Differential Diagnoses

A Comparative History of Health Care Problems and Solutions in the United States and France



Cornell University Press, September 2007


Read a Primer On French Health Care

drawn from Differential Diagnoses



From the Back Cover

Although the United States spends 16 percent of its gross domestic product on health care, more than 41 million people have no insurance coverage, while one in four Americans report difficulty paying for medical care.  Indeed, despite being the most expensive health care system in the world, it 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 Dutton, Americans could learn a lot from 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.


Advance Praise for Differential Diagnoses

"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."

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



“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.”

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



“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."

—Timothy B. Smith, Queen's University







Paul V. Dutton

Associate Professor of History

Northern Arizona University


Fellow in Residence, Woodrow Wilson International Center for Scholars, 2004-2005


Affiliated Scholar, The Brookings Institution, Center on the United States and Europe, 2002-2003


Research Fellow, Health and Human Services Agency for Health Care Research and Quality, 2001-2002




Northern Arizona University

Department of History

Box 6023, Flagstaff AZ 86011

928 523-8830




Origins of the French Welfare State

The Struggle for Social Reform in France, 1914-1947,

Cambridge University Press, hardcover 2002, paperback 2005




Reviews of Origins Of The French Welfare State


“refreshingly clear and concise account”

- Times Literary Supplement


"This is an important and informed work. Highly recommended."

- Choice


"The major strength of this carefully-researched, well-written book is the rich account that it offers of the struggle for control over social policy by major interest groups and sectors in the interwar period. Dutton's book is a fine contribution to the limited literature on this subject."

- American Historical Review


"Dutton's analysis offers the first comprehensive overview of welfare state evolution in France in English...Dutton's work is intended primarily for professional historians, but should be accessible to graduate students and advanced college students."

- History


“…the premier account of welfare state building in France between the wars and essential reading for anyone seeking to understand the complexity and popularity of the system that emerged after 1945.”

       - International Labor and Working-Class History


"Although this is a book of finely crafted history, complete with ample archival sources and rich empirical detail, it will be of interest to a much larger readership than period or area scholars only."

- Canadian Journal of Sociology



Other Publications by Paul Dutton


"SystŹmes de santé en France et aux USA: une convergence caché?," Revue Européene d'Histoire Sociale, Fall 2004.


"La Médecine libérale rencontre le médecin syndicaliste," Bulletin de l'Histoire de la Sécurité Sociale, Fall 2004.


"Health Care in France and the United States: Lessons for Each Other," Commissioned Policy Brief, The Brookings Institution, Washington, DC, July 2002.


"An Overlooked Source of Social Reform: Family Policy in French Agriculture, 1936-1945," Journal of Modern History 72:2 (June 2000), 375-412.


"French Versus German Approaches to Family Welfare in Lorraine, 1918-1940," French History 13:4 (December 1999), 439-463.