by French Imp
Hi! I'm French, I live in France but I've been around here on DKOS for quite some time (it all began shortly after the Iowa primary). Although I've written many comments, this is my first diary. An awe-inspiring occasion: Jerome a Paris has set very high standards!
However it occurred to me that the point of view of a Frenchman might be relevant to the current debates, since the French system is considered exemplary by many here, but I realize that it is not always well known. I'm no healthcare expert, mind you. I intend to present general facts about the French system (la Sécurité Sociale, colloquially la Sécu), its origins, how it works and how it is perceived (as far as I can tell) and then, I will give you a personal appreciation on the present situation in the US, in the light of this foreigner's experience.
Perhaps I should note that I've been a heartfelt Obama supporter from the start, so feel free to consider me prejudiced if you like. However, I will try to describe as objectively as I can the French system, and when I express opinions about it I'll try to make it clear.
How did La Sécurité Sociale come about?The underlying principle of the French welfare system was originally instituted by the Conseil National de la Résistance or CNR. The CNR, which represented both the communist and the gaullist resistance was the coordinating organ of the French Resistance during the war, and played a major role in shaping post-war institutions and promoting social justice.
La Sécurité sociale was not created by one single piece of legislation. It was a very protracted process. Initially it concerned only employees in the private sector (1945)), civil servants (1947), agricultural workers (1961), other workers (1966). It became universal only in 1999 (until then part of the population and notably the homeless were not covered). There was a gradual shift as initially, the aim was to protect 'workers and their families', whereas today healthcare is considered as a human right rather than a worker's right.
How is it organized and managed La Sécurité Sociale is what you people call a single-payer system. It covers 4 'branches' namely - Health Insurance (l'Assurance Maladie - we always seem to favor the pessimistic point of view) - Insurance against work accidents and illnesses - Pensions - Subsidies for families with >= 2 children
(Insurance for workers who lose their jobs belongs with a separate but similar entity called ASSEDIC).
La Sécurité Social
is not government-run.
It has its own budget and is managed jointly (on a 50-50 basis) by trade unions and employer's organizations. In fact the employers are united and the trade unions are divided so that for all practical purposes the employers prevail, but they can't do exactly what they would like to do. (This is a personal appreciation based on facts).
How is it paid for? It's
not free! It is
not paid for by taxes (or should not be) !
So how does it work? Let me give first my personal example. Each month I get about 4200 euros on my bank account from my employer. But my employer
pays 9500 for my salary. The difference, that is 5300, goes almost entirely to la Sécu (that's the social contribution). About half of that serves for Health insurance.
On the 4200 I get, I still have to pay the tax on the revenue (about 450 in my case) and local taxes (about 450 as well - I live in a city where local taxes are very high).
I think I have convinced you that it's not for free.
The algorithm for computing social contributions is complicated but roughly speaking, half of what an employer pays goes to the employee and the other half is the social contribution. That is, the social contribution is hardly progressive (meaning the ratio contribution/salary is roughly constant, unlike the ratio revenue tax/revenue).
Are there problems?The system works well in the sense that if you are seriously ill you do not have to worry too much about money; essentially all is paid for.
Still everything is not paid for (especially in the case of everyday ailments) and there are more and more exceptions, more and more cases when you have to pay something - or even everything. But, if this trend is alarming to many people, right now we pay on average a tiny proportion of the costs.
It has drawbacks. The social contributions are public money (in a sense) which goes essentially to private pockets: most physicians, pharmacists and other medical professionals work in the private system, some hospitals are private, others are public. The fees are in principle negociated with La Sécurite Sociale but very often physicians ask for much more than what will be refunded to their patients. And of course the Pharma industry profits vastly. La Sécurité Sociale is not in a strong position to negociate as it is basically run by employers and governments are submitted to constant lobbying from the industry and physicians' organizations.
Moreover employers complain that the cotisations sociales are too much of a burden for them and since around 1970 all governements have granted them rebates (recall that basically employers also manage la Sécu). In principle those rebates are complensated by government money (that is taxes!) but in fact the government owes a huge amount to la Sécu. What with that and the increase in costs, la Sécu has a big deficit (in fact it's not that clear - according to some it is made up) which is constantly invoked to reduce payments.
Also, part of the population say that La Sécu is ill-managed, that many people cheat etc. In my opinion this is only marginally true and is mostly used as a political weapon against La Sécu.
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