Differential Diagnoses

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.

Paul V. Dutton is Associate Professor of History at Northern Arizona University and Executive Director of the Interdisciplinary Health Policy Institute. He is a past Fellow at the Woodrow Wilson International Center for Scholars and the author of'Origins of the French Welfare State.

The health care systems of France and the United States began the 20th century looking very much alike, then gradually moved in different directions while retaining a surprising number of common features. Dutton believes that both countries would benefit from taking a careful look at their similarities and differences. Both systems utilize a public/private mix of financing, maintain the fee-for-service basis for physician reimbursement, and hold out the ideals of physician practice autonomy and patient choice of doctor. Dutton says that the United States is almost inadvertently expanding coverage but with little planning; at the same time, the French are adapting U.S. managed-care techniques in an attempt to keep down costs and improve efficiency in a system already offering universal coverage.... This distinctive, readable, and well-organized history is recommended for public and academic libraries, especially where health-care reform is a hot topic.

Victor G. Rodwin, Professor of Health Policy and Management, Wagner/NYU; and Director, World Cities Project, International Longevity Center-USA:

Paul Dutton exhibits superb scholarship and insight on the evolution of health care financing and organization in France and the United States. His lucid book demonstrates that France's health system is more relevant for the United States than the health systems of the usual suspects—Canada, Germany, and Britain. It should be read by all health policy analysts, scholars, and social reformers who are searching for ways to achieve universal health insurance coverage in the United States.

Timothy B. Smith, Queen's University:

In Differential Diagnoses Paul V. Dutton tells the story of two nations over the course of an entire century. This remarkable book is one part history, one part policy analysis, and it is held together by strong conceptual glue. Differential Diagnoses is distinguished by Dutton's smooth, jargon-free writing, its accessibility, its richness of anecdote, its blending of original archival research with synthetic research drawn from several disciplines, and its timely and level-headed diagnosis and prescriptions for change.

Jeremy Shapiro, Fellow and Director of Research, Center on the United States and Europe, The Brookings Institution:

By first exposing the stereotypes and then carefully exploring the distinct histories of health care provision in the United States and France, Paul Dutton provides unique and valuable insight into how both countries can better address their respective health crises.