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For more than 15 years, the public authorities have been groping about the subject of financing dependency care in France. After many reports, the most recent of Mr Libault made on March 28, 2019 presented 175 proposals “for a strong and new policy of old age in France” which were to serve as a basis for a law announced at the end of 2019. While this issue appeared in head of the concerns expressed during the Great Debate, the tumultuous news of recent months (pension reform and today the Covid-19 epidemic) got the better of the legislative calendar. But this subject nonetheless remains a crucial issue for our society.

A paradoxical but profound evil

The evil is deep even if, paradoxically, it stems from good news for Humanity: we are living older and older. Thus, the number of centenarians is expected to increase from 21,000 today to 165,000 in 2050. Much more seriously, the working population in France should contract by 5% by 2060 (and even more strongly elsewhere in Europe: -35% in Poland, -30% in Germany, -20% in Spain for example); but coupled with the fact that only 6% of Europeans can finance the costs of taking care of dependency with their retirement income, it is a cataclysm that risks befalling our societies if nothing is done to stem this issue. All the more so since the drop in the frequency of dependency risk is not expected for a long time, on the contrary (today, 17% of people aged 70 and over are dependent; 2 in 10 people die in a situation of dependency heavy).

So who should take the lead?

If the State must initiate change, it cannot take charge of this issue alone; it is important that it also mobilizes the insurance sector, but also citizens.

The state could then decide to create a 5th risk of social security; the consequence of this would be to be able to target funding and, above all, to force the French to participate in this insurance mechanism. But this new compulsory and solidarity insurance will certainly not be sufficient to cover the dependency risk in its entirety (one in two dependent people is not eligible for APA according to a recent study by INSEE). Insurance companies, which today find it difficult to sell their products as citizens are convinced that the public authorities will seize on the subject, should be led to offer additional cover for this public base; with regard to the nature of the risk (significant time lag between the initial subscription and the occurrence of the risk,prediction of the occurrence of the risk still very difficult) private insurance should even be compulsory and reinsured. A 3nd additional financing lever should also be able to be mobilized, that of assets (today valued at more than 5 billion), especially since the financing needs of the economy are very high.

Waiting for everyone to die in good health

Even if the biology of aging (which aims to allow the elderly to stay in good health by fighting or even eliminating diseases linked to aging) is a discipline in full development, it will take a few more decades before its applications benefit everyone. world in routine.

In the meantime, prevention , from an early age and not only from the moment of retirement, can also be an important means of changing mentalities and adapting our society to an aging society. Beyond primary prevention actions, other levers must be activated to delay the age of entry into dependency: keeping an activity and continuing to acquire knowledge.

The law so often postponed and now announced for next summer (at least the bill) will it be the law that was originally planned 10 years ago or will it incorporate all these key elements (the financing in its plurality, a real prevention plan, in addition to the upgrading of old age professions in particular)? This is now becoming essential in order to successfully set up a fair and efficient system.

Clément Laverdine and Olivier Milcamps

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