What America can learn from the French health-care system

I have to make a confession: I lead a double life. You see, by profession, I'm an American policy wonk of the conservative persuasion, who spends a lot of time thinking and writing about the American health-care system; but in real life, I'm a French health-care consumer.

It's an interesting dichotomy. Progressive American policy wonks seemingly spend all their life praising the French health-care system. And yes, according to many international estimates, France has the best health-care system in the world. I often find much of this praise to be naive; but as a French health-care consumer, I have to admit the system has some pretty great features.

Let me give you a concrete example of something the French get right.

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Yesterday morning, my 5-year-old daughter awoke with flu-like symptoms that quickly grew serious enough that I wondered if I should take her to the emergency room. If you're a parent, you know exactly this feeling of creeping paranoia. Thankfully, the French equivalent of 9-1-1 provides a helpful service: An operator will put you in touch with an actual doctor who will tell you whether your child has an emergency condition or not. The person who first took my call asked some basic questions and then patched me through to the doctor, who was friendly and competent, and already knew what I'd told my first point of contact. This is totally free, and helps unclog the emergency services for people with actual emergencies.

My American friends tell me similar hotlines do exist in the States, mostly served by private insurance operators, but that they're much less useful. For many of them, you're not talking to an actual doctor, you're talking to someone in a call center working off a form. These people never tell the caller anything definitive, most likely due to liability issues: If something seems benign but is actually deadly, that's lawsuit material. So they say noncommittal things like, "Well if you think it's an emergency, you should go to the emergency room," which sort of defeats the point of calling an expert to figure out if you should be going to the emergency room in the first place.

It turned out my daughter's condition wasn't an emergency, but I did need a house call. For this, I got in touch with SOS Médecins, which is basically Uber for doctor house calls. They don't actually have an app, but the idea is the same: Call them, and a doctor will show up on your doorstep within the hour, 24/7. Like Uber, the service is a platform that connects independent contractors with customers. Unlike Uber, SOS Médecins is a non-profit that was started in the 1960s, although it has now become so ubiquitous that many people assume it's a public service. The price of the service varies but it's typically only slightly more expensive than a typical doctor's visit, in the range of 50 to 100 euros; in France, the national insurance scheme pays a minimum rate for doctor's visits and if the price is higher, it may or may not be covered in full or in part by your private insurer, which most people have. (Yes, France has private health insurance.)

Some American startups are trying to become the Uber for health care, but they tend to be held back by red tape, high prices, and insurance regulations. So far they seem to have attracted venture funding but don't seem to have become ubiquitous.

The idea of a medical concierge — a primary caregiver who can eventually forward you to specialists and get you to do tests and so forth, but also help you navigate the health-care system more generally — seems like common sense, but do a little research and you'll find it's basically illegal. Doctors have a legal monopoly on prescribing many things, a practice that is an absolute racket. Also, insurers aren't too keen on the idea that patients would have an expert on their side who might reduce their information monopoly. In most cases in the U.S., concierge medicine is only for rich people, even though there's nothing intrinsically expensive about it. It's a subscription business model with an 80-20 rule (meaning most people wouldn't actually use it most of the time), which is exactly the sort of business model that tends to scale well. Indeed, if medical concierges were legal, they would probably be widespread, and cheap.

In the end, my daughter only had a stomach bug. But my main takeaway from the experience was that there are indeed many things that France gets right, and that, in order to improve the U.S. system, policymakers need to slash useless regulations that represent giveaways to entrenched industries that don't serve patients' interests.