Uncle Sam Is Not in Good Health

Uncle Sam is not in good health.

It wasn’t without pain that Barack Obama promulgated an historic piece of legislation in the spring of 2010, aiming to eventually extend health insurance to an extra 32 million Americans. 10 years after the application in France of the legislation creating the universal sickness benefit, the United States completed, amidst much controversy and arguments, the flagship project of its new president. Didier Tabuteau, counselor of state and professor of health policy at the Institut d’Etudes Politiques and the University of Paris-Sud and Victor Rodwin, professor of health policy and management at NYU Wagner School of Public Service, selected this key moment in American social history to reflect on the evolution of the American and French health systems.

In their book “To Uncle Sam’s Health: Cross Perspectives on the American and French Health Systems,”* they remind us that “since the beginning of the eighties, the French system seems to be under a permanent state of reform that never succeeds.” Laws and plans have followed each other, and even though this has led to deep changes, the national social security deficit never stops growing. In an ironic twist of history, they say, it is at that same moment that the Obama reform seeks to reinforce the role of the federal government toward a solidarity increase and, at the same time, to control the rising cost of health.

Necessary Solidarity

As for the battle against waste, abuse and fraud, they estimate that “In spite of the proclaimed objectives, there is little probability that the reform will succeed in containing the evolution of health costs in the United States.” For this to happen, these two professors in public health policy write that other measures will be needed, as is the case in France. Most of all, it will be necessary one day to confront the underlying — but nonetheless crucial — question: “will we indefinitely be able to guarantee the reimbursing of everything, in all circumstances?” A topic that, at present, is still taboo.

However, following much discussion and debate, Didier Tabuteau and Victor Rodwin agree. They share the same conviction about the importance of the ongoing reforms as well as on the necessary solidarity that must preside over health insurance in our countries. They hope that their close scrutiny of public health and insurance in the United States and France “will help the readers detect points of analysis that can only be seen through an ultrasound or MRI scan.”

*Published by Éditions Jacob-Duvernet