Healthcare: facts & lies

Though they have never been absent, the problems of our healthcare system are now in the news more than ever. I have worked in hospitals both public and private, and in a publicly subsidized private one. I have also had the privilege of studying the pros and cons of various systems, in lands as various as the US, France, England, Germany, Norway, Taiwan, India, China, Syria and Jordan. In the light of which, I can say that most of the opinions one sees in the media are characterized by ignorance and/or political sectarianism.

While not claiming to offer any clear solution (nobody has found one), I would like to disabuse the reader of some of the falsities that are flying this way and that, in a crossfire where the principal victims are the patients. I am going to enumerate a series of facts and lies that are hardly ever admitted by the contenders on either side; in the hope that this may generate some useful debate.

1. The Spanish public health system is the best in the world. Lie.

2. The carving up of our national healthcare system into 17 regional fiefdoms is an atrocity. Fact.

3. Access to the public healthcare system is fair and equitable. Lie.

4. Some doctors use the public system for private enrichment. Fact.

5. The only way to improve the management of a public hospital is to hand it over to a private company. Lie.

6. Politics has infested public hospitals, rendering them ungovernable and economically unsustainable. Fact.

7. Private healthcare is always better than public. Lie.

8. In public healthcare there is no control of accounts. Fact.

9. Private medicine is good only for unimportant things. Lie.

10. There is corruption in both public and private systems. Fact.

11. Europeans come to Spain for operations because they are better and quicker here. Lie.

12. Doctors are poorly paid and this, in a sense, is at the origin of the corruption. Fact.

13. Those who come out in the street to protest against privatization are doing it solely in defense of the public health system, and not of their own interests and privileges. Lie.

Now for some opinions. Without a well-organized, well-administered system, in which the doctors feel they play a leading role, you cannot have good healthcare. Family doctors and specialists have to be free to send the patient to the hospital that supplies the best results in a given pathology; to which end these results must be known and published. As an example I may mention New York, where anyone can look up the surgical mortality rate of each and every heart surgeon.

In this way the money would go where the patient decides. Thus the hospital where more patients go, because it does a better job, will receive more money, and can pay its professionals better for a job well done. Just the contrary of what now happens in the public hospitals, where the same amount of remuneration goes to professionals good and bad, bright and dull, hard-working and lazy, honest and dishonest.

Authority over healthcare has to be returned to the central government. A National Health Service has to be rebuilt and, by means of a pact between the parties, placed outside the political fray.

Only a well-educated population makes correct use of medical care. Thus the "less Latin and more sports" orientation, recommended years ago by one of Franco's ministers, has made Spain a power in certain sports, and a pariah in international educational rankings. Perhaps, then, in our suddenly impoverished country, we could at least maintain our national healthcare system - one of the pillars of our national welfare, which distinguish us from what we are pleased to call the Third World.

Norberto González de Vega is a cardiovascular surgeon. Twitter: @Ndevega