In a speech this week in the southern French city of Montpellier, French President Emmanuel Macron outlined his policies for a reform of the French social welfare system which confirmed what will be a profound transformation of the system in place since the end of the Second World War.
Speaking on Wednesday before a congress of France’s private ‘mutuelle’ health insurance companies, a vast sector which mostly provides top-up insurance for healthcare fees, Macron outlined the broad thrust of a programme that will affect welfare spending on social benefits, healthcare and for the elderly between now and 2021 – one year before the end of his current mandate.
He argued that those living from welfare benefits must find emancipation through work, and that people must be made responsible for their quality of life in order for the state to be able to assist them more pertinently, criticising a current system which is composed of a “universality that is moth-eaten with exceptions”, warning against “giving in to the adoration of totems” and calling for the reinvention of “a welfare state of dignity and emancipation”.
Enlargement : Illustration 1
While the exegetes of the French president’s speeches were given their money’s worth, that appeared less likely to be the case for the most vulnerable in society once the reforms are complete.
Meanwhile, he confirmed the already promised introduction by 2021 of a total reimbursement of a number of basic medical acts, in dentistry (such as essential implants), ophthalmology (essential spectacles), and hearing aids. At present, such vital prostheses can cost a patient many hundreds of euros, which for many represents a prohibitive sum.
The funding is to be shared to different degrees by the state social security system and the top-up health insurance companies. A possible consequence of the progressive introduction of this, what he called a “plinth” in healthcare, is an increase in private healthcare insurance. One unnamed participant in negotiations with the insurance companies and bodies representing healthcare professionals which began last autumn told French daily Le Monde that the likely cost to the private insurance sector is estimated at 200 million euros per year.
Macron told the congress that as a result of the move there could be “no specific increase” in the price of top-up healthcare insurance policies. But already, without taking into account the introduction of the “zero-cost” prostheses, a study by French consumer organisation UFC-Que Choisir published this month found that private healthcare insurance policies in France had risen by an average 47% over the past 11 years, in part matching their increasing participation in the refund of medical acts.
The French president also called for a more “preventive” approach to healthcare, meaning tackling early on the problems that later lead to ill health – or to coin a phrase he often uses in policy announcements, “to attack the root of the problem”. In dentistry, for example, he announced the introduction of a mandatary dental diagnosis for everyone, at the age of three and 24, entirely refunded by the social security system.
There was however no reference to the effects of his governments labour law reforms in which have degraded the protection offered to those in physically arduous jobs, nor any move to halt the collapse of the system of company and school doctors. Meanwhile, the president’s parliamentary majority previously threw out a submission of proposed legislation by the radical-left party La France Insoumise to reduce the risks of occupational burnout, instead placing the problem as an issue to be dealt with in labour negotiations. Nor did Macron mention the question of the potential health effects of the lengthening of working years as a result of the pension reforms.
During his speech he gave little concrete detail about the future reforms of the welfare system, beyond the injection of an extra 80 million euros in funding of care homes for the elderly, the promise of an already delayed drive to alleviate poverty and a future pension reform plan.
As in past comments on the subjects of poverty and social inequalities, Macron underlined the importance of improving education, saying, in a reference to the jobless, that “meritocracy in school, at each stage in life, means the end of house arrest”. Sticking to concepts rather than advancing figures, he insisted that, in what he argues is a necessary reform of a broken, unequal and outmoded welfare system, “the solutions that we must bring to problems cannot be budgetary”.
One of the key concepts of his speech was the need to make those who depend upon state benefits responsible for their lives, which he described as putting themselves in “control” – a less overtly aggressive take on those the traditional Right dismiss as living on state handouts. It nevertheless implied there were two categories of the socially excluded; those who can emancipate themselves by finding work and who must be made responsible for their condition, and those who are the poorest of the poor who should be financially helped. But Macron gave no indication of how those who make up these different categories can be concretely defined.
That concept is illustrated in the French governments approach to the unemployment benefits system, with the introduction of tighter controls of those claiming benefits – what the French president might argue is a manner of making some more responsible for their situation – while broadening the coverage of the system, just as is planned for those claiming the benefit payment top-up for those with very low income, the RSA.
“What is certain is that the two aspects of ‘control’ are mobilised alternatively in political speech, because it’s very useful,” commented Didier Demazière, a sociologist specialised in unemployment issues and a senior researcher with France’s National Centre for Scientific Research, the CNRS, in a recent interview with Mediapart (see here, in French). “One can see very clearly the alternating between a stigmatisation of the unemployed, who supposedly profit from their situation in an unjustified and immoral manner, living off the backs of collective society, and at the same time politicians who argue that this doesn’t apply to all the unemployed because some are virtuous, make necessary efforts [to find work] and deserve to be encourage. That tension is permanent.”
As has become something of a government mantra these past months, Macron insisted on Wednesday on the importance of employment in reducing poverty, however incongruous regarding the most excluded who already face a challenge in finding accommodation and being able to feed themselves, not to mention the existence of those among the por who are already in employment. For the government, the reduction in the rate of corporate social contributions, the lowering of income and wealth tax for the highest earners, will in turn reinject investment in the economy and thus reduce inequalities and poverty.
But the desired result is far from demonstrated. In an opinion article published in Le Monde on June 8th, Thibault Gajdos, a French economist and researcher with the CNRS, wrote: “Between 1970 and the end of the 1990s, the unemployment rate in France never stopped increasing, moving from less than 3% to almost 10%, while the poverty rate fell from 18% to 13.5%. Inversely, between 2010 and 2016, the unemployment rate in Germany fell from 7% to 4.1%, while the poverty rate grew from 15.6% to 16.5%.” Gajdos concluded: “That is exactly the choice that faces us: there is no doubt that by reducing social [welfare] payments will lead to a rise in inequalities and poverty in France.”
But the French government appears more concerned with reducing the public debt rather than attacking the problem of inequality, and with his comment that “the solutions that we must bring to problems cannot be budgetary” the French president clearly implies that no increase in funding of the welfare system is on the agenda.
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- The French version of this article can be found here.