france's has a high floor and no
ceiling. the government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance -- which 86 percent do, most of them through employers, with the poor being subsidized by the state.
this allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in france.
france's system is further prized for its high level of choice and responsiveness -- attributes that led the world health organization to rank it the finest in the world (america's system came in at no. 37, between costa rica and slovenia). the french can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed.
a wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. the french have addressed this by creating what amounts to a tiered system for treatment reimbursement. as jonathan cohn explains in his new book, sick
in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government limits every individual's out-of-pocket expenses. in addition, the government has identified thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.
the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.