Health without papers

The government has sent a proposal to Spain’s regions — which are responsible for healthcare under the current system — suggesting that immigrants who do not have their residency papers in order, and will soon be left without healthcare following the passing of a recent decree, should be able to enjoy medical cover by paying a kind of insurance premium. The proposed figures are 60 euros a month for those between 18 and 65 and 155 euros for seniors. The measure has been roundly rejected by a number of medical associations and regional governments, who fear the current model of universal and free healthcare is being dismantled.

A consequence of this universality has been the consideration up until now of healthcare as a right for everyone, without taking into account situations that are more or less transitory, such as a lack of residency papers. This is what is under threat, given the changes being introduced by the government. The need to reduce spending on healthcare is not being questioned, but the methods used to do so are.

Since the middle of the past decade, there were doubts about whether a system in which costs were growing rapidly could be sustained. The number of people covered by the Spanish healthcare system also rose as a result of the mass immigration the country saw from 2000 onward, thanks mostly to the construction boom. But there is proof that this was not the only reason for a rise in healthcare costs, given that during 2004 and 2005, the population covered by the system grew 3.2 percent, but the costs of the system went up by 22 percent. As such, there was a clear need for cuts, but there was a line drawn: they would be made without touching the principles of availability for all and zero cost for patients. The exclusion of immigrants without papers is the first step toward abandoning those principles, and the proposal of charging for healthcare is an indication of the criteria that are going to be followed. The fact that the cost is higher for those who are over the age of 65 reflects a mercantile mentality: those who must pay more are not those who have more, but rather those who receive — and need — more attention.

The argument has been voiced that these amounts are far below the average cost of a person’s cover, and that the difference will be made up by the state. But that is the case for many public services. The key to this debate is whether the savings achieved actually justify such a discriminatory measure against some of the weakest members of society: out-of-work immigrants. What’s more, it is yet to be seen what will happen to irregular immigrants who are suffering from chronic illnesses and cannot pay the charges.

Studies carried out during the last decade demonstrated that immigrants rely on the health system to a lesser extent than Spaniards, and that the money they pay into the social security system more than compensates the cost of their cover. Many irregular immigrants will get their legal status in order one day, and in the meantime they should have the right to medical cover. For humanitarian reasons or for ethical ones, a public health system cannot be solely run according to mercantile criteria. Those who cannot afford cover will be left excluded and discriminated against. And there is an additional risk for public health: a civilized country cannot tolerate having pockets of the population that are not monitored by the health authorities.