Clément Viktorovitch returns each week to the debates and political issues. Sunday, June 4: the divisive question of state medical aid, which allows foreigners in an irregular situation to benefit from certain care.
The Republicans have announced that they could agree to pass an immigration law, provided that the government agrees, among other things, to question state medical aid. Gérald Darmanin replied that he was ready to discuss it. But this is a trapped debate, a sea serpent that keeps coming back when we talk about immigration.
Created in 2000 by the government of Lionel Jospin, the AME has never ceased to be challenged since. First, by the National Front, then the National Rally, but also part of the UMP then, today, almost all the Republicans: all criticize this aid, which benefits nearly 400,000 people. It would create a “draft”, even a “suction pump” which would encourage irregular immigration and would weigh on the state budget.
But there is nothing to confirm this objectively. Already in October 2019, the previous Defender of Rights, Jacques Toubon, regretted “the misconception that the AME would lead to the reinforcement of illegal migratory flows”. The following month, in November 2019, a major study conducted by the Institute for Research in Health Economics provided eloquent evidence: half of those eligible for AME did not take the steps to benefit from it. The vast majority of exiles interviewed do not even think of citing health among their reasons for emigrating. For these researchers, the conclusion is clear: “Any measure aimed at limiting the AME in order to combat illegal immigration would certainly miss its target. The risk, on the other hand, would be to endanger the state of health of a very precarious population.”
The AME represents 0.5% of health expenditure
The AME has a cost, it’s true: more than a billion euros per year. On paper, that’s a lot. But this actually represents only 0.5% of public health expenditure. We are in the thickness of the line. And above all, the AME probably brings in more than it costs. As Professor Pierre Tattevin, vice-president of the Society for Infectious Pathology, reminds us: “Many historical examples have shown that epidemic control is more difficult and more costly when the reaction is delayed, which is inevitable if one restricts access to care.”
The Republicans and the RN are not asking for the outright abolition of the AME: on the contrary, they are proposing to retain emergency medical aid. But all the doctors tell us that it is inapplicable in practice. For a simple reason, moreover: from when is a treatment considered “vital”? Are we going to voluntarily let pathologies deteriorate in order to treat them only when they are much more dangerous for patients, and much more costly for the health system? And even, beyond that, from an ethical point of view: what about painful but non-vital pathologies? For example, imagine a 12-year-old girl. His parents took him across the Mediterranean in a boat. It is present on the territory, illegally perhaps, but it cannot do anything about it. This little girl has a decayed tooth. It is painful, but it is neither vital nor urgent. Are we going to let this young girl suffer, when we could treat her? This is, concretely, what the abolition of State Medical Aid would lead to. We can wish it. But then you have to agree to face up to the suffering that you create.
The executive is ambivalent on this issue
On the one hand, Gérald Darmanin opened the door to a questioning of the AME. On the other hand, it is precisely this presidency that has contributed to restricting State Medical Aid. Since 2019, it is necessary to justify three months of presence on the territory to be able to benefit from it. And above all, the administrative procedures have been made much more restrictive. Result: last March, a study conducted by several associations, including Médecins du Monde, highlighted a significant deterioration in access to AME due to “from an accumulation of administrative obstacles”. In other words: today, in our country, some of the people present on the territory without a residence permit are no longer treated. And it is the President of the Republic who bears the responsibility.