The health of a nation

Saving, however justified it may be in times of crisis, cannot prevail over the general interest. The public powers must protect all citizens’ right to the healthcare guaranteed in the Constitution. With this argument, the Constitutional Court has refused to suspend the decree by which the Basque regional government eluded the implementation of the healthcare reform approved by the central government. This reform introduced co-payment for all citizens, and ordered that healthcare cards be withdrawn from illegal immigrants, who can now receive only urgent attention during and after childbirth. Several regional governments opposed the reform, and decided to go on giving medical care to this group. In the case of the Basque Country, the regional government passed a decree suspending the two measures, against which the central government brought an appeal before the Constitutional Court.

Though this is not yet the definitive ruling (nor does it enter into the question of the different administrations’ powers), the writ does endorse the implementation of healthcare co-payment throughout Spain, but not the exclusion of immigrants without papers, because this provision violates the universal right to healthcare. The first argument is that the protection of health must prevail over the supposed economic benefit with which the exclusion was justified. The government claims that the measures applied have already saved 800 million euros, but it is hard to calculate how much of this might proceed from the exclusion of immigrants. In any case, experts in healthcare management have questioned the supposed saving, pointing out that attending only to urgent cases means that when the immigrant does finally receive attention, the pathology will have worsened. This not only causes unnecessary suffering, but renders the care more expensive.

The second and important argument is that the exclusion of illegal immigrants puts at risk not only their own health, but that of others. To leave certain groups unattended reduces the efficacy of measures designed to control certain infectious diseases such as tuberculosis, whose eradication depends on proper follow-up of the patient and their contacts. It must be remembered that in recent years new multi-resistant strains of tuberculosis have appeared, that do not respond to available treatments, so that the principal weapon against these variants is prevention of contagion.

The Health Ministry has already stated that the ruling will be effective only in the Basque Country, and that immigrants from that region will have no right to medical care when they travel to other parts of Spain. At this time there are nine regions that apply a total exclusion of illegal immigrants, one of these being Madrid. But there are four others — the Basque Country, Andalusia, Asturias and Catalonia — that still give them coverage, and another four that offer some care through other legal formulas, thus consolidating a situation of inequality that is not only unfair, but dangerous in terms of public health.