The World Health Organization has ranked the French health insurance system, where the labor movement is involved in its policy-making from top and bottom, as the best in the world. While doctors are self-employed, the major hospitals are public. The cost of prescription drugs is controlled. There is little profit. So the question arises: how could 15,000 mainly elderly people die in the crushing heat wave of last August?
The right-wing government of France lead by Jacque Chirac has been mostly silent. A lot of the press focused on Chirac being in Canada during all of August while the health minister was vacationing in the South of France. Chirac’s apologists pointed to the fact this was the normal vacation period and the French people just forgot about their elderly mothers and fathers. Others pointed to the new 35-work week, including for physicians, as the culprit.
What the media left out of the discussion were Chirac’s cutbacks to health budget. Chirac was elected to head the French government by almost 90 percent of French voters. Chirac interpreted the election as a mandate to bring in for-profit insurance companies to replace the current system. Although Chirac has not been successful to date, this struggle at the front door has enabled back-door cutbacks in community health programs.
The visible part of the Chirac cutbacks was to the health insurance system where the government would cover less of the physician and hospitals bills, thus requiring more out-of-pocket cost from individuals. But these cutbacks to the health insurance system did not cause this crisis.
Just paying physician, hospital, and prescription drug bills does not solve the health crisis in France, in the U.S., or anywhere in the world. These costs must be paid. Under an efficient system these costs would be held to a minimum, as is the case under socialized medicine in the U.K. and the health insurance systems in most of Europe.
But focusing on this part of the health crisis is simply not enough. For example, in the U.S., the focus of most health insurance legislation is paying the bills, excessive bills at that. HR 676, the Conyers National Health Insurance bill, is an extremely important advance and will make sure that physician and hospital bills will be paid. HR 3000, the Barbara Lee National Health Service bill, goes the next step by making sure that health services are available and other crucial public health activities are operative.
In the French crisis, activists and labor policy leaders are now focusing on the failure to fund and expand what might be called a “community-based health surveillance system” that immediately identifies problems. In this case, the heat crisis and the deaths of those people who are at risk – the elderly, disabled, people with respiratory problems – would have been identified immediately.
Health policy makers in the U.S. should take a lesson from the French crisis and make sure that proposals being put forward by all presidential candidates cover not just the paying of bills but also a public health infrastructure, including massive federal support for local, state and federal health department activities to protect everyone.
The French heat crisis is a good lesson for all of us. Let’s not forget it.
The author can be reached at pww@pww.org
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