A-Infos (en) Italy, Sicilia Libertaria: Public health: a planned destruction (ca, de, it, pt, tr)[machine translation]

It is now known that the NHS is experiencing a systemic crisis, worsened 
from government to government, which increasingly resembles a planned 
metamorphosis. The institution of the NHS dates back to 1978, a period 
in which capitalism was already being reorganized in a neoliberal sense 
in the rest of Europe. This testifies to the "peculiarity of the Italian 
laboratory of the seventies". The NHS was in fact born from the synergy 
between trade union and workers' struggles, feminist and student 
demands, and from the shared vision of "health as a social and political 
fact (social in its genesis and political in its resolution)". Both 
universalist ambition and democratic demands converged in the NHS, by 
virtue of which a decentralized model was opted for, close to the real 
problems of the population, and with a privileged focus on prevention. 
Thanks to these factors, the Italian NHS remained an international point 
of reference for many years.

But the current situation appears very different. Today the NHS is 
fragmented into many small regional health systems, increasingly 
absorbed by market logic, and shows its inability to guarantee effective 
equity of care to the population. The reasons for this decline are 
numerous and complex, and only partly attributable to neoliberal austerity.

If on the one hand the institution of the NHS has overcome the 
paternalistic model of the Mutua, on the other hand it has strengthened 
that process of "monopoly of care", whose genealogy Foucault traces back 
to the 18th century in the West. The healthcare institution has 
gradually swallowed up the entire scope of care. The very definition of 
"health" and "disease" has become the prerogative of the dominant 
classes, no longer an expression of what populations and different 
cultures develop. From an instrument of political redemption, healthcare 
has become a system of disciplinary and homogenizing power. As Illich 
pointed out, the rigidification of healthcare institutions has deprived 
them of their conviviality, that is, the possibility of sharing 
knowledge and/or living with other people's knowledge.

On the other hand, with families "nuclearized" and deprived of the 
material and cultural possibilities to exercise care, the domestic 
environment has become an increasingly hostile place for the elderly and 
chronically ill. Hospitalization has increased exponentially, thanks to 
a distorted vision that sees "life extension" (at all costs) as 
synonymous with "health protection". In this cult of longevity, which 
permeates the underlying ideology of US-led techno-science, we glimpse 
the ancient and crazy dream of immortality. Death ceases to be a natural 
fact, it is just an accident, and as such it should not be accepted but 
fought technically. The therapeutic fury produced by this 
non-relationship with death, in which a certain obscurantist Catholicism 
still plays its part, translates into the chronicity of many terminally 
ill patients. The tensions between healthcare workers, frustrated by 
having to "cure" patients without any prospect of improvement, and a 
social fabric that can no longer take care of family members, 
plastically measure all the critical issues underway.

It is on these structural critical issues that austerity - imposed by 
precise political choices - has launched its deadly attack. In Italy, 
health spending has been in constant decline since 2011, with a spending 
review process of the health sector which already in 2012 the Court of 
Auditors considered "the most advanced and complete experience of what 
should be a spending review process ". The public has been deliberately 
impoverished to the advantage of the private sector, with the almost 
forced recourse to more or less direct outsourcing: let's think about 
how long waiting lists force people to turn to affiliated centers for 
instrumental diagnostics (for those who can afford them) or how the 
shortage of doctors in emergency rooms is addressed by "token 
operators". But market logic pollutes the public sector from within. We 
already see this with the DRG system, which assigns a "price" to each 
pathology on the basis of which the hospital is paid. Hospital 
companies, like any other company, are induced to grab the most 
profitable DRG, and to try to maintain, from year to year, equal or 
greater quantities of that given DRG. Here Healthcare unmasks its new 
nature, which is not that of guardian of health, but of "incubator" of 
disease. The disease becomes to all intents and purposes a commodity, 
and the hospital is the factory responsible for its processing. It goes 
without saying that reducing the incidence of illnesses through 
prevention is of less and less interest: both because it is not as 
profitable and because it would be equivalent to depriving oneself of 
the goods from which the company derives profits (fewer illnesses = 
fewer DRGs paid). Lastly, because it would mean recognizing the social 
nature of most evils, which would force us to question the entire 
capitalist system. The political and bioethical impasse into which the 
NHS has fallen seems clear to me.

And yet internal healthcare debates are few and almost exclusively 
focused on the salary issue. But increasing funding is not enough to 
overcome this stalemate. What is needed first and foremost is collective 
awareness of how market logic is incompatible not only with the equity 
of care, but with the very right to health protection. Second, we must 
abandon the current elitist-corporate approach of the medical class, and 
admit that there is no truth, because there is not a single concept of 
health. To do this we need to "re-democratize" the concepts of health 
and illness, to frame pathologies no longer as the exclusive problem of 
the individual, but in their social dimension. Lastly, it is necessary 
to promote the territorialisation of Care, actively involving mutualisms 
from below.

Disseminating scientific knowledge and sharing the means to produce it, 
indeed restoring conviviality to it, is not equivalent to giving rise to 
gurus or false cures; at least no more than is already happening (think 
of the murky nutraceutical sector). Spreading knowledge and 
resocializing Care is the only real remedy to make us less manipulable 
and regain control of the management of our lives.

Riccardo Ricceri

http://sicilialibertaria.it
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