Give health priority over the market
Updated: Aug 1, 2020
Europe at war with the coronavirus
by Marc Botenga MEP
The (European) emperor is naked. Failed. After years of austerity measures, the healthcare system is failing the coronavirus stress test miserably. Hospitals are short of beds, staff, respirators, masks etc. In short, they are lacking the necessary resources. Applauding the healthcare workers is fantastic, but it is not enough. We now have to do everything we can to stop the epidemic and restore a health system worthy of the name. To this end, tough choices will have to be made, including at European level.
A shortage of masks, staff, beds, respirators and testing equipment. Lombardy, home to 10 million people, today has more victims than China, which has a population of 1.4 billion and a per capita GDP that is considerably lower than that of Italy. For lack of resources, some French hospitals would no longer ventilate patients over 75 years of age.
And in Belgium, hospitals are appealing to the population for donations for respirators. The European healthcare system should be the best in the world, but it seems less well-equipped against the corona pandemic than its Chinese, South Korean, Vietnamese or Singaporean equivalents.
Chronicle of a health disaster foretold
On 6 February, at the initiative of both the PTB-PVDA and the group of European United Left (GUE/NGL), we hosted a meeting of health workers from about ten European countries in the European Parliament. These women and men are today's true heroes of a merciless war against corona. They have been on the warpath for a very long time already. On this very 6 February, the European austerity dogma has been clearly identified as the enemy. The testimonies all converge and sound the alarm. Whether in Czech, French, German or Spanish, the message is that of a canary in the mine.
Over a period of fifteen years, French hospitals have seen tens of thousands of beds and healthcare personnel disappear. The message conveyed by 70 French university hospital directors is perfectly clear: "The public hospital is in a state of collapse and we are no longer able to carry out our mission." At that time, over 200 French emergency services had already been on strike for ten months.
In Italy, the national healthcare budget has been in constant decline since 2010. Over the period 1998-2017, Italy lost 120,000 hospital beds. Nowadays, the number of beds is down to 3.6 beds per thousand inhabitants.
Germany is doing better, yet without mass-screening, the 28,000 beds available in intensive care would not suffice, notes Die Welt. It is especially so because a bed alone will not save anyone. That is where healthcare personnel is needed. And that is what is often lacking.
The German trade unions are reporting a shortage of tens of thousands of health workers. In 2019, over one-third of hospitals temporarily excluded beds from their intensive care units due to staff shortages, according to a report from the German Hospital Institute published in December.
In Greece, following the economic crisis, the main hospital for respiratory diseases, the Sotiria Hospital in Athens, lost a third of its doctors and over a quarter of its lung specialists in training. In Belgium, both the white-coats movement and the call for donations to hospitals have clearly shown that the healthcare budget is not meeting the needs at all.
"Liberals have never accepted that healthcare is a public service independent from the market"
"We are engaged in a war", liberal French President Macron said. Well now, ours is an army disarmed by years of austerity governance, that now has to fight the coronavirus. It has decimated the ranks of the anti-corona soldiers - for that is what our caregivers are - and devastated the trenches on which our hospitals are based today. Both the Italian and Spanish governments are now in a situation where they are obliged to requisition or nationalise private hospitals in order to use them in the fight against the coronavirus.
Christophe Prud'homme, spokesman for the French emergency doctors' association: "The liberals have never admitted that both healthcare and education are public services which are not subject to the laws of the market. They are now taking their revenge by following a very clear strategy: they are creating deficits and letting the public sector gradually die off in order to introduce a profit-seeking private sector as a substitute for the supposedly failing public service." And consequently, they reintroduced the market.
Such is the strategy of the European Commission. The model they were supporting before the corona crisis is the American liberal healthcare model. Instead of recognising public services, the European institutions have been increasingly referring to medical services as "services of general economic interest". It follows that they must, of course, respect the market rules. Thomas Zmrzly, a German surgical assistant, member of the Ver.di union, denounces that today "even public hospitals have to comply with strict 'cost-efficiency' criteria".
This same logic drove the historic Amsterdam Slootervaartziekenhuis towards bankruptcy. A real shock wave. It shows why even in non-commercial hospitals more and more activities are being outsourced: cleaning, catering, laboratory analyses, transport of beds, transport services, supply of medicines, laundry services, etc. Subcontractor chains are benefitting from temporary, low-wage workers.
At the same time, from Germany down to Spain the retirement home sector is dominated by large private profit-making groups. What is their only purpose? Profitability.
Where is the much-needed European solidarity?
With health systems reaching their limits, rapid and concrete solidarity between European countries would have been all but a miracle. In spite of all its fine rhetoric, the European Union is primarily based on 'free' and 'open' competition. Let's face it, it is everyone for themselves.
This is how, over the past decades, the stronger regions have been allowed to become richer at the expense of others. For years now, the winners of that crazy race have been rejecting solidarity mechanisms that would eliminate inequalities. The lack of any perspective for their economy is causing an exodus in whole regions in the east and south of the continent. The Cohesion Funds are as effective as a twig in the path of a runaway train.
This European Union is not encouraging Member States to show solidarity. The corona crisis is making this painfully clear. Italy has been openly complaining about the absence of European solidarity and has directly asked for help from China, from Cuba that is recognised worldwide for its quality public healthcare, and from Venezuela. Russian planes carrying medical equipment were actually personally welcomed by the Italian Minister of Foreign Affairs.
It goes without saying that we can only welcome this international solidarity that, moreover, is being shown including by countries against which European sanctions have been imposed. It is in sharp contrast however with the every man for himself logic applied within the European Union.
For instance, Germany initially prohibited the export of medical mouth masks to Italy. Later on, it (somewhat) changed its mind. One month after the outbreak and thousands of deaths later, it offered to provide treatment to eight (8!) Italian patients in Germany. We also saw how the Czech Republic - by mistake it was said - seized masks destined for Italy.
We heard the chairwoman of the European Central Bank (ECB) state that the increasing interest rate differences within the eurozone (the 'spread') were not her problem, after which she was forced to correct herself somewhat.
We saw the president of Serbia, a candidate Member State, dismayed by a European embargo on medical equipment. The "European solidarity never existed", it was all just a fiction on paper, he declared at a press conference. Consequently, when he turned to his "friend and brother Xi Jinping" (the Chinese President) the European Commission hurriedly came up with an initiative for candidate countries.
In Bulgaria, too, did the Union hit a lousy figure. The Bulgarian Prime Minister stated that "European solidarity is at risk of being shattered" and turned to Russia. The European Commission's initiatives are largely based on the recycling of structural, cohesion or other funds. It seems to be a case of too little, too late.
"Whatever it takes" for our health care system
The austerity dogmas and market absolutism of the European Union are the gravediggers of our healthcare system. By suspending the Stability Pact, the Union is admitting as much. However, that does not mean it is going to change course.
On Thursday 19 March Didier Reynders, freshly appointed European Commissioner, put his cards on the table. The European Commission intends to tackle the health crisis the way it tackled the banking crisis in 2008. Back then, all the European rules were put on hold in order to save the banks. Afterwards, the rescue costs were recovered from the people. Cuts for everyone and everywhere. For every bank that was rescued, a public service was sacrificed.
Commissioner Reynders now wants to use the same recipe for the present health crisis. The Member States are allowed to increase their budget deficits in order to safeguard the profits of large companies. In Italy, both the Confederation of Italian Enterprises, that represents large companies, and the banks are already in eager anticipation. "But" Reynders said, "after that, public expenditures will have to be brought back into balance". This means that first the profits of the private sector will be safeguarded, after which the health system will be further broken down.
That is completely ridiculous. What is needed is a sanitary Big Bang at European level, without repeating the recipes of the past. Faced with the evidence, even Emmanuel Macron acknowledges, in words at least, that certain sectors need to be protected from the market.
Austerity is a proven and acute health disaster. No, the Stability Pact should not be suspended. It has to be abandoned for good. We now urgently need public investment to restore a health system that has been undermined by cutbacks. This is the only way we can meet society's needs.
"We will do whatever it takes to save the euro", the governors of the European Central Bank are yelling. The time has come for us to reply to them: "Whatever it takes for our public health". Investment plans and emergency funds must give priority to the restoration of our healthcare system. But without the anti-social conditions of the European Stability Mechanism (ESM) of course.
Public health, a cathedral to be restored
Rebuilding our public health systems must be at the centre of all our efforts. The public sector not only stands for accessible healthcare, but also offers enormous advantages in terms of front-line care and, therefore, screening. The reorientation by Germany to a screening mechanism generally used for seasonal influenza has shown its effectiveness compared to the situation in France, Belgium or elsewhere.
The WHO points out that, while demanding behavioural change from their citizens through social distancing, Western countries are falling far short of a second crucial factor: testing and actively tracking down patients infected with Covid-19. These methods have been proven successful in China and other Asian countries. Comprehensive screening requires a strong public health system at all levels, with frontline care facilities close to the population and capable of mobilising the population.
A quality public service is an absolute necessity. Public services should not be profit-driven, they should not generate any financial gain. No. They are entitled to all the financial means needed in order to carry out their assignments satisfactorily. We need to invest massively in public, humane, quality health care.
Health should not be a commodity, it should be a right for everyone, as described in the WHO Declaration of Principles: "Enjoying the highest attainable level of health is one of the fundamental rights of every human being without distinction of race, religion, political opinion, economic or social condition".
This means protecting, restoring and developing public hospitals, investing in prevention and screening, and more generally in developing a public health system with a solid, social primary health care. The entire healthcare system stands or falls depending on first-line care. In Belgium, only a mere 5 % of the healthcare budget goes to primary care. That is totally insufficient.
Let's make the winners of the banking crisis pay for the health crisis. At the moment, taxes on large assets in Europe remain anecdotal. In a number of countries, the introduction of a Corona tax on big fortunes is already on the agenda. The coronavirus crisis shows that our societies can no longer afford the luxury of billionaires.
Marc Botenga is member of the European Parliament for the Belgian PTB-PVDA. This article originally appeared on the PTB-PVDA website.