Health service rebellion

After 100 days in office, the Catalan regional government headed by nationalist Artur Mas is facing a rebellion from health workers who are protesting against cuts to the public health system. The issue has garnered widespread public support, with unions and opposition parties joining in the protest. But protests to proposed cuts to the welfare system are not limited to Catalonia, and could well become a major issue in next year's general elections. Whichever party emerges victorious will face huge problems in maintaining health spending. The system is on the verge of collapse, and its deficit continues to swell: at present it is between 11 billion and 15 billion euros. At the core of the problem are the costs of caring for an aging population, and the universal trend for healthcare costs to spiral.

If Spain intends to avoid economic collapse in the face of the demands of the money markets, then it will have to rethink the way that its healthcare system is financed. In short, reform is both urgent and unavoidable; this is why Catalonia's regional government has put the matter at the top of his agenda- unlike regional chiefs across the rest of the country, who go to the polls in five weeks time, and are keen to put off the debate until after the May 22 elections.

Along with education, the public healthcare system lies at the heart of the welfare state. It takes up the lion's share of social spending, and soaks up a huge amount of the budgets of our regional governments, to whom responsibility for spending has been transferred by the central government. Nobody would disagree that something must be done. The problem is deciding what action to take. The issue is sensitive, and requires consensus from all stakeholders, something that has not been sought in Catalonia.

The response of the Catalan government to the huge and continuing demonstrations that gridlocked the center of Barcelona on Tuesday might reasonably be described as inopportune. The regional government has dismissed the protests as simply electioneering on the part of the opposition, when the proposals have been criticized by hospital managers who probably voted for Mas, along with those of the head of the Catalan College of Doctors Miquel Vilardell, who is an advisor to the regional government.

The problem with the plans for health cuts in Catalonia is that there doesn't seem to be a plan. Each day sees new and clearly improvised announcements of cuts, accompanied by calls for healthcare staff to work harder and to be more efficient. Reasonable proposals such as delaying further investment in hospitals or not covering all absent staff are thrown in with decisions that seem to make no sense, such as closing operating theaters, ending access to essential medicines, or no longer guaranteeing a maximum six-month waiting list for operations.

Nobody is denying that if we are to retain our public healthcare system, tough decisions on cuts will have to be made. The problem is with the approach of the regional government of Catalonia, which sees the answer as simply slashing spending. There are alternatives, such as increasing some taxes (rather than eliminating inheritance tax), or increasing user charges in some areas. The challenge is that implementing these kinds of proposals requires political courage and leadership.