France: Heat wave catastrophe exposes health care crisis

The health crisis that erupted in France following the August heat wave was anything but accidental. For years, health care workers had been warning of the potential results of policies that have led to shortages of staff, lack of training and equipment, hospital closures and more expensive health care for the public.

The crisis came just weeks before the right-wing government of Jacques Chirac and Jean-Pierre Raffarin planned to impose a “reform” package aimed at the foundations of health care as it has existed in France since the end of World War II. Not surprisingly, the government has found itself confronted with a massive wave of anger, especially from health workers and doctors, whose warnings and fears have been tragically confirmed.

The most immediate cause of the heat wave’s heavy death toll was the inaction of the government, which ignored calls for emergency intervention as fatalities rose dramatically in the first two weeks of August. Ministers stayed in their holiday residences, while President Chirac remained silent for three weeks as the heat wave was allowed to take its heavy toll. When the government finally returned from their holidays, and was forced to intervene amidst a mounting wave of public anger, their first reaction was to blame ordinary people and to defend their own inaction, refusing to take any responsibility for the disaster.

For two weeks after the peak of the heat wave in mid-August, the French administration refused to release any official figures, insisting it could not gather accurate estimates. For over a week a polemic raged over the number of heat-related deaths. Serious doubt was cast over the government’s motivation following its refusal and alleged inability to publish figures. Many doctors, health officials and funeral services challenged the government’s handling of figures and accused it of trying to minimise the crisis.

On August 23, Raffarin was roundly booed when he opened the World Athletics Championships in Paris. Finally, on August 29, the government suddenly announced that over 11,000 people had died in France’s heat wave in the first half of August alone.

For the last two weeks of August, Chirac and Raffarin persistently tried to push the line of most of the media—faithfully parroted against all evidence—that “everybody was responsible” and that the lesson from the heat wave was that the French lacked a basic sense of solidarity. To ensure the message got through, much fuss was made by administration officials and the media about corpses of victims not being claimed by relatives and having to be buried in unidentified paupers graves. This was then cynically used to make a case for the need for everybody to “show solidarity” with the elderly.

In fact, criticism of health care for the elderly in France is not new. Opposition to government cutbacks also has a tradition. Between 1988, which saw one of the biggest strikes by hospital staff in post-war history, and 2003, there have been a series of strikes and demonstrations opposing budget cuts, hospital closures, cuts in services and medicine. The protests were aimed at the refusal by governments—both those led by the Socialist Party and those of the right—to invest in health and against their moves to privatise the health service.

Health workers and doctors have consistently warned against the general decay of the health system and its dangerous consequences for the population. In the last four years alone there have been numerous protest actions by almost all sections of the health service, nurses, junior and senior doctors, dentists and hospital staff in general. These protests were invariably portrayed by the various governments as selfish or sectionally motivated and as a disruption of patient care. From 2000 through 2003, hospital staff staged large demonstrations and widespread strike action, either on their own or together with other public service workers.

The staff of many hospitals went on strike again in May and June of this year as part of a massive movement against attacks on pensions and to protest plans of the government to impose its new “hospital plan,” whose aim is hospital privatisation.

On June 18, the 16 professional organisations for homes for the elderly in France called for a day of protest against government policy. In a joint statement they explained their action: “Because we (the residents, families and directors) don’t want second class social insurance and we don’t want to wait any longer: social security (health insurance in France) has been created by our generation not only for the young, the rich and the ill, but also for the elderly, the poor and the handicapped ... because we want solidarity in society which doesn’t forget its elders in the old people’s homes...”

Far from responding to these demands, the Raffarin government is exploiting the crisis in order to impose even more drastic attacks on the health care system. On August 26, Raffarin invited a number of representatives of health and elderly care organisations for talks at Matignon (the residence of the prime minister) to discuss the health crisis, but he refused to free up any emergency finances or even discuss what money might be made available. Prior to the meeting, heads of care homes had been demanding a “Marshall Plan” for the elderly, asking for 7 billion euros to be made available. Instead, Raffarin announced at the end of the talks that he intended to scrap one public holiday to pay for elderly care!

Following this announcement, and notwithstanding widespread public hostility to the proposal, the main “debate” in the media focused on which public holiday should be sacrificed to finance support for the elderly. Various proposals were made for a holiday to be sacrificed including May 8 (celebrating the defeat of Nazi Germany), November 11 (commemorating the Armistice of 1918) and Pentecost Monday. The Catholic Church was one of the first to approve, indicating that there was no “theological” argument against the scrapping of Pentecost Monday. The head of Medef (the employers federation), Ernest-Antoine Seillières, speaking from the Medef’s yearly “Summer University” conference near Paris, immediately congratulated the government, saying the proposal was “terrific” and that in order to resolve problems “people had to work more in France.”

Deputies of the right-wing UMP (United Movement for the President) immediately went into overdrive and stated that France had the highest number of public holidays in Europe anyway (which is not true), with former Prime Minister Edouard Balladur even calling for the scrapping of two public holidays. Raffarin argued that such a step had been taken in Germany already and was quite normal. In reality, the move to cut a Bank Holiday in Germany was vigorously, if unsuccessfully, opposed by workers in 1995. Employers are now demanding—independently of the question of funding elderly care—that more public holidays should go, arguing that people should work more for the same wages.

The employers federation clearly took the government’s announcement as a signal that their calls for more work for less pay have been heard and that they could soon expect the removal of any obstacles to lengthening working hours. One of the first reactions by ministers accused of negligence by doctors had been to blame the 35-hour week introduced by the previous government, declaring (against all evidence) that this measure had created the crisis by reducing hospital staff coverage.

The announcement sparked a wave of vocal opposition from the official left (the Socialist Party, the Communist Party and the Greens) and almost all the trade union organisations, many expressing disbelief at the government’s attitude. Others denounced its cynicism or made satiric comments. One Force Ouvrière local union branch proposed to celebrate Christmas once every four years, if the Medef decided that Christ was born on February 29. Many of these statements were made to pre-empt the deep public anger caused by the government’s actions.

The unions are not fundamentally opposed to these sorts of measures and are clearly quite ready to discuss attacks on pensions and health care with the government. In fact, this very measure had been discussed before the heat wave struck with at least one trade union, Force Ouvrière. According to Agence France Presse, FO leader Marc Blondel said, “The prime minister had already mentioned to him the ‘idea of working one day for nothing and to put the resulting bonus to the handicapped, an idea that was suggested to him by (Health Minister Jean-François) Mattei.’”

The crisis is far from over for the Chirac-Raffarin government. On September 2, Raffarin, visibly perplexed by the opposition which erupted during August and the battering taken by his health minister, announced he would postpone the “reform” of social security (the health insurance system) until October 2004.

This “reform” consists partly in the plan to open hospitals and old peoples homes to private capital along the lines of the “American model.” For that purpose, changes in structure and management of hospitals are supposed to be carried out, with the aim of running them according to market-based criteria. A burgeoning private health market has developed and is rapidly expanding—to the extent that some private health operators are now quoted on the Paris stock exchange.