Tribune. By asking the High Council for the Future of Health Insurance (HCAAM) to think once again about the idea of a “Grande Sécu”, that is to say the merger of the health insurance. Complementary disease (AMC) and compulsory health insurance (AMO), Olivier Véran, Minister of Health, is preparing the second term of Emmanuel Macron. The idea is attractive, and the reasoning simple.
Today the compulsory health insurance (AMO), the “Sécu”, finances 78.2% of medical care; complementary health insurers (AMC) – mutuals, provident institutions and private insurers – reimburse 13.4%; 6.9% remaining the responsibility of households and a little less than 2% the responsibility of the State and local communities.
For most medical care, there are therefore two funders: the “Sécu” and the “Mutuelle”, to use the usual terms. If there were only one, the “Grande Sécu”, the procedure would be greatly simplified and the savings could be substantial if the reasoning is limited to a rule of three. The HCAAM estimates it at 5.4 billion euros or, for the most part, the management costs of AMCs, nothing negligible therefore.
Cascading consequences
For the State, this would translate into an increase in public spending of 22.4 billion euros, or almost 1% of gross domestic product (GDP). France, the world leader in compulsory levies, would further increase its lead …
For Medicare, the financial equilibrium of the operation would require an increase of 12% of its financing needs, i.e. both an increase in employers’ contributions to Social Security, and an increase in the CSG in a proportion still unknown.
For companies, there would be simultaneously an increase in social contributions and a decrease in the financing of complementary health insurance, but this decrease would not, however, compensate for the growth in the employer’s share of health insurance contributions, which would result in a overall increase in labor costs.
Increase in purchasing power and increase in the CSG
For the French, this would lead on the one hand to an increase in their purchasing power because it would no longer be necessary to pay a premium to the health insurer, but simultaneously an increase in the CSG. As a result of the changes in the funding bases of health insurance, the main beneficiaries would be the elderly with high healthcare costs, and the most penalized would be the working, while retirees are already generally the beneficiaries of social transfers. at the expense of young workers.
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