Wednesday, November 16, 2011

Attacking Welfare Fraud--Again

Sarkozy and his minions are highlighting the issue of welfare and health care fraud and publicizing the cost to the state. They will do something about it, they promise, if re-elected in 2012. The only problem is that they harped on the same string in 2007, made the same promises, and accomplished nothing in the four years since then. As policy, therefore, their promises ring hollow, but of course the purpose of such campaign rhetoric is not to outline policy but to stigmatize groups associated with the other side.


Kirk said...

You may be wrong. I think they have started implementing a lot of stuff to combat fraud, but it's taken a long time.

You're aware of what a Carte Vital is, I'm sure. I had to visit a hospital in Lyon a couple of months ago, and, even after presenting my card, I had to show a photo ID. The person explained that this was recently implemented to ensure that multiple people don't come for health care on a single card (apparently something that happens often with sans papiers).

The other day, talking to my dentist, as I waited for numbness to set in, she explained that the cards, when renewed, will have to have photos, to simplify the process of checking who they belong to.

Now, I don't know how much this represents, but given the size and inertia of the French system, I think it's fair to say that any measures to combat fraud do take some time to get put into action. So I'd be less critical than you.

Arthur Goldhammer said...

Fair enough.

FrédéricLN said...

Same as Kirk. There has been some progress in the efficiency (and profile) of anti-fraud departments.

But the two main sources of fraud are 1) under-declarations by companies about their staff — and Mr Sarkozy's TEPA law about "heures supplémentaires" did increase the issue, rather than reduce it ;

2) RSA, that has been created by the present government. I don't know if the fraud is larger than with the previous RMI. But there is an issue around any aid adversely related to other incomes: a strong incentive to under-declare your other incomes. We (MoDem) were rather in favour of a points-scale-based unified allocation, and stronger transfer of "social cotisations" (on wages) onto taxes, in order to make work "naturally favourable" to workers (instead of subsidizing work).

Steven Rendall said...

The area of "arrêt maladie" is a current target, and seems to me to in fact need serious revamping. Doctors have no real incentive not to give patients time off at full pay anytime they are asked for it. We know several people who are on long-term arrêt maladie because they find work "too tiring." At the risk of sounding like an American right-winger (which I most emphatically am not), it's evident that a lot of people are "working the system" rather than working--the result being that people who really need the help may end up not getting it.

Steven Rendall said...

Checking my facts, I found this on the French Wikipedia: "Les indemnités journalières maladie représentent 6,6 milliards d'euros en dépenses par an en 2011. Elles progressent à un rythme élevé: + 3,9 % en 2010, + 5,1 % en 2009"--so significant amounts of money are involved here. Fonctionnaires who receive a certificate from their doctors have a right to three months' pay at full time, and half-pay for another nine months; in the private sector, social security pays half the salary, and the employer usually picks up the rest. Reforms so far have consisted in increasing the number of days before payments begin, from three to four, which does not address the basic problem. There appears to be no mechanism for verifying the doctor's assessment, and the grounds for the leave often seem ludicrous. The system almost seems to invite abuse.

Kirk said...

Actually, the can verify the doctor's assesment, and call you in to see a doctor who works for the Securité Sociale, but it doesn't happen often. What does happen more often is random visits to people's homes to see if a) they are home, and b) they look sick. If you're on paid sick leave, you're only allowed to leave home at certain hours, or to visit doctors, so this does weed out some of the slackers.

Every once in a while, on the news, they do a hidden camera thing where a journalist goes to three doctors, says s/he isn't feeling well, and tries to get put on sick leave. In most cases, it works with more than 50% of doctors. However, in recent years, you've been required to chooes a primary doctor (medecin traitant), so it's not as easy to just go to any doctor to get put on sick leave.

(BTW, that's another anti-fraud technique that's been implemented. Now, if you want to see a specialist, you have to go to the medecin traitant first and get a letter from them. This apparently prevents people from seeing multiple specialists for the same problem.)

There is a lot of abuse; over the years, I've known lots of people who take advantage of it. In the many years my son was in school, the number of teachers out of work for more than a couple of days was always quite amazing. In lycée, there was a philosophy teacher who was out several months _every year_.

Yet, on the other side of the coin, freelancers such as myself get no sick pay, unless we take out a private insurance contract for it. Yet I pay _more_ than an employee in payroll taxes.

Anonymous said...

Of course there are abuses of the system, but this police-like checking on people who say they are sick shouldn't be the sole priority!

I once met an older doctor, who told me that, decades ago, when he was a beginner, people would come to him, not even pretend they were not feeling well, just coolly ask for a two-weeks "arrêt de travail", because they wanted to repaint their house or something. And the doctor knew perfectly well that, should he refuse this outrageous demand, the guy would just go to other doctors, at the expense Social Security, until he found one willing to sign the form.

But he tells me he is confronted these days by an ever-growing problem, that of totally exhausted and ill people, for whom he suggests some rest, and the patient refuses, as, if he is not then fired on some pretext, he won't be replaced and will have to work doubly hard upon the return to catch up with the backlog accumulated in his absence.


Steven Rendall said...

Good points. It's true that inspectors occasionally check up on people who are on long-term medical leave. But the crucial thing here is that there is little checking-up on doctors, despite the measures rightly mentioned by Kirk. I am not against arret maladie; on the contrary. I just think steps to prevent abuse may be necessary to save it.