"Americans often assume that when people get universal coverage, they give up their choice in doctors, hospitals and care. That's not the case in France, Dutton says. The system is set up both to ensure that patients have lots of choice in picking doctors and specialists and to ensure that doctors are not constrained in making medical decisions.
In France, the national insurance program is funded mostly by payroll and income taxes. Those payments go to several quasi-public insurance funds that then negotiate with medical unions to set doctors' fees. (Doctors can choose to work outside this system, and a growing minority now charge what patients are willing to pay out of pocket.)
The government regulates most hospital fees. This system works collectively to keep costs down.
When someone goes to see a doctor, the
national insurance program pays
70 percent of the bill. Most of the other 30 percent gets picked up by supplemental private insurance, which almost everyone has. It's affordable, and much of it gets paid for by a person's employer.
"There are no uninsured in France," says Victor Rodwin, a professor of health policy at New York University, who is affiliated with the International Longevity Center.
"That's completely unheard of. There is no case of anybody going broke over their health costs. In fact, the system is so designed that for the 3 or 4 or 5 percent of the patients who are the very sickest, those patients are exempt from their co-payments to begin with. There are no deductibles."