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	<title>ScoopDaily &#187; Michael Barrett</title>
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	<link>http://www.scoopdaily.com</link>
	<description>Fresh Lens on the 44th President</description>
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		<title>U.S. Ambassador to France Talks to ScoopDaily</title>
		<link>http://www.scoopdaily.com/2009/12/09/exclusive-u-s-ambassador-to-france-talks-to-scoop-daily/</link>
		<comments>http://www.scoopdaily.com/2009/12/09/exclusive-u-s-ambassador-to-france-talks-to-scoop-daily/#comments</comments>
		<pubDate>Thu, 10 Dec 2009 04:05:26 +0000</pubDate>
		<dc:creator>Michael Barrett</dc:creator>
				<category><![CDATA[Politics]]></category>

		<guid isPermaLink="false">http://www.scoopdaily.com/?p=10359</guid>
		<description><![CDATA[Questions for the Honorable Charles H. Rivkin, U. S. Ambassador to France and Monaco ]]></description>
			<content:encoded><![CDATA[<p>The U.S. has a significant presence in France; in addition to the main Embassy in Paris, the U.S. operates consular offices in Bordeaux, Lyon, Marseille, Strasbourg, Toulouse, Rennes and Lille.  Ambassador Rivkin was appointed by President Obama on June 1, 2009 and was sworn into office on August 3rd. He graciously answered my questions regarding Franco-American relations, diplomacy and business.</p>
<p><a href="http://americanexpatinfrance.files.wordpress.com/2009/12/ambassadorrivkinweb2.jpg"><img class="size-medium wp-image-324 alignright" title="Ambassador Rivkin" src="http://americanexpatinfrance.files.wordpress.com/2009/12/ambassadorrivkinweb2.jpg?w=240&amp;h=300" alt="" width="153" height="192" /></a><strong>What is your connection to France and the French language, and what about diplomacy interests you?</strong></p>
<p>My family has deep connections to France.  My father participated in General Patton’s French campaign during World War II for which he was decorated by the French government.  My parents sent me to study at the Franco-American Institute in Rennes.  I later interned at Renault.  I also went to Cannes every year while managing a media firm.</p>
<p>I have been exposed to diplomacy from an early age, while my father was Ambassador to Luxembourg and to Senegal.  Every year, in his name, my family and I award a prize to an American diplomat for the best example of constructive dissent that advances American diplomacy.</p>
<p><strong>What do you th</strong><strong>ink of the French-US relationship today, and how do you think Presidents Obama and Sarkozy can work together on different issues from economic recovery to NATO efforts in Afghanistan?</strong></p>
<p>The U.S.-French relationship today is outstanding, with cooperation on all levels.  France is one of our oldest allies.  Exchanges on all levels – cultural, commercial, and political – are extremely important.  We do $1.2 billion in trade, investment, and affiliate sales revenues a day between the two countries.  Moreover, President Obama regards France as a key ally in almost all the major issues that he is managing today.  The fact that he visited France two times in his first five months as President provides the proof.  France is either leading or a close partner on the issues of Afghanistan, Pakistan, Iran, the Middle East Peace Process, climate change, and the financial crisis.  The two Presidents speak to each other regularly by telephone, and are both men of action who work well together.<br />
<strong><br />
In your role as Ambassador to France, how involved will you be with the different institutions of the European Union? What role do they play in the work of a US Ambassador to a European country?</strong></p>
<p>We have a Mission to the European Union based in Brussels that leads in the relationship between the United States and the European Commission.  Nonetheless, we approach Member States on European Union issues that are being considered in national capitals, which is appropriate since the Embassy manages bilateral relations.  France does tend to punch above its weight in the European Union.</p>
<p><strong>What city do you enjoy the most in France, and are there any areas you would like to explore in particular?</strong></p>
<p>France is a wonderful country, geographically diverse, boasting a large variety of regional cuisines and wines, and possessing a rich history.  It is hard to choose one city above another, although I do have a certain affection for Rennes since I spent part of my youth there.</p>
<p><strong>Many Americans do not speak a foreign language. How do you think this could be changed, and is the US Embassy in Paris involved in any language programs?</strong></p>
<p>One of President Obama’s priorities is to improve the language abilities of public school students so that future leaders of America have a more international vision.  The U.S. Embassy, our Consulates, and American Presence Posts play a role in this mission by actively sponsoring exchange programs, Fulbright Scholarships, and Sister City relationships that bring Americans to France and French to the United States.</p>
<p><strong>How do you think the French view President Obama, and vice versa for Americans&#8217; opinion of President Sarkozy?</strong></p>
<p>According to the opinion polls, 80 percent of French support President Obama, and 77 percent of French now have favorable opinions of the United States.   Similarly, most Americans have a very positive opinion of President Sarkozy, whose addresses in the United States have been warmly welcomed.</p>
<p><strong>Does the US Embassy keep up regular contact with all of the major French political parties?</strong></p>
<p>Yes, this is our practice worldwide.</p>
<p><strong>What do you like most about France?</strong></p>
<p>The people!  French people are among the most hospitable people I have ever met.  French people have strong personalities and opinions, which ensures stimulating conversations and exchanges.</p>
<p><strong>If students are interested in diplomatic careers, what advice would you give them?</strong></p>
<p>My advice would be to learn a language and spend some time abroad to ensure that you would enjoy a career abroad.  Studying international affairs is important, but there are terrific careers abroad for economists, health professionals, managers, IT specialists, and professionals of almost every stripe.  “Diplomacy” now encompasses almost every profession, specialty or walk of life.</p>
<p><strong>You have had a very successful business career. What advice would you give entrepreneurs in this economy, and what do you think of French efforts to boost entrepreneurship?</strong></p>
<p>Recessions are undoubtedly tough for businesses, but the fact is that businesses that start in recessions, with good ideas, a well-thought business plan, and financing, are much more likely to succeed than those that start in more prosperous times when it may only be possible to make sales as long as the good times last.  French and American entrepreneurs are alive and well.  Efforts to improve training and make available financing are two very important elements of any effort to boost entrepreneurship.</p>
<p>You can check out the U.S. Embassy in Paris <a href="http://france.usembassy.gov" target="_blank">here</a>, as well as on their <a href="http://www.facebook.com/usdos.france" target="_blank">Facebook page.</a></p>
<p>ALSO: Be sure to visit Michael Barrett&#8217;s website at <a href="http://americanexpatinfrance.com" target="_blank">http://americanexpatinfrance.com</a></p>
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		<title>College Grad Job Blues Not Just in US</title>
		<link>http://www.scoopdaily.com/2009/12/01/college-grad-job-blues-not-just-in-us/</link>
		<comments>http://www.scoopdaily.com/2009/12/01/college-grad-job-blues-not-just-in-us/#comments</comments>
		<pubDate>Tue, 01 Dec 2009 15:30:45 +0000</pubDate>
		<dc:creator>Michael Barrett</dc:creator>
				<category><![CDATA[Politics]]></category>

		<guid isPermaLink="false">http://www.scoopdaily.com/?p=9994</guid>
		<description><![CDATA[Will young people continue to suffer from the bad decisions of their elders?]]></description>
			<content:encoded><![CDATA[<p>With the U.S. unemployment rate for 16-to-24-year-0lds at more than 18%, the current generation is getting hit hard by the effects of an economic crisis brought on largely by older professionals on Wall Street. But of course, America is not the only country feeling the negativity; as <em>Business Week </em>recently <a href="http://www.businessweek.com/magazine/content/09_42/b4151032038302.htm" target="_blank">published</a>, this reality may in turn be contributing to the demise of a whole generation of graduates.</p>
<p>For the same age range, unemployment in Spain is at a whopping 39%, France is over 24%et Britain 19%. For many youth in the French <em>banlieue</em> (the word for suburb, with a negative connotation), there is an added risk of racism complicating matters for third-generation French from North Africa who want to get hired. In the recent French magazine <em>Entreprendre</em> (December 2009) some of these former <em>banlieue</em> residents are now successful entrepreneurs – men and women.</p>
<p>Karim Astitou is the CEO of Alys Conseil (an IT consultancy) and he says that “the <em>banlieue</em> positively influenced me and helped me to criticize, argue and disagree constructively.”  Mohamed Colin is another successful example, launching a unique newspaper for French Muslims called.</p>
<p>Not only are they leading by example, but many of these successful businessmen and women return the favor by mentoring students in the <em>banlieue</em>. Aziz Senni founded <a href="http://www.scr-bac.fr/" target="_blank">Business Angels des Cités</a> (<em>cité </em>meaning roughly “housing projects”), a 15 million euro investment firm dedicated to the advancement of business ideas in the <em>banlieue</em>.</p>
<p>As he states, this part of France makes up 10% of the national population, 25% of births, and about 25% of the unemployment rate. This, combined with other structures such as PACE (Point d’accueil et d’information sur la création d’entreprises, a structure that supports business creation) serve as tools for possible entrepreneurs.</p>
<p>What about fresh graduates in France? The website dedicated to students, <em>lEtudiant.fr </em>gives advice, news and links to jobs in order to help current students and recent graduates towards careers they would like. A recent <a href="http://www.letudiant.fr/jobsstages/jobs-stages-emploi-premier-emploi/jeunes-diplomes-jusqu-ou-vont-ils-pour-trouver-un-job-12488.html" target="_blank">article</a> speaks about a 23-year-old, Yannick Miel, who after sending out more than 300 résumés, advertised himself like a product on Ebay with the message “Practical, with cheap upkeep charges, you will not regret choosing this superb graduate in good health.”  Outcome? He is now working on a government panel under Martin Hirsch, the High Commissary for Youth.</p>
<p>The site goes on to give <a href="http://www.letudiant.fr/jobsstages/10-conseils-pour-trouver-un-emploi-en-temps-de-crise-14485.html" target="_blank">10 key tips</a> for finding a job in this economic downturn: 1) stay flexible and open in your search; 2) don’t hesitate to personally contact employers instead of relying on job ads; 3) make yourself stand out from the crowd in your skills and personality; 4)  have multiple job contacts and leads in case something should fall through; 5) network on the Web; 6) dare to apply for unadvertised positions; 7) show interest in the work world well before joining a specific industry; <img src='http://www.scoopdaily.com/wp-includes/images/smilies/icon_cool.gif' alt='8)' class='wp-smiley' /> really practice for the job interview; 9) go abroad for work and study experience; and 10) orient yourself towards careers that are recruiting.</p>
<p>To help students and young graduates further, <em>L’Etudiant</em> has published a <a href="http://www.letudiant.fr/metiers/100-metiers-qui-recrutent-malgre-la-crise-18764/100-metiers-qui-recrutent-malgre-la-crise-12363.html" target="_blank">guide to the 100 careers</a> that are recruiting in spite of the economic situation.</p>
<p>These are all encouraging tips and news for the young graduate looking into career options, in France or elsewhere. After all, we live in a globalized world.</p>
<p><a href="http://www.businessweek.com/magazine/content/09_42/b4151032041892.htm" target="_blank">http://www.businessweek.com/magazine/content/09_42/b4151032041892.htm</a></p>
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		<title>Afghanistan and The Winter of Discontent</title>
		<link>http://www.scoopdaily.com/2009/11/30/afghanistan-and-the-winter-of-discontent/</link>
		<comments>http://www.scoopdaily.com/2009/11/30/afghanistan-and-the-winter-of-discontent/#comments</comments>
		<pubDate>Mon, 30 Nov 2009 16:27:48 +0000</pubDate>
		<dc:creator>Michael Barrett</dc:creator>
				<category><![CDATA[Politics]]></category>

		<guid isPermaLink="false">http://www.scoopdaily.com/?p=9917</guid>
		<description><![CDATA[As President Obama reflects about a new strategy, allies come under pressure.]]></description>
			<content:encoded><![CDATA[<p>With the <a href="http://news.bbc.co.uk/2/hi/americas/8365990.stm" target="_blank">latest news</a> that President Barack Obama will soon be deciding whether or not to send more U.S. troops to Afghanistan, it is important to know in more detail about the contributions of the coalition.  Called the International Security Assistance Force (ISAF), it includes 42 countries, 28 of which are <a href="http://www.nato.int/cps/en/natolive/topics_8189.htm" target="_blank">North Atlantic Treaty Organization (NATO) members</a>.</p>
<p>ISAF’s duties include engaging local Afghan communities, training the Afghan National Army (ANA), supporting the Afghan National Police (ANP), humanitarian assistance, governance, anti-narcotics control and other vital functions. They are part of the reason Obama called this the “just war” during his presidential campaign, as ISAF adds a level of international legitimacy.</p>
<p>One organization suffering from a crisis of legitimacy at the moment, however, is the Afghan National Government.  This could have detrimental effects on how successful the overall Afghanistan War turns out, and the level of engagement between the U.S. and Afghan governments relies on mutual trust.</p>
<p>But with loud claims of election fraud and deep-rooted corruption at the heart of President Hamid Karzai’s government, those who would argue for less engagement and in some cases a complete withdrawal from the country are being bolstered in their views.</p>
<p>If President Obama does end up sending more American troops (which is looking to be the probable case), will allies step up to help?</p>
<p>In all, there are around 35,000 non-U.S. foreign troops in Afghanistan (compared to about 60,000 U.S. soldiers), most of whom are from Europe.</p>
<p>TheU nited Kingdom (UK) has the most number besides the U.S., with 9000 troops. <a href="http://news.bbc.co.uk/2/hi/uk_news/7410931.stm" target="_blank">Fatalities</a> have increased in the past year as the debate heats up as to whether or not they should stay in Afghanistan. A poll conducted in recent months found 60% of British opposed to the war.</p>
<p>Germany currently has around 4000 troops deployed, and as the <em>Wall Street Journal</em> <a href="http://online.wsj.com/article/SB125382797428838875.html" target="_blank">stated</a> its reason for sending troops was “justified as an economic-reconstruction mission &#8212; now its 4,000 troops are facing dangers their government hadn&#8217;t bargained for” as the Taliban is resurgent in many areas. Their mandate is up at the end of December, and anonymous sources close to Chancellor Angela Merkel said that Germany would likely <a href="http://tempsreel.nouvelobs.com/depeches/international/asiepacifique/20091118.FAP3769/lallemagne_va_prolonger_sa_mission_en_afghanistan.html" target="_blank">extend their presence</a> from 12 to 18 more months with another 500 troops added. But most Germans do not approve of this war, with the same polled September putting approval at 57%.</p>
<p>Here in France, opposition in the poll was listed at 51% and from personal experience it seem like more and more people are against a war that they do not think directly concerns them.  For many on the opposition, President Nicolas Sarkozy’s decision to return to the NATO military command was a huge symbolic gesture of surrender to American influence. Nonetheless, <a href="http://www.lemonde.fr/asie-pacifique/article/2009/11/17/les-senateurs-francais-pour-un-nouveau-mandat-de-l-onu-en-afghanistan_1268242_3216.html" target="_blank">says</a> <em>Le Monde</em>, the Afghanistan war “does not divide French electors as much as it does Democrats and Republicans in the U.S.”</p>
<p>French politicians of various political stripes seem to agree that this is a major conflict that deserves attention but not unlimited resources. One said that a withdrawal within 4-5 years seems reasonable, but another one stated that it was not possible to specify. Perhaps the strongest statement was that of French Defense Minister Hervé Morin, who criticized “the insufficient attention and resources devoted to European security and defense.” Foreign Minister Bernard Kouchner further stated that he had “even with our 3700 brave soldiers, we cannot dictate policy to others” so they had taken matters into their own hands.</p>
<p>In Canada and the Netherlands, they both plan on reviewing their Afghan missions in 2011, meaning that they could potentially withdraw at that time. Meanwhile, Slovakia has approved a <a href="http://tempsreel.nouvelobs.com/depeches/international/asiepacifique/20091117.FAP3689/la_slovaquie_envoie_250_soldats_supplementaires_en_afgh.html" target="_blank">plan</a> to send 250 more troops, doubling their size to about 500. They are currently concentrated in the Kandahar region but could be redeployed to hot spots throughout the country.</p>
<p>Italy, Romania, Poland and Spain are also big contributors to the NATO efforts, but the question is how will President Obama’s decision affect the policies of the other countries? Indeed, Boguslaw Winid, Poland’s ambassador to NATO, told the <em>Wall Street Journal </em>in the aforementioned piece that NATO allies in Europe “will have to follow the U.S. strategy because the U.S. is providing the biggest number of troops.”</p>
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		<title>The New Europe After Lisbon</title>
		<link>http://www.scoopdaily.com/2009/11/19/the-new-europe-after-lisbon/</link>
		<comments>http://www.scoopdaily.com/2009/11/19/the-new-europe-after-lisbon/#comments</comments>
		<pubDate>Thu, 19 Nov 2009 05:03:52 +0000</pubDate>
		<dc:creator>Michael Barrett</dc:creator>
				<category><![CDATA[Politics]]></category>

		<guid isPermaLink="false">http://www.scoopdaily.com/?p=9670</guid>
		<description><![CDATA[The European Union faces a key turning point towards a multi-polar world.]]></description>
			<content:encoded><![CDATA[<p>As the U.S. continues to struggle in the aftermath of a brutal economic recession, becoming ever-more indebted while spending unprecedented amounts on stimulus programs and fighting two expensive wars, emerging economies like China, India and Brazil are experiencing growth and expanding investment in scientific research and renewable energy technologies.</p>
<p>Beijing hosted the 2008 Olympic Games, South Africa will host the 2010 World Cup, Russia the 2014 Winter Olympics and Brazil will get both (2014 World Cup and 2016 Olympics).  China holds an estimated $1.5 trillion in dollar reserves and is signing many free trade pacts while the U.S. relies on it to finance its ballooning debt and deficit.  The G20 has replaced the G8. These all serve as reminders of the gradually changing balance of geopolitical and economic power in the world. Indeed, we may be witnessing the beginning of the end of what former French Foreign Minister Hubert Védrine called its hyperpower dominance.</p>
<p>One global actor that is playing an increasingly important role in foreign affairs is the European Union (EU), whose members’ diversity has often undermined any sense of unity.  But that could soon change, as Ireland and the Czech Republic recently became the last member countries to ratify the Lisbon Treaty.</p>
<p>Could this be another hint of the likely multi-polar world to come, and what effect will Lisbon have on Europe’s structure and status on the world stage?</p>
<p>In Fareed Zakaria’s book The Post-American World, he states that the EU is now “the largest trade bloc on the globe” (with a collective GDP of about $18 trillion, compared with approximately $14 trillion for the U.S.). In 2006, the U.S. had two-thirds fewer Initial Public Offerings (IPO) while European stock exchanges “expanded their IPO volume by 30 percent.” Zakaria refers to this increasing growth and influence in Europe, Asia, Africa and the Middle East as “the rise of the rest.”</p>
<p>Europe may be a big economic player, but what about its political influence? There is no doubt that it has played a key role on issues such as Iran, the Russian-Georgian war, climate change and the G20 response to financial crisis.  But as it grows in diversity and membership, it is hampered by an outdated governing structure that has been slow to adapt to changes.</p>
<p>The six founding members (France, Germany, Italy, Belgium, Luxembourg and the Netherlands) that made up the European Coal and Steel Community (ECSC) in 1951 now find themselves with 21 other countries and counting in a vast bureaucracy governed by the European Commission and the European Parliament, among other bodies. Thus reform was pushed in order for the EU to be able to have a clear and coordinated foreign policy.</p>
<p>In 2005, there was an attempt at passing a European Constitution that failed mainly because misinformed voters believed that Brussels would be given too much power. I was studying in Angers, France when French voters rejected the referendum (followed soon thereafter by a Dutch “no” vote) and remember the fierce debate that raged then between those wanting to protect French sovereignty from Brussels bureaucrats and those hoping to promote a new and united Europe. Although this deliberation between sovereignty and unity persists today, the EU was recently able to pass the Lisbon Treaty. Some critics call it a copy of the EU Constitution project, but proponents refer to it as “watered-down” version. So what does this entail?</p>
<p>According to the official site above, the Treaty aims to “reinforce democracy in the EU and its capacity to promote the interests of its citizens on a day-to-day basis” by enforcing transparency, increasing “participatory democracy” and including national parliaments in the decision-making process more often. The EU Parliament, the only institution directly elected by voters, will also get a bigger say in policy-making, and there will be more majority voting rather than unanimous voting on issues which made it very difficult in the past to come to agreements.</p>
<p>Perhaps the two most important details of the Lisbon Treaty, however, are the new posts it will create: the “High Representative for Foreign Affairs” (like a Foreign Minister, with his or her own staff) and a new President of the Council (“President of Europe”) on a 2.5 year mandate. The President will be chosen by the 27 member states, out of majority vote and can be re-elected once. He or she will lead EU summits, guide the work of the EU Council of Ministers and represent the EU on the world stage. Former British Prime Minister Tony Blair was rumored to be the front-runner for President but his support for the Iraq War counted against him. Europe is getting closer to decision time, and the rumor is that the President will be from a smaller member state.</p>
<p>The current front-runner for President is said to be Belgian Prime Minister Herman van Rompuy, who seems to have the approval of all the countries including Germany and France. Others include Jean-Claude Juncker (Luxembourg), Jan-Peter Balkenende (The Netherlands), John Bruton (Ireland) and Vaira Vike-Freiberga (Latvia).</p>
<p>The likely candidate for High Representative is former Italian Prime Minister (1998-2000) and Foreign Minister (2006-08) Massimo D&#8217;Alema. But the Financial Times reports that he does not speak fluent English, which is “all but essential in top-level international diplomacy.” So nothing is for sure, and there could be surprises.</p>
<p>What does this all mean for Europe? With a more cohesive organizational structure in touch with its constituents and a bolder foreign policy lead by two key players in the High Representative and the President, the EU looks set to stay as a power player. Indeed, Europe is well aware of the possibilities of a bigger global role</p>
<p>Why should Americans care? As the dominating power in the world shifts from the U.S. to a more multi-polar order in the generation to come, transatlantic relations will remain an important facet of U.S. foreign policy. It is therefore in our interest to know who our future partners will be and what their geopolitical interests are.</p>
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		<title>Yes &quot;Oui&quot; Can? Informing the Healthcare Debate: The French Example</title>
		<link>http://www.scoopdaily.com/2009/09/07/yes-oui-can-informing-the-healthcare-debate-the-french-example/</link>
		<comments>http://www.scoopdaily.com/2009/09/07/yes-oui-can-informing-the-healthcare-debate-the-french-example/#comments</comments>
		<pubDate>Mon, 07 Sep 2009 08:28:05 +0000</pubDate>
		<dc:creator>Michael Barrett</dc:creator>
				<category><![CDATA[Culture]]></category>
		<category><![CDATA[Feature]]></category>
		<category><![CDATA[Foreign Affairs]]></category>
		<category><![CDATA[Politics]]></category>
		<category><![CDATA[Scoop Stories]]></category>
		<category><![CDATA[france]]></category>
		<category><![CDATA[health care]]></category>
		<category><![CDATA[healthcare reform]]></category>
		<category><![CDATA[mutuelle]]></category>

		<guid isPermaLink="false">http://scoop44.com/testbed/?p=7869</guid>
		<description><![CDATA[French healthcare is often misunderstood by Americans who say Obama's plan is similar.]]></description>
			<content:encoded><![CDATA[<p style="text-align: left;">As the healthcare debate remains intense in Washington and across the country, leaving fiery protests at town hall meetings in its wake, one way to have a more knowledgeable discussion is by looking to examples of healthcare in other countries.</p>
<p style="text-align: left;"><span>The Obama administration has been criticized by some conservatives as wanting to impose a socialist system in not just healthcare but also in economic matters. One of the countries referred to the most by both critics and proponents of Obama’s policies is France, the supposed beacon of socialism and the welfare state.<span> </span>It is important, however, to get beyond ideologies and examine the facts. What could the U.S. learn from the French healthcare system, both what to do and what not to do?</span></p>
<p style="text-align: left;"><span>France’s public health system provides a basic form of mandatory health coverage for everyone, including foreign residents like myself with valid working papers. The main fund, <em>Sécurité Sociale </em>(<em>Sécu</em>), covers 80 percent of the population, and two other entities exist for the self-employed and agricultural workers. France also provides <a href="http://www.justlanded.com/english/France/France-Guide/Health/Special-health-coverage" target="_blank">options</a> for those ineligible for <em>Sécu </em>or below a certain salary threshold<em>.</em></span></p>
<p style="text-align: left;"><span>Everyone covered by the system uses a health insurance card resembling a debit card, called a <em><a href="http://www.cpam-bordeaux.fr/newsletter/images/images_08_07/Vitale2.jpg" target="_blank">Carte Vitale</a>. </em>This is equipped with a computer chip that can be read by doctors&#8217; and pharmacists’ computers to access a patient’s insurance coverage information. All French citizens from 16 years old are required to have one; those younger are on their parents’ plans. While practical, this card can represent the excessive paperwork and hurdles that foreign residents must get through in order to obtain one.<span> </span>It took me several months to get my <em>Carte Vitale, </em>somewhat delayed because I had provided one too many pieces of identity for their comfort.</span></p>
<p style="text-align: left;"><span>This notorious bureaucracy makes even the French cringe, but there is a silver lining: when getting laid off from a job does not result in losing a steady health insurance plan, the benefits seem worth the hassle.<span> </span>These are reaped not only individually but also economically.<span> </span>Indeed, the French social safety net played a role in bringing France <a href="http://news.bbc.co.uk/2/hi/business/8198766.stm" target="_blank">officially out of the recession</a> this past quarter, providing a stable foundation for increased consumption and other economic activity.</span></p>
<p style="text-align: left;"><span>In addition to the public system, there exists a huge private market for health insurance in the form of supplementary medical plans known as <em>mutuelles</em>. These tend to pay for some of the costs not covered well by <em>Sécu. </em>Most French opt for these; the <em><a href="http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/" target="_blank">Boston Globe</a></em> puts the rate at 90 percent of the population.<span> </span>For non-E.U. citizens moving to France, <a href="http://www1.internationalliving.com/reports/france09/" target="_blank">private medical insurance</a> is mandatory.</span></p>
<p style="text-align: left;"><span>These <em>mutuelles </em>are run by private insurers that offer a variety of plans to different groups, from students to professionals (and this is again subdivided into job sectors, like teachers). They often cover expenses not already paid for by the <em>Sécu. </em>For example, the standard doctor’s consultation will cost 22€ (about $31) and <em>Sécu</em> will normally reimburse 70% of this, or 15.40€. The <em>mutuelle</em> will usually make up some or all of the difference. My <em>mutuelle </em>is with the <a href="http://www.lmde.com/" target="_blank">LMDE</a> (<em>la mutuelle des étudiants</em> – student’s private option), which along with the other student option (<a href="http://www.smerra.fr/" target="_blank">SMERRA</a>),<strong></strong>offer beneficial plans to students in coverage and cost.</span></p>
<p style="text-align: left;"><span>I just upgraded mine, and it will help cover most prescription costs, doctor visits, some dental and eye appointments as well as hospital stays. The cost for my total coverage per year? <span> </span><strong>393€</strong> (195€ for <em>Sécu, </em>198€ for LMDE) – about <strong>$560 </strong>a year ($47 a month). Not bad, considering that this covers the entirety of my asthma prescription costs for medicines I take daily, for which I’d pay a lot in the U.S. even with insurance. Not to mention a good portion of the costs incurred for hospital visits, dentist appointments and other procedures. </span></p>
<p style="text-align: left;"><span>This is one of the key differences between the French and American systems. In the U.S., if you are prone to illness or have a chronic condition, health insurance providers will often either increase your payments or drop your coverage. <span> </span>As stated in the <em>Boston Globe</em> article, the French system makes it “more difficult for insurers to deny coverage for preexisting conditions or to those who are not in good health.”</span></p>
<p style="text-align: left;"><span>Another difference is that associated with unemployment. If you lose your job in the U.S. and are not covered by government employee plans, you will likely have to pay more for private health insurance than through a company-provided scheme. <span> </span>In France, everyone is covered by the public option so that even those laid off by their employers don’t have to fear enormous costs in going to the doctor in case of illness. <span> </span></span></p>
<p style="text-align: left;"><span>One more aspect is that when ambulances are dispatched to treat injuries, a doctor comes along with appropriate equipment to start treating the patient at the scene before going to the hospital for further care. This was <a href="http://www.youtube.com/watch?v=uNR_6UuVl4s" target="_blank">featured</a> by CBS news.</span></p>
<p style="text-align: left;"><span>The benefits can be seen in many ways, such as <a href="http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy" target="_blank">life expectancy</a>: France is ranked 7<sup>th</sup> among UN nations (77 years for men, 84 for women), whereas the U.S. is at 35<sup>th</sup> (75 for men, 80 for women). Moreover, the World Heath Organization (WHO) has ranked <a href="http://www.euro.who.int/countryinformation/CtryInfoRes?COUNTRY=FRA" target="_blank">France’s healthcare system</a> as the best (though debatable). Indeed, according to the <em>Boston Globe </em><span>article, France’s ranking is based on “its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and the longevity of the country’s population.”<span> </span>The U.S. comes in at a meager 37<sup>th</sup> place</span>. People like Fox News anchor <a href="http://www.thedailyshow.com/watch/thu-august-13-2009/glenn-beck-s-operation" target="_blank">Glen Beck</a> should reconsider their statements.</span></p>
<p style="text-align: left;"><span>So we see that the system in France has positive aspects, but what could be the costs of such a universal scheme? It does not come cheap, at about $3500 per capita (<em>Boston Globe</em>), but it is much less expensive than the U.S. ($6100). In terms of overall spending, France devotes 10.5% of its GDP to healthcare, whereas America spends 16%. More on the U.S compared to other countries of the Organization for Economic Cooperation and Development (OECD) can be found in this 2004 <a href="http://assets.opencrs.com/rpts/RL34175_20070917.pdf" target="_blank">report</a>.<span> </span>As addressed by <em><a href="http://www.medicalnewstoday.com/articles/9994.php" target="_blank">Medical News Today</a>, </em>the financing for the public health system is provided for by employers, employee contributions and personal income taxes, with around 20 percent of a working person’s gross salary deducted to pay for the <em>Sécu</em>.</span></p>
<div class="wp-caption alignleft" style="width: 266px"><img style="margin-left: 5px; margin-right: 5px;" src="http://media.economist.com/images/20090509/CFB413.gif" alt="" width="256" height="264" /><p class="wp-caption-text">Image: The Economist</p></div>
<p style="text-align: left;"><span>There should be no surprise, therefore, that French authorities are trying to cut down on costs in the system. According to this <a href="http://blog.cleveland.com/pdopinion/2009/04/comparing_french_us_health_sys.html" target="_blank">article</a> , instead of years ago when people would go to any doctor they wanted, “family doctors must now coordinate treatment.” I have witnessed this in France, where a patient must have the approval of his or her general practitioner before going to a specialist for a specific problem (exceptions: gynecologists, ophthalmologists and dentists – no need for referral). <span> </span></span></p>
<p style="text-align: left;"><span>There certainly needs to be reform in the U.S. of some sort. Indeed, the <a href="http://pewresearch.org/pubs/1293/health-care-public-gives-lukewarm-rating-to-american-system" target="_blank">majority of Americans</a> view the U.S. health system as “average” or “below average” according to the Pew Research Center. Even if a public option comes into existence in the U.S., it would likely not be mandatory for everyone, unlike the French system. The crux of the debate is whether or not a government-run public option would result in healthy competition with private insurers and lower premiums or if it would dominate the market and be a weight on business. A public health insurance option in the U.S. might dramatically increase coverage, but it will be vital in the long-term to reduce cost. Streamlining government bureaucracy could contribute to that endeavor.</span></p>
<p style="text-align: left;"><span>Policymakers in Washington would be wise to take heed from French lessons of mixing public with private insurers. According to the <em><a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447687" target="_blank">American Journal of Public Health</a></em>, these lessons include: “the importance of government’s role in providing a statutory framework for universal health insurance” and “understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.”</span></p>
<p style="text-align: left;"><span>We can learn from France without becoming France, taking what works and leaving aside any nuisance to long-term growth while encouraging innovation to reduce costs, increase coverage and improve medicines. Our collective health depends on it.</span></p>
<p style="text-align: left;"><em><span>If you would like a very in-depth analysis of the benefits and pitfalls of France’s whole economic system, I invite you to read the Economist article cited above. You can find more info on the French social protection system <a href="http://www.adecri.org/images/stories/the_french_social_protection_system.pdf" target="_blank">here</a> and on this <a href="http://www.frenchentree.com/fe-health/" target="_blank">site</a>.</span></em></p>
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