Marine's story shows the struggle for mentally handicapped to get sufficient care in France - though France has universal healthcare, care and education for mentally handicapped is expensive and difficult to create - right now, there is a shortage of care, and the care and education that does exist is not specialized enough to really ameliorate the situations of the patients.
Saturday, June 13, 2009
Sunday, April 26, 2009
U.S. Supporters of universal healthcare may find looking to the French risky:
often used as an example, sky-rocketing deficits in French healthcare prove problematic
By: Cat Contiguglia
In recent weeks, President Barack Obama has made clear that healthcare reform is a top priority for his administration, stating at a White House health summit, “This time, there is no debate about whether all Americans should have quality affordable health care. The only question is how.” To answer that question, the President has opened up the floor to healthcare specialists and lobbyists from across the spectrum.
One end of the debate that has been largely dismissed by the Obama administration is a single-payer system, which consists of one insurer, most often the government, to which everyone pays into. The insurer then pays for doctors, medicines and procedures at a preset rate, and procedures or materials that are not approved by the insurer can be obtained out of the system, paid for by the patient. According to a 2008 poll published in the medical journal Annals of Internal Medicine, 59 percent of U.S. physicians support national health insurance, which in most cases is prescribed through a single-payer system.
France, which is often used as the example by U.S. single-payer supporters, ranked first in healthcare among industrialized countries in a World Health Organization Survey based on life expectancy and avoidable deaths. The United States ranked last. These numbers, in addition to the fact that the United States pays the most for its system, have been a major rallying cry of single-payer supporters in the United States.
However, developments in the French healthcare system that could indicate difficulty in sustaining such a system have remained largely unaddressed by single-payer supporters in the United States. Since the 1990s, France has regularly been implementing restrictions on the national health insurance to contain the cost of the system, which has a rapidly growing deficit. According to figures from an Atlanta Journal Constitution article, the cumulative deficit for 1997 to 2006 was around 49 billion euros.
The reforms include higher copayment costs for medicines, as well as the exclusion of more medicines classified as “medicaments de comforte,” or comfort medicines, as well restrictions regarding access to specialist doctors. All citizens covered by the system are required to register with a general practitioner who they must see to be referred to a specialist, to alleviate the skyrocketing costs caused by patients “shopping around” for doctors, and most recently, in 2009, coverage has been cut down to just 30 percent of the cost of a visit to a specialist without a referral from a general physician.
French citizens tend to agree the costs of the system are rapidly becoming infeasible, but some believe the current system with the reforms is actually creating a tiered system, where the rich receive better care than the poor.
Beatrice Laplante, an administrator at the American University in Paris, said she now has to pay for her blood circulation medicine, because under the new reforms, it has been classified as a “medicament de comforte.”
“It leads to un medecins de deux vitesses (two levels of healthcare), one for the rich, one for the poor, and maybe three vitesses. People are not able to pay from their own pocket – drug prices have gone up times four or five,” Laplante said. “I think in a few years, it will only be vital medicines that are rembourser (reimbursed). It’s a trend. More and more, it’s as if securite sociale (social security) is disappearing except for extremely up of most majority. All those medicaments du comforte turn out to be necessary.”
Although the way in which the reforms were enacted remains controversial among French health care professionals, most concede that reform is necessary.
In a 2007 letter published in the International Herald Tribune, French physician Dr. Israel Cemachovic of Dijon wrote, “It is true that the freedom enjoyed here in France by both the doctors and the patients is remarkable and enviable but it has an increasing cost that the government can no longer afford.”
Despite all this, supporters for universal healthcare in the United States don’t appear to be shaken, and tend to agree that whatever problems the French system is currently facing, it is still a vast improvement on the current U.S. system.
Paul V. Dutton, an associate professor of history at Northern Arizona University who has published several articles and a book, Differential Diagnoses, regarding the French healthcare system, said in an email interview that despite the financial issues facing the French healthcare system, United States health system reformers should still regard France’s system as a model for reform.
“If U.S. leaders are willing to do so, then they’ll find that the values that guide French health care are virtually the same as what patients in this country want,” Dutton wrote. “You can’t name a health care system in the world that isn’t in trouble these days, running deficits, cutting back on provided services, covered procedures, etc. But American health care has all that with far, far greater costs and ever greater numbers of uninsured.”
Some supporters of the single-payer system profess that despite France’s financial difficulties with the system, it would actually reduce health costs. According to Dr. John Battista, a leading member of the Connecticut Coalition for Universal Healthcare, by creating a system where people are more likely to go to the doctor before they get seriously ill, health care costs be reduced.
“Universal healthcare systems don’t stop health inflation, but they’re able to constrain it by prevention,” Battista said in a phone interview. “France is a really good example of that, with emphasis on primary care and because people are covered they’re seen so you avoid what we have which is avoidable hospitalizations and overuse of emergency services.”
Battista warned, however, that the using the French model healthcare system would require some tweaking, including creating best practices guidelines for reducing unnecessary costly tests and overuse of specialist medicine. Battista also said that if the United States were to implement universal healthcare, while in the long run, costs would be reduced, the first few years might prove to be significantly more expensive because of the numbers of people who would flock to doctors after years of avoiding the hospital due to medical costs.
“You’ll have massive increased demand in first few years until you have preventive healthcare boom, but that take decades, so in the first few years you’ll be met by all unmet medical needs,” Battista said. “Lots of people are not getting medical needs met, trying to save costs, even if it’ irrational. If you don’t have health insurance, you’ll say, I’m not going to get that colonoscopy, or that breast exam.”
The long and growing list of U.S. health experts in support of a single-payer healthcare system in the United States does not; however, seem to be winning the fight. Many supporters concede that it is highly unlikely the Obama administration will consider a single-payer system because of the stigma of being associated with socialist governments in addition to the problems of introducing such a system with the current economic crisis.
But, according to John Billings, an Associate Professor of Health Policy and Public Service at New York University, maybe that’s even more all the reason to give it a shot.
“We’ve been trying to do this thirty years now, so I don’t know (if it will happen), Billings said in a telephone interview. “We need to do it; we definitely need to have it. We have 48 million uninsured right now. The big issue is how we are going to afford it right now. But maybe this is the time to try it, when everyone is losing their jobs and they’re going to want a safety net under them.”
often used as an example, sky-rocketing deficits in French healthcare prove problematic
By: Cat Contiguglia
In recent weeks, President Barack Obama has made clear that healthcare reform is a top priority for his administration, stating at a White House health summit, “This time, there is no debate about whether all Americans should have quality affordable health care. The only question is how.” To answer that question, the President has opened up the floor to healthcare specialists and lobbyists from across the spectrum.
One end of the debate that has been largely dismissed by the Obama administration is a single-payer system, which consists of one insurer, most often the government, to which everyone pays into. The insurer then pays for doctors, medicines and procedures at a preset rate, and procedures or materials that are not approved by the insurer can be obtained out of the system, paid for by the patient. According to a 2008 poll published in the medical journal Annals of Internal Medicine, 59 percent of U.S. physicians support national health insurance, which in most cases is prescribed through a single-payer system.
France, which is often used as the example by U.S. single-payer supporters, ranked first in healthcare among industrialized countries in a World Health Organization Survey based on life expectancy and avoidable deaths. The United States ranked last. These numbers, in addition to the fact that the United States pays the most for its system, have been a major rallying cry of single-payer supporters in the United States.
However, developments in the French healthcare system that could indicate difficulty in sustaining such a system have remained largely unaddressed by single-payer supporters in the United States. Since the 1990s, France has regularly been implementing restrictions on the national health insurance to contain the cost of the system, which has a rapidly growing deficit. According to figures from an Atlanta Journal Constitution article, the cumulative deficit for 1997 to 2006 was around 49 billion euros.
The reforms include higher copayment costs for medicines, as well as the exclusion of more medicines classified as “medicaments de comforte,” or comfort medicines, as well restrictions regarding access to specialist doctors. All citizens covered by the system are required to register with a general practitioner who they must see to be referred to a specialist, to alleviate the skyrocketing costs caused by patients “shopping around” for doctors, and most recently, in 2009, coverage has been cut down to just 30 percent of the cost of a visit to a specialist without a referral from a general physician.
French citizens tend to agree the costs of the system are rapidly becoming infeasible, but some believe the current system with the reforms is actually creating a tiered system, where the rich receive better care than the poor.
Beatrice Laplante, an administrator at the American University in Paris, said she now has to pay for her blood circulation medicine, because under the new reforms, it has been classified as a “medicament de comforte.”
“It leads to un medecins de deux vitesses (two levels of healthcare), one for the rich, one for the poor, and maybe three vitesses. People are not able to pay from their own pocket – drug prices have gone up times four or five,” Laplante said. “I think in a few years, it will only be vital medicines that are rembourser (reimbursed). It’s a trend. More and more, it’s as if securite sociale (social security) is disappearing except for extremely up of most majority. All those medicaments du comforte turn out to be necessary.”
Although the way in which the reforms were enacted remains controversial among French health care professionals, most concede that reform is necessary.
In a 2007 letter published in the International Herald Tribune, French physician Dr. Israel Cemachovic of Dijon wrote, “It is true that the freedom enjoyed here in France by both the doctors and the patients is remarkable and enviable but it has an increasing cost that the government can no longer afford.”
Despite all this, supporters for universal healthcare in the United States don’t appear to be shaken, and tend to agree that whatever problems the French system is currently facing, it is still a vast improvement on the current U.S. system.
Paul V. Dutton, an associate professor of history at Northern Arizona University who has published several articles and a book, Differential Diagnoses, regarding the French healthcare system, said in an email interview that despite the financial issues facing the French healthcare system, United States health system reformers should still regard France’s system as a model for reform.
“If U.S. leaders are willing to do so, then they’ll find that the values that guide French health care are virtually the same as what patients in this country want,” Dutton wrote. “You can’t name a health care system in the world that isn’t in trouble these days, running deficits, cutting back on provided services, covered procedures, etc. But American health care has all that with far, far greater costs and ever greater numbers of uninsured.”
Some supporters of the single-payer system profess that despite France’s financial difficulties with the system, it would actually reduce health costs. According to Dr. John Battista, a leading member of the Connecticut Coalition for Universal Healthcare, by creating a system where people are more likely to go to the doctor before they get seriously ill, health care costs be reduced.
“Universal healthcare systems don’t stop health inflation, but they’re able to constrain it by prevention,” Battista said in a phone interview. “France is a really good example of that, with emphasis on primary care and because people are covered they’re seen so you avoid what we have which is avoidable hospitalizations and overuse of emergency services.”
Battista warned, however, that the using the French model healthcare system would require some tweaking, including creating best practices guidelines for reducing unnecessary costly tests and overuse of specialist medicine. Battista also said that if the United States were to implement universal healthcare, while in the long run, costs would be reduced, the first few years might prove to be significantly more expensive because of the numbers of people who would flock to doctors after years of avoiding the hospital due to medical costs.
“You’ll have massive increased demand in first few years until you have preventive healthcare boom, but that take decades, so in the first few years you’ll be met by all unmet medical needs,” Battista said. “Lots of people are not getting medical needs met, trying to save costs, even if it’ irrational. If you don’t have health insurance, you’ll say, I’m not going to get that colonoscopy, or that breast exam.”
The long and growing list of U.S. health experts in support of a single-payer healthcare system in the United States does not; however, seem to be winning the fight. Many supporters concede that it is highly unlikely the Obama administration will consider a single-payer system because of the stigma of being associated with socialist governments in addition to the problems of introducing such a system with the current economic crisis.
But, according to John Billings, an Associate Professor of Health Policy and Public Service at New York University, maybe that’s even more all the reason to give it a shot.
“We’ve been trying to do this thirty years now, so I don’t know (if it will happen), Billings said in a telephone interview. “We need to do it; we definitely need to have it. We have 48 million uninsured right now. The big issue is how we are going to afford it right now. But maybe this is the time to try it, when everyone is losing their jobs and they’re going to want a safety net under them.”
Friday, April 17, 2009
Report on musicians in the Paris metro
For my first post, I'm going to put up a piece I already shot and edited about musicians in the Paris metro. To play in the metro, you have to audition - out of a couple thousand who audition, only a few hundred are selected. The auditions are every March and September. The musicians in the piece explain their lives playing music and what it takes to play in the metro. The voice over and reporting was done by a friend of mine.
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