Martin Hirsch: "What if we created a public health service?"

The bill aimed at limiting the freedom of doctors to set up [ adopted on first reading on May 7 ] divides all the unions Medical professionals have found their unity to oppose it; local elected officials have overcome partisan divisions to demand its adoption; the government has come up with an alternative with the obligation to devote two days a month to areas under pressure; patients are seeing the spread of medical deserts, an expression that has little geographical reality, because access to certain specialties is sometimes complex in certain metropolises, including Paris.

What if this debate stumbles on the fact that we haven't approached things in the right order? Shouldn't we start by creating a public health service, which, curiously, doesn't exist? When it comes to organizing healthcare, there is a public hospital service, but primary care doesn't follow this logic. It's a bit as if, in terms of education, the public service began at high school or university and had "forgotten" primary and secondary school, with everyone having to manage the first years of education on their own.

This "oversight " is no accident. It serves as a reminder that a century ago, health insurance was established with opposition from the medical profession, with a sort of "Yalta": national solidarity would not contradict the principles of liberal medicine, including freedom of establishment, but also payment per service, and would not interfere with the organization of non-hospital care.

However, the Public Health Code does recognize a broad right for patients: "Every person has, taking into account their state of health and the urgency of the interventions that it requires, the right to receive, throughout the territory, the most appropriate treatment and care." And the initial article of this code, L. 1110-1, charges "health professionals and establishments, health insurance organizations (...) and health authorities (...) with local authorities and their groups" to "guarantee equal access to care for each person." This right is reflected in health insurance that has very recently become universal, but not in the organization of care, which deprives it of part of its content.

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