Robert Turn
ROME
"Hands off our powers." While fiscal federalism continues in Montecitorio, receiving less and less criticism even from the Regions, yesterday the governors issued a dry halt against any attempt at parliamentary intrusion into local prerogatives. And precisely on the hottest chapter of the current geeky federalism, which with the federal tax authorities will become even more the match of all matches: health care.
The text drawn up in the Chamber's restricted committee on "health governance" ended up in the sights of the Regions: from the new anti-parceling rules on the choice of managers to those on primary doctors, from the so-called "clinical governance" of the NHS to the free profession of doctors up to the retirement age of the same doctors in Italy, in particular non-university ones less protected than their university colleagues who historically enjoy baronial protective shields.
The opinion of the governors was lapidary: "The proposal for a unified text presents characteristics of unconstitutionality". A full blown rip off. Because the reform of Title V of the 2001 Constitution, as the Constitutional Court has repeatedly reiterated in recent years, does not allow for interference in the powers which the Regions have at their disposal and which they intend to defend grudgingly and without any derogation. With the current rules, and certainly even more so with those that will result from the forthcoming reform of fiscal federalism.
On the planning, organization and management of public health services, the governors essentially say, the Regions have more or less carte blanche. And that text that the Chamber is preparing - as already happened when the former minister Livia Turco tried it - is all wrong, and everything needs to be redone.
"We are widely available for discussions", the Regions diplomatically affirmed yesterday in the hearing in the Social Affairs Committee of the Chamber. Even if in the closed-door meeting held in the morning in preparation for the hearing, there were heavy accusations against a reform proposal considered a real blitz. "Disruptive" and "subversive" proposals with respect to the constitutional provisions, those being studied by Parliament, was the final judgment. Which in form deferred any comment on the two-year-old position – and which continues to remain unchanged – already formulated on the government bill then led by Romano Prodi. No discounts then, no discounts now, is the substance of the reasoning. Not without pointing out that in the meantime there must have been some institutional short circuit, given that once a month the so-called "health commission" of the Regions meets with the Government. And on those occasions of reform of "health governance" there was never a discussion.
This leaves a bad taste in Parliament's mouth. Now we will try to negotiate, to mend, to find an agreement. To make it. Also because if the Government does not uncoil the extra funds for the NHS – at least 7 billion since 2010, the governors are asking – the Regions will remain on the Aventine Hill. And the "governance" can wait too.
Il Sole 24 Ore of 03/20/2009 p. 17
AF
