Tribune. The discussions, apparently technical, on the “great Security” reveal a more fundamental debate, bearing on democracy and the way of organizing solidarity. The idea of ”great security” is based on a conception of democracy structured around an omnipresent and centralized State. The current system, with its multiplicity of actors, is considered inefficient and generates inequalities. The objective would be to give back to a social security under state control the responsibility of organizing solidarity between citizens, because the state would be the only legitimate one to do so.
But this approach badly conceals another reality, that of a minimal State which refers to a conception of democracy where individual freedom and responsibility prevail over equality and solidarity. In this case, public expenditure is devoted to a base of minimum protections, leaving for the rest the individual free to choose protection offers on the market.
It is easy to understand that, in a situation where public finances are becoming scarce, the public funds allocated to social protection will depend more on budgetary constraints than on the needs of the populations. Behind the idea of ”great security” looms the reduction in public spending on social protection, a drying up of the dynamics of solidarity carried by mutuals, and the development of a two-speed health system.
Deciphering what is at stake in this debate is not easy, especially since we are emerging from a pandemic during which concrete measures were taken to simplify the procedures for patients by offering 100% care of the patients. care and hospitalizations related to Covid-19. The French have therefore experienced a less complex system, which may make them sensitive to the idea of ”great security”.
Four challenges to overcome
What is less visible is the cost of the operation. In the immediate term, the government decided to tax mutuals and other complementary health insurance to finance the additional costs. In the future, as the report of the High Council for the Future of Health Insurance underlines, compulsory contributions will have to increase, while their weight, we are told, is already too high in France.
Overhauling our social protection involves meeting four challenges. First, to fight against inequalities in access to care generated by questions of solvency for a certain number of people, and by organizational problems of the health system itself. Second, further develop prevention, the poor relation of our current system. Third, to innovate in useful care but not taken into account by the Health Insurance which, according to the direction of Social Security, “Is not intended to reimburse activities with positive externalities on health”. It is in this context that mutuals can innovate, as they have done by paying for consultations with psychologists, for example. Fourth, give back spaces of collective responsibility to citizens in the organization of local civil solidarity initiatives.
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