for the supplemental was calculated as a percentage of take home. So somebody who made less than I did would get the same coverage at a lower price. My employer paid €95.57.
8) When the kids were small, we were paid a premium of about $100 for taking them to the pediatrician.
9) One of my kids is severely handicapped and lives in a home run by the French Red Cross. La Sécu pays for his care, lodging and food. In addition he receives a small pension to cover clothes, toiletries, entertainment etc. La Sécu helped us fund an adapted minivan so that he can ride around in his wheelchair. It also covers some physical therapy that supplements the standard PT available where he lives.
10) For the indigent etc. la Sécu is free.
11) Self-employed people pay the sum of employee and employer parts based on the rates in section 6 above.
12) You pay doctor visits at a standard rate of €23 (2011). The doctor swipes your national health card, and you are automatically reimbursed to your bank account. La sécu recovers the 35% it doesn’t pay from your supplemental insurance.
13) Pharmacies are a little different. The pharmacist swipes your national health card and la Sécu takes care of reimbursing the pharmacist. You pay nothing to the pharmacist for prescription drugs.
14) There is a service called SOS Médicin that will send a doctor to make a house call. It costs a bit more than a visit to the doctor’s office, but la Sécu covers it. Pediatricians make house calls as a matter of course.
15) Most French doctor’s offices would be unrecognizable to an American. My family doctor had a waiting room with 10-12 chairs and no receptionist. He would simply stick his head out the office door and say, “Next”. If you needed lab work, he would give you a prescription to get it done at a lab. He shared a telephone answering service with other doctors to take appointments, but you could just walk in off the street without an appointment. The longest I ever waited was about half an hour. His office was a 5 minute walk from home. Some specialists have slightly more sophisticated operations, some don’t.
16) For 8% of your income, you can buy into la Sécu and live out your retirement in France. Who would want to do that, though?
The French system could be simpler. It could pay 100%, rather than giving private insurers a hand out. That would mean higher payroll taxes, but probably lower overall cost.
