Cornell University Press,
Read a Primer
On French Health Care
drawn from Differential
From the Back
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
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.
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.
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,
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
of Origins Of The French Welfare State
“refreshingly clear and concise account”
- Times Literary Supplement
"This is an important and informed work. Highly
"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
- 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."
“…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
"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
Publications by Paul Dutton
"La Médecine libérale rencontre le médecin
syndicaliste," Bulletin de l'Histoire de la Sécurité Sociale, Fall 2004.
"An Overlooked Source of Social Reform: Family Policy in
French Agriculture, 1936-1945," Journal of Modern History 72:2 (June
"French Versus German Approaches to Family Welfare in
Lorraine, 1918-1940," French History 13:4 (December 1999), 439-463.