Liberty, equality, fraternity and the delivery of health care in France.

As U.S. policy makers debate President Clinton's health care reform proposal, we need to remind ourselves that no other country has actually solved the health care cost problem. There are no solutions, only alternative approaches to the problem. Proponents of the social insurance model will argue that countries like France have a better system--one that delivers high-quality medical care to everyone with no financial barriers. If the evidence is examined honestly, it becomes clear that the French system, while meeting the goal of universal access, has a long way to go before it solves the spending problem. National health insurance does not guarantee public satisfaction with the system. In a recent survey, over half of the French citizens responded that they felt that their health care system needed fundamental changes or should be completely rebuilt, and only 41 percent were happy with the way the system worked. Citizens in all but two of the ten countries studied by Blendon et al. (1990) had similar responses. Only in Canada and Germany did fewer than half of the respondents desire significant change. A nationalized system can eliminate financial barriers to access but it cannot guarantee that social disparities will be eliminated. National health insurance has actually exacerbated inequalities across social classes in France. Per capita consumption varies as much as 50 percent across income levels and 100 percent between occupational categories. In their quest for social solidarity and equality, the French have given up a lot. Practitioners have suffered an erosion in their real incomes relative to the rest of the population.(ABSTRACT TRUNCATED AT 250 WORDS)