"Our health insurance system is in danger", declared Philippe Douste-Blazy in July 2004, then French Minister for Health, so justifying his "last chance reform". As the Heads of Government Summit on the future of the European Union's social model is about to be held at Hampton Court, those who could be tempted to copy the French public health system and so have a growing sickness fund covered by the State, should think it over. After the record shortfall of 2004, the French social security administration announced that this would "remain very high in 2005". On 28 September the current Minister, Xavier Bertrand, presented the social security finance bill for 2006, announcing new measures going in the same direction as the preceding ones, such as lower reimbursements, new taxes and expenditure "controls". After 60 years of existence and twenty-two rescue plans, it should be clear that these social security reforms do not provide significant results. These measures cannot save it because an obligatory and universal system institutionalises irresponsibility and thus carries the seeds of its own destruction.
The obligatory character of the system and its monopolisation have made it possible to gradually transform insurance into an enormous machine to redistribute proceeds. The merging of mechanisms for payment and the financing through obligatory contributions has thus made it possible to disconnect services from contributions. Moreover it is this which Xavier Bertrand rejoiced over in Le Figaro on 4 October proclaiming that "if each citizen contributes according to his means, he is supported according to his needs". Poor as the contribution of someone may be, he can reclaim all foreseen costs for his diagnosed health problems. Through force of law, the health care consumer is put in an irresponsible position. When one can count on others to pay the bill, health expenditure is higher than it would otherwise be.
Let us now examine what happens on the financing side. The key point is that bills come from compulsory contributions. Taxes or social security contributions reduce the incomes of those who support them. It is true that this is not a pure loss that the contributor/insured must pay since these open the right to services. However, as it acts in terms of substituting an income in kind for a monetary return, there is certainly a reduction in purchasing power. But this means that work is penalised in comparison to its alternative, leisure. One thus works less and the fund allowing the financing of promised benefits is equally less replenished. Not only does the obligatory system of redistribution push expenditure but it tends to drain its own source of financing.
The process is cumulative. As obligatory redistribution penalises productive healthy people to the benefit of those on sick leave, the former are encouraged to give up the first role for the second, in passing for patients or by taking less precautions to prevent illness. Expenditure should thus increase while proceeds decrease relatively. It is therefore necessary to find new income by widening the scope of obligatory contributions or in raising taxes. This must create an additional penalty on work and encourage people who have not yet given up to do so and become net consumers of taxes and contributions rather than contributors, and so on and so forth. The apparently unstoppable upward tendency of public health expenditure and deficits is therefore not accidental. It is inherent in the system.
Such a system cannot last indefinitely. Invocations of "social justice" and the "Republican pact" cannot wipe away its internal contradictions. Today, the real question is to know if one is continuing the intravenous feeding, leaving the supposed beneficiaries of the system to be entrenched in its downfall, or if one allows people to get out, allowing them to leave the health care security system.
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