Three questions to understand the “Grande Sécu” project

• A report containing a “Grande Sécu” project has been in the works for several weeks.

• With this scenario, almost all healthcare reimbursements would be provided by Medicare.

• Emmanuel Macron could use it as a campaign promise.

Will there still be additional health insurance in a few years?

The question had already been addressed in 2017, when Jean-Luc Mélenchon promised “full social security”.

It is back in the public debate thanks to a future report from the High Council for the Future of Health Insurance (HCAAM).

It should normally close its debates on December 16.

According to a working version that has leaked to the press, several scenarios are mentioned for the future of Social Security.

One of them quite simply plans to create a “Grande Sécu” which would absorb almost all complementary health insurance.

takes stock of the implications of such a project.

Why is the current system criticized?

Currently, the health expenses incurred by a patient are reimbursed both by Social Security and by the complementary health (or mutual) to which he adheres.

It is therefore a mix between state management and private management.

At the beginning of the year, the HCAAM had lit a first fuse.

In a working document published in January 2021, he listed several inequalities related to complementary health insurance. “Inequalities in access to coverage, with people who are not covered more frequently belonging to vulnerable categories; cost inequalities, which disadvantage people with low incomes in particular (…); inequalities linked to generalization by professional status, employees in the private sector being on average in a more favorable situation than the other categories ”.

He also denounced the "sophistication of the contracts" proposed, leading to the creation of "zones of opacity for the consumer".

Finally, he asserted that the “competition” of complementary products, supposed to benefit policyholders, was in part an illusion: “the market (…) is fragmented (…) The margins of differentiation through the guarantees offered have been considerably reduced”.

What concrete changes could this “Grande Sécu” have for the insured?

According to the HCAAM scenario, repatriating all health reimbursements within a single entity would avoid more than 5 billion euros in management costs generated by private structures. To finance the transfer, employers' social contributions and the CSG would be increased. In total, employees could save 100 euros per year, the self-employed 130 euros, inactive 50 euros and retirees 170 euros. A significant gain in purchasing power when other items of expenditure - fuel, gas - soar.

But mutual and complementary health insurance do not intend to let it go. Faced with the threat of the suppression of their market, they put forward their arguments. “Would [the“ big Sécu ”] mean that there would be no more out-of-pocket expenses? In any case, assured mid-November Eric Chenut, president of the French Mutuality, interviewed by France Culture. There are fees overruns, there are supplements for private rooms, there are a certain number of expenses, almost 10 billion euros each year, which will not be covered by health insurance ”. Jean-Paul Ortiz, President of the Confederation of French Medical Unions (CSMF), for his part fears the establishment of "two-tier medicine", with on the one hand the wealthy patients, capable of paying the overruns. 'fees, and on the other,those obliged to consult only the cheapest practitioners.

Why could the subject of "Great Security" become a theme of the presidential campaign?

Initially, Olivier Véran, the Minister of Health, seemed in favor of the expansion of Social Security, to the detriment of complementary health.

"There are a lot of things we can do, I sowed small stones during the health crisis (of the Covid-19), everything was covered 100% by Health Insurance and I have saw no one complaining, ”he said in October.

But according to

, Emmanuel Macron would not plan to take up the idea as it is in his future campaign program.

Contacted by

, Olivier Véran's office had not yet responded at the time of publication of this article.

The right has in any case not missed the opportunity to attack the executive. Xavier Bertrand, candidate for the LR primary, thus published a column on the subject in the

of November 7. The former Minister of… Health estimated that “Emmanuel Macron and Olivier Véran are working undercover” on this “crazy project” which he promises to bury “if the French [trust him]”.

For Luis Godinho, president of the Union of hearing aid professionals and member of the HCAAM, the 2022 election is above all an opportunity to put things back on track.

“Today, not changing anything in the system is no longer possible,” he explains to

.

Many French people find it difficult to cover the cost of their supplement, and at one point, they will no longer be able to pay them.

Our role at HCAAM is to put all options on the table.

It will then be up to the politician to decide ”.

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• Health Insurance

• Social Security

• Olivier Véran

• Health

• Economy

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