I can't imagine a scenario of nationalization of the complementary sector

Michaël Zemmour, economist at Paris Panthéon-Sorbonne University, explains why the Hcaam scenarios do not meet the challenges of the future of Social Security.

Faced with the Covid-19 crisis, has Social Security played its role?

Michaël Zemmour: The crisis has revealed strengths in the social protection system. For the majority of the population, covering health costs has not been a problem. And there were important reflexes in the prevention policy, such as free tests. Weak points should also be underlined: people who had insufficient additional cover may have had very high hospitalization costs.

Can other European countries or the United States envy us?

MZ: In the United States, a measure for public coverage of Covid-related costs has ended up being introduced. But it was not immediate. Part of the population was hesitant to even contact their GP. We see that for the French, despite some limits, the financial support of the costs linked to the Covid was not a major concern, which is a demonstration of force. The debt that the Covid will leave is charged to the Social Security budget, via the Social Debt Amortization Fund (Cades).

Why this choice according to you?

MZ: The government has a strategy to reduce public expenditure. One of the ways of doing this is to voluntarily put the social accounts in deficit. By spending a lot of money on paying off a debt, Social Security will have less for current spending, which will show a bigger deficit. This will be an additional argument in order to be able to justify an effort on expenses. This is called the "empty box strategy", which we already knew but which is likely to be multiplied during this post-Covid.

Can't this accumulated debt be taken as a pretext by the government to want to reform and lead to social security at a discount?

MZ: The risk, in the years to come, is that the level of debt and the Social Security deficits will be interpreted as a sign of current mismanagement. However, a large part of the new debt which is linked to Covid comes from decisions by the State in the face of an exceptional circumstance. It would be more logical for it to be carried by the State and reimbursed over a long period, rather than amortized on a forced march by the social accounts, to the detriment of their missions.

@TMZ figure out how to properly write a headline without bias. You people are losers that never expose you “writers”. Sham!

— Matt Price Fri Nov 06 00:21:32 +0000 2020

What to think of the four scenarios of the Hcaam about the future of health insurance?

MZ: The current trend, which is towards a reduction in the coverage of routine care by Social Security and an increase in coverage by complementary health insurance, is more expensive and promotes inequalities. We could resume the path of an increase in social security coverage, provided that it is thought out with the regulation of the supply of care and prices. The health contributions that we would pay to health insurance, we would no longer pay them to complementary health insurance, it would cost less.

Is one of the scenarios, the “Grande Secu” project, realistic?

MZ: It's not impossible. But the question is rather: “What are we putting behind this project? We could envisage a system where complementary organizations would be entrusted with preventive actions or the management of a regulated healthcare offer. In the event of a medical service rendered, the payment of health costs could fall largely, or even exclusively, to health insurance, provided that its funding is increased and rates are controlled. But I do not envisage a scenario of immediate nationalization of the entire complementary sector.

What will be the means for what support?

MZ: The means are always the contributions, public or complementary health, and the coverage, we want it to be really as uniform as possible. One of the consequences of the generalization of complementary health is all the same the diversification of offers, and therefore the rise of inequalities. Here too, the role of Social Security is to define the quality of the offer: homogeneous with regulated prices.

Isn't the “Grande Secu” project an element of pre-electoral language?

MZ: The expression is a slogan, like “100% health”. Moreover, having set up the 100% health, which increases the place of complementary health, and talking about "big Secu" is a paradox. The government may be seizing a real debate, that is to say the place of Social Security, the efficiency of the system and the inequality linked to complementary, without wanting to reveal itself. But if there is a shortage on the supply side of care, all this does not answer anything. A key element is to resume the operation of the financing of health insurance at levels that are sufficient.