LONDON

ON THE FACE OF IT, the logic behind President Obama’s proposed “public insurance option” to achieve universal health coverage seems impeccable. Creating a large public insurance fund will provide quality coverage for those currently uninsured and force competing private insurers to lower their costs. Everyone would be a winner — apart from the greedy insurance and pharma companies who profit from the current system.

In practice, though, things are rarely this simple. Just take a look at European countries like Britain and France, which have had state-dominated health care for many years. Both these systems have financial problems, and patient care that often falls below standards.

Although proponents of the Obama plan claim that the “public option” will make the overall health insurance market more competitive, this is unlikely. Heavy taxpayer subsidies will give it a significant competitive advantage, leading to an estimated 118.5 million people moving from private insurers to the public system. The new public option will eventually dominate the market — hardly a competitive situation. The United States would then have a health care system very similar to Britain’s.

In Britain, the state pays for and provides the majority of health care via the National Health Service. Patients have almost no say over which physician, surgeon or hospital they can use, while doctors and hospital managers have to abide in minute detail by the plans and targets laid down by central government. After this system was instituted in 1948, government planners soon found that “free” health care created a massive increase in demand. Its founder Lord Beveridge absurdly predicted that free health care would actually decrease overall spending as the population’s health improved. He was proved spectacularly wrong: Between 1949 and 1979, NHS spending tripled in real terms. The service now costs twice as much as it did 10 years ago, even while productivity has declined by 4.5 percent annually.

When a service is given for free, government planners have to find ways other than cost to limit demand. For example, they decree which new drugs can be prescribed by doctors and, as a result, many drugs which are widely available both in America and continental Europe are denied to British patients.

State mismanagement has also created queues. The average wait for admission into hospital is currently 8.6 weeks and, as of April, more than 43,400 English patients were waiting even longer.

Meanwhile, budget restrictions on cleaning have given British hospitals alarmingly high rates of the MRSA “superbug,” turning even routine surgery into a lottery with death.

Britain may be an extreme example of government control of health care. Many American pundits point to France as a better example of a progressive health system that uses public insurance to deliver high quality, equitable care. It is true that French patients enjoy a higher standard of care and shorter waits than the British. But this is thanks to a far greater reliance on independent health care and greater freedom from government for doctors and patients.

As in America, this freedom is gradually being eroded as the French government seeks to control costs by increasing regulation and requirements on the private sector. Soon, France could end up with a system not unlike Britain’s.

Already, so-called “medical deserts” exist in many areas of French health care, particularly in the suburbs and rural areas. In some places, a patient has to wait for more than six months to get an appointment with an ophthalmologist. In 2004, 286 of the country’s most senior hospital doctors signed a petition bemoaning the shortage of doctors and nurses and increases in waiting lists. “In casualty units, sick people have to wait for hours, sometimes even days, on gurneys, because there are no beds for them in the hospital,” said the doctors’ petition, sent to the newspaper Le Monde.

And it hasn’t saved money, either. Every two or three years the French government rolls out yet another cost-cutting reform but the books haven’t sustainably balanced since the inception of the current system in 1945. President Obama, who recently signed an agreement with health professionals in which they agreed to reduce the annual growth rate of health care spending by 1.5 percentage points, should take note.

To be sure, there are lessons to be learned from overseas which would save America money. But France and Britain show that nationalizing care is not one of them: what it does do is damage patient care. Americans would do well to take heed.

Guillaume Vuillemey and Philip Stevens are researchers at, respectively, France’s Institut Economique Molinari and Britain’s International Policy Network think tanks.