There is currently an active debate taking place on the extent to which solidarity should be maintained in our health care system. According to some surveys, 30% to 40% of the Belgian citizens who responded are in favour of excluding people aged over 85 from expensive forms of care. In addition, 20% to 40% would accept differentiation in terms of the extent to which health care is reimbursed or the contributions that must be paid, on the basis of lifestyle: people with an unhealthy lifestyle either having to pay a higher contribution or receiving a lower reimbursement when they become sick 20.
If, however, citizens are given the necessary time to consider this issue and the space to debate it with each other and with experts and stakeholders, they are in fact still very strongly attached to a public health insurance system based on the principles of solidarity and everyone’s right to health care.
The citizens also support the principle of so-called ‘lifestyle solidarity’ – solidarity with those who are at greater risk of incurring medical costs because of their behaviour (see also the section on ‘Responsibility’ below). They also reject the use of a maximum age or maximum price above which a treatment is no longer reimbursed: age must not be used to exclude people from having a particular treatment.
The deliberative citizen confirms that solidarity must remain the core principle of our health care system. Solidarity is based on the idea that, in principle, all ‘health victims’ are helped. The traditional role that we have assigned to health care systems in Europe is that they help everyone (‘no patient is left behind’). In concrete terms that means that we organise solidarity at the level of society and we show solidarity to everyone.
The unconditional provision of care and support to people is based on the idea that all people are naturally of equal value but the circumstances of our lives differ drastically. Consequently there is no need for a balance in terms of the cost of each individual person to the system. Hence the idea of social security: what happens to us could happen to anyone, so we show solidarity to each other.
The CitizenLab shows that we have to be very careful when interpreting surveys and questionnaires addressed to individuals which claim that solidarity in health care is coming under pressure.