opinion | The social budget for 2022 is a sign of political impotence

Published 1 Dec 2021 at 10:29

The Social Security Finance Bill of 2022 (known as PLFSS 2022) has just been voted on in Parliament in almost general indifference. However, it marks a lasting exit from the social accounts, with no prospect of a return to balance in the medium term and a level of expenditure of DKK 581 billion. EUR, ie 1.5 times the state budget.

The main reason for the deficits in 2020 and 2021 is called Covid, although one may wonder about the economic and political relevance of letting social security bear the Covid debt. The same applies to the takeover of the debt for hospitals belonging to the state and managed by the state.

After a deficit of 40 and 35 billion euros respectively in 2020 and 2021, the deficit on social security will remain at around 15 billion euros in 2025, while taking into account that Covid will no longer have an effect after 2022. The analysis of social security accounts per . 2025 strongly illustrates that the main problem in our social model is based on the health sector, suggesting that restoring this health is also the main part of the solution.

Eloquent economic paths

PLFSS 2022 provides clear indications on the situation of the various sectors of social security. AT-MP and the family branches have a structural surplus in the medium term (+ 10% to 15% of the budget in 2025), the old age branch has a small deficit (-3%), and the health branch is structurally largely in deficit with a forecast deficit of 15 billion . in 2025. The welfare department, which should be integrated into health, is in deficit until 2023, while it does not integrate the necessary increase in expenditure to meet growing needs in 2025.

The very deplorable situation of our social protection focuses mainly on the decay of our health system, which requires a global overhaul. The rest is, above all, a budgetary arbitration. What to do with the profits of AT-MP and family branches: more generous sectoral policies, a reduction in taxes, the financing of the deficit in the branches or the repayment of social debt? It would have been useful to discuss it in Parliament, which was not done!

The pension deficit is solved by postponing the average retirement age by one year (a gain of 10 billion euros), which can be done in several ways, by incentive or by commitment depending on political visions. With an employment rate of 55-64-year-olds (57% in 2019) among the lowest in the European Union (60% on average, 73% in Germany), an effective age for leaving the European Union labor market is a would think that this one-year deferral target would be relatively easy to achieve.

On the other hand, if we assess in terms of life expectancy in good health for men, which in France is among the lowest in Europe, which has stagnated at 62.6 years for 10 years, and social inequalities in health among the highest in Europe, we can see that the matter is becoming more complicated, due to the absence of a policy of maintaining good health. We return to the overhaul of the health care system, political priority number 1, without which nothing is possible to effectively renovate our social protection.

Ségur de la santé’s economic time bomb

The main budgetary measures integrated into the 2022 budget are linked to the Ségur negotiations. Faced with the shock of the first wave, the government decided at the time to apply whatever it cost to the salaries of hospital staff to enable hospitals to cope with the pandemic. This budget bears the brunt of Ségur’s double fault: on the one hand, the lack of structural reforms and, on the other hand, the lack of consideration for staff competencies and the difficulty of the tasks in the revaluations.

The budget expresses, while underestimating its impact, the economic time bomb about a uniform wage increase in the hospital. From 8.5 billion euros in Ségur’s initial accounts in 2020, the bill rose to 12 billion euros in 2021, to which it was necessary to add 120 million euros during parliamentary consideration for the 20,000 staff of institutions for the disabled. The requirements will continue as long as the individual health worker has not been assigned the nominal increase to the hospital and as long as the legitimate requirements to take into account the assessments of skills and difficulties have not been met.

Expression of political powerlessness

In the face of the deterioration of the organization of care, politicians must show that they are acting. Examination in the National Assembly of PLFSS 2022 gave rise to changes to deal with the medical shortage, by demedicalizing the printing of glasses and access to physiotherapists. If a transfer of task movement is necessary, it must be considered globally, based on scientific and technological realities, performed with health professionals and built in a spirit of reassessment by all professions. In this case, the only mind is dealing with the medical shortage, which will only lead to accelerating it, as in the hospital where a demedicalization of governance was carried out in 2009.

The health budget for PLFSS 2022 underestimates the current spending for the next few years, knowing that these new payroll expenses are entirely funded on credit. The social debt is already at the end of 2021 at 161 billion! The magic money of central banks has caused people to lose awareness that long-term social spending is financed by an income and not a deficit accumulated in a debt paid by future generations. When the sea of ​​massive bond purchases from central banks will subside (during 2022), the pressure on social accounts will impose a policy of social saving that is likely to be politically and socially unsustainable.

Whether it’s gimmicky amendments or the vote on a social budget with no prospect of a return to balance, PLFSS 2022 is actually the current sign of a sense of political powerlessness over our social model. This vote could have been accompanied by a national consensus in Parliament on the absolute necessity of carrying out, in 2022, regardless of the next President of the Republic, the general overhaul of our health care system, which we have seen was the cornerstone of a social security reconstruction. To paraphrase Bill Clinton’s 1992 campaign strategist, PLFSS 2022 and the 2022 campaign can be summed up in one sentence: “it’s stupid.”

The Grande Sécu project can be a good way to start the debate on the new health model! It seems that this door has hardly opened, has already been closed by the government, a further sign of the political powerlessness of the moment on priority issues for the French!

Frederic Bizard is chairman of the National Institute of Health.

Leave a Comment