Oser se passer d'une mutuelle

Article très pertinent dans Le Monde

Premier constat  : les soins de santé, en France, restent largement pris en charge par la Sécurité sociale. En 2014, la Sécu a remboursé 76,6 % des dépenses de santé, alors que les complémentaires en ont assumé 13,5 %. Les ménages en ont payé 8,5  % de leur poche. D’un point de vue macroéconomique, les mutuelles sont donc accessoires.

Deuxième constat  : les complémentaires ont peu d’utilité en cas de maladie grave ou face à un traitement très coûteux, les soins engagés dans ce cadre étant pris en charge à 100 % par la Sécurité sociale.

Autres constats: Les mutuelles couvrent très mal les dépenses mal prises en charge par la Sécurité Sociale (optique, soins dentaires,...) Seules 72% des primes versées sont reversées sous forme de remboursements de soins.

Bref, si l'assurance hospitalisation semble bien justifiée (hors cas de maladies graves), les arguments en faveur de la souscription d'une assurance complémentaire semblent assez légers...

Lawlessness at sea

From The New York Times:

Few places on the planet are as lawless as the high seas, where egregious crimes are routinely committed with impunity. Though the global economy is ever more dependent on a fleet of more than four million fishing and small cargo vessels and 100,000 large merchant ships that haul about 90 percent of the world’s goods, today’s maritime laws have hardly more teeth than they did centuries ago when history’s great empires first explored the oceans’ farthest reaches.

Murders regularly occur offshore — thousands of seafarers, fishermen or sea migrants die under suspicious circumstances annually, maritime officials say — but culprits are rarely held accountable. No one is required to report violent crimes committed in international waters.

Through debt or coercion, tens of thousands of workers, many of them children, are enslaved on boats every year, with only occasional interventions. On average, a large ship sinks every four days and between 2,000 and 6,000 seamen die annually, typically because of avoidable accidents linked to lax safety practices.

Ships intentionally dump more engine oil and sludge into the oceans in the span of three years than that spilled in the Deepwater Horizon and Exxon Valdez accidents combined, ocean researchers say, and emit huge amounts of certain air pollutants, far more than all the world’s cars. Commercial fishing, much of it illegal, has so efficiently plundered marine stocks that the world’s population of predatory fish has declined by two thirds.

One main culprit:

The modern flagging system, which allows ships to buy the right to fly the flag of a country as long as it promises to follow its laws, provides good cover for the unscrupulous.

Usually, a ship may be stopped on the high seas only by a law enforcement or military vessel flying the same flag. The world’s navies, though, have been scaling down for decades. Most nations, including the Bahamas, whose flag the Dona Liberta flew, have no ships that regularly patrol beyond their national waters. (Some landlocked countries like Mongolia and Bolivia offer flags for cheaper costs.)

When wrongdoing occurs, no single agency within a country or specific international organization typically has a sufficient stake in the matter to pursue it. The stowaways on the Dona Liberta, for example, were undocumented immigrants from Tanzania, living in South Africa and brought to shore in Liberia. The ship was owned by a Greek company incorporated in Liberia, crewed primarily by Filipinos, captained by an Italian, flagged to the Bahamas and passing through international waters. “Who leads such an investigation?” Mr. Young asked.

Stowaways as collateral victims of tightened borders:

More humane captains put stowaways to work before dropping them off at the next port. But in recent years, European immigration laws have tightened, terrorism fears have grown and port authorities around the world have responded by raising the penalties for ships arriving with people not listed on the manifest.

Targeted transfers in the Big White Ghetto in the US

I am not a big fan of National Review, but this article is worth reading. It describes the "Appalachian white ghetto", one of the poorest parts of the US:

There are lots of diversions in the Big White Ghetto, the vast moribund matrix of Wonder Bread–hued Appalachian towns and villages stretching from northern Mississippi to southern New York, a slowly dissipating nebula of poverty and misery with its heart in eastern Kentucky (...)

If the people here weren’t 98.5 percent white, we’d call it a reservation.

The most interesting part of the article is the description of the use being made by locals of the "food stamp" (EBT) program:

it turns out that the local economy runs on black-market soda the way Baghdad ran on contraband crude during the days of sanctions.

It works like this: Once a month, the debit-card accounts of those receiving what we still call food stamps are credited with a few hundred dollars — about $500 for a family of four, on average — which are immediately converted into a unit of exchange, in this case cases of soda. On the day when accounts are credited, local establishments accepting EBT cards — and all across the Big White Ghetto, “We Accept Food Stamps” is the new E pluribus unum – are swamped with locals using their public benefits to buy cases and cases — reports put the number at 30 to 40 cases for some buyers — of soda. Those cases of soda then either go on to another retailer, who buys them at 50 cents on the dollar, in effect laundering those $500 in monthly benefits into $250 in cash — a considerably worse rate than your typical organized-crime money launderer offers — or else they go into the local black-market economy, where they can be used as currency in such ventures as the dealing of unauthorized prescription painkillers — by “pillbillies,” as they are known at the sympathetic establishments in Florida that do so much business with Kentucky and West Virginia that the relevant interstate bus service is nicknamed the “OxyContin Express.” A woman who is intimately familiar with the local drug economy suggests that the exchange rate between sexual favors and cases of pop — some dealers will accept either — is about 1:1, meaning that the value of a woman in the local prescription-drug economy is about $12.99 at Walmart prices. (...)

It’s possible that a great many cans of soda used as currency go a long time without ever being cracked — in a town this small, those selling soda to EBT users and those buying it back at half price are bound to be some of the same people, the soda merely changing hands ceremonially to mark the real exchange of value, pillbilly wampum. 

Direct cash transfers also have drawbacks:

“The draw,” the monthly welfare checks that supplement dependents’ earnings in the black-market Pepsi economy, is poison. It’s a potent enough poison to catch the attention even of such people as those who write for the New York Times. Nicholas Kristof, visiting nearby Jackson, Ky., last year, was shocked by parents who were taking their children out of literacy classes because the possibility of improved academic performance would threaten $700-a-month Social Security disability benefits, which increasingly are paid out for nebulous afflictions such as loosely defined learning disorders.