Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France

This book came BEFORE the estimated date and was in the best conditioin possible! Buy from this seller!

This is a useful book. Like another reviewer, I wish the author had included a more thorough description of the present French system. My understanding is that electronic medical records, to some extent at least, are embedded in the health care card carried by members. When they visit a doctor's office, a swipe of the card in the reader, conveys some information (I wish I knew how much) to the doctor's office record and, at the same time, deposits the Securite Sociale payment in his practice account. It is interesting to see how much the French have preserved the private fee-for-service system. The author decries this a bit, emphasizing the risk of excessive utilization in the fee-for-service system. That is definitely true but the prepaid system of the HMO has the mirror-image risk of denying service to reduce expense. Buyers of new home prepaid service plans know how difficult it can be to get the service technician to come out to fix the dishwasher when he has already been paid. The parallel history format of the book is good and, while I am very familiar with the history of US health care, it was valuable to see the contrast with the French system. The unique circumstance that had a lot to do with the diversion of the French system from ours was the loss to Germany in 1940 and the subsequent period of Vichy rule. All the older structures of government and the hierarchy of the medical profession were upset and replaced by a diluted version of the Nazi regime. The 1944 invasion and liberation placed the De Gaulle organization in charge and it was very interesting to learn that health care reform was a concern of the Free French even during the period of exile from 1940 to 1944. Again, the intervention of President DeGaulle in 1960 to establish fixed fee schedules was new to me and makes the two chapters, numbers five and six, the best part of the book. I have a few disagreements with the author. He is obviously an enthusiast for the failed Clinton Health Plan of 1994 but he ignores the principle reason why it failed. He is correct that union opposition has been a barrier to reform in both countries, prolonging the employment link to health insurance far beyond the time when it made sense. He does not inform the reader, however, that the secrecy and the failure to include any non-academic providers in the task force preparing the plan led to widespread distrust and opposition. Additionally, the criminal penalties attached to practice outside the Clinton cooperatives alienated physicians completely. Having said that, I generally support his history of the US system although Paul Starr's book is more complete. He does misstate the position of the American College of Surgeons on a national health plan for the US. I have been a member of the College since 1972 and it first testified in favor of a national health plan in 1938. The fierce opposition he describes as coming from the AMA (and he is correct) was always the position of general practition

Once again with an upcoming election health care shows itself a major concern of the American people. Health care costs are soaring, the ranks of the uninsured and underinsured are increasing, over 50% of bankruptcies are due to medical expenses and employers are dropping coverage. Not only is our system the most expensive by far in the world; but the most complex and bureaucratic. Its costs affects the competitiveness of American firms on the world market and people often seek or retain jobs based on availability of health insurance rather than matching skills and interests, thus lowering productivity. Polls show the American people want change and see the Canadian single-payer system as a model. However, not too long ago the World Health Organization ranked the health care system of France as number 1 with the U.S. in 37th place, something unknown to most Americans until Michael Moore's recent film, Sicko. So why not consider French health care as a possible system to model after rather than Canada ? For many, the answer is obvious. Americans would never tolerate "socialized" medicine. But is France 's health care "socialized medicine?" Paul V. Dutton's timely book answers this question with a resounding, NO! It turns out that no other country on the face of this earth has as similar 18th Century liberal values of individual freedoms and responsibility to those of the U.S. as France and it shows in their health care system. "Socialized Medicine" is for the French as anathema as it is to us. Yet France has managed to attain universal coverage, high quality medicine, and no waiting lines in a system of private fee-for-service medicine that Americans could only dream about and at lower cost. In their laws, basically etched in stone, are guarantees of individual choice of doctors and hospitals, medical decisions to be made between doctors and patients with no third party interference, strong protections for doctor-patient confidentiality, and direct payment of bills by patients. But isn't this exactly what the American medical profession has fought for over many years? This is the story that Dr. Dutton's book weaves in a well-written fascinating account of how two nations with similar values, especially within their respective medical professions developed their respective health care systems. Certain key decisions sealed their respective fates. In France , the medical profession rather than fighting some form of government required universal health care, supported it with the strong proviso of legal guarantees that are the bedrock of their private fee-for-service system. In the U.S. , the medical profession fought tooth and nail against any government involvement developing instead the non-profit Blue Crosses and Shield's with community ratings and no exclusions due to pre-existing conditions. Only then did for-profit insurance companies enter the health care market, cherry picking healthy workers with offers of lower premiums to their emplo