If there is but one rare subject on which the president of the Republic
seems to make unanimity today, it is the one on the importance of urgently
settling the issue of dependency of the elderly.
From left-wing to right-wing, everyone seems to think that because of the
lengthening of life expectancy, we will soon be flooded with an army of
disabled elderly, alzheimerised or parkinsonian, whose pensions will not be
enough to pay the cost of their care, and who will need to be assisted for a
great many years. Everyone believes that if we are not able to finance this
risk in advance, we will see reappearing the old hospices, where millions of
old people will be abandoned for decades to a pitiful fate.
Actually, the fact of living longer does not increase the duration of
dependency, it only delays the final year of life, which constitutes the
bulk of health care expenditures. Except for the small number of those who
are or will be dependent: They are now one million (3 million if you count
the low-level dependencies) and their number will increase by only 1 to 1,
5% per year by 2040. The average duration of dependency is 3.7 years for
men. One more year for women. Half of people reaching 65 will experience a
year of dependency. Only 6% of men and 15% of women will experience more
than 5 years of life in dependency. Their cost, today of about 1% of GDP
will increase by 4% a year, with 2.7% per year paid by households, including
1.1% covered by pensions. What is left to be financed will only grow to 1,
6% per year. Where is the financial avalanche?
In addition, technical progress will reduce these costs by improving health,
and allowing home maintenance for the elderly. Finally, expenditures for
dependent care assistance are creating a large number of jobs.
Dependency thus is not a major issue today. In reality, the reason why this
subject is terrifying is that we are in societies dominated more and more by
selfishness, of every man for himself, and loneliness. Everyone thinks, deep
down, that he will be abandoned by his children, whom in fact he has abandoned,
and he can only rely on himself, or society, but no more on his family.
Hence a debate that will likely be about the only narrow dilemma between
funding by contributions of a « fifth risk » (by society) or by insurance (by
oneself). In addition, by calling on the need to finance these expenditures
supposedly cataclysmic, proponents of reducing health care costs hope to
find another argument to justify their position.
Finally, as we are increasingly in a society dominated by old people, it is
no coincidence that the president has chosen as the great national challenge
this subject and not that of nursery school, those who fear hospices vote;
those who are forgotten without formal education of quality do not vote.
There is set up the gear: Young people, who are forgotten, take revenge on
old people, who live off the backs of the youngest.
If we want to break this infernal circle, we must recognize that the real
issue of dependency is elsewhere, in the care for one another, in family
ties, in the way parents care for their children, in empathy, in
brotherhood, in altruism.
The president is right to want a debate on the subject of dependency. It
will be worth it only if all the facets are examined.