La mercantilització de la sanitat

Encara que sovint només recordem la salut després d’emmalaltir o patir per la mort d’un ésser estimat, la gran majoria de ciutadans europeus (més de 4 de cada 5) pensa que la salut és un bé essencial per assolir una bona qualitat de vida. És lògic. Quan tenim bona salut disposem de més energia, més capacitat per estudiar, buscar feina, desenvolupar les nostres capacitats creatives i oci, més possibilitats per tenir millors relacions socials, a més de sentir-nos més alegres, satisfets i tenir més llibertat.

Sembla indubtable que els que estan malalts, amb discapacitat, o dolor tenen menys autonomia i independència, al tenir més salut augmentem la nostra capacitat per triar, prendre decisions, ser més lliures.
Tot i no ser el principal determinant social de la salut, no hi ha dubte que accedir a una adequada atenció sanitària quan ens posem malalts (amb professionals sociosanitaris ben qualificats i preparats, una atenció ràpida i eficient, un ús assenyat de la tecnologia i el millor tracte humà i personal possibles) té gran valor per a la nostra salut i llibertat.

EnviaLa literatura científica i l’OMS són contundents en assenyalar que els sistemes sanitaris universals, amb propietat i gestió públiques, basats en l’atenció primària i una elevada qualitat de prestacions, no només ofereixen millors resultats de salut sinó que també són més eficients, equitatius i humans. La suposada major “eficiència” de l’atenció mercantilitzada es fonamenta en gran mesura en estalviar en personal i oferir salaris baixos i males condicions laboral, la qual cosa afecta la salut dels propis treballadors sanitaris i afecta la qualitat de l’atenció. A més, els centres privats seleccionen els pacients, donen altes prematures, cobren per acte mèdic i realitzen més proves i intervencions innecessàries.

La Llei General de Sanitat va assentar el 1986 les bases del Sistema Nacional de Salut (SNS) que va ampliar la cobertura i proveir atenció sanitària de bona qualitat per gairebé tota la població de l’Estat espanyol. Malgrat les seves insuficiències i limitacions: restringida despesa pública, desenvolupament limitat de l’atenció primària, la salut laboral i la salut mental, excessiva despesa farmacèutica i baix ús de genèrics, i escassa atenció a determinats col·lectius, amb el SNS gairebé tota la ciutadania va obtenir una bona atenció independentment de la classe social, poder adquisitiu i lloc de residència.

Des de llavors, els grans conglomerats empresarials i lobbies de la indústria farmacèutica i tecnologia sanitàries, han incrementat la seva pressió per transformar el SNS i obrir noves oportunitats i models de negoci. Com que la sanitat pública i privada són “vasos comunicants” (si es deteriora la primera es reforça la segona i a l’inrevés), les estratègies polítiques, legals i econòmiques de mercantilització sanitària dels darrers anys han passat no només per incentivar i enfortir al sector privat (privatitzar o ampliar l’espai per a lucrar-se, realitzar concerts amb la sanitat pública, afavorir l’assegurament privat), sinó també per afeblir, desprestigiar i fer més opac al sistema públic (retallar pressupost i recursos, fragmentar, desregular o concertar serveis, establir “repagaments”).

EnviaLes conseqüències són conegudes: tancar centres d’atenció primària, urgències i quiròfans, i augmentar les llistes d’espera i reduir el nombre de professionals, produint-se un increment del risc d’emmalaltir i morir prematurament i un augment de les desigualtats. En aquest procés, la ideologia i confluència d’interessos entre les elits econòmiques privades, i molts gestors públics i dirigents polítics ha estat manifesta, la qual cosa es reflecteix en valors i interessos compartits i en pràctiques de clientelisme i “portes giratòries”. Boi Ruiz, home de la patronal sanitària i actual conseller de Salut de la Generalitat de Catalunya, ho va dir rodonament en explicar que la salut “és un bé privat que depèn de cada ciutadà i no de l’Estat” i que “no hi ha un dret a la salut”.

Un important punt d’inflexió en aquest continu procés cap a la mercantilització va tenir lloc amb l’aprovació del Reial Decret 16/2012. Dèiem fa una mica més d’un any (veure ” Avanzar al pasado: la sanidad como mercancía”, El País 16-08-12), que es tractava d’una autèntica contrareforma sanitària, un canvi radical que significava passar d’un SNS a un sistema de pagament per als rics, seguretat social amb menys i pitjors serveis per a treballadors i una classe mitjana empobrida, i una sanitat de beneficència per a pobres i marginats. Un canvi per acabar amb la sanitat com a dret i donar pas al classisme, la discriminació i la desigualtat.

Des de la implantació del RD fa un any les coses no han parat d’empitjorar. S’ha retallat la despesa sanitària pública al voltant del 12%, s’han reduït els metges i infermeres en almenys 52.000, ha augmentat espectacularment el nombre de desprotegits (més de 870.000), s’han allargat les llistes d’espera (entre 20-40%), s’ha reduït la capacitat assistencial dels centres públics, i ha empitjorat la qualitat de l’atenció primària i especialitzada. A això cal sumar el creixent augment de “repagaments”, on cada vegada són més els pensionistes que no poden fer front al pagament de medicaments.

Es confirma una nova retallada de la despesa fins arribar al 20% en els propers anys, el sistema sanitari públic rebrà el cop de gràcia final, creant problemes de salut pública i desigualtats encara més grans. Si amb les retallades han empitjorat l’accés, qualitat i equitat de l’atenció sanitària, amb la mercantilització de la sanitat es perdrà definitivament no només el dret a l’atenció i la salut, sinó també llibertat.

El pensament liberal sosté de forma interessada i classista que un individu és lliure quan fa el que vol, quan pot prendre decisions sense que hi hagi interferències externes. Sota aquesta visió, un esclau seria lliure quan un amo extremadament bondadós li deixés fer tot el que volgués. Però hi ha una altra manera de veure les coses que entén que la llibertat no neix de la voluntat de l’amo sinó de l’existència de drets socials (per exemple, el dret a treballar la terra, la democràcia a l’empresa, o rebre una renda bàsica universal), on els ciutadans disposen dels recursos, els mitjans i la protecció adequats per treballar i viure dignament i amb bona salut. Igual que poder votar lliurement, tenir una pensió, o rebre educació, ser lliure significa que qualsevol individu tingui per llei, de forma garantida, el dret a una atenció sanitària pública de qualitat, no mercantilitzada.

EnviaTambé aquí, Boi Ruiz va assenyalar amb claredat la seva ideologia de classe en indicar que triar una mútua sanitària privada és una forma de “lliure elecció” de la gent (llegiu classes benestants), un “dret” que s’ha de reconèixer fiscalment. L’atenció sanitària no pot ser la mercaderia d’una minoria amb “llibertat” (llegiu diners) per poder pagar-la, sinó un dret universal garantit que ens faci ciutadans lliures i amb més salut.

A la coneguda pel·lícula de Frank Capra ¡Qué bonito es vivir!, Clarence, un àngel de segona classe que intenta obtenir les seves ales, dóna l’oportunitat a que un George Bailey (James Stewart) escurat, desesperat i a punt de suïcidar-se, pugui mirar què hauria passat a Bedford Falls en el supòsit que no hi hagués viscut. George se sent llavors immensament feliç quan comprèn les espantoses conseqüències socials que haguessin ocorregut en el seu poble si les moltes accions solidàries i justes que ha portat a terme durant la seva vida no s’haguessin realitzat. Pensem per un moment en l’incomptable sofriment i dolor, en les malalties i morts, en la brutal desigualtat, sobretot en les classes populars i immigrants, si en les últimes dècades no hi hagués hagut un SNS públic, universal i amb un bon nivell de qualitat. Imaginem-ho.

Podem apreciar les conseqüències que tindrà la caiguda del SNS? Reflexionem sobre això perquè, si els moviments socials i sindicals al costat dels partits polítics que els donen suport no ho impedeixen, la sanitat pública, universal i de qualitat que hem conegut està en trànsit de desaparèixer. Rebel·lem-nos. Igual que per a George, entendre que les lluites justes valen la pena ha de crear felicitat i esperança. La llibertat i la salut estan en joc.

 

Joan Benach és professor i investigador de salut pública i director de GREDS-EMCONET (Dept. Ciències Polítiques i Socials, UPF). El seu últim llibre publicat és “La sanitat està en venda” (Icaria). En l’actualitat és coordinador del projecte en vies de finançament a través d’un crowdfunding Privatitzant la Sanitat. Impacte en la salut de la privatització de la sanitat a Catalunya

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