Merge Social Security and complementary health insurance, a false good idea

In our health system, two payers reimburse patient care: Social Security and complementary health insurance. All this for a single act. Could we not simplify this model? This is the idea of ​​”Grande Sécu”, in which health insurance would cover all reimbursements for care. This would put an end to mutuals. The idea is very popular with Olivier Véran, who commissioned a report from the High Council for the Future of Health Insurance (HCAAM). The report is expected by Thursday.

Grande Sécu: an additional cost of 20 billion for public finances

This idea of ​​”Grande Sécu” is an idea that comes up regularly. In my opinion, this is a bad idea. The basic argument of the supporters of this reform consists in saying that the money which is today emitted by the complementary health in marketing and in advertising (approximately 5 billion euros), could be restored to the insured. The Social Security would no longer need to advertise and would not need marketing funds since it would be the only one to ensure reimbursements.

First detail: according to the HCAAM, this case would cost at least 20 billion euros to public finances. Whatever the cost, I supported him, it was great. But here we are no longer in the context of the crisis. Consideration may have to be given to reducing public spending.

Less diversity in contracts and less innovation

On paper, this idea of ​​a single payer for the same care makes sense. And then, complementary health does not do everything well. The elderly, people who do not work in a company and who are not covered by collective contracts are less well insured than others.

Complementary health insurance could innovate more, for example in the field of prevention. But at the same time, nothing tells us that the Social Security would do better. I am a liberal and I do not like monopolies, whether public or private. I’m suspicious of it. So, of course, we would perhaps save management costs, but we would have less diversity in the contracts. We would probably have less innovation, too, with a single social security. Remember, for example, that following the Covid crisis, it was the complementary health workers who decided to reimburse psychological care. That was a real innovation.

We must keep two sources of funding

We must regulate health care spending. We are already doing it. Moreover, the complementary ones do it with the networks of care, but it is necessary to distinguish well the regulation and the rationing. And Social Security, it is rationing. Health expenditure paid by Social Security is voted on each year by Parliament. The increase is of the order of 2% per year. And in reality, it’s not a lot. Because with the aging of the population, with therapeutic innovation, with unfortunately the greater spread of chronic diseases, we know that the rate of increase in health spending should be of the order of 3 or 4%. per year minimum if we want to have a system that satisfies the French. So that represents a lot of money.

When you have a system that requires so much funding, it seems to me that it’s healthier to have multiple sources of funding. It’s better to have two: a source of public funding and a source of private funding. This helps to irrigate the system better.