As an American who lives in France, I have to say I have witnessed first-hand the issues facing the French medical system.

The new “Sicko” movie has me astonished by it’s slanted perspective of France and the average 8K-euros/month middle class income?? This is entirely FALSE. Perhaps France is leading the world in terms of access to healthcare, but there are a ton of issues that go along with this socialized system.

Pros:

1. French Doctors are SO darn NICE. It seems they are doctors because they are compassionate and have a true desire to help other humans first and foremost. They also have a fond appreciation when I say I’m “American.” I can’t figure out why, but thanks to you American doctors, we have a very good reputation in the healthcare realm. It is not unusual to discuss personal information (small talk) between both the dr. and patient – making for a much more human and trusting relationship.

2. Doctors usually answer their own telephone and book an appointment quickly, most often the same day or the day after. They save expenses of hiring a receptionist and “insurance filer” even though you could be in the middle of a consultation and he/she might need to answer the telephone.

3. The system does work pretty well amid all the red tape.

Cons:

1. I had to take my son for stitches at the hospital ER. Aside from passing through the cloud of cigarette smoke at the entrance door, the place was filthy, no ventilation, a hole in the wall, blood stains on the ceiling/walls. While awaiting a doctor, another patient walked in and vomited on the floor of the entryway. NO ONE cleaned it up. It was there for 1.5 hours. The nurses were stepping over it with their open-toed shoes. Then I asked if anyone planned on cleaning that up. They went and got a sheet and covered it up with a sheet. I seriously felt like I was in the Twilight Zone. The lack of ventilation worried me about tuberculosis, since there are a LOT of 3rd World immigrants in France these days.

2. Hygeine, to expand a little on the above comment, it seems they do not wash their hands between patients. And so darn friendly that a handshake is always polite.

3. The machines and/or equipment is very old and often outdated. They are still doing CT Scans and MRIs are very hard to get access to.

4. French people tend to go to the doctor for the smallest little cough or sniffle so they won’t have to pay out-of-pocket for the medicine. If you have a prescription you are reimbursed. If you want to buy Actifed without a prescription, you pay out of pocket. This makes for unnecessary doctor visits. You really have to scrimp and save around here because salaries are SO low and taxes SO high. Even with 80K-euros/annual income, we live in a town with a very bad reputation and have to budget very, very carefully.

This socialized system has actually enabled its citizens similar to a drug dealer enables an addict. The French look to the government for too much. They have the attitude that there is “no corruption” in the French government and the high taxes are well spent. If you’ve never lived elsewhere, how else could you expect to think differently. However, I have noticed some progress and one they catch on they are quick to implement.

To sum it up, I think there is no perfect system. I can only imagine how hard doctors work and study and they deserve the compensation. It would be great if we could meet somewhere in the middle between the French and American systems.

You seem to be a genuine, wonderful person and health care practitioner. It is my sincere hope that we are training future MDs with your ethics and social consciousness. Individuals like you deserve every penny they earn.

Americans are struggling with health care expenses and I’m one of them. I am a Physician.
Physician salaries in the US are higher compared to Europe and Canada because of a difference in work ethic. The French are beginning to realize that they have a serious “socialization” problem. French doctors take 10 to12 weeks of vacation per year. I haven’t taken that much time off in the last 3 to 4 years. British doctors often quit working for afternoon “Tea”. It’s a fact that foreign doctors are not as productive. I put in 12 hour plus days for weeks at a time. I do health screenings and health fairs during weekends and evenings off. I “squeeze” surgeries in on my afternoons off. I attend numerous volunteer meetings during my work days. My partners volunteer at the Greenville Free Clinic, and we rotate through the Free Clinic at GMH.
If I’m sick, I want the brightest, most skilled people in the country to take care of me. My medical training was 13 years of higher education. (There went my 20’s.) The French only do 6 years after high school. What’s it worth to Americans to have highly trained individuals care for their health? If you want to pay Physicians minimum wage, then the brightest and smartest in America are not going to go into medicine, simply, because they are the brightest and smartest. It will only weaken our health system. Then we can outsource health care to foreign medical graduates, requiring a translator to communicate, in English, with your physician. Pay me like the French, and then I’ll start taking my 12 weeks vacation. I did not go into medicine only for the money, I like what I do, I took an oath, and I have 3 decades in medicine.
Yes, doctors are paid for procedures. Similar to how a mechanic charges for automotive repair. It’s like being an auto mechanic that gets a flat fee for fixing the problem regardless of what is necessary to correct it. And then for 90 days you give free alignments, oil changes, and wash and waxes. You work on cars, but you can’t sell cars, or gas, oil, or parts, and you have to send them out to diagnose the problem. Then you train to repair the newest models, at your expense. And if the car isn’t better than it was before, they blame you. The human body is not a car.
Physicians are limited by regulations and reimbursements for test and procedures they perform and interpret. We limit tests and treatments we provide because reimbursements are less than our costs. And you seem to think we order test unnecessarily to “pad” our incomes. That is simply not true for any ethical physician. In fact, because we do not order tests needlessly we struggle to pay expenses, maintenance, and payments on expensive equipment. And this equipment is vital to our group in providing timely, convenient, and accurate treatment of our patients, making us More Productive! Of course the insurance companies and Medicare want to further cut reimbursements for these procedures making it harder to pay the “bill” on these diagnostic tools. The insurance industry is the only industry that continued to be profitable during the most recent economic down turns this decade. You want to cut salaries? CEO’s of the Top Ten US insurance companies made a combined $76.6 million, while those company’s profits totaled $25.2 Billion in 2003 (Forbes.com) William McGuire, the CEO of United Health made in 2005 – 124.8 million dollars – and that’s not counting his stock options.
Medicine is one of the most highly regulated industries in the US. It’s not a free market system! Complying with rules and regulations alone drive up the cost of health care. Federal law mandates that any Physician in the US, at their expense, must provide a translator for any non-English speaking patient. Do you think they do that in France or Mexico? The free care we provide is not insignificant. And you know we still have to pay the bills even if we don’t collect on services rendered. We still have all the legal liability associated with patient care regardless of weather we collect payment or not. Also our malpractice premiums have tripled in the last 5 years. Let the federal government and Hillary manage health care!? The VA system and the health care of our injured troops, these are two shining examples of how the government will manage our health care. Just ask any Vet!
The US now has about 800,000 active physicians, and there is predicted to be a shortage. Annual health care costs may be 4 trillion dollars in another decade. Physicians are in the highest tax bracket with 50% of our income going to taxes, and you think we all make $300,000 plus per year. The average internist makes about $150,000 per year. But say at $300,000 we cut physician salaries in half then they will be getting $150,000 per year. Take home pay of $75,000! Britney Spears makes $700,000 per month. I may do better as an entertainer! And actually may get more free time.
Contrary to what you think, American Physicians are the greatest in the world. We do not control the prices!! To balance the health care budget on our back is only going to hurt health care more. We do not just “check feet and eyes” we do inform patients what is good for their health. I can’t make sure that a patient “goes out and exercises”. The average American has no clue about their body and how it works. Most take better care of their car than themselves. I’ll be more than happy to take care of you when you have an illness but don’t get mad at me when you’re sick. This is a complex issue and I don’t have all the answers but I do have a better perspective. And please don’t get me started on smoking!!!

Sincerely,

J. David Rice, M.D.

http://www.businessweek.com/magazine/content/07_28/b4042070.htm
http://www.marginalrevolution.com/marginalrevolution/2007/03/french_health_c.html
http://time-blog.com/curious_capitalist/2007/06/the_filthy_rich_doctors_explan_1.html

” “Seemingly intelligent people who would never find any rational way of justifying price fixing in any other economic enterprise”".

“Health is not best treated in a for profit model.

You might want to believe so, but what is your proof? From medical device innovation, to continuing education, to pharmaceutical development, to investment in medical education and establishment of private practice and surgery facilities, the for-profit, private business capitalist model is the dominant model. Sure, non-profits have had a role in the industry, in hospitals and some insurance entities (sadly perverted at this time)but not in employing private individuals. Doctors have always been allowed to act as private for profit workers, just like every other kind of professional person who work.

People who advocate caps like these are really advocating a form of confiscation (never mind the other destruction their ideas will wreak on the markets they want to regulate.)

>”That’s where you are wrong.

Is this just a polyanna-ish wish, or is there proof? So far, our society does little on the investment side to support the private individual wanting to become a physician (at least no more support that it gives prospective students of any other occupation). We certainly don’t come close to the system in France (and BTW, follow the links; the purported French salary average quoted for doctors is disputed by the EU doctors who say that number is just flat wrong.)

Capping doctors’ income without compensating them for their investment is just outright confiscation. We might as well do the same for other things we think are non-negotiable, like housing and food. Certainly they aren’t less important.

last i checked we are a capitalist society, and as a doctor i am (as yet) not forced to work for little/nothing.

So all those screaming about healthcare being a “right” need to ponder who will be there to provide it when politicians translate that into universal coverage, which will inevitably mean lower reimbursing docs less than the cost of doing business.

This is no different than medicaid, tenncare, etc., and what is actually becoming of medicare now too.

“Seemingly intelligent people who would never find any rational way of justifying price fixing in any other economic enterprise”.

Health is not best treated in a for profit model.

That’s where you are wrong.

-education was paid for
-35 hour work week
-6 weeks paid vacation
-rent stipend for expensive cities
-generous pension

But I don’t think that’s what the people suggesting this plan have in mind (but it is what they have in France). They want to cut doctors off at 55 or so k a year thinking that it will save money.

I know a good number of dedicated doctors who want nothing more than to do research and help, but taking a vow of poverty (55k in NYC?) isn’t part of the plan.

You can’t compare the return on investment without taking into account the difference in the denomenator.

Unless we nationalize the private schools and much more heavily subsidize the ones that are already public. There would be few qualified applicants because people intelligent enought to perform as physicians are smart enough to know that 300,000+ is an excessive investment for an opportunity to earn that income.

Physician net income is not the cause of the high cost of American health care. If you reduced physician net to absolute zero, but changed nothing else (and docs would keep working), you would remove 10% of the costs–only a little more than one years increase at current rates. Physician income only represents 10% of health costs. Reducing it 50% would only take out 5% of the costs–all else being equal.