Everyone at the public health funeral

Fedaisf editorial staff

July 13, 2016

With scissors. 3 billion would be needed, but what the government passes is 800 million. The worst cut to essential levels of assistance. The definancing criterion adopted for the national health fund is also extended to the Leas: I give you x therefore less than what would be needed, to make x sufficient you have to cut on y if you don't cut it's your business. The Lea will cost 3 billion and will be financed for only 800 million euros. The rest is talk.

12.7.2016 – il manifesto

THEThe government has developed a measure to define the new Leas. What are? The acronym stands for essential levels of assistance, i.e. benefits by right for citizens at the expense of the State. They concern hospital care, pharmaceuticals, specialist care, basic care, vaccines, prostheses, collective prevention.

The last time they were redefined was way back in 2001, so it's been at least 15 years that especially the Regions have been asking for them to be updated. In this time, as can be imagined, new therapies have arrived, new treatments, new social needs, new aids, new technologies, even new diseases, to which the Regions systematically subjected to definancing have responded as best they could at times by adopting, despite of the saints, new safeguards but taking on additional burdens without the government ever providing adequate financial coverage.

Before becoming essential, these levels were minimal to indicate a political passage of great significance which, starting from the 1990s, took place from a broad, all-encompassing universalism to a more restricted and contingent universalism.

Until now, no government has wanted to adjust the Lea for fear of giving more and increasing health care costs. On the contrary, little by little, in Lea invariant, measures have been adopted which, in the name of appropriateness and cost-effectiveness, aim to reduce healthcare consumption by peremptoriness.
Today the Renzi government adjusts the Lea not to give more, but on the contrary to give less and make a drastic cut in consumption. From minimal to essential and now to life-saving.

As? The definancing criterion adopted for the national health fund is also extended to the Leas: I give you x therefore less than what would be needed, to make x enough for you you have to cut on y if you don't cut it's your business.

THEThe government has allocated only 800 million for the Lea, even if their update costs at least 3 billion, arguing that what is missing, that is, a good 2 billion 228 million, that is a mountain of money, will have to be compensated in various ways, extending the tickets, resorting to tenders and continuing to pursue appropriateness objectives.

Although this measure overcomes the odious decree on appropriateness and reduces the constraints for doctors to respect in prescriptions, the way it has been devised risks being the biggest blow inflicted on the universalism of the public system and I am amazed that up to now no its subversive scope has been understood since cutting the Lea is the necessary condition to make room for mutual societies and insurance companies, exactly as recently proposed by friends of the government such as Gimbe (see manifesto of 10 June) and as the neoliberals have been proposing to us for decades . That is, a three-legged system: public for the indigent, retired and unemployed, mutual aid for those with an employment contract, insurance for those who have an income and can afford it.

This affair of the Leas even has grotesque aspects if one considers that the Ministry of Health has quantified the effective financial requirement for their coverage, net of cuts and compensations, at just 771.8 million euros, i.e. even less than the meager allocations decided with the 2016 stability law.

I have a bad feeling that we are nearing the end. That is, another couple of years and the system will no longer be what it is now. The definancing of healthcare has been planned in order to reduce healthcare spending by at least one and a half points of GDP in 2019. It is probable that after this operation on the Lea, the national health service by 2019 will no longer exist. Certainly in the middle and fortunately there are many political facts, such as the referendum, the 2018 general elections, but under conditions that are not prevented, i.e. with the government unchanged, the measure adopted for the Leas in fact resizes and not just the value of the 'universalism.

TO make me become a pessimist apart from the numbers are the complicity. The Regions didn't bat an eye, in other times they would have raised hell, today completely subordinate to the Renzi government they collect the 800 million and then we'll see. The unions all lined up and covered and those who grumbled showed they did not understand the sinister sense of the Lea operation. As for the Fnomceo, the highest representation of the medical profession, if on the one hand the constraints of appropriateness that doctors will have to respect seem to be reduced, on the other hand the Nas carabinieri have begun to visit doctors in their clinics and there are many specialties that complain a reduction in performance.
All of this is the result of a fatal encounter whose outcomes were anything but unforeseeable I have always feared and denounced, between the policies of definancing of public health and the weak thinking of those who from the left in recent years have spoken to us of rationalisation, of inappropriateness, of useless tests, of healthcare consumerism, but always with the invariance of that is without ever really changing. The thing I know for sure is that the Leas will cost 3 billion and will only be financed for 800 million euros. The rest is talk.