Haro on the “Grande Sécu”! “Financial madness”, “Two-tier medicine”, “Nationalization of the health care system”, proclaim those who oppose it. So goes the political debate in our country: an idea is introduced into the pre-electoral arena in the form of a report requested from the High Council for the Future of Health Insurance (HCAAM), whose analysis is consistent with that issued for a long time by many experts, all critical of a system unique in the world by its complexity.
But those who have things to lose in such a reform open fire immediately: especially insurers, mutuals, insurance companies and provident institutions, and the allies of these organizations. The Minister of Health, Olivier Véran, is already backing down, thus burying the possibility of gaining purchasing power, equity and better access to care. Let us therefore continue to overplay solidarity where there are above all well-understood economic interests.
What should we expect from Social Security? That it allow equal access to healthcare for all, without siphoning off citizens’ income. What the HCAAM report calls “great security” has these two objectives. But how ? Isn’t the French health system the best in the world, the most egalitarian, with the lowest costs paid by OECD countries? Well no, when we look at reality beyond statistical averages, our system does not guarantee equal access to care, nor complete solidarity between the sick and the healthy, nor the absence of excessive expenditure for insurance.
All this because of its baroque architecture, where two different organizations, Social Security and complementary insurance, combine to cover the same care. When Social Security was created, it was decided that coverage would not be 100%. “User fees” have been introduced, of 30% for consultations in town and 20% for hospital care. These costs, not covered by Social Security, could be covered by additional insurance.
Complexity of procedures
The problem is that complementary insurance activities are subject to market constraints, including for mutuals. This excludes solidarity in setting prices, with age-specific pricing and bonuses independent of affiliate income. This is why access to complementary health insurance is difficult in France for retirees and people with low incomes. The HCAAM has calculated that the acquisition of a supplement represents on average 7% of the income of the elderly (” The role of complementary health and provident insurance in France “, working document, January 2021).
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