The 7 Primary candidates from the left answer Pourquoidocteur’s questions. The day after the 1st TV debate, place the former Minister of Education Vincent Peillon.
After the success of the Primary of the right and the center (4.4 million voters in the second round) which crowned François Fillon, it is the turn of the French left to elect – on January 22 and 29 – its candidate for the 2017 presidential election. And a notable change has taken place compared to the previous election, health is at the center of the debates. Health insurance, hospital … the French wanted to hear about it, they are served.
But a few days before the second televised debate (1), Why actor wishes to expand the list of medical subjects to be addressed (cannabis, environment, etc.) Our series of interviews with the seven candidates for the Primary of the Belle Alliance populaire ends the week with the former Minister of National Education Vincent Peillon.
The community will no longer be able to cover the cost of innovative drugs. Should we devote a specific budget to the support of these therapies, and how to finance it?
Vincent Peillon : The price negotiation of targeted therapies, mainly in oncology, must be done collectively, on a European scale, to benefit from the largest possible volume effect. The cost of clinical research is the essential argument justifying these very high prices. But is the current, very expensive therapeutic trial model with its large patient cohorts still suited to the age of personalized medicine? Reviewing our standards would lower costs. Finally, it is essential to better promote French fundamental research. We have top researchers, doctors, pharmacists. A certain number of drugs are the result of the discoveries of our teams. The establishment of a public drug sector is an option that we must study.
To ensure the coverage of health expenses, should mandatory reimbursements be limited to serious and / or chronic illnesses (care basket), or rather act on funding by broadening the base of levies (for example with the CSG )?
Vincent Peillon : I will not reimburse any care. Financing our social protection is a strong political act, it corresponds to the wish of the French, that of maintaining an efficient and united system. I am proposing a merger of the CSG with income tax, because it is the fairest way to finance social protection. Significant structural savings are possible: by setting up an ambitious prevention strategy, by continuing the ambulatory shift, by setting up the shared medical file, and for public hospitals by revising the public procurement code and renegotiating the rate of Bank loans. I want to give sufficient budgetary means to the health system, while optimizing public spending in this sector.
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Hospital
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The hospital must simultaneously reconcile medical excellence with its social missions. In view of the budgetary constraints, does activity-based pricing (T2A) appear to you to be suited to this dual requirement?
Vincent Peillon : Pricing per activity must evolve to adapt to all hospital activities, but its philosophy is not to be called into question: it allows hospital care activities to be valued as closely as possible. What is at issue is the level of prices, which have been falling continuously, several times a year, for too long! This drop must be stopped, which is why the level of the ONDAM must evolve in line with the natural evolution of health expenditure. We have reached an untenable level for the public hospital.
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Medical deserts
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One in four general practitioners will not be replaced by 2025. How do you plan to fight against medical deserts?
Vincent Peillon : I am against coercive, ineffective and counterproductive measures. The only numbers of doctors available are those combining employment and retirement, and the ever-increasing number of replacements. I want to encourage them to practice in areas that will be recognized as a priority at the level of the large regions, through advantageous fiscal measures. In the long term, the aim is to promote the emergence of outpatient care teams, grouped, coordinated, and structured, carrying a medical and paramedical project at the service of a population pool. The regionalization of the incentive to settle around a single player, the ARS, is essential. Finally, the development of telemedicine, whose effectiveness has been demonstrated, must be a priority.
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Cannabis
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France is the European champion of cannabis consumption. It is also the country which has the most prohibitive law. Should we decriminalize use and should the State organize the production and distribution of cannabis?
Vincent Peillon : I think this subject deserves an honest debate, taking into account the imperatives of public health. Many quality works exist, as well as several examples abroad. I undertake to open a consultation, without passion or dogmatism, to arrive at a concerted and reasonable proposal. On these subjects as on the others, I claim a method of government: that of intelligence.
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PMA
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In a manifesto, French doctors admitted having helped lesbian couples and single women to resort to assisted reproduction abroad. Can we continue to reserve it for heterosexual couples?
Vincent Peillon : I am in favor of opening medically assisted procreation for female couples, it is a measure of equality and social progress. I undertake to implement it.
What would be the first concrete measure you would take to limit the harmful effects of pollution on our daily lives? And when?
Vincent Peillon : The first victims of pollution are, as always, the most fragile: those who live in poorly insulated housing, who live near major highways. The ecological question is closely linked to the social question. We must make our modes of transport more sober, by gradually phasing out diesel, which I plan to ban in 2025, but also by investing in research into clean vehicles and renewable energies. I want to increase their share to 32% of final energy consumption in 2030 and 40% of electricity production. I will direct the research funds towards questions of production and distribution of renewable energies.
(1) Sunday January 15: second citizen Primary debate. The 7 candidates, Jean-Luc Bennahmias, François de Rugy, Benoît Hamon, Arnaud Montebourg, Vincent Peillon, Sylvia Pinel and Manuel Valls will debate at 6 p.m. on BFMTV and Itele.
Monday January 16, find our interview with François de Rugy
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