Trout Nazi said:

Oh, now its the pharma companies fault, huh? If you knew how much it cost, and how many years, in total it took to bring that little purple pill to market, then you wouldn't be bitching and moaning about it. And on top of that you only have a relatively short period of patent protection to turn a buck before everyone and their mother in India and China make a generic version. And no, there is not cheap way to develop drugs.

Here's the alternative. The pharma companies can stop innovating, and not come up with cures for anything.

Click to expand...

I know first hand that the pharma companies spend tons of money every year to maintain, calibrate and validate the equipment they use, so medications do what they are supposed to.

The major manufacturers conform to the FDA regs. I wish I could say the same for many of the generic manufacturers. Some small generic manufacturers in THIS country don't calibrate or validate squat until they're busted in an FDA audit! It may not seem like a big deal, but it determines a lot in the scheme of things when you are talking about QC with drugs. When you are paying for 15mg of a drug or you need to take 15mg of a drug; the accuracy of the manufacturing and testing process is huge.

I have a great idea for our illustrious Congress; set up a model Obamacare plan and YOU use it for two years and report your findings to an independent review panel and the taxpayers.

• That means that Teddy "Brain-Tumor" Kennedy will have to wait in a queue at the local hospital and get no preferential treatment just because he is a senator who drives dames off bridges.

• That means that Arlen "Who's Side Am I On" Specter will have to wait his turn to get his cancer treatment from a doctor from Afghanistan and he won't get pushed to the front of the line just because he can't make up his mind which party he wants to be in.

• That means that the next time Robert "KKK" Byrd has a old age related issue; the government controlled heath care system will evaluate his relative uselessness to society and pull the plug on him because he has lived long enough and contributed more carbon dioxide emissions than all of the coal fired energy plants in his home state.

• And guess what Nancy "Sea Hag" Pelosi or Joe "Hair Plug" Biden; no more cross country flights for more cosmetic surgery. You'll wait a few months and get treated at the local clinic like the rest of us schlubs! Maybe in your cases, it will be an improvement!

Hey US Congress, try it YOURSELF first and see how YOU like it!

:finger:

Let me start by saying I work for one of he top 5 pharmaceuticals in the world. Im telling you this so no one can claim I have some “hidden” agenda.

jlajoie said:

You do realize, that right now, you are paying for all those people out there that can't afford to have insurance, so they wait until it is necessary or the only option to go to the emergency room, and muddle that up. No matter what, we are all going to be paying for people who aren't contributing. It has been happening for years with the Social Security mess, and it has been happening for years with insurance. Your health coverage won't change, unless you make that decision. And as far as all of the pharma companies in Jersey, well, a little regulation probably wouldn't hurt them either. I am really tired of paying through the nose far a little purple pill, because the pharma companies won't allow a generic version.

Click to expand...

From my understanding, hospitals increase the cost of service due to non-paying patients. Since I have health insurance Im only paying a small percentage of the non-paying patients cost. The rest is paid by my insurance company. Im sure there is also some sort of government relief mixed in there that my taxes are also paying, but I don’t know anything about it. Speaking to the cost of non-generic prescription drugs, Trout Nazi hit the nail on the head. Developing a drug is a very expensive process.

P.S. I apologize for the smilies in my last post. I spell checked my response it word, which must have put that code in there.

MrJesse34 said:

100% true. The whole problem is with the pharmaceutical companies. I have friends that I went to college with, who were literally the dumbest kids I knew, who are now doing pharmaceutical sales and making six figures. Its sick. Their job is to meet with doctors and convince doctors to use their products. You would think the doctors would prescribe drugs that they thought would be the best for the patient, but in reality they prescribe the ones that give them the best kick backs or whatever.

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You have to understand, like anything else in a capitalist society marketing is absolutely required to succeed. For most illnesses, there is any number of drugs to treat it. Not all drugs are better or worse than its competitors. With that in mind, how would a Doctor choose one over the other if both have a similar efficacy? Secondly, the adds you see out there are partially information and partially public relations. Pharmaceuticals need you to trust the drug that is being prescribed to you, otherwise you will tell your doctor to prescribe something else. Lastly, there are regulations out by the FDA that state how expensive any gift can be. Do all pharmaceuticals abide by those regulations, probably not, but that cant be prevented. It has to be handled with a reactive approach.

BIGBOW said:

Good point. Furthermore, lets not forget to mention the fact that many (not all) of these uninsured who wait to the last minute for medical attention could have been treated much earlier for their symptoms if they had coverage. The actual cost would have been much cheaper for us if this premeasure was taken. Instead, they wait to things worsen and when they finally do see a specialist, the fix is a lot more out of "our" pockets because they didnt take the preventative steps from the start.

Click to expand...

I have a friend who grew up in Canada. Her father who has recently been diagnosed with a pretty serious illness had to wait two months to see a specialist. God forbid he had a brain tumor; he could have died before even setting a foot into that specialist’s office. Understand that your preventative approach really only works for common illnesses like an upper respiratory infection that could become bronchitis. With this socialized medicine approach I would expect to see the mortality rate for fast acting illnesses to drastically increase.

NJDrew said:

P.S. I apologize for the smilies in my last post.

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No need to apologize.<O</O
<O</O

Anyone who wears a cowboy hat while fishing... it is not unexpected.

You did however forget to say, "Have a nice day."

C'mon now AK, would you call that a cowboy hat or a crusher?

It's not a coincidence that most new drugs are discovered in the US and it's not a coincidence that people from all over the world come here for medical treatment. There aren't a whole lot of people who go to Canada or the UK for treatment. We have the best health care system in the world and my choice would be to keep it that way.

AKSkim said:

No need to apologize.<O</O
<O</O

Anyone who wears a cowboy hat while fishing... it is not unexpected.

You did however forget to say, "Have a nice day."

Click to expand...

Conversely being a fedora hat wearing fishermen, like myself, decorum is always expected.

Have a dapper day, AKSkim

Ryan R said:

C'mon now AK, would you call that a cowboy hat or a crusher?

Click to expand...

I call it something never to be found sitting atop my head.

NJDrew said:

Let me start by saying I work for one of he top 5 pharmaceuticals in the world. Im telling you this so no one can claim I have some “hidden” agenda.

Ah, but there is an agenda even if its not hidden. Trying to save your own arse and job.. understandable.

From my understanding, hospitals increase the cost of service due to non-paying patients. Since I have health insurance Im only paying a small percentage of the non-paying patients cost. The rest is paid by my insurance company. Im sure there is also some sort of government relief mixed in there that my taxes are also paying, but I don’t know anything about it.

Duh, of course its OUR taxes.

Understand that your preventative approach really only works for common illnesses like an upper respiratory infection that could become bronchitis.

I'd expect a bit more knowledge from someone in your field. There are dozens of infections, diseases, cancers, and many other illnesses that worsen if not initially treated. What are you even thinking saying this??

Click to expand...

Although we have some of the most reputable doctors in the world, our healthcare system is certainly nowhere near the top of the list. Read some reports by the World Health Organization and you will see that. Just under a decade ago we ranked in the upper 30's out of the world. More recently, they've ranked us behind New Zealand, Australia, UK, Germany, and yes.. Canada. I know other countries like France and Italy also have much better healthcare systems than us. We may have some of the best doctors in the world, but I dont care what kind of coverage you have, you better be rich or willing to sell your house to be treated by those doctors.

AKSkim said:

I call it something never to be found sitting atop my head.

Click to expand...

I hope that list also includes Australian bush hats, Irish tweed, up-downers, Amish straw, or Tilly hats.

I'm personally going to get a "double naught" spy derby like Odd Job so I can wing it at all of the health care reformers or guys who crowd me on the stream.

BIGBOW said:

NJDrew said:

<O

Let me start by saying I work for one of he top 5 pharmaceuticals in the world. Im telling you this so no one can claim I have some “hidden” agenda.


Ah, but there is an agenda even if its not hidden. Trying to save your own arse and job.. understandable.<O</O

<O</O
lol, I have no agenda. Im only voiceing my opinion. If the entire pharmaceutical industry shutdown tomorrow, I would go and do something else. I work my job to live my life, not live my life to work my job.


From my understanding, hospitals increase the cost of service due to non-paying patients. Since I have health insurance Im only paying a small percentage of the non-paying patients cost. The rest is paid by my insurance company. Im sure there is also some sort of government relief mixed in there that my taxes are also paying, but I don’t know anything about it.


Duh, of course its OUR taxes.

<O</O
ok?... well Im glad it obvious to you, but it may not be so obvious to the rest of us.<O</O


Understand that your preventative approach really only works for common illnesses like an upper respiratory infection that could become bronchitis.


I'd expect a bit more knowledge from someone in your field. There are dozens of infections, diseases, cancers, and many other illnesses that worsen if not initially treated. What are you even thinking saying this??<O</O

When I said “your preventative approach” I was referring to the idea that social healthcare would allow anyone to be treated immediately. The less common illnesses or harder to diagonose illnesses require a specialist that you will likely have to wait to see under socialized healthcare. More common illnesses or easier to diagonose illnesses could be treated by a general physican and may not require you to wait for a specialist The current preventative approach allows anyone who is ill, with or without insurance, to walk into any emergency room or free clinic and get treated. If they choose to wait, that is solely on them. This was a bad choice of words on my part, I apologize for that.<O</O

Click to expand...

<O</O

<O</O
Although we have some of the most reputable doctors in the world, our healthcare system is certainly nowhere near the top of the list. Read some reports by the World Health Organization and you will see that. Just under a decade ago we ranked in the upper 30's out of the world. More recently, they've ranked us behind <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com

</st1:country-region>New Zealand, <st1:country-region w:st="on">Australia</st1:country-region>, <st1:country-region w:st="on">UK</st1:country-region>, <st1:country-region w:st="on"><ST1Germany</ST1</st1:country-region>, and yes.. <st1:country-region w:st="on"><ST1Canada. </ST1</st1:country-region>I know other countries like <st1:country-region w:st="on">France</st1:country-region> and <st1:country-region w:st="on"><ST1Italy</ST1</st1:country-region> also have much better healthcare systems than us. We may have some of the best doctors in the world, but I don’t care what kind of coverage you have, you better be rich or willing to sell your house to be treated by those doctors.

Click to expand...

Based on what criteria? If it is based on free healthcare for it citizens, then yes we would be behind all those countries.

P.S. Are you referring to the 2000 WHO Ranking of Health Care Systems?

interesting read: http://www.cato.org/pubs/bp/html/bp101/bp101index.html

The simple reality of this whole thread, short of the hat discussion , is that you cant trust anyone else to truthfully interpret data for you. Freedom of Speech, one of our greatest liberties is also one of our greatest constraints.

In the interest of stoking the flames:

Link: washingtonpost.com

article:

Republicans Propagating Falsehoods in Attacks on Health-Care Reform

By Steven Pearlstein
Friday, August 7, 2009

As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don't agree. Today, I'm going to step over that line.

The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.

There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.

Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.

The centerpiece of all the plans is a new health insurance exchange set up by the government where individuals, small businesses and eventually larger businesses will be able to purchase insurance from private insurers at lower rates than are now generally available under rules that require insurers to offer coverage to anyone regardless of health condition. Low-income workers buying insurance through the exchange -- along with their employers -- would be eligible for government subsidies. While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy.
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There is still a vigorous debate as to whether one of the insurance options offered through those exchanges would be a government-run insurance company of some sort. There are now less-than-even odds that such a public option will survive in the Senate, while even House leaders have agreed that the public plan won't be able to piggy-back on Medicare. So the probability that a public-run insurance plan is about to drive every private insurer out of business -- the Republican nightmare scenario -- is approximately zero.

By now, you've probably also heard that health reform will cost taxpayers at least a trillion dollars. Another lie.

First of all, that's not a trillion every year, as most people assume -- it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.

Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year.

The Republican lies about the economics of health reform are also heavily laced with hypocrisy.

While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers -- the only two ways I can think of to credibly bring health spending under control.

When Democrats, for example, propose to fund research to give doctors, patients and health plans better information on what works and what doesn't, Republicans sense a sinister plot to have the government decide what treatments you will get. By the same wacko-logic, a proposal that Medicare pay for counseling on end-of-life care is transformed into a secret plan for mass euthanasia of the elderly.

Government negotiation on drug prices? The end of medical innovation as we know it, according to the GOP's Dr. No. Reduce Medicare payments to overpriced specialists and inefficient hospitals? The first step on the slippery slope toward rationing.

Can there be anyone more two-faced than the Republican leaders who in one breath rail against the evils of government-run health care and in another propose a government-subsidized high-risk pool for people with chronic illness, government-subsidized community health centers for the uninsured, and opening up Medicare to people at age 55?

Health reform is a test of whether this country can function once again as a civil society -- whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.

If health reform is to be anyone's Waterloo, let it be theirs.

Steven Pearlstein can be reached at pearlsteins@washpost.com.

But of course, that is a comment from the liberal media! j/k.

You guys are going to force me to read this healthcare reform bill aren't you? If I start now I might have an informed opinion by september :beingsick:

Lastest waste of tax payer money. As we already know the Speaker of the House loves flying in Air Force High End executive Jets, but as she can't always get the ones she wants, Congress is now BUYING their own fleet of Executive Jets...I kid you not! This from the same crowd that went after the auto industry about their private jets! And no I didn't read this on Fox News1

If this plan is so good, why are members of Congress not be covered by it?[/quote]

That is the million dollar question!

I always felt that only when the politicians have the same health care and pension plans as the general public, will these problems be resolved.

Its like after 9-11. They tell you its safe to fly but they take the train. :finger:

That's all I'm going to say about politics here. Back to fishing for me.

Stonefly said:

Lastest waste of tax payer money. As we already know the Speaker of the House loves flying in Air Force High End executive Jets, but as she can't always get the ones she wants, Congress is now BUYING their own fleet of Executive Jets...I kid you not! This from the same crowd that went after the auto industry about their private jets! And no I didn't read this on Fox News1

Click to expand...

What I find ironic is that they build the Dulles Airport so the congressmen could get to an airport relatively easy via the Dulles Toll Road with two lane dedicated for airport travel and a large majority of them use Reagan National which if you've ever been to is a classic butt f--k to get in and out of.

Every one of these politician should be voted out until they get the message that we employ them and they are there to serve us not the other way around.

Stonefly said:

You need to log on and read the plan, while the Pres says they can keep their plan, that's not what it says in the bill.

Click to expand...

Granted I've only made it 5 pages in so far but I've already found this:

Page 5 Under Section 3 "Insurance Reforms", part (B)

"creates a new Health Insurance Exchange, with a public health insurance option alongside private plans"

$200 Million Dollars allotted for these executive jets for that old crow and her hypocritical cronies.

Stonefly said:

Lastest waste of tax payer money. As we already know the Speaker of the House loves flying in Air Force High End executive Jets, but as she can't always get the ones she wants, Congress is now BUYING their own fleet of Executive Jets...I kid you not! This from the same crowd that went after the auto industry about their private jets! And no I didn't read this on Fox News1

Click to expand...

Kilgour Farms said:

Every one of these politician should be voted out until they get the message that we employ them and they are there to serve us not the other way around.

Click to expand...

I wouldn't mind being elected to office.

AK Skim
King of the United States and Delaware River

AKSkim said:

I wouldn't mind being elected to office.

AK Skim
King of the United States and Delaware River

Click to expand...

I think that the problem is, they have to be voted out before you get voted in, Skim!

jlajoie said:

I think that the problem is, they have to be voted out before you get voted in, Skim!

Click to expand...

Hummm.. not really.

As always, think coupe d'etat...

AK Skim
Your King

maybe I am just a bit slow picking up on it, but.... how does this translates to fly fishing? what's the direct and indirect consequences of the bill, passing or not, on our sport?

Karel said:

maybe I am just a bit slow picking up on it, but.... how does this translates to fly fishing? what's the direct and indirect consequences of the bill, passing or not, on our sport?

Click to expand...

IT DOESN'T

This is just a bitch session.

So shut the F-Up

Karel said:

maybe I am just a bit slow picking up on it, but.... how does this translates to fly fishing? what's the direct and indirect consequences of the bill, passing or not, on our sport?

Click to expand...

You ever have a chuck and duck session, and forget to duck?
:down:

And AK, I love that song...
<object height="344" width="425">
<embed src="http://www.youtube.com/v/w_aeSJlVDdQ&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="344" width="425"></object>

here's the news link on the jets: Congress Gets an Upgrade - WSJ.com

Wall Street Journel By DAVID GAUTHIER-VILLARS

When Laure Cuccarolo went into early labor on a recent Sunday night in a village in southern France, her only choice was to ask the local fire brigade to whisk her to a hospital 30 miles away. A closer one had been shuttered by cost cuts in France's universal health system.
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<CITE>Agence France-Presse/Getty Images</CITE> Doctors, trade unions and others have called national protests against French health-care cutbacks this year. One petition signed by prominent physicians said they feared the intent of the reform was to turn health care into a 'lucrative business' rather than a public service.






Ms. Cuccarolo's little girl was born in a firetruck.
France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.
And service cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.
The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.



French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it. France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.
The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.
France's woes provide grist to critics of Mr. Obama and the Democrats' vision of a new public health plan to compete with private health insurers. Republicans argue that tens of millions of Americans would leave their employer-provided coverage for the cheaper, public option, bankrupting the federal government.
Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.
France faces a major obstacle to its reforms: French people consider access to health care a societal right, and any effort to cut coverage can lead to a big fight.
For instance, in France, people with long-term diseases get 100% coverage (similar to, say, Medicare for patients with end-stage kidney diseases). The government proposed trimming coverage not directly related to a patient's primary illness -- a sore throat for someone with diabetes, for example. The proposal created such public outcry that French Health Minister Roselyne Bachelot later said the 100% coverage rule was "set in stone."
Health Expenditures

Total expenditure on health in 2007, as a percentage of GDP.
<TABLE width=264><TBODY><TR class=odd><TD vAlign=top>Australia</TD><TD vAlign=top>8.7%†</TD></TR><TR class=even><TD vAlign=top>Austria</TD><TD vAlign=top>10.1%</TD></TR><TR class=odd><TD vAlign=top>Belgium</TD><TD vAlign=top>10.2%*</TD></TR><TR class=even><TD vAlign=top>Canada</TD><TD vAlign=top>10.1%</TD></TR><TR class=odd><TD vAlign=top>Czech Republic</TD><TD vAlign=top>6.8%</TD></TR><TR class=even><TD vAlign=top>Denmark</TD><TD vAlign=top>9.8%</TD></TR><TR class=odd><TD vAlign=top>Finland</TD><TD vAlign=top>8.2%</TD></TR><TR class=even><TD vAlign=top>France</TD><TD vAlign=top>11.0%</TD></TR><TR class=odd><TD vAlign=top>Germany</TD><TD vAlign=top>10.4%</TD></TR><TR class=even><TD vAlign=top>Greece</TD><TD vAlign=top>9.6%</TD></TR><TR class=odd><TD vAlign=top>Hungary</TD><TD vAlign=top>7.4%</TD></TR><TR class=even><TD vAlign=top>Iceland</TD><TD vAlign=top>9.3%</TD></TR><TR class=odd><TD vAlign=top>Ireland</TD><TD vAlign=top>7.6%</TD></TR><TR class=even><TD vAlign=top>Italy</TD><TD vAlign=top>8.7%</TD></TR><TR class=odd><TD vAlign=top>Japan</TD><TD vAlign=top>8.1%†</TD></TR><TR class=even><TD vAlign=top>Korea</TD><TD vAlign=top>6.8%</TD></TR><TR class=odd><TD vAlign=top>Luxembourg</TD><TD vAlign=top>7.3%†*</TD></TR><TR class=even><TD vAlign=top>Mexico</TD><TD vAlign=top>5.9%</TD></TR><TR class=odd><TD vAlign=top>Netherlands</TD><TD vAlign=top>9.8%*</TD></TR><TR class=even><TD vAlign=top>New Zealand</TD><TD vAlign=top>9.2%</TD></TR><TR class=odd><TD vAlign=top>Norway</TD><TD vAlign=top>8.9%</TD></TR><TR class=even><TD vAlign=top>Poland</TD><TD vAlign=top>6.4%</TD></TR><TR class=odd><TD vAlign=top>Portugal</TD><TD vAlign=top>9.9%†</TD></TR><TR class=even><TD vAlign=top>Slovak Republic</TD><TD vAlign=top>7.7%</TD></TR><TR class=odd><TD vAlign=top>Spain</TD><TD vAlign=top>8.5%</TD></TR><TR class=even><TD vAlign=top>Sweden</TD><TD vAlign=top>9.1%</TD></TR><TR class=odd><TD vAlign=top>Switzerland</TD><TD vAlign=top>10.8%*</TD></TR><TR class=even><TD vAlign=top>Turkey</TD><TD vAlign=top>5.7%‡</TD></TR><TR class=odd><TD vAlign=top>United Kingdom</TD><TD vAlign=top>8.4%</TD></TR><TR class=even><TD vAlign=top>United States</TD><TD vAlign=top>16.0%</TD></TR></TBODY></TABLE>* Estimated
† For 2006
‡ For 2005
Source: OECD Health Data 2009


"French people are so attached to their health-insurance system that they almost never support changes," says Frédéric Van Roekeghem, Assurance Maladie's director.
Both patients and doctors say they feel the effects of Mr. Sarkozy's cuts. They certainly had an impact on Ms. Cuccarolo of the firetruck birth.
She lives near the medieval town of Figeac, in southern France. The maternity ward of the public hospital there was closed in June as part of a nationwide effort to close smaller, less efficient units. In 2008, fewer than 270 babies were born at the Figeac maternity ward, below the annual minimum required of 300, says Fabien Chanabas, deputy director of the local public hospital.
"We were providing good-quality obstetric services," he says. "But at a very high cost." Since the maternity closed, he says, the hospital narrowed its deficit and began reallocating resources toward geriatric services, which are in high demand.
In the Figeac region, however, people feel short-changed. "Until the 1960s, many women delivered their babies at home," says Michel Delpech, mayor of the village where Ms. Cuccarolo lives. "The opening of the Figeac maternity was big progress. Its closure is perceived as a regression."
For Ms. Cuccarolo, it meant she would have to drive to Cahors, about 30 miles away. "That's fine when you can plan in advance," she says. "But my little girl came a month earlier than expected."
France launched its first national health-care system in 1945. World War II had left the country in ruins, and private insurers were weak. The idea: Create a single health insurer and make it compulsory for all companies and workers to pay premiums to it based on a percentage of salaries. Patients can choose their own doctors, and -- unlike the U.S., where private health insurers can have a say -- doctors can prescribe any therapy or drug without approval of the national health insurance.
Private insurers, both for-profit and not-for-profit, continued to exist, providing optional benefits such as prescription sunglasses, orthodontics care or individual hospital rooms.
At a time when the U.S. is considering ways of providing coverage for its entire population, France's blending of public and private medical structures offers important lessons, says Victor Rodwin, professor of health policy and management at New York University's Wagner School. The French managed to design a universal system incorporating physician choice and a mix of public and private service providers, without it being "a monolithic system of Soviet variety," he says.
It took decades before the pieces fell into place. Only in 1999 did legislation mandate that anyone with a regular residence permit is entitled to health benefits with no strings attached. Also that year, France clarified rules for illegal residents: Those who can justify more than three months of presence on French territory, and don't have financial resources, can receive full coverage.
That made the system universal.
In the U.S., health-overhaul bills don't attempt to cover illegal immigrants. Doing so would increase costs and is considered politically difficult.
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<CITE>Agence France-Presse/Getty Images</CITE> A protest in April in Caen, France.






Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.
Proponents of the private-based U.S. health system argue that competition between insurers helps provide patients with the best possible service. In France, however, Assurance Maladie says its dominant position is its best asset to manage risks and keep doctors in check.
"Here, we spread health risks on a very large base," says Mr. Van Roekeghem of Assurance Maladie.
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The quasi-monopoly of Assurance Maladie makes it the country's largest buyer of medical services. That gives it clout to keep the fees charged by doctors low. About 90% of general practitioners in France have an agreement with Assurance Maladie specifying that they can't charge more than €22 (about $32) for a consultation. For house calls they can add €3.50 to the bill.
By comparison, under Medicare, doctors are paid $91.97 for a first visit and $124.97 for a moderately complex consultation, according to the American College of Physicians.
In France, "If you are in medical care for the money, you'd better change jobs," says Marc Lanfranchi, a general practitioner from Nancy, an eastern town. On the other hand, medical school is paid for by the government, and malpractice insurance is much cheaper.
In 2000, the World Health Organization ranked France first in a one-time study of the health-care services of 191 countries. The U.S. placed 37th.
Financial pain has long dogged the French plan. As in the U.S., demand for care is growing faster than the economy as people take better care of themselves and new treatments become available.
Tilting the Balance

Since France began building up its universal health-care system, in 1945, successive governments have been faced with the challenge of balancing the national health insurance budget without going back on the original promise of taking good care of the entire population. For the past three decades, small reductions in health care coverage and incremental increases in health-care taxes have been the main recipe.
1976 -- Coverage of ambulance costs is reduced.
1977 -- Coverage of some medications is reduced. Some hospital beds are closed.
1982 -- Patients must pay a "moderating fee" of 20 francs (3 euros) out of pocket when they are hospitalized.
1985 -- Coverage of some paramedical procedures is reduced.
1986 -- Increase in health-care payroll taxes.
1987 -- Letters sent to the national health insurance must be stamped.
1988 -- Creation of a special tax on medication advertising to help fund health care.
1990 -- Introduction of the CSG, a new tax levied on all types of income to help fund health care.
1991 -- Increase in health-care taxes levied on payroll.
1993 -- Increase in CSG rate. Coverage of doctor consultation is reduced.
1996 -- Increase in health-care taxes. A new health-care tax is levied on private health-care plans.
1999 -- New tax levied on drug makers when their revenue exceeds a pre-defined level.
2000 -- Doctors are required to explain to the national health insurance why they granted a worker sick leave.
2003 -- The "moderating fee," which was increased over time, is raised to 15 euros.
2004 -- Patients must register with a "preferred" general practitioner who will reroute them toward specialists when necessary, or face lower reimbursement for care.
2005 -- The national health insurance deducts 1 euro off doctor consultation fees before it starts calculating how much it must reimburse patients.
2008 -- The national health insurance deducts 50 cents off every pack of medicine before it starts calculating how much it must reimburse patients.
Source: WSJ research.


Since the 1970s, almost all successive French health ministers have tried to reduce expenses, but mostly managed to push through only minor cost cuts. For instance, in 1987, patients were required to put a stamp on letters they mailed to the national health insurer. Previously, postage was government-subsidized.
In 2004, France introduced a system under which patients must select a "preferred" general practitioner who then sends them onward to specialists when necessary. Under that policy -- similar to one used by many private U.S. health-care plans -- France's national health insurance reimburses only 30% of the bill, instead of the standard 70%, if patients consult a doctor other than the one they chose.
At the start, patients balked, saying it infringed on their right to consult the doctors of their choice. But the system is now credited for helping improve the coordination between primary and specialty care, which remains one of the main weakness in the U.S. health-care system.
In recent years, Assurance Maladie has focused on reducing high medicine bills. Just like U.S. insurers and pharmacy-benefit managers, France's national health insurer is promoting the use of cheaper generic drugs, penalizing patients when they don't use them by basing reimbursements on generic-drug prices.
The most important aspect of Mr. Sarkozy's latest health-care legislation, passed this summer, focuses on reducing costs at state hospitals. About two-thirds of France's hospitals are state-run, and they are seen as ripe for efficiency savings. Among other things, Mr. Sarkozy has asked them to hire more business managers and behave more like private companies, for instance, by balancing their budgets.
The proposals didn't go down well.
In April, some of France's most famous doctors signed a petition saying they feared Mr. Sarkozy would turn health care into a "lucrative business" rather than a public service.
In the U.S., hospitals are paid for each individual procedure. This system, called fee-for-service, is suspected of contributing to runaway costs because it doesn't give hospitals an incentive to limit the number of tests or procedures.
Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment.
France's private hospitals are more cost-efficient. But state hospitals say it is unfair to compare the two, because state hospitals often handle complex cases that private hospitals can't.



"When a private hospital has trouble with a newborn baby, we are here to help, night and day," says Pascal Le Roux, a pediatrician at the state hospital in Le Havre, an industrial city in northern France. "Having people standing by costs money."
In theory, Assurance Maladie should be able to contain hospital costs the same way it does with doctors: by harnessing its position as the dominant payer in the health-care system. In practice, it doesn't work that way.
The state hospital of Le Havre, called Groupement Hospitalier du Havre, or GHH, has nearly 2,000 beds and is one of the most financially strapped in France. A 2002 report by France's health-inspection authority found that the hospital had a track record of falsifying accounts in order to obtain more state funds.
Philippe Paris was hired about two years ago to help fix the hospital's spiraling costs. He is cutting 173 jobs out of the staff of 3,543.
And he is trying to enforce working hours. "People don't work enough," he said. "If consultations are scheduled to begin at 8 a.m., that means 8 a.m. and not 11 a.m."
Yet even the smallest budget moves are proving controversial. Local residents are up in arms over a cost-cutting measure that makes patients pay €1.10 an hour to park at the hospital. "It's a scandal," says retired local Communist politician Gérard Eude. "It goes against the very idea of universal health care."
Write to David Gauthier-Villars at David.Gauthier-Villars@wsj.com
<CITE class=paperLocation>Printed in The Wall Street Journal, page A1</CITE><!-- article end -->



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jlajoie said:

It has been happening for years with the Social Security mess, and it has been happening for years with insurance. Your health coverage won't change, unless you make that decision.

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They can't run cash for clunkers, or social security, and we expect them to be able to run new health care reform?

Also, you can keep your insurance, unless you loose your job, and then you have to take the government option, but I could be wrong.

CTobias said:

Also, you can keep your insurance, unless you loose your job, and then you have to take the government option, but I could be wrong.

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Don't the employers choose what health insurance plan that they will offer their employees? I mean even if I liked my plan, couldn't my employer choose to offer the government plan to its employees?

Future Fanatic said:

Don't the employers choose what health insurance plan that they will offer their employees? I mean even if I liked my plan, couldn't my employer choose to offer the government plan to its employees?

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Yes, and I would think all or at least most state governments would immediately opt for the government plan.