Healthcare system survives an assault

On Monday the Spanish public health service overcame an important challenge. The Madrid regional government’s plan to privatize the management of six hospitals threatened to torpedo one of the best public healthcare systems in Europe.

To place a health service used by more than a million people in private hands would open a breach in the defenses of the system by transferring to private interests a wide range of installations, services, health personnel and know-how paid for entirely with public money. The Madrid regional High Court has ruled that the regional government was trying to effect such a transfer, by means of an irreversible procedure which was clearly prejudicial to the health personnel concerned, and by a public tender process sufficiently suspicious in terms of irregularities as to be pending annulment in the near future.

Ignacio González, the regional premier, has for months disregarded the massive demonstrations and work-to-rule strikes against his plan. The “white tides” (so called for the demonstrators’ white medical coats) have paralyzed operating and consulting rooms. The protests aroused public fears that so essential a service would decline in quality if managed not on a basis of medical necessity, but on the guidelines of profitability that the companies would logically apply. González has likewise turned a deaf ear to court rulings that repeatedly warned of the serious problems entailed in a privatization process carried out on the basis of unproven claims of efficiency and savings, and which was lax in procedural terms.

On Monday, the region’s top court having rejected the option of canceling its suspension of the privatization plan — a plan of such reach as to have few precedents — the logical option was to bury it.

Premier without a plan

But that was not the only consequence. González, who inherited the post of premier after the retirement of Madrid Popular Party (PP) leader Esperanza Aguirre, was committed to two important strategic projects: the Eurovegas casino complex; and the promised savings on public healthcare expenditure, by means of the euro-per-prescription co-payment plan and the privatization of hospitals. Both of these having failed, González has now jettisoned his health department chief, Javier Fernández-Lasquetty, in an attempt to minimize the damage.

Together with education, the area of public healthcare — in which, of course, there is room for improvement without needing to touch its ownership — is the weightiest heading in the budget of Madrid or any other region. Madrid is not the only region where politicians have used this sector to frame a comfortable revolving-door system (public officials transferring to jobs in private industry and vice versa); nor is it the only one where privatization has been seen as an easy way of favoring certain firms with disregard to the problems involved in a public healthcare service.

But Madrid has sought to be the brightest boy in class in exploiting a made-to-measure ideology, which does not lead to free competition and confuses private management efficiency with asset-stripping of a public system. The result is an unmitigated defeat for a certain way of understanding what politics represents.