by Ivan Cavicchi
The authors of the article published in QS want us to believe that the risk of privatization is a probability oriented towards the future, forgetting that privatization, now precisely because of the policies made in particular by Bindi up to now, is already a full-blown reality. That is, it is not a risk and therefore a probability but a dramatic fact
17 SET – Premise
The other day in this newspaper a 6-handed article was published (Bindi, Dirindin, Geddes) with which we are very simply told that in our public health there is a “creeping privatization”. (QS September 14, 2021)
In this article the minister in office is never mentioned and least of all it refers to mission 6 of the PNRR and least of all it refers to the counter-reforms made in the past, so the doubt that arises is that this “creeping” thing is at least the work of the holy spirit.
Unlike Maffei, (QS September 15, 2021) I consider this article, precisely because of its “authors” and its “contents”, to be anything but “authoritative” without too many salamons and turns of words.
We don’t have a nose ring
I understand that for Bindi, therefore, for the association she founded “Health fundamental right”, it is not at all easy to have, these days, an original political space compared to that of Article 1, that is the current minister of health and PNRR.
But this, however legitimate and understandable, in no way authorizes her and her acolytes to consider all of us naïve with the ring on the nose and least of all to twist ourselves with false speeches in an attempt, in my opinion as ridiculous as grotesque, to to give us as well as to Speranza, that soup now gone bad and which is called 229. And that Bindi, having nothing else to offer, continues to offer us.
I will not repeat my analysis on 229 and above all on the government left which, as Bindi itself testifies, has shown, facts in hand, to be incapable despite the need to have a true reformist thought on healthcare. For this I refer to my book “The left and health from Bindi to Hope with a pandemic in the middle” (Castelvecchi publisher) and to the forum that, starting from the book, took place with great critical success in this newspaper.
Inadmissible theses
The basic political thesis of the article, reminding everyone that we are in a pandemic, is the typical one of the left that asks for money but never to change, that is, to survive: it is a question of “strengthening” (Hope, that is, the PNRR says ” strengthen ”) the health system that exists therefore with an invariant system of refinancing it adequately. Nothing original old story.
In other words, without any other thought, it is a matter of confirming, never changing, all the political “choices” we have made in recent years, even those that have proved a fiasco (title V, companies, reorders, privatization, mutuals, de – hospitalization, job insecurity, DM 70, weighted capital quota, health mobility, administered medicine, etc.)
Since the PNRR and mission 6 are also inspired by the postulate of strengthening invariance, it follows that the authors of the article, but without saying it explicitly, take sides in support of the PNRR and mission 6, that is, in support of their beloved party mate Hope.
Mission 6 in its basic logic is none other than the mutatis mutandis re-proposing of 229 of ’99, of its logics and choices. Who cares about the pandemic.
According to the authors of the article, what endangers the operation of strengthening what is there are the financial policies of underfunding of the government. This is the first thesis. Hope can feel comfortable.
But what creeping privatization are you talking about?
The second thesis mirrors the first: underfunding policies “favor the expansion of private supply”. Indeed, the authors of the article write verbatim that there is even “the plan to privatize the Italian health system, injecting generous doses of the market”.
The authors of the article want us to believe that the risk of privatization is a probability oriented towards the future, forgetting that privatization, now precisely because of the policies made in particular by Bindi up to now, is already a full-blown reality. That is, it is not a risk and therefore a probability but a dramatic fact.
Let’s clarify for a moment how things are. The first to resurrect mutuals and insurance funds was De Lorenzo in 1992, although he limited himself to admitting only health services not included in the lea. Bindi in 1999 widened the range of private services and also admits those included in the lea, those accredited, those social health (point 4 art 9 229). That is, with the Bindi supplementary assistance becomes substitute. The private can replace the public.
To supplant public protection with private protection, Bindi does not limit herself to throwing open the doors to financial speculation but operates a true neoliberal overturning (and thank goodness she was the passionate of health and rights), first of all overturning of principles:
• first establishes the principle of “economy in the use of resources” (point 1 article 1),
• therefore it recognizes the principle of compatibility (point 2 art 1) subordinating the right to health to the economic limit,
• finally defines “contextually” the lea to the resources made available by the government (point 1 art 1),
• the gaps between resources and de facto rights delegate them to the private sector which is now fully cleared of customs and free to compete with the public system.
The hunt is open. Bindi has created the conditions from which to build a true system replacement. So a counter-reform.
Without this counter-reform it would not have been possible to speak subsequently either of a multi-pillar system (Sacconi 2009) and nor to pave the way with the jobs act, and therefore with Renzi, to corporate welfare.
It must be remembered that Bindi, in its counter-reformation, did not oppose but on the contrary borrowed the law of De Lorenzo, which provided for collective agreements and collective agreements, including corporate agreements, among the founding sources of the supplementary funds.
In this regard, it must be remembered that on the basis of the jobs act in the name of “welfare on demand” insurance funds are guaranteed tax incentives. That is, the state with tax money incentives the private against the public, that is, by recognizing the private as an important function in the governance of sustainability.
But not only I would like to remind you, again, that with the 2019 Growth decree (art. ‘field of non-commercial activities, considering that financial intermediation which, as everyone knows, is the promoter of the funds is not a speculative subject.
Why do you look at the speck in your brother’s eye, while you don’t notice the beam in your eye?
Having clarified this, speaking by Bindi of creeping privatization is an insult both to our memory and to our intelligence. The real problem today are not the jokes mentioned in the article, that is the 4 clues, but it is to repair the damage caused by the neoliberal counter-reform which in fact has already replaced, in part certainly, a public system with a multi-pillar system. Today public health, at least that intended by 833 in ’78, no longer exists.
Today we have a multi-leg system. Exactly that system first prefigured by Bindi in 1999 and then theorized by Sacconi, then by the Berlusconi government, in 2009 and finally perfected by Renzi with corporate welfare in 2014. It was the time when the most popular slogan was “it is no longer possible give everything to everyone “.
So I find it outrageous to tease us with the story of “unfair competition” (third clue). If there were not already a de facto multi-pillar system thanks to Bindi, there would be no problem of unfair competition.
Procurement and Ministerial Decree 70
While a bogus “creeping privatization” is feared, I find it curious that it is completely silent on the fact that another form of privatization is envisaged in the PNRR, which is the procurement of certain services (home care, elderly, frail and non self-sufficient persons, etc.) to the private and the social private sector.
I know that Bindi and all left-wing Catholics like her really like it and I know that her association is based on a movement called “community first”
But it is still a question of privatization, that is, our multi-pillar system with the third sector, goes from three to four legs.
For Bindi and colleagues, the “fourth leg” is evidently not part of the advanced privatization process. On the contrary, it is social sharing and subsidiarity. Yet sanity, just like the Moon, either for one reason or another keeps losing quarters and getting thinner and thinner. And I who had deluded myself that after the pandemic we would have more public health, not less.
Finally, one thing that Maffei likes very much the dm 70. I would like to advise him first but also everyone to read the document published the other day in this newspaper and written by the Permanent Forum on the National Health System in the post-Covid coordinated by the president di Foce Francesco Cognetti (QS 15 September 2021).
These are 12 illustrious scientific societies plus a few university professors who, on the basis of their experience in a hospital in a pandemic, are calling for the abolition of Ministerial Decree 70 and a lot of other things (refer to the document). One wonders what does the Ministerial Decree 70 have to do with privatization?
The reckless de-hospitalization of recent years and above all the obtuse and bureaucratic idea of a “minimal hospital” that is the basis of Ministerial Decree 70 has favored all those phenomena of privatization well described by Maffei. I believe that the minimal hospital in fact has favored not only the escape of the sick from public to private hospitals but also, and in this I agree with Maffei, the still ongoing flight of many good doctors from public to private.
The logic of making the number of beds depend on the territory is the one that underlies the law 229 but it is also the one that underlies the mission 6.
If community homes and community hospitals are a function that decides according to dm 70 the number of beds needed apart from intensive care and a few other departments, there is a risk of having a smaller hospital than before.
If this were to be the case, confirm the Ministerial Decree 70 applies to creeping privatization how to accentuate the privatization process already underway
Conclusion
The article by Bindi, Dirindin and Geddes seemed to me a clumsy operation of political misdirection, that is, an opaque and instrumental operation in relation to the real risks that health care runs with the PNRR.
It is an expedient to pull the sprint to Hope and therefore to repair the PNRR that is mission 6 from the criticisms that are overwhelming it and to block any attempt at reform.
In the end, what is inadmissible to me is his cynicism.
And all this why? To deny one’s mistakes, to hide one’s limits, to hide the non-existence of a reforming thought, that is, to make us believe what one is not and to deny other possibilities.
Ivan Cavicchi
September 17, 2021
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