Equality and Solidarity: A Manifesto for the French Health System

A group of senior academics and policy leaders in health released a "Manifesto for Equality and Solidarity in Health" this past September. The Manifesto has attracted a good deal of attention as it was signed by a long list of French opinion leaders and personalities (including a few well known actors). I learned of this during my last trip to France to teach and had the chance to listen to one of its main authors, Didier Tabuteau, discussed the Manifesto at one of the EHESP regular Thursday seminars in Reid Hall where I teach.

I had expected a more impassioned presentation that focused on the justice of an egalitarian health system rather than the recounting of the history of the financing of the health system and the effects of macro-economic trends and realities on its ability to continue to provide services to all but a few in the population.

But the emphasis on the realities of public finance for health care and how it interacts with the larger economy is just the kind of discussion that is occurring in the United States as we begin the understand the limitations of the Medicare system and its finances.

Tabuteau held that the "Secu," the French social security system that is the overall financing vehicle for health services in France, was not doomed to end up in a "hole"(trou). He argued that a continuous adjustment process was necessary to titrate the tax rates that would support healthcare and that titration would rise or fall with the economy.

One point he the authors made make in the Manifesto that he didn't touch on much in the presentation at the EHESP was the "crisis of identity of professionals." According to the authors, doctors and other health care workers are experiencing a "profound malaise" accompanied by a steep decline in their conditions of work; "primary care physicians are living through a crisis that is without precedent" and students choosing to enter the field of medicine are facing hard choices.

The Manifesto speaks of and condemns an "ideology of management" (idéologie gestionnaire) that is affecting prices and costs as "the number of private operators, notably international groups, are investing massively in the health field, seeking to find profits..."

The Manifesto ends with a series of recommendations, primarily to increase reimbursement for care, especially long term care; the "reconstruction of a better payment system (convention) for private doctors; a "re-founding" of the public hospital system and the institution of a "true system of sanitary security and collective prevention."