What is the path from healthcare as we’ve known it to a society where everyone has the resources necessary for their full development? The mire of healthcare reform in the United States and the constant vigilance necessary to develop public health systems in other countries can obscure the need for a longer term strategy. Today we are sharing the translation of an article from Spain that describes how capitalism corrupts health care, and a strategy to move from our defensive stance today towards a decentralized collective system of healthcare owned and organized by workers and the community.
By Pedro Heraklio 5/8/2015. Translated by S Nicholas Nappalos
Taken from Regeneración Libertaria
The current health industry must be understood as a sectorial-economic framework consisting in elements important for our welfare: the hospitals as guarantors that give access to services, mutuas,[1] clinics that fill gaps, and pharmacies that provide the material or social services which prevent the deterioration of our quality of life. But as important as the pharmaceutical industry are the universities or the media, which form the social imaginary about health services, our perception and degree of satisfaction with them.
This fact does not go unnoticed by the capitalists who take advantage of any sliver of weakness within their own system to personally benefit, at any cost including our health. Over time we see clearly the strategies used, but also ways to correct them.
Business strategy: obtaining liquidity to be used in investment funds
Private healthcare rubs their hands whenever a service concession is on offer in a territory. Of note are the 256 private companies in Madrid. Among them we highlight Capio, Chiron, Mapfre, Adeslas, Sánitas, Red Cross, and Orden de San Juan de Dios as some of the most powerful. These companies dominate the private market. The Health Lobby in Spain is grouped in Sedisa, an association of 900 health industry executives who use their money to buy legislators and control the concessions.
Here is a list of health companies in the Spanish State:
http://empresite.eleconomista.es/Actividad/SANIDAD-PRIVADA/.
The healthcare industry is not the only industry represented by its infamous flagships interested in the privatization of the health, there is also the infamous insurance industry, organized in its no less infamous Adecose lobby. They do not only seek the privatization of the health system, but also that public pensions to pass into private hands, which would enhance the insurance sector and advance the market feast for investment funds. It is a chain in which the latter are the real stakeholders. The changes are gradual, but obviously decided. Among the operators in Spain we find heavyweights like AXA, Allianze, Atlantis, Reale, Mapfre, or national leaders such as Mutua Madrileña, Mútua Catalana, Patria Hispana or Pelayo.
Media Strategy: Professors, scientists and journalists on the payroll
The following article shows how the healthcare industry uses all possible means to acquire health services in different countries. It is disturbing to see the relationship of the industry with scientific societies and the media, who are always willing to publish studies to the letter that benefit their patrons. Teachers, scientists, journalists, politicians and counselors are part of the propaganda apparatus.
Aging population will not trigger health costs – CAS
Contrary to what is being said in recent years by various tribunals, the aging of the population will not lead to an exponential increase in health expenditure, according to the Institute for Research and Socioeconomic Information (IRIS) in a recent study whose authors Affirm that discursive “catastrophism” is a strategy in the service of privatization.
The “assistance” of the private sector
IRIS notes an annual increase in spending of barely 1.28% associated with aging – a “perfectly sustainable” situation, Hébert says. “Alarmist speech prepares the ground for massive privatization. When the State declares itself incapable of maintaining the supply of health services, people are told that it will be necessary to obtain assistance from the private sector”.
The study concludes that “the greatest risk in terms of aging is the neoliberal ideology that informs almost all state reforms and the implementation of public policies.”[2]
Luckily, homogenous thinking and ubiquitous propaganda are compensated for by alternative and counter-currental media that are increasingly being accepted in society. They require too many obvious lies to maintain the system.
Political Strategy: revolving doors
It is also curious to see how a necessary non-elective public service is given to private companies who charge double or triple the price.
Such a loss of public capital is only explained by the feedback between political power and private interests; They make deals in the shadows, usurping control through these maneuvers from public representatives (opposition parties, trade unions and professionals). There are, in these practices, flagrant conflicts of interest and the abusive and shameful use of revolving doors.
“Some characters (Lamela, Güemes, Rocío Mosquera, Antonio Burgueño) have achieved notoriety by skillfully practicing the “revolving door”. The damage caused by these actions – to society, to the health system and its workers, to our health and our descendants – is immeasurable. These fraudulent practices evade social control, the oversight of public bodies, and justice. But they become consummated facts that, in some cases, can be difficult to reverse”. Diario Digital Nueva Tribuna
Recovery of Universal Health: Social Strategies in Health
Current Problems:
Briefly summarizing general problems derived from our needs. The main objective would be to maintain the services and ensure their future functionality.
– The chief threat is the lack of budgets and debts contracted.
– The current semi-private management is deficient and more than doubles costs compared to public management, which is why the current scenario of economic instability threatens the medium-term viability of services.
Partial solutions:
The solution of the different governments,[3] both central and regional, with their neoliberal traditions, is to privatize services and consultation, which further increases the cost per patient, making the system unsustainable. The solution is even worse than maintaining the current system.
A quick solution would be the internalization of the privatized services, which would reduce the price of the service per patient to practically half.
Another solution in the medium term would be to rethink the general strategy of health services, currently with a medicine dominated by the Pharmaceutical Industry and focused on biological causes. The concepts of Health-Disease and a psycho-social cause approach should be raised again. Here the problems and resistance of the oligarchies would begin, as they influence the prevailing order and system.
But all this would maintain the current structural problems: waste and scarcity, duplicities, bureaucratization, diversion of funds, nepotism or incompatibilities that lead to health to be a product at the service of economic and political powers, full of parasites and on the brink of inefficiency and not a public service.
Ultimate solution: unlinking the economic benefit and social benefits
For health to be sustainable and efficient, we need to dissociate the economic benefit from social benefits. This could not be done through a state or privatized model.
The current model is unsustainable. But not only for health, but rather for any public service. It is a business model of management that enhances profit in economic terms, hiding itself behind health indexes demarcated by social agents. But these agents also act on the terms of business, such that commercial objectives are imported to public services with the same terms.
As long as the current, corporate and politicized model continues, reproducing the shortcomings, the conflicts of interest which lead to health to be one of the main budgetary problems of the country will continue.
A model change is needed: entrepreneurs and politicians are unable to meet our health needs. We need services managed and controlled by employees and users and not by entrepreneurs, technicians or politicians with personal interests in taking advantage of their privileged position to take advantage as we see today.
The method would be to organize services managed by communities horizontally. Which would require:
– Specific management methods, going beyond the business model, not only in health centers, but also in neighborhoods, districts, municipalities and regions.
– Overhaul of the portfolio of services – Reorganize the organizational chart based on workers units of management and commissions, and not by management. – Review the responsibilities of the positions: elected or rotating, revocable and depoliticized, without positions based on faith.
– Review of coordination with other institutions
Model Change: Independent Management Units and District Assemblies
This model change has already been realized in other times, so we know it is possible and has worked. The key and the problem lies in getting political power away from economic power.
In order to achieve control, sustainability, and the rational supply of this vital social good, economic self-management was proposed, embodied by the CNT’s plans, to organize the management of the means of production to be demand-driven, rather than supply driven. The model is quite simple: workers organized in independent, self-managed, coordinated and federated work units rationalize production; a logical, economical (cheap), and transformative plan, but one that is far from the current social prospects. Capitalists also realize the power of this model, but when these units are managed in a business way they are a disaster, i.e. a way of introducing privatization, increasing costs and reducing services. This is because their way neither has workers units, nor is managed, nor is independent.
Private property is too protected by repressive means, so a possible start would be to separate politicians, who are often entrepreneurs, from their political positions. To throw them out of town councils, institutions and offices.
A District Assembly that organizes a Health Commission could be able to make some changes, especially in the portfolio of services and coordination with other institutions, but the general policy is demarcated by the state and the Health Act. We recognize here an opportunity with great potential.
[1] A type of semi-cooperative insurance system in Spain.
[2] Sources: http://iris-recherche.qc.ca/publications/vieillissement via Anti-privatization Coordination of Public Health in Madrid
[3] The Spanish state is partly constituted by various regional governments with a degree of autonomy in some cases.