Differential Diagnoses

Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France

Paul V. Dutton
Copyright Date: 2007
Edition: 1
Published by: Cornell University Press,
Pages: 272
https://www.jstor.org/stable/10.7591/j.ctt7v8j9
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  • Book Info
    Differential Diagnoses
    Book Description:

    Although the United States spends 16 percent of its gross domestic product on health care, more than 46 million people have no insurance coverage, while one in four Americans report difficulty paying for medical care. Indeed, the U.S. health care system, despite being the most expensive health care system in the world, ranked thirty-seventh in a comprehensive World Health Organization report. With health care spending only expected to increase, Americans are again debating new ideas for expanding coverage and cutting costs. According to the historian Paul V. Dutton, Americans should look to France, whose health care system captured the World Health Organization's number-one spot.

    In Differential Diagnoses, Dutton debunks a common misconception among Americans that European health care systems are essentially similar to each other and vastly different from U.S. health care. In fact, the Americans and the French both distrust "socialized medicine." Both peoples cherish patient choice, independent physicians, medical practice freedoms, and private insurers in a qualitatively different way than the Canadians, the British, and many others. The United States and France have struggled with the same ideals of liberty and equality, but one country followed a path that led to universal health insurance; the other embraced private insurers and has only guaranteed coverage for the elderly and the very poor.

    How has France reconciled the competing ideals of individual liberty and social equality to assure universal coverage while protecting patient and practitioner freedoms? What can Americans learn from the French experience, and what can the French learn from the U.S. example? Differential Diagnoses answers these questions by comparing how employers, labor unions, insurers, political groups, the state, and medical professionals have shaped their nations' health care systems from the early years of the twentieth century to the present day.

    eISBN: 978-0-8014-6047-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. PREFACE
    (pp. ix-xiv)
  4. 1 COMMON IDEALS, DIVERGENT NATIONS
    (pp. 1-30)

    Washington, D.C. I’m attending a good-bye party for a friend who is leaving her job at a local museum. A friendly group has gathered at a fashionable northwest restaurant for drinks and hors d’oeuvres. I find myself face to face with an art historian from the National Portrait Gallery. I get the standard question, “What do you do?” I tell the interrogator that I’m writing a book on U.S. and French health care. “Oh really,” he responds. “Theirs is government imposed, isn’t it?” Another scene. Flagstaff, Arizona. A Halloween party for kids, mostly of faculty from Northern Arizona University. I’m...

  5. 2 HEALTH INSURANCE AND THE RISE OF PRIVATE-PRACTICE MEDICINE, 1915–1930
    (pp. 31-64)

    The First World War (1914–1918) marks the end of what historians call “the long nineteenth century.” The war brought about such rapid social, political, and economic change that the first president of the United States elected after the conflict, Warren Harding, vainly coined a new word, “normalcy” to promise Americans a return to a bygone era. As the bloody site of most of the fighting, France also yearned for a return to what many now termed la belle époque of the turn of the century. So it is altogether fitting that the evolution of health care during the early...

  6. 3 HEALTH SECURITY, THE STATE, AND CIVIL SOCIETY, 1930–1940
    (pp. 65-96)

    Among large Western democracies, France and the United States were the most active social reformers in the face of the Great Depression that began in 1929. Sheer misery motivated much of this action. Reform-minded politicians, especially President Franklin Roosevelt and Prime Minister Léon Blum, enjoyed electoral successes that would have been impossible just a few years earlier. Leaders in both countries enacted social insurance and Keynesian public spending programs in an attempt to revive their stalled economies. The task in the United States was truly monumental. The gross national product of the United States plummeted 44 percent between 1929 and...

  7. 4 CHALLENGES AND CHANGE DURING THE SECOND WORLD WAR, 1940–1945
    (pp. 97-111)

    In May 1940 German forces launched their long-planned blitzkrieg against France. The French army, backed by a British expeditionary force, was quickly split in two by the fast-moving German tank divisions and aerial attacks. With supply and communications lines disrupted, the Nazi advance quickly turned into a rout. Only an unusually dense fog over the English Channel prevented the total destruction of the fleeing French army and their British allies. Six weeks later, the troops of what many had regarded as the most formidable army in Europe sat helplessly in German prisoner-of-war camps or had already fled to Britain. As...

  8. 5 LABORʹS QUEST FOR HEALTH SECURITY, 1945–1960
    (pp. 112-133)

    Like two sides of the same coin, health care in France and the United States exhibited different images after 1945. The French side portrayed public compulsory health insurance with mutual societies and private insurers providing supplemental coverage for employers and individuals who could pay for it. The U.S. side showed the power of private voluntary insurance to afford comprehensive health security to millions, with compulsory public programs intervening only to cover some who were left out. Also like a single coin, the currency of health care in France and the United States remained the same. Political leaders, workers, employers, doctors,...

  9. 6 THE CHOICE OF PUBLIC OR PRIVATE, 1950–1970
    (pp. 134-156)

    A 1951 tour by French medical leaders of the United States provides us with a telling glimpse into the different choices that each nation made between public and private insurance. The French doctors stopped first in New York, where they met George Baehr, medical director of the Health Insurance Plan of Greater New York, a group practice founded by Mayor Fiorello LaGuardia. The plan offered prepaid medical services to city employees and later spread to include three hundred thousand subscribers in and around greater New York. Baehr was LaGuardia’s personal physician and had been instrumental in the plan’s creation. The...

  10. 7 COST CONTROL MOVES TO THE FORE, 1970–2000
    (pp. 157-183)

    The late 1960s and 1970s were a time of profound social upheaval in France and the United States. The war in Vietnam waged by the United States provoked widespread protests there and in Europe, especially in France where, it should be remembered, French troops had already shed their own and Vietnamese blood before withdrawing in 1954. Although French student protesters identified with their U.S. counterparts about the war, they were also focused on the inadequacy of schools to meet the demands of the bulging baby boom generation. Add to these developments a critical new awareness of environmental destruction and the...

  11. 8 HOSPITALS AND THE DIFFICULT ART OF HEALTH CARE REFORM, 1980–PRESENT
    (pp. 184-211)

    Hospitals underwent a substantial transformation during the twentieth century. French hospitals, in particular, had a history of religious charity care that dated back several centuries, usually under the auspices of a Catholic diocese. Successive republican governments of the nineteenth century, however, transferred hospital control to public authorities. But the state’s displacement of religious authority remained deeply unsatisfying to the unions and employers that dominated Sécurité Sociale governing boards after 1945. They believed that, since workers and employers essentially paid for hospitals through payroll levies, they should have a corresponding influence in their management.

    “We just don’t understand why,” complained a...

  12. 9 LES JEUX SONT FAITS? 2000–PRESENT
    (pp. 212-222)

    In 1943 the French writer Jean-Paul Sartre published a play entitled Les Jeux Sont Faits (The Chips Are Down). Set in an unnamed city bringing to mind France under German occupation during the Second World War, it is a story about our inability to be free of our pasts. The main characters, Eve and Pierre, meet in the afterlife, only to discover that a terrible mistake has been made. Both have just been murdered by trusted friends; she by her husband, he by a fellow insurgent. But according to a distressed heavenly official, they were supposed to have met, fallen...

  13. NOTES
    (pp. 223-246)
  14. INDEX
    (pp. 247-254)