Quel avenir pour la Sécurité sociale ?

Abstract

What Prospects for French Social Security ? A. Fonteneau, A. Gubian, H. Sterdyniak, C. Verpeaux In the future, the ageing of the population, increases in health expenditures, the rise of unemployment and the necessity to encourage the birth rate will make the problems of the social security more acute. Is it possible to finance spreading social transfers without undermining economic growth ? Could one reform the social welfare system to avoid the extension of transfers ? To get clearer social choices and to aim at macroeconomic balance, social benefits should be financed only by households. Workers would contribute to the insurance role of social security ; income tax would provide for solidarity. Shifting all contributions on to wage earners and raising wages accordingly would have no short-term impact. However, employers would be assured that gross costs were not to be increased and indeed would remain stable. Replacing employers' contributions by a turnover tax or by VAT would not result in better economic performance. Substituting part of the employers' contributions by a tax on machines would stimulate the saving of capital and employment. A solution of liberal obedience that would separate solidarity financed by the Government from privately financed individual insurance seems neither viable nor desirable. As far as health expenditures are concerned, the development of private insurances would deny the principle of equality of all men in respect of medical care. Insurance companies would be tempted to make a select among their potential clients and to exclude those who present too many risks. Two other ways seem to be more promising, even though they include risks. In the first case a centralized control of the care supply is based on an assessment system of medical techniques. In the second one, coordinated networks of care are based on decentralization.