Health is priceless but it has a cost. So said a French politician to the Gauteng Legislature's health committee that recently visited France to examine their health system.
France has the world's best system, according to the World Health Organisation, but it has a high price .It consumes 11% of GDP, the third-highest percentage in the world. Unlike the British and Canadian systems, there are no long waiting lists to see a doctor or have operations.
Patients can choose their doctor or hospital. The underlying principle is solidarity i.e. richer people pay more in a compulsory system so that everyone gets uniform care.
The poorest 10% of the population receive treatment free without any contribution. For others, the reimbursement for treatment is 77%, so private insurance through various bodies provides the rest.
In reality, those who can afford it will pay extra to see a favoured specialist. There are also regional variations, with a shortage of doctors in certain areas, especially rural.
I found it interesting that locally trained doctors are happy to stay in France, with few imported foreign doctors. This is unlike Britain where the joke is that "British health care is the best that Pakistan can provide."
French doctors are mostly not employed directly by the state, although they earn well through state payments for their patients. They have high prestige and political influence - about a third of French senators are doctors. It's one reason there is lots of waste with over-servicing of patients.
The French use three times as many antibiotics as the Germans, and more than twice as many anti-cholesterol drugs as the British. Many reforms have been brought in to try and rein in costs and reduce inefficiencies.
But deficits have risen inexorably, as much as 15 billion euros (R140 billion) this year. Hard decisions need to be made to sustain the system, probably involving extra private contributions or some reduction of services. Much is dependent on the overall growth of the French economy, but extra health taxes would curb this and increase unemployment.
We face the same dilemma more acutely.
The burden on 5 million private taxpayers supporting welfare grants to 14 million recipients is already a huge strain. In our proposed National Health Insurance plan these few taxpayers are expected to pay an extra tax for a service they most likely won't use.
The irony is that huge extra spending on NHI is probably not the best way to increase general health. The NHI focuses on medical treatment, whereas having a job is the single greatest factor to improve health.
This is because rising wealth leads to better nutrition, sanitary conditions and other factors that historically have contributed most to increasing life expectancy. Jobless people are also more likely to turn in despair to harmful drink and drugs.
Better hospital treatment for the unemployed is less of a health priority than creating jobs that allow them to help themselves. Curbing crime and road accidents would also contribute powerfully to decreasing the trauma burden in hospitals.
The French health system was built up only after many decades of strong economic growth.
We must not put the cart before the horse in doing what is needed to grow a much larger economy that will be more healthy for everybody.
Jack Bloom is a Democratic Alliance MPL in Gauteng. This article first appeared in The Citizen.
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