A-Infos (en) Italy, Sicilia Libertaria #462 - HEALTHCARE. Behind the "Gettonisti", Privatization Advances (ca, de, it, pt, tr)[machine translation]

On July 31, the controversial system of "gettonisti" - doctors and 
nurses hired by private cooperatives to work shift by shift - was 
halted: Italy's local health authorities (ASL) are now forbidden to sign 
new contracts with the cooperatives employing these professionals. 
Existing contracts, however, remain valid until their natural 
expiration. ---- This is a measure long hoped for, but its sudden 
implementation inevitably sparks concern and uncertainty, given how 
deeply embedded the gettonisti have become in Italy's National Health 
Service (SSN). Today it's estimated that doctors on these temporary 
contracts cover 20-30% of Italian emergency rooms - in some cases up to 
80% of shifts.

The shortage of healthcare personnel is often framed as an emergency, 
but in reality it's the predictable outcome of a deliberate strategy to 
dismantle the SSN.

Austerity policies have hit healthcare with some of the harshest cuts. 
Since 2004, no fewer than seven measures have limited new hires by 
imposing spending caps on staff; none of the governments over the past 
20 years have tried to reverse course, even while hypocritically 
lamenting the SSN crisis and claiming urgent structural reforms were needed.

Symbolic is Law 191/2009 of Berlusconi's third government, which decrees 
that "personnel expenses[...]shall not exceed for each of the years 
2010, 2011 and 2012 the corresponding amount of 2004, reduced by 1.4%."

As with this measure, other restrictions were initially temporary but 
then renewed and entrenched by successive governments - the classic 
script where the normalization of an "exceptional state" paves the way 
for a new paradigm. And the paradigm is precisely the shift from public 
to private healthcare, from a universal system to an exclusionary and 
unequal one. As in many other sectors, health services are being 
forcibly outsourced, with strategies that, in the case of the 
gettonisti, border on the absurd.

Gettonisti are paid by the ASL (through cooperatives) salaries up to 
five times higher than those of permanent employees, often working 
beyond the hours allowed by national contracts and sometimes providing 
mediocre service: understandable, as they don't live the daily life of a 
ward and often lack the right qualification or the psychophysical 
stamina needed (it's not uncommon to see doctors over 70 years old in ERs).

A brief "anthropology" of the gettonista is worth sketching: the 
category contains impulses not always to be condemned, from a spirit of 
protest to the desire for greater economic and social mobility. There's 
the fresh graduate working "a bit in France, a bit in Dubai"; those who 
work half the year; those planning to buy a Porsche. But often, those 
who turn their backs on the SSN's safe harbor carry frustration, the 
urge for redemption or revenge - an expression of a wider distrust 
toward institutions. The "Great Resignation" phenomenon is so 
far-reaching that it demands serious reflection.

Not infrequently, the gettonista combines profit maximization - 
presenting as a perfect homo oeconomicus, a true child of neoliberalism 
- with union grievances and a drive to sabotage a system perceived 
(often rightly) as unjust, unequal, estranged from its universalist 
ideals, and incapable of valuing competence.

It's not for us to judge whether these impulses are sincere or merely 
mask a latent guilt - the stigma inevitably weighing on the gettonista: 
being little more than a mercenary or, worse, a vulture feeding on the 
carcass of a dying SSN.

You might ask: why are ASL willing to pay these exorbitant rates instead 
of hiring stable, qualified staff?

First, because many jobs have truly become unattractive; competitions 
are announced but go unfilled. And this is true not only for emergency 
care, as one might expect, but also for specialties. Today it's not rare 
to find gynecology, neurology, internal medicine, and orthopedics 
staffed by gettonisti.

But above all, it's about the spending cap mentioned earlier. Often ASL 
can't hire new staff because they'd exceed their personnel budget 
limits. So how do they pay for gettonisti? Simple: by categorizing them 
under "Goods and Services" - like a canteen, an electrical contractor, 
or any other outsourced service needed to run a hospital.

It's clear, then, that the issue isn't purely financial. If ASL have the 
money to pay gettonisti, they'd also have it to hire directly. This 
proves it's a political choice: the move from a public to a de facto 
private system.

Several ASL, now dependent on gettonisti, are already asking to delay 
the decree's application. Whatever path the government takes, it's easy 
to imagine the only way to keep many emergency rooms open will once 
again involve tricks. These are already on the horizon: direct hiring of 
doctors as freelancers (essentially gettonisti without the cooperative 
middleman) or temporary hiring of trainees, underpaid and often unqualified.

Thus, the sudden halt to new contracts - without a serious policy to 
assess and meet healthcare staffing needs - seems just another 
(pseudo)muscular move by the government: a blend of false pragmatism, 
anti-bureaucratic rhetoric, and anti-scientific populism. A propaganda 
strategy to calm public anger while hiding the decades-long agenda: 
dismantling public healthcare to protect the interests of industrial and 
mafia consortia.

Riccardo

https://www.sicilialibertaria.it/
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