The first is the socialization of the cost of care

For us, French, America's health is a legitimate concern. The health of Americans is much less, as our two systems appear to be the very opposite. The debates ignited the project of reform of Obama have had little echo on this side of the Atlantic. As if the problems of health of the United States were not ours. Both systems have, in appearance, little in common, both in their organization in their performance. One is the archetype of the liberal model in which the majority of citizens ensure with private companies to cover care provided by the private sector. The other is not the most complete form of the public health system - the prerogative of the English - but a "mix" in which the expenditure of care private is collectivized.

Albeit at the cost of a huge deficit - it also apply to the real cost of health-, the France managed to ensure equal access to quality care for all. The United States are far away. All developed countries, is one who spends the most money on health (16 of GDP), and that for the benefit of a portion of its population, since 47 million people about have no social cover throughout the year (and 90 million in the year). Social inequalities Add strong regional disparities in the quality (much better in Minnesota to Texas) care, coverage in the disease (almost universal in Massachusetts, very poor in the South in General). Finally, the life expectancy at birth (78 men and women alike) and the infant mortality rate put the United States between the 25eet the 30th in the world from the point of view of health outcomes.

These weak performance began to be wanting, because, inter alia, specific social factors, as ethnic diversity and the proportion of smokers to the point that a prominent researcher as Samuel Preston (University of Pennsylvania) refuses to be attributed to the system health itself (1). But, for interesting they are, these voices are still minority and create an artificial border between health policy and health education. Despite their differences, French and Americans are facing same drift of their expenditure. In the United States, it has more than tripled in current dollars since 1990, point Laurence Hartmann, lecturer at the CNAM (2). At the current rate, it will reach 20 of GDP by ten years. In a study published by the Brookings Institution, Henry Aaron and Paul Ginsburg economists estimate that "the United States devoted to health double the average of the other ten richest countries" (3).

Some of the causes of the evil are specific to Americans: a per capita income higher than that of other nations; a very nonformalistic patient-physician relationship, which imposes premiums liability exorbitant, escalations on rates of care; more expensive drugs than elsewhere, whose prices are driven by the patent regulation which leaves little time for profitable innovation.

But three causes of increases in the cost of health in the United States are more familiar to us. The first is the socialization of the cost of care. A widespread perception, the public financing of health is, in the United States, greater private funding, this because of the place taken by Medicaid (insurance for the poor) and Medicare (the cover of the elderly and disabled) "the share expenses assumed by the public sector rose in fact 60 if it includes subsidies in tax credits"highlight Sylvie Cohu and Diane taxi-Slama, researchers at the French Ministry of health (4). However, observes the Economist Claude Le Pen, "when you socialize private expenditure, expenditure tends to increase very quickly" (5).

In the United States, the MIT Amy Finkelstein Economist calculated that about half of the increase in the expenditure of health between 1950 and 1990 is attributable to Medicare. Congressional budget experts believe that the share of GDP devoted to programs Medicare and Medicaid will increase by 2050. The inflationary nature of public funding is indeed for much of the reluctance of opinion in the Obama project. Second informative because of the cost of health in the United States: the failure of competition over the overflow of competition. Even if it is to defend a more effective public regulation, Pierre - Yves Geoffard, Professor at the school of Economics, Paris, observed recently that "in many U.S. States, three insurers cover more than 75 of the population" and that "the concentration even increased in recent years".

Even if the effects of competition on the very atypical market of health are in dispute, this concentration would explain the absence of downward pressure on prices in the presence of a multiplicity of providers. A third disability that we share with the United States is the poor organisation of a system of care even more fragmented there than here, with a multiplicity of small sous-occupés, and inefficient hospitals and a wide lack of coordination between health professionals. As in France, these defects result in unnecessary costs and administrative costs inflation. The ills of America are just ours.