Lhe speech delivered on January 6 at the South Ile-de-France hospital by the President of the Republic on the occasion of the presentation of his wishes to health professionals included a list of promises pleasant to hear for his audience: continuation of the revaluation of salaries of hospital staff, increase in the payment of night and weekend work as well as on-call and on-call duty, allocated housing plan in large cities, teamwork, relaxation of working hours for more stability, increase in the number so-called “advanced practice” specialist nurses, essential role of clinical services, freedom of organization of establishments, end of activity-based pricing (T2A), governance shared between caregivers and managers.
These remarks were however marred by two untruths. Contrary to what has been said, the government did not increase the T2A tariffs in 2018, on the contrary it lowered them that year by 0.5% and did not increase them again, only by 0.2% , than in 2019. As for the 19 billion in investments announced repeatedly, they are programmed over ten years, include a share of debt assumption and are not intended only for the hospital, but also for the city and to medico-social.
For city medicine, the priority of first resort was reaffirmed (development of professional communities in the territory, doubling of medical assistants, increase in the income of private doctors in exchange for their participation in the training of young people, the permanence of care and acceptance of new patients). No coercion, only incentive.
But the denunciation of the irresponsibility of patients “too many do not honor their appointments” refers to a liberal and individual vision of health where “seekers” and “providers” of care meet on a free market. This vision is incompatible with public health and collective solidarity for the use of a superior common good financed by the nation and “placed outside the laws of the market”to use the words used by President Macron himself during the first wave of Covid-19.
In private what is profitable
Setting the budget for health insurance and its accounting regulation are the responsibility of successive governments. And they must assume the state of disrepair of the healthcare system and in particular of the public hospital. This is not the consequence of the irresponsibility of individuals who are consumers of care, but the fault of governments who have not adopted a ratio of caregivers per hospitalized patient, who have not strongly supported multi-professional health centers and health centres, which have not increased the tariffs reimbursed by Social Security to eliminate excess fees, aggravating social inequalities in health, which have not regulated the freedom of establishment of doctors, and above all which have accepted the increasing privatization of health sectors.
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