Austerity and Health
Based on the European Semester process and the rules set out in the Stability and Growth Pact, the Commission asked EU Member States over 300 times, between 2011 and 2018, in a wide range of areas, including by reducing wages, lowering pensions, and so on.
There were over 300 such recommendations by the European Commission.
No fewer than 63 of these recommendations related to health care.
In other words, the Member States were asked on 63 occasions to either privatise parts of the health care sector or cut costs massively, which of course has an adverse impact on the population as a whole because it quite simply takes health care to a much lower level than before.
What's more, that figure of 63 doesn't even include all the demands imposed by the Troika on Greece, Spain, etc.
during this period.
When the pandemic arrived the shortage of hospital beds became clear.
There was a shortage of about 12, 000 beds.
That's enormous, especially since there was also a shortage of health care personnel.
The Spanish health care system lost 20, 000 to 30, 000 or more personnel and their working conditions and their legal protections have deteriorated significantly.
In other words, there are two problems: the lack of personnel and the percentage of precarious workers, which can be as high as 30% in some services and is 40% across all health care staff.
These health care professionals work under appalling conditions, because before 2008 and until 2009, even though our health care spending was lower than the European Union average, we had a primary health care system that was extremely solid, a universal model.
In Spain, everyone had access to health care.
But the implementation of adjustment policies – not only with respect to health care spending, but also in connection with austerity policies encouraged by the European Commission – changed all that.
This whole coronavirus pandemic has acted like a magnifying glass, highlighting the problems that already existed in German hospitals.
The issue of inadequate staffing in both specialist departments and nursing predates the crisis.
In the run-up to the pandemic, we had a heated debate on the whole topic of 'minimum staffing levels' and 'demand-oriented staff planning'.
There have been proposals on the table at the Ministry of Health for some time, from ver.
di, the German Hospital Federation and nursing associations.
These proposals are currently not being addressed.
Quite the reverse: during the pandemic, the Ministry of Health once again suspended these minimum staffing levels for nursing, which we believe are inadequate anyway.
It also allowed shifts of up to 12 hours, which is known can result in increased mortality.
This is putting patients at risk, if not actively harming them.
That's how things are right now.
The situation was bad before, but it has got even worse during the pandemic.
There are also some initial studies being carried out to try to clarify which population groups are hardest hit by the health crisis.
I'm aware of studies from the UK and the US that show that poorer population groups in particular, often with a migration background, are massively affected.
For example, the coronavirus mortality rate among black people in the United States is much higher than for white people.
This of course reflects income levels, as well as the health care received in earlier life.
There is a very clear connection between wealth or income distribution and the impact of the health crisis that has now broken out.
And I think it must be clearly stated that general cuts in health care sectors, or public services generally, are always at the expense or detriment of those who depend on a strong state – who rely on the public sector, i.
the state, being able to provide them with suitable health care and with other social benefits that enable them to lead a reasonable and decent life.
Those on high incomes aren't so badly affected because they can afford to buy any additional things they need.
At one end, our insurance premiums are used to fund hospitals.
At the other end, profits are distributed to shareholders.
It's the same money.
It's not different money, it's the same money.
The fact that hospitals can make hard profits in this way is partly due to the funding system of flat rates per case.
Naturally, they try to keep the costs below the amount paid per case, because then they've made a profit.
You could say that the pandemic revealed and brought to light the shortages in and weaknesses of the public health care system.
In addition to all the seriously ill patients suffering from the coronavirus, it was the health care professionals, in other words us, who were the first to suffer.
We had to cope with the situation without the necessary protective equipment.
The workload and the lack of protective equipment were such that we started protesting and organising, albeit in a very different way.
There had already been protests in some hospitals.
The movement has been developing for about a decade.
It began in the Charité hospital in Berlin, which saw the first-ever strike in a German hospital.
The strike wasn't about pay or working hours, but about the need for more staff and better working conditions in hospitals.
Since then, there have been some 14 or 15 collective agreements covering this issue in Germany, but mostly in university hospitals.
The movement hasn't yet spread fully to other hospitals, but I think the recent debate around workload has created a new impetus, and it could well become more widespread now.
I hope so, because to some extent we need this protest action by nursing staff to get things back on track.
Health care and health care policy are a public good that must be publicly funded and independent of third-party interests.
We need to uphold that independence.
There's also the issue of patents.
It's just not right that essential drugs are covered by patents that, for example, prevent people in the Global South from accessing those drugs.
We cannot allow that.
There isn't really much research into diseases that are still huge problems in the Global South, for example.
On the topic of research and development in general, we need to ask: where is it taking place? There isn't really much research into diseases that are still huge problems in the Global South, for example.
As everyone knows, the health care system has a significant impact on the health of people – typically from 11 to 12%, sometimes as much 20%, but still a limited degree.
The remaining 80% comes from government policies at all levels, in other words what are called in other words what are called social determinants and gender determinants.
In other words, economic policy, employment policy, housing policy and other policies have a bigger impact on our health.
As does anything to do with education policy.
By that, I mean that we should address the other policies via education policy.
What we've seen in recent weeks and months in the EU and in Member States is that some very specific professional groups, i.
systemically important groups, have kept society going.
Like most people, I'm thinking here primarily of staff in the health and care sectors, public transport workers, and those who have kept our power and water supplies running, as well as supermarket sales staff who have gone into work day after day.
As well as thanking these people, we also need to think hard about how we can improve their working and living conditions.
In the debate about how to achieve better public services, and indeed better health care, I think that these people are our number-one allies.
Of course, our approach has to be based on winning over a majority in society.
It isn't just about reflecting the strength of left-wing parties in parliaments.
Naturally, we have to work with trade unions to represent the interests of the people I mentioned, but within much of civil society we've also seen that there is clear agreement on the need to improve their working and living conditions and to start investing much more in public services and the health care sector once again.
I believe that is one of the key lessons from this health crisis.
The health care system should be both a social system and a health care system.
The pandemic made that clear.
Where was the mortality rate the highest? In nursing homes.
That was true around the world.
So, just as much attention must be paid to nursing homes as to the health care system.
All this needs to be integrated within the framework of a republic, that much is clear.
To finish off, I will simply say that we have plenty of money for all this.
Any country in Europe can do this, but since governments don't seem very interested, it is critical that the population mobilise if we want it to get done.
I think that such a programme could only be successfully implemented if the people fight for it.
and invest in economic and social reconstruction as well as in strengthening public services and health care sectors.
In fact, that's essential.
It is not the policies of the European Commission, powerful as it may be, that have the final say.
It is not the policies of capital that have the final say.
It is all of us citizens, in our conscious struggle for an alternative model, who have the final say.
Of course, we also have to think about how we can change macroeconomic management in the EU.
That sounds very abstract, but I'll explain what I mean.
One example is the Stability and Growth Pact, which effectively prevents investment because it prescribes a specific debt target.
The Stability and Growth Pact actually has to be surmounted, permanently, so that countries can learn the lesson from this crisis and invest in economic and social reconstruction as well as in strengthening public services and health care sectors.
At the same time, we need to have a debate within society about the importance of public services.
It is regrettable that the German concept of 'öffentliche Daseinsvorsorge' [literally 'public subsistence provision'] doesn't exist in English, and therefore in European legal terminology.
The term used is 'public services', and of course services in the internal market are subject to competition rules and state-aid rules.
In my view, exceptions need to be made here, because public services are for the good of the public as whole, as with health care.
It shouldn't be a case of the cheapest provider getting the contract or Member Sates being asked to privatise and make cuts.
Rather, health care should be provided to everyone, according to the needs that exist in society and among the population.
That principle should not be undermined.
Hospitals shouldn't be there to make a profit but to keep people healthy!.