A Tale of Four Countries- Part 1: France, Malpractice, Doctors and Nukes

Before getting into the specifics of this entry, I am a firm believer in American exceptionalism. We are “not just another country” out of many. We have been a beacon at times when the world was dark- World War II, the Cold War, a stand against Islamofascism (until Obama came along). People from around the world immigrate to our shores- sometimes legally, sometimes illegally- to avoid religious, economic and political persecution in their home countries. Despite the warts that sometime happen upon our collective psyche (since Obama came along), we remain the greatest country in the world.

As a point of transition, I am also a firm believer that the states are the great laboratories of American democracy. What may work at the state level may (Wisconsin style welfare reform) or may not (Romneycare) work at the federal level. Many federal programs are modeled on those that were first used by the individual states and there is nothing inherently wrong with that. In effect, states are the true laboratories where experiments are carried out to determine their effectiveness. But, there are other real world examples other than states that the federal government can look to when considering important policies and programs and reforms. And these are foreign countries. Unlike a lot of those who discard the French socialized medicine system, there are tangential parts of it that have some redeeming value. If anyone has read any of my entries here, you would know that I am a huge opponent of a centralized, socialized medical system. Yet, if one researches enough and digs deep enough, some nuggets of goodness can be found in systems used in foreign countries. Granted, I do not find much to like about probably 98% of any system of socialized or single-payer medicine. But, that is the gist of this article and it covers four areas where reforms in other countries could serve as a template and example for necessary fundamental reforms in domestic programs in this country.

The first country is France and there are actually three reforms that come from this country. One of the justifications for the high price of medical care is physician pay. Those high salaries are dictated by the cost of medical education and malpractice insurance. In France, provided the graduate agrees to practice as a general practitioner in a high need area for a specified period of time, the government pays the cost of their medical education. This program does not extend to specialties. It costs about $35,000 a year- $140,000 for a full 4 years- of medical education. By 2015, the Bureau of Labor Statistics estimates a 55,000 doctor shortfall, not all of them general practitioners. Assume roughly half, or 28,000, general practitioners are needed, that would require an approximate $1 billion annual investment.

In essence, this would be akin to ROTC programs or TEACH grants. Why general practitioners? First, there is a need. Since 1995, the number of medical students entering this field has decreased more than 50%. If the so-called doc fix is ever enacted, the AMA estimates 62% of such doctors would retire. More importantly are the long-term effects on health care.

With just a 5% increase in the number of general practitioners, the following is estimated:
800,000 less hospitalizations per year saving $3.48 billion;
4.8 million less emergency room visits saving $6 billion;
For every increase in general practitioners per capita, there is a corresponding decrease in hospitalizations for most diagnoses;
In areas where they are wanting, there is an 80% increase in the incidence of hospitalization;
In states with high per capita rates, infant mortality, heart disease, cancer, and Medicare costs are lower;
Countries with high per capita rates have generally lower health care expenditures.

Another area that affects health care is tort reform. Here, France may be onto something. Although malpractice may account for about 2% of health care inflation, it does force doctors to practice defensive medicine which drives the costs up for everyone. We have the highest per capita rate of malpractice suits among industrialized countries, but our awards are 14% lower than other countries. In France, instead of directly going to the formal legal system, they have regional review boards who then have the authority to award monetary damages. The source of those funds is through malpractice insurance, surcharges or from the general revenue fund. It is akin to the workman’s compensation system here in the US where monetary awards are made without blame being assigned. In this way, the more frivolous cases are dealt with and the more serious ones allowed to proceed to a trial. In fact, many have noted that awards in Europe are lower because they place less emphasis on civil jury trials and it is juries that usually make the huge awards. Of course, the only ones that may object to such a system would be the ambulance-chasing legal industry. Additionally, the results of these review boards could be made public to increase consumer knowledge when choosing physicians.

In a totally unrelated area, the US can learn from France when it comes to nuclear energy. The biggest impediment to the construction of nuclear plants is regulatory/litigation costs and rising commodity prices (copper, steel, cement). Government regulations themselves dictate greater amounts of these commodities in plant construction. Secondly, the US has large domestic reserves of uranium. Even if we didn’t, three of our most reliable allies- Canada, the Czech Republic, and Australia- have huge reserves. Australia is especially important since they have banned the use of nuclear energy and have no need for their domestic reserves. The point is that these three allies are infinitely more reliable than Middle East oil dictatorships.

The French derive 80% of their domestic energy needs from nuclear power. There is no aversion to nuclear power or unrealistic safety concerns such as exists in the United States. Despite safety and construction regulations considerably more lenient than here, they have an impeccable safety record. The biggest problem is nuclear waste. The French have developed a technique where they recycle spent nuclear rods and recover about 60% of all spent nuclear fuel. The remaining 40% is sealed in drums and dumped in the sea. Those drums are constructed to withstand the worst elements and decay so that any sign of deterioration would occur in 1,500 years. If the United States was to increase their reliance on nuclear power, we would have to rely on the French and French technology to recycle spent rods. That is truly sad given this country’s scientific and technological superiority.

Also, consider this as no-cost private investment job initiative that benefits the country as a whole. In France, incidentally, towns compete for the siting of the nuclear recycling facilities because they know they create permanent, high-paying jobs. It is estimated that if the US were to build 16 new nuclear plants by 2030, it would create 350,000 permanent high paying jobs. Although there are regional variations, it is also estimated that 15 new nuclear plants would generate an additional $3.6 billion in revenue for states. Throw in regional recycling plants and those jobs figures and state revenue dollars are only increased.

Imagine the advantages this country would realize with an increased reliance on nuclear power. It would fundamentally change our foreign policy. We would be more reliant upon stable governments and reliable allies. We would create numerous high-paying permanent jobs. It would create unrealized increases in state tax revenues. We could potentially become a net exporter of fossil fuels. As an added bonus, if you are into that BS, we would decrease greenhouse gases considerably below those called for by the Kyoto protocols without resorting to costly cap-and-trade schemes.