A limited right

In the name of ensuring the sustainability of the National Health System, the government of Mariano Rajoy has robbed it of its very essence. Public healthcare has since 1986 been a universal right of “all Spaniards and foreign citizens” who have established “their residence in Spanish territory.” Now, with the royal decree approved by the government it is a right only for “those persons possessed of the status of being insured” as laid down in the text of the decree published Tuesday in the Official Gazette, exposing the gainsaying of the Health Minister Ana Mato, bent as she is on denying what is evident.

The General Health Law of 1986 was an important social conquest. Its implementation has taken years and there are still areas pending. It is a key law in the development of the Spanish healthcare system. It establishes that health should be “oriented toward eliminating territorial and social imbalances.” The Royal Decree of Urgent Measures to guarantee the sustainability of the National Health System disembodies the law of its spirit by leaving certain groups — immigrants without papers — without cover, and complicates access to the system for those older than 26 who have not paid social security, and divorced people without resources.

It is hardly credible that the government has used a royal decree to present a battery of cost-cutting measures to carry out such a profound change. A change, which as the government plans, will not be subject to the parliamentary debate that it requires. The text appears to leave the door open for a different model, full of disturbing unknowns. The Health Ministry needs to explain what will happen after September 1 to immigrants without papers being treated for a serious illness, or what will be required of young people who have not paid social security when it comes to renewing their health cards. Behind Mato’s affirmation that “no one will be left without cover,” there is now a weaker legal base. Those who have not paid contributions, retirees, those earning below the minimum wage, and those who receive social benefits will be left outside the system. And if everything will remain the same as Mato claims, couldn’t we have saved ourselves the new legislation that imposes so many conditions?

The change is even more inexplicable if you take into account the scant savings it will generate, which is well below the 500 million euros estimated by Mato. Experts calculate the figure will be less than half that. The situation is the same for the new rules on prescription drugs. The 165 million euros in savings the ministry estimates imposes a heavy burden on retirees and the chronically ill. It incorporates the co-payment system announced last week, but the royal decree penalizes these groups more than was expected by establishing a reimbursement system that obliges people to pay the health system up to six months in advance. This is an authentic abuse of those most in need of medicine, besides users of non-urgent transportation and other services.

Lastly, the royal decree in its cost-cutting bent implies another turn of the screw for pharmaceutical companies and serves to impose on the regions the prioritization of delivering a balanced budget ahead of offering healthcare services not included in the established list. Its precepts widen the powers of the central government to control the regions with a hint of recentralization that might be more ideological than pragmatic.