Aide Médicale d’Etat Now Costs 30 Euros Per Year

Medical Care in FranceI would like to expand on this news because there is a lot more than meets the eye. There are many different ways to look at healthcare and access to medical treatments. For the longest time, France and the USA represented pretty much the two extremes on this issue in the Western world. In France, for a minimum of 50 years, up until very recently, the consensus was that healthcare was a public good and was therefore the government’s business. To put it very plainly, the reasoning was that the greater good of the nation could be achieved only if people knew they were protected in this area. Among other health-based services, everybody is checked and treated for any kind of infectious disease, because everybody is covered by national health care. In the USA, also until very recently, the reasoning was that one’s health was mostly a private matter and that the individual had to make sure he/she could handle their own medical problems regardless of the cause.

The French approach reached its logical conclusion when the Couverture Médicale Universelle and Aide Médicale d’Etat programs were set up. They made it possible for absolutely everybody in France to have access to medical treatment. The C.M.U. also works for legal immigrants living in France, and can be free for very poor people. The A.M.E. is for undocumented aliens, and until recently was free, the assumption being that illegal aliens did not have much income and therefore had very little financial means.

Both programs are dedicated to the financially disadvantaged, who are not eligible for the normal program of coverage that is based on working in France.

The French health care system does cost a lot of money, an issue I addressed about two years ago; everyone’s social charges pay for these services. On the other hand, it confers a true and long-lasting peace of mind, since health need not be a financial issue; anything can happen, but no one goes broke or has to be deprived of something to pay a medical bill.

In recent years, however, the approach in France has changed. Now it is felt that health-related costs are too high and that people are way too careless with the system, going so far as to take advantage of it. Financial concerns prevail and current thinking is  that if access to medical treatment or a doctor had a higher out-of-pocket cost, people would be more careful. The theory is that this would cut down on people seeking second opinions and the scams people pull to make money gaming the system. In the grand scheme of things, however, those two types of “abuse” have a negligible impact on the overall costs. So this reasoning is spurious: the plain truth is that the French conservative government is lowering the level of coverage, passing its costs on to the people, especially those who are sick and often poor.

After reducing the ratio of coverage in the normal program, then, the latest law signed on November 3rd has instated an annual fee of 30€ for the A.M.E. It is clear that almost anyone in France can afford that much for health coverage, so from a financial point of view, the move is not scandalous. But to say that is to miss the point totally. The reality is something else again. Only a tiny minority of people plan ahead and have such a conservative way of life that they are always prepared and anticipate problems that can be avoided. The vast majority live from paycheck to paycheck and there is no room left for savings. One can regret this situation and presume that with a good education and good role models, people would be wiser and more conservative in their decisions. But this amounts to wishful thinking. It’s a fact of life that most people covered by the A.M.E. will suffer financial hardship when it comes time to renew the coverage because their budget is that tight. Therefore, some people will end up not being covered.

I believe that, in the name of equality and justice, foreigners and French people, legal and illegal residents, should be treated the same way in this matter, and if the A.M.E. costs 30€ then the C.M.U. should cost at least the same. That being said, however, the point I want to make here is something else entirely.

This is just another step in the direction of turning health coverage over to the private sector. That is exactly what the American president was walking away from. Just keep in mind that prevention costs less than treatment at the very last minute, even though on the other hand it does allow one to delay paying the cost by several decades. Governments should know better: just like deficits, this is creating extra debt or costs for the generations to come!


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