Editor's blog 29 May 2009: Gallic shroud-waving over Loi Bachelet, and John Appleby

Posting twice in one day? I am spoiling you, Ambassador ...

However, this piece in the Staggers caught my eye irresistably. I don't think I have chuntered on yet about the Loi Bachelet, which basically proposes that managers will decide what care hospitals deliver.

It is much in the French media, and the article quotes Dr Bernard Granger (couldn't be any relation to Richard, surely?), a professor of psychiatry and president of SCCAHP. The article describes SCCAHP as "the union of clinical heads and hospital assistants; a large, but historically moderate, grouping that has sworn to bring the government down if the Loi Bachelot is passed", and Granger tells the author Andrew Hussey, “France is at a real crisis point, and the real issue is about control – who controls the daily lives of ordinary people. There is no issue more fundamental than health. Everybody knows if this law is passed, ordinary people will die.”

The French health system is generous and well-funded. One of Sarkozy's early reforms was to make it less accessible to expatriate British people who move to France (they must now get expensive medical insurance or self-pay until they reach 65). France is being less hit by the recession so far than many have anticipated, partly because its unemployment was already comparatively high and because its welfare system is generous, so those who lose their jobs stay on about 80% of their previous wage for at least a year.

But what Sarkozy is doing here is brave. It will be interesting to see if it passes. Some French friends who were enthusiastic about Sarkozy in the run-up to his election ("he will bring change ... we need change ... the French act like adolescents when it comes to change") have since changed their view as the husband's sector of education has faced reform ("he's going too far now ...").

Is France going to revolt? No, I don't think so. It has long had a militant tendency, and likes the pose of revolution. But the French, despite their love of dirigisme in politics, are also a conservative nation (small c). Les manifestations, la greve - these are ritual and theatre, a civil Mass for a secular state.


You should also nip over to the funkily-redesigned the Kings Fund website, where the lovely John Appleby has written a very thoughtful pice about commissioners and making markets work. John reiterates the key question about what is the right type of competition in a single-payer healthcare 'market' and the trade-offs between costs and benefits - and who benefits - and of course, what it all costs.