In France, we grew up with an almost self-evident idea: if we fall seriously ill, Social Security will be there.

A hospitalization, a chronic illness, cancer, or an extremely expensive operation does not generally mean personally receiving a bill corresponding to the total cost of care.

But that obviously doesn't mean healthcare is free.

We finance it collectively, directly or indirectly, and many French people also pay for complementary health insurance. So a question deserves to be asked: is this system really more advantageous than that of the United States?

The American healthcare system: more complex than it seems

This is a first misconception to correct.

The United States also has significant public programs, notably Medicare and Medicaid. But their system relies much more heavily on private insurance.

In 2024, 92% of the American population had health insurance for all or part of the year, while 27.1 million people, or 8% of the population, had not been insured at any time during the year.

Employment-based insurance is by far the most common: it covered 53.8% of the population. Medicare covered 19.1% and Medicaid 17.6%. Some people may belong to multiple categories during the same year.

For some American employees who benefit from very good professional insurance, the healthcare system can therefore be much more protective than one might imagine in France.

But the problem arises when coverage is insufficient or non-existent.

Overall cost of healthcare: who pays more?

This is where the comparison becomes particularly interesting.

No. Overall, the United States does not spend less on health. They spend enormously more.

According to the Commonwealth Fund, American spending exceeded 16% of GDP in 2022. In the nine other wealthy countries studied, it was around 8% to 12% in 2023.

In other words, eliminating a system comparable to our Social Security by no means implies that healthcare costs society less.

The money simply changes channels: private insurance, employers, public programs, deductibles, patient co-payments, medical bills…

And this is probably one of the most counter-intuitive pieces of information in this comparison: the country that relies most on private insurance is also the one that spends the most on its healthcare.

Financing of the French healthcare system: collective and individual participation

It would be equally wrong to present our system as free.

In France, financing is collective, and households also directly bear a portion of the expenses.

In 2024, after intervention by the Assurance maladie, the State, and complementary insurers, 20 billion euros in health expenses remained directly payable by households, representing 7.8% of healthcare and medical goods consumption.

This represented an average of €291.60 per inhabitant over the year for this scope of expenses.

However, be careful: this figure does not represent “everything a French person pays for their health.” It obviously does not equally include all levies used to finance the system or the cost of complementary insurance.

This is precisely what makes comparisons like “how much do I pay out of my pocket?” much more complicated than they seem.

Quality of care: is France the best?

Here again, the answer holds some surprises.

The Commonwealth Fund compared ten healthcare systems based on 70 indicators, including access to care, equity, administrative efficiency, health outcomes, and care processes.

France is not first. It is fifth.

Australia is first, followed by the Netherlands and the United Kingdom.

The United States is… tenth and last.

But it would be unfair to conclude that American care is systematically bad.

In the category evaluating care processes—including prevention, safety, coordination, and patient involvement—the United States ranks second.

It is therefore much more subtle: the United States can offer excellent quality care, but its system faces significant difficulties in access, equity, cost, and outcomes across the entire population.

Coverage in case of serious illness: a philosophical divergence

This is probably where the philosophy of the two systems diverges most.

The French model relies heavily on risk pooling: everyone contributes so that whoever, tomorrow, needs very expensive care can be largely covered according to the system's rules.

In the United States, the situation depends more on the coverage the person has.

Two Americans suffering from exactly the same illness can therefore experience very different financial situations depending on their insurance, their employer, their income, their age, and the terms of their contract.

This is a fundamental difference.

Should we abandon our Social Security for the American model?

The available data does not allow us to conclude that it would be financially advantageous.

The American model generally costs more while leaving a part of the population uninsured.

But this does not mean that the French healthcare system is perfect.

France is only fifth in the Commonwealth Fund comparison. It notably ranks 6th for access to care and 7th for care processes.

And above all, there is more than just the choice between “French model” and “American model”.

The Netherlands, Australia, Germany, Switzerland, or the United Kingdom have built very different organizations.

The Netherlands, for example, ranks second overall and first for access to care. Australia ranks first overall.

The real question: improve our system without giving up protection

Ultimately, the debate should perhaps not be:

“Should Social Security be abolished?”

But rather:

“How can we maintain protection against major risks while making our system more efficient?”

Because the figures show two things at once.

France does not have the best healthcare system in the world, and we would be wrong to consider our model untouchable.

But the American example also shows that a much greater role for private insurance absolutely does not guarantee lower expenses or better access to care for the entire population.

And when it comes to health, the question is ultimately not just how much we pay.

It's also about what happens the day we truly need the system.