Parliament voted the railway reform finally on 14 June. The so-called reformist unions, CFDT and Unsa, called on their members to suspend the strike during the exam period (800,000 young people sat the baccalauréat between 18 and 25 June), and they seem to accept the ending of the strike on 28th June as programmed. On the other hand, the CGT wants to continue the strike into July and Sud talks on continuing in August.
Macron seems to have won. This was more an ideological fight than one that will reap benefits for business. The opening of the freight service to competition has led to losses and a decrease in the use of rail for goods transport; it remains to be seen if passenger transport will improve.
The union fight will continue anyway, in order to negotiate the new pay and conditions after the civil servant statute is abolished.
Macron visited the birthplace and on a separate occasion the grave of George Clemenceau (1841-1929). This is fitting since Clemenceau, as minister of the interior, and ‘first cop of France’ (premier flic de France) made his name as a strike-breaker. He earned the nickname of Tiger for his vigour in organising the police service, then he earned the nickname ‘Père la Victoire’ (Father Victory) for keeping the war going in 1917, but he was seconded in that endeavour by Pétain. And then he was the one who wanted punitive measures against Germany after the war. These are three reasons why he has not up to now been adopted as a hero. He said in his last book, while deploring England’s ‘old policy of strife on the Continent’ (aka ‘balance of power policy’):
‘The leader who can fight his corner best is the one who, without empty talk, shows the strongest and most tenacious will.’ This would appeal to Macron.
Eyes Teeth and Ears
Clemenceau was strongly anti-socialist, but he passed laws limiting work in the mining industry to 8 hours a day. Macron is also concerned with the welfare of the disadvantaged, and he is pushing a law designed to benefit the less well off. Macron as candidate promised that glasses, dental crowns etc. and hearing aids would be 100% refunded, with nothing left for the patient to pay, ‘zero remainder to pay”.
Thanks to the new law, the state health system plus personal insurance will refund 100% of dental and eye care costs (deaf aids in 2021). The directive is that contributions to contributory insurance will not go up as a result of this change in the law.
The reform of the SNCF was not in Macron’s election programme. What was in the programme was a reform of the system of refunds for eye, teeth and hearing, which is now getting under way. Many people did not get their teeth replaced, or buy glasses or hearing aids, because of the cost involved, say 2000 euros for hearing aids. Macron said in a speech to the Mutualité congress on 13 June, talking about the 4,7 million people in France thought to forego dental treatment, and the 2.1 million not seeking hearing aids: “Many of our fellow citizens with simple pathologies are forced to give up the thought of seeking care. That means that our fellow citizens are deprived of the possibility of smiling, seeing, hearing, eating normally sometimes, because of this ‘remainder to pay’ which stops access to treatment.”
This is not a simple reform. The Health system pays for a proportion of health costs; 95% of the population contribute, often through their place of work, to a ‘contributory insurance’, which makes a further refund. These supplementary insurance schemes are administered by ‘mutual’ or other groups, for example there is a teacher’s health insurance mutual. These groups belong to a national association called the Mutualité française (to whom Macron was making the speech quoted above). There are a large number of such groups, with varying levels of cover and prices. The government is promising that contributions to contributory insurance will not go up.
So the government negotiated with the insurances companies, to get assurances from them that contributions will not increase, even though insurances schemes will have to pay out more. Macron says the answer will be competition between insurances companies to bring costs down.
The reform also means that the three professions involved will have to give up, partially, their freedom to charge as they like.
So there is negotiation with dentists, to decide which treatments will be refunded 100%; it seems there will be a three-tier system, with the top tier, top of the range, entirely paid by the patient. The government promises that the two lower tiers will be ‘good quality’. Dentists have had directives (e.g., crowns in the back of the mouth will be metal, not ceramic) to keep prices down. In compensation, some operations will cost more (e.g. root canal treatment will go up 20% but still be refunded 100%) so the dentist gets more income.
There was negotiation with opticians and ophthalmologists. Opticians have been invited to provide glasses, thin, anti-scratch and anti-glare, with 17 different frames below 30 Euros.
Negotiations with hearing aid specialists were difficult, and the lowering of costs to patients will be gradual; the price hearing specialists will be allowed to charge will go down, and the refunds will go up over three years.
There will be a mixture of obligations and incentives for these specialists to induce them to meet this new legislation.
Macron pointed out that the market for these treatments will now open wide, with hundreds of thousands of new customers who were previously excluded because of cost now able to seek treatment; this will bring income for dentists etc and also for insurance companies, because members will buy new contracts to extend the cover they previously had. Some people have a supplementary insurance that covers only the eventuality of a hospital stay (which can be 1000 euro a day in the Paris region, excluding cost of any operation), these contracts are the cheapest. The idea is that people will be encouraged to take up new contracts e.g. for dental treatment, confident that now they will no longer have to make up a payment to the dentist themselves.
Until now the public spent 4 billion euro from their own pocket in ‘remains to pay’ for these treatments, and that sum will now be paid by social security plus supplementary insurance. This will happen gradually, and some people will continue to pay for top of the range equipment.
These new refunds will not be means tested, but open only to people with complementary health insurance.
Next year, Macron promises a reform of pensions and a reform of care for the aged. He is taking advantage of the absence of real opposition either in the country or in parliament to push through outstanding reforms. The parties have fallen apart, both the right and the socialists. A quasi non–parliamentary regime can get a lot done.