“I’ve been doing interviews for now many years with the Center for Studying Health System Change (as part of the Community Tracking Study), and I have to maintain the anonymity of those I talk to, but some of the finest, most well-respected multispecialty groups will acknowledge in confidence that they’re able to ask for 200 or even 250 percent of Medicare (costs) to do what they are doing very well. I think this issue of market power is a real one. I would say, however, that this issue exists regardless of whether we move to accountable care organizations; it’s just the ability of hospitals, mostly, but also single-specialty groups increasingly, to figure out what the leverage game is all about. Market power is an issue that we need to find a solution to, and I’m not sure I see one other than a regulatory one.”

My own years of experience as a medical director, in a multispecialty group and several health plans, confirms Berenson’s statement, particularly including the use of local and sometimes regional market power by single and multispecialty groups, not just hospitals. Anesthesiology, radiology, orthopedics, ENT, multispecialty and other specific examples abound in my own Oregon-Washington market. This is one of the most important reasons why a “public option,” if not a single payer solution, is critical to any realistic hope of addressing costs to make coverage for all affordable. It will address much more than just negotiating drug prices with the pharmaceutical industry.

The Health system (Assurance Maladie) is based on the concept of providing a large amount of help for any medical need, and total help when it is serious : on the basis of a standard cost, medical care (doctors appointments and visits, dental care, etc..) is reimbursed around 80%, medicine from 80% when corresponding to a real medical need to 40% for less needed and of course 0% for others ; standard cost for a doctor is 22 Euros (sometimes, they can charge 30 Euros or more: dépassement d’honoraires) ; serious illnesses, including those due to old age, are covered 100%. Practically speaking each person has a chip card (Carte Vitale) which is read by the doctor’s or pharmacist’s terminal and a 13-digit “numéro de Sécurité Sociale”.

Contrary to what one could expect from a large, state-owned and centralized organization, the system is very efficient : the administrative cost of the health system is around 4,5% (for US private insurance companies : 10 to 13%) and 1,2% for the retirement system (vs. around 10% for most pension funds). The health system reimburses very quickly (after four days).

The Social Security structure is managed on a paritary basis: each regional organization (Caisse) is managed by a board composed 50/50 of representatives of labor unions on one side, employers associations on the other side, with the State playing the role of a referee ; the financial contribution of the patient is very limited and most of the public funding is public.
The state is considered responsible of its good functioning, but it is not accurate to call it a “socialized system”.
The Family system (Allocations Familiales) is a financial help to all families (whatever their income) plus various services such as day-care or vacation centers (according to income) ; when a family is expecting a child, it gets approximately 2,000 Euros in three installments (the first two of them corresponding to a mandatory medical visit, the third to the birth) ; then the family receives a monthly allowance till the child is 20 (for two children or more, around 100 Euros/month/child) ;
The Retirement system (Assurance Vieillesse) provides a minimal pension (in the range of 750 Euros/month) to any person who has worked 40 years.

Any system offered by a company to its staff is in addition to these national systems (for example the basic coverage for glasses of orthodontic care is pretty low, so you can chose or your company can provide a additionnal private coverage) and health insurance and retirement pension NEVER depend on the financial situation or even the survival of your employer(s) or former employer(s). For the French, it is just unthinkable that, if you lose your job, you also lose your health plan : those two hazards must not be linked. This is a typical example of what we Frenchs call our social model.

Forget your prejudices about what so many people call “socialized medicine” without knowing what it is : look at the facts ! In France you can choose freely your doctor and he/she is free of his/her prescription : you are not treated by the governement !

I am convinced that implementing such system in the US is unrealistic, but I still regret that those options and few good ideas cannot be reused in the public debate here! This kind of system keeps a space for private insurer, keeps your right to chose your doctor, insurer is more fair because there is not taxpayer money use to fund the system…

Even if our system also face numerous challenge: ageing population, tendancy to overconsume health care there is good things in it and it works!

for more detailed information, I can advise you this link ( in english)

http://france.angloinfo.com/countries/france/socialsecurity.asp

http://en.wikipedia.org/wiki/Social_Security_in_France

What you put forth is the recipe for more costly health care.

The issue with that is people will not go in for routine care if they have to pay up front. Things will always come up, and they will often put off that test or checkup until it hurts too much, then it will be too late to do anything. People need to be encouraged to go in EARLY so things can be caught EARLY in the development of disease.

Most people don’t like to go to the doctor, so if you take away the excuse that it will cost them you have more going in when something can actually be done for them.

Wow, no thought as to whether those people were suffering and dying before and that now they are actually getting some health care. The only thought is “Oh, my, the are actually USING the health care they can get now. Oh noooo!”

I’m thinking it’s like a dam bursting, at first there is more use because people have all kinds of things that haven’t been taken care of. It will level out eventually when they can get enough preventative care.

But, keeping the health insurance companies in the mix really doesn’t help the cost, regardless. They insist on their profits, which drives the cost up, while not doing anything that matters to those that are getting health care. Get them out of the mix, and see the costs go down.

They don’t always come here, they sometimes come here. There are many people that go to places like France to get their care when they are critical. For instance, Charlie Rose went to France when he had heart surgery. He loved it.

I am not sure I trust the Wikipedia article on Health care in Canada. It states in Canada, per capital healthcare spending in 2008 is $5,170. (The Canadian dollar was trading, in 2008, at near par with the USD.)

The OECD states it this way. In 2006 per capita spending on health care: Canada 3678 USD. United States 6714 USD.

It also quotes the Fraser Institute which is a right-wing think tank (for lower taxation, deregulation, privatization of healthcare and education.) The Fraser Institute has been criticized for publishing healthcare studies that are — not peer reviewed — that the corporate media then reports as credible.

It also quotes a former Canadian Medical Association president on the state of Canadian health care. This former CMA president has lately appeared in American TV ads with Rick Scott and Conservatives for Patients Rights.

I could be wrong. But I am wondering if someone (formally or informally affiliated) with the Fraser Institute cranked the Wikipedia article out.

Certainly in a very fundamental way: if you yourself wanted to open a one-person business as a health care provider, you cannot, unless….you pay your dues to the monopoly guild, including years of time and usually many tens of thousands of dollars in tuitions, etc. In contrast in a open market, you could indeed open your business, and start working, if customers chose you for care. Now that’s obvious, but…we forget about this non-market situation sometimes.

But there is a fundamental way to improve the “market” in actual care itself (not insurance, but actual care) other than simply opening it to competition (which would be interesting, and is already happening anyway in a less-efficent way — the expanding black market in care and medicines)

The “market” until now has been in insurance which pays fee-for-service payments to providers (which of course have and must have most of the decision making power). So the patient feels: I already paid, now I should get what I can. The doctor feels: I could run some more tests, and try a few more things, and that won’t hurt the bottom line. The insurance company feels: we need to raise premiums and cancel more policies.

Now…what if instead of fee-for-service, we had a very difference mechanism of payment. Not just fee-for-outcome, but a carefully formed outcome-based variable fee tied to diagnoses, both narrow and at times wider?

Here’s a result of some discussion and a lot of thought:

http://findingourdream.blogspot.com/2009/06/new-way-to-hold-down-health-care-costs.html

Without information arbitrage – it’s difficult for an insurance company to compete – gain advantage over another. But we need someone to continually find efficiencies – which can only truly be found/proven when exploited or realized – so we need arbitrage.

Not an easy conundrum to address at such a large scale.

In my view, these comments are just off point. The Obama administration says it wants a public insurance plan that will compete on a level playing field with private plans (that is, without taxpayer subsidies). Is there any cogent economic analysis that suggests that such a policy addresses problems of adverse selection and moral hazard? None that I know. If it has to stand on its own financially, the public plan has no special advantage in addressing these issues.’

Paul Krugman is not the last word on this. Mr. Kwak is too enamored with Mr, Krugman.

Like if you have any negotiating power agains BS of CA (Blue Shield) or Anthem. They just give you the numbers – take it or leave it. That is, if you’re healthy enough.
Have you even read the article we’re commenting on? “In the median state in the U.S., the top two insurers have a combined market share of 69%.” This is free market? Where are you gonna go?