I like to drag this out once a year:

Its hospitals gleam. Waiting-lists are non-existent. Doctors still make home visits. Life expectancy is two years longer than average for the western world.

....For the patient, the French health system is still a joy. Same-day appointments can be made easily; if one doctor's advice displeases, you can consult another, a habit known as nomadisme medical. Individual hospital rooms are the norm. Specialists can be consulted without referral. And while the patient pays up front, almost all the money is reimbursed, either through the public insurance system or a top-up private policy.

For family doctors too, liberty prevails. They are self-employed, can set up a practice where they like, prescribe what they like, and are paid per consultation. As the health ministry's own diagnosis put it recently: The French system offers more freedom than any other in the world.

The Economist on France's socialized healthcare, May 13th, 2004

Maybe they can teach us how to build nuclear reactors again, too.

It's rather convenient that you left out the headline of that article: "Trouble for French medicine". As the rest of the article notes, France pays for this system in part with cheaper machines and technology. Moreover, as the Slate piece alludes to, American healthcare is largely more expensive because we elect much more costly and advanced procedures, sometimes using our superior (and therefore more expensive) technology. We could easily make America's healthcare system cheaper by providing less services on outdated technology.

Don't take the above comment as a defense of the American system, which has plenty of shortcomings. Rather, I offer the above as an explanation as to why comparisons to France must be taken with a grain of salt.

Josh,

Then why would African Americans have twice the infant mortality rate as the national average? Are they really receiving better medical care than the rest of the population?

If the idea is that better care is one reason, the biggest reason, etc., that would be one thing. However, I don't see the article in Slate as connecting all the dots. What part is due to the numbre of older women having children?

I am very sympathetic to the main point of the post, that one has to be careful in interpreting a lot of health care stats. (A related concern has to do with attempts to standardize metrics of physician effectiveness, most of which have the unfortunate side-effect of penalizing physicians who take on more challenging cases.)

But the swipe at Medicaid funding seems to me to be completely unmotivated by the data referred to. (Even with the remarkable advances in fertility treatments for 'mature' would-be mothers, I don't think that Medicare will be relevant to infant mortality any time soon!) After all, the 2002 NEJM article _did_ find a difference between the very-low supply areas and the low-supply areas, and it would not be unreasonable to wonder whether increased medicaid funding would move more areas out of the very-low category. Also, the authors do not suggest that public funding is the problem, but rather that "[i]n neonatology, the rapid growth in the numbers of neonatal intensive care units and neonatologists over the past 30 years was less the result of a plan to meet regional needs than a result of market forces, in particular the twin institutional interests of establishing prestigious birthing services and securing a large share of the health care market for young families." So it looks like it's basic market forces, not the government, that is to blame here.

Unrelatedly, I would like to agree with the spirit of looking at both France's and the U.S.'s (and everyone else's) healthcare systems with an eye towards what works & what doesn't & for how much. There's so much knee-jerk resistance ou there to the idea that there's _anything_ to be learned from looking at other country's systems, that anything that breaks down that barrier to reasonable healthcare policy is a good thing indeed.

But the swipe at Medicaid funding seems to me to be completely unmotivated by the data referred to.

Perhaps I wasn't clear. My intention for specifying Medicare/Medicaid was not as an attack on those programs (although plenty are available). I did that to differentiate funding resources from the many other medical resources.

And for all intents and purposes, Medicare/Medicaid drives the market forces. Although there are certainly private insurers, from my six months of experience drafting physician employment agreements and medical operating agreements, I can assure you that Medicare/Medicaid funding drives the health industry's "business" decisions.

I agree that the public health funding does have a major impact on the structure of the healthcare economy, but "drives" might be a little strong... but that's neither here nor there.

Anyway, what's interesting here is that the authors of the article in question do not attribute the misallocation of neonatal medical resources to medicaid but rather to competitive market forces. Which is not to say that they're automatically right -- the authors are not, I think, economists; and it was a claim in the discussion section, not part of their data. But it's importantly in keeping with one theme of the last thread here on healthcare that the market has its own real effects on costs, distribution of care, etc., and that we can't assume that those effects are always good ones from a public-policy perspective.

I can't say how reliable this source is, but they attempted to break down the numbers of those uninusred by months. According to their white papers, these people have no insurance (e.g. not underinsured, receiving medicaid, medicare, children's benefits from states, etc.).

This data was gathered in 2002-03 and published in 2004.

Source - www.familiesusa.org

a. 1 to 2 months = 5.8 M
b. 3 to 5 months = 22.6M
c. 6 to 8 months = 12M
d. 9 to 12 months = 9.6M
e. 13 to 23 months = 18M

According to their white papers, the people that fall in the 1 to 5 month uninsured range are transitioning between jobs. Everyone else just doesn't have it, which works out to be about 40 Million Americans in 2004.