A budget that plans to reduce health spending
The French Hospital Federation (FHF), representing hospital management, sound the alarm. According to his estimates, the Social Security Financing Bill (PLFSS) of 2025 presented this October 10 by the Barnier government, will greatly worsen the situation of hospitals.
Alongside the attacks on pensions, whose indexation to inflation will be frozen until July 2025, the social security budget plans to put health insurance on a diet. Since 1996, the State has had an austerity management tool, the National Health Insurance Expenditure Objective (Ondam), through which it sets each year in the budget a maximum amount allocated to health expenditure. This year, Ondam is set at a 2.8% increase in spending compared to last year’s budget.
Behind this apparent increase is in fact an austerity cure against the hospital. During the 2024 budget, the CGT compared the increase in the budget allocated to health insurance with the “natural evolution” of health spending (aging of the population, renewal of equipment and infrastructure), which the union then established at 4.6%. In fact, in relation to the increase in needs, the funds allocated to the hospital are decreasing!
We must also take into account inflation, estimated at 1.8% in 2025, which eats into the 2.8% “increase” in authorized expenditure. Hospital management is also warning that these expenses will be largely affected by the increase in pension contributions. Indeed, the 2025 budget could require employers to increase the share of contributions paid to the national retirement fund for local authority employees (CNRACL), to which those in the hospital public service are attached.
The systematic use of contract workers (who contribute to the general system) under the grounds of austerity and managerial logic in hospitals massively reduces the number of contributors to the civil service fund. Likewise, stagnant wages represent a shortfall in terms of contributions. The CNARL could thus find itself in debt to the tune of 11 billion euros by 2030. The responses of the bourgeoisie are known in such cases: after having organized the shortage, it prepares the switch to the general regime of workers in activity or attacks against retirees in the sector to reduce expenses.
Once inflation and the increase in pension contributions are taken into account, the French Hospital Federation estimates that the real increase in health spending could reach only 0.2% compared to 2024, or 200 million euros… The FHF estimates that hospitals need a budget increase of 6% for their proper functioning – proper functioning which remains far from the standards of care of previous decades. The situation, already extremely serious, will therefore get worse.
Hospital staff, on the front line of austerity
But the FHF’s alerts in the press clearly focus on the refusal to pay the increase in employer contributions to finance pensions. Taking note of budgetary rigor, hospital management will place all the sacrifices on the workers. Because the demands for a budget increase from health employer federations are largely hypocritical. The FHF is led by executives from the parties who have shared power for decades in this country and who have all actively participated in the destruction of the public hospital. From its former president Gérard Larcher, leader of the LR in the Senate, a good part of whose team now sits in the government, to its current president, Arnaud Robinet, member of Horizons, a party which supports Emmanuel Macron, all will in reality support the austerity budget planned by Barnier. Everyone is responsible for the deterioration of the health system!
It is the hospital workers who will have to deal with budgetary rigor, they are the ones who will have to deal with patients and families, and who, with disregard for their health, will work to the point of physical and moral collapse to avoid the tragedies which are the cost of austerity imposed on the rich and the bosses.
These tragedies will be suffered by the most precarious workers. Those who cannot afford to go to a private clinic or who live too far from health centers. They are the ones who will suffer the deterioration of care and services, the increase in treatment times (the time to get an appointment has doubled in a few years) or delays in diagnosis, including in cases of life-threatening emergencies.
Only workers can avoid disaster
Faced with this situation, numerous local strikes take place more or less permanently to protest against degrading working conditions and the impossibility of providing proper care. Since the end of summer, strike notices have been popping up here and there. In Le Havre, emergency workers have been on strike since July. In Toulouse, staff in the pediatric hemato-immune-oncology department started an indefinite strike last week in order to obtain a bonus for the “critical care” they perform. In September, midwives at Toulouse University Hospital launched a strike to demand additional positions facing staff burnout. In Beaujon in Hauts-de-Seine, the unions meeting in a general assembly filed a strike notice on October 4 in order to obtain additional resources
Same thing at Vichy, in Clermont-Ferrand or even in Lorientwhere caregivers and researchers begin mobilizations.
These local reactions demonstrate the need for a coordinated overall plan, preparation for massive and widespread struggle. However, during this time, the union leaderships are committing to the government to participate in social dialogue to find, in collaboration with the employers, ways to save money on our backs.
Faced with a radialized bourgeoisie that wants to violently attack public services and the civil service, there is nothing to discuss! There is an urgent need to organize a determined fight for a 100% public health system, under the control of health workers and users! An ambitious and well-prepared mobilization in the health sector could attract the sympathy and participation of the entire working class and a very large part of the population. It is on these forces that we will have to count to fight against the austerity of Macron, Barnier and Le Pen.
