Spain’s Socialist Party (PSOE)-Podemos government has drawn up plans to massively expand the role of the private sector in Spain’s health care services. The draft proposal, if implemented, would be the most significant assault on Spain’s public health care system since it was implemented in the 1980s after the fall of the fascist regime of General Francisco Franco amid mass protests and strikes in the 1970s.
The 27-page document, dated December 7, 2022 but leaked to the press in late March this year by Basque trade union LAB, proposes to vastly increase the role played by mutual insurance companies in Spain’s health care system. Mutual societies would become the backbone of the health service and would be responsible for the medical care of 90 percent of Spain’s working population.
The model agreement, sent to the heads of Spain’s 17 autonomous regions for approval, was negotiated between Minister for Social Security José Luis Escrivá and the Association of Mutual Societies for Workplace Accidents (AMAT). AMAT is a nationwide umbrella organisation of mutual societies, private companies operating under the aegis of Spain’s Ministry of Social Security to provide health services to workers suffering from work-related injuries or conditions.
The proposed legislation would hand all medical care for workers and the self-employed to mutual societies. This includes treatment for common illnesses and mental health problems, as well as rehabilitation, medical discharge, surgical interventions, diagnostic tests and other procedures. The current public medical system would become accessible only to pensioners and children.
The document states that “both institutions [AMAT and the Ministry for Social Security] are interested in improving the efficiency of management and control of temporary disability benefits stemming from common contingencies, and as such believe it necessary that the [mutual societies] cooperate with the corresponding public health services, allowing them to act upon any type of pathology, anything which would result in alleviating the burden of care and the waiting lists for the public health services, as well as reducing the unnecessary duration of [sick leave processes].” (Emphasis added.)
While couched in terms of improving “efficiency” and reducing “waiting lists”—now at record levels due to systematic underfunding, austerity and the impact of COVID-19 pandemic—the draft plan would lead to the privatisation of the country’s public health care service through the back door, and the degradation of working conditions and medical care for the Spanish working class. The public system would be gutted, medical care for workers subjugated to private companies linked to their employer, and sick workers forced back to work before they are medically fit.
Sick workers treated by mutual societies receive substantially less time off than those given care by public health services. Figures from 2021 show an average temporary disability leave of 49 days under the public social security system, versus 45.9 days under mutual insurance companies.
The PSOE-Podemos government aims to reduce the “burden” that worker sickness poses to businesses and the capitalist state, with absenteeism due to sickness having increased dramatically over the last decade, due in part to the impact of the ongoing COVID-19 pandemic. Expenditure on sickness benefits in 2021 increased by 15 percent on pre-pandemic figures, while costs more than doubled between 2013 and 2022—from €5 billion to €10.8 billion.
Over the last several decades, successive Spanish governments have gradually worked to undermine and roll back the social right to public health care, and increase the role of the private sector.
By 2017, agreements with private health centres made up 11.2 percent of total public expenditure on health care, with 27 percent of all hospitals in Spain being state-subsidised private entities by 2019. This equates to a total of 233 privately owned, state-funded hospitals in operation in 2019, compared to 220 in 1996.
In fact, despite the introduction of a publicly funded system in the 1980s, 53 percent of all hospitals in Spain remain in private hands, only a slight decrease from the 63 percent that were privately owned in 1970, during the last years of Franco’s rule.
The leaking document sheds more light on the PSOE-Podemos plans to impose mass austerity. Last Friday, Madrid told the European Commission of its intention to cut the 2023 deficit to 3.9 percent of the GDP from the current 4.8 percent and to 3 percent of GDP in 2024. This will mean cutting public expenditure or raising taxes by almost €24 billion.
A major driver of these attacks on the working class is NATO’s war against Russia in Ukraine. Spain, like all the countries involved in this war, is diverting billions of euros to remilitarise and turn Ukraine into a killing field.
Last year, the PSOE-Podemos government increased military expenditure by 26 percent to €27 billion, or €75 million daily. By conservative estimates, Madrid has also sent €700 million in weaponry, for training and for Ukraine’s public expenditure. On top of this it has implemented a reactionary labour and pension reform to pay for the COVID-19 EU bailout fund for corporations and banks. And with assistance of the trade unions, it maintained salary increases below inflation last year, at 2.9 percent salary increases amid 8.6 percent inflation levels.
These conditions are producing an international upsurge of the class struggle. Across Europe, millions of workers have been on strike against the impact of inflation and eroding wages, including in France, the UK and other European countries. Mass anti-government protests continue to take place in Sri Lanka, and over 100,000 civil service workers have been striking in Canada. In the US and Canada, opposition is building among more than 160,000 autoworkers.
In Spain, the leaking of the document comes amid the largest recorded wave of health care protests and strikes. Hundreds ofthousands of nurses, doctors and other health workers have taken part in industrial action across Spain over the last year, including in Cantabria last November, Catalonia in January and Navarra in February.
In Valencia, 15,000 medical workers went on strike March 6 and April 3, while an indefinite health care strike is set to begin on May 8 in the Canary Islands. In Galicia, an indefinite strike of doctors began April 11, leading to the suspension of 163 operations on its first day.
In Madrid, numerous strikes and demonstrations have taken place across the city since late last year, including a strike by between 12,000 and 14,000 health care workers across 34 hospitals on March 1 and 2. This comes in the wake of a rally of up to 1 million people in Madrid in support of doctors and in defence of public health in mid-February.
On March 25, tens of thousands also joined protests across the southern Spanish region of Andalusia in defence of public health care, under the slogans “Public health is not for sale” and “Public health is in your hands.”
There is no lack of willingness in the Spanish working class to fight to defend public health care. But such a struggle must take place independently of pseudo-left and social-democratic parties like Podemos and the PSOE, whose draft policy has demonstrated again their implacable hostility to the working class; and independently of trade unions such as the LAB, which has organised no opposition to the plan. Instead, it simply asked the Basque regional government to “give a resounding ‘no’ to this privatisation attempt.”
Spanish workers must look for allies to the working class in Europe and internationally, forming independent rank-and-file committees to unify the growing wave of industrial action in a coordinated struggle against austerity and for socialism.