Spain Nationalized Private Clinics To Fight COVID-19—What Happens After The Pandemic?

March 30, 2020

Spain faced the second worst infection rate in Europe, and took control of the country's private health care companies to improve its response. What does this mean for Spain's public health care system going forward?

Spain faced the second worst infection rate in Europe, and took control of the country's private health care companies to improve its response. What does this mean for Spain's public health care system going forward?


Health workers go back to work after after a break at La Fe hospital on March 25, 2020, in Valencia. Jose Jordan/AFP via Getty Images

Story Transcript

This is a rush transcript and may contain errors. It will be updated.

Greg Wilpert: It’s The Real News Network. I’m Greg Wilpert in Arlington, Virginia. Here at The Real News Network, we have been covering how different governments are dealing with the coronavirus pandemic, and whether the private or the public sector is better equipped to deal with such a large-scale crisis.

One government that is adopting a decidedly state-centered approach is Spain. Currently, Spain has the second most number of infections in Europe, and the second most number of deaths in the world. Last week, the center-left government of Spain announced that all private hospitals and private healthcare companies will be managed by the government until the crisis is over. Here’s how a Spanish nurse described the increasingly dramatic situation in Spain’s hospitals.

Speaker 2: There are no waterproof gowns. The colleagues protect themselves with garbage bags, and trying to get the protection that the hospital does not give them. Waiting rooms have been set up to treat patients without oxygen, neither respirators, and the situation is in chaos.

Greg Wilpert: And here is how Deutsche Welle correspondent, Jaime Velazquez, says the government is diverting resources to provide to emergency health services.

Jaime Velazquez: Yeah, well the government has just announced that they have bought 700 extra respirators and 240,000 rapid coronavirus tests. They want to increase that number of tests up to 6 million in the coming days and weeks. And also, as you said, in the Exhibition Center in Madrid, 5,000 beds hospital has been put in place. Also, hotels are turned into hospitals a way to host some of the patients and those home health workers that are coming from other parts of Spain. Well, we will still need to see exactly probably in these coming days how these new infections are building, how the things are building up.

Greg Wilpert: Joining me now to discuss how Spain has been dealing with the Coronavirus pandemic is Sebastiaan Faber. He’s Professor of Hispanic Studies at Oberlin College, and author of the book Memory Battles of the Spanish Civil War. Welcome back to the Real News Network, Sebastiaan.

Sebastiaan Faber: Great to be back, Greg.

Greg Wilpert: So, how does Spain’s healthcare system first of all work more generally,, before the crisis broke out? And from the point of view of the patients, the families and the people who need to be tested for the coronavirus, how important is it to have even private facilities managed by the government?

Sebastiaan Faber: Well, it’s important first to point out that Spain has long had a very robust single-payer public healthcare system, in part because in the Spanish Constitution of 1978, access to good quality public health care is a right. It’s a constitutional right in Spain. So Spain has had a very strong healthcare system, often ranked in the top 10 of the world. And, at the same time that there are also private hospitals and private clinics, but those make up about half of the country’s hospitals, about a third of the country’s available hospital beds, for about only 20% of the population. Only 20% of the population has a private health insurance. Everybody else can get healthcare for free whenever they need it, in any of the country’s, hospitals. This healthcare system is managed regionally, so the hospitals are funded by, and controlled by, regional governments.

Now what the state of emergency that was declared on March 14th did, I was not quite nationalize that private part of the healthcare system, but to put it under the direct control of the Ministry of Health. So under direct control of those regional governments. That is important to basically help coordinate the response to this incredibly overwhelming crisis. Like you said, Spain is among the countries hardest hit by the spread of the coronavirus, and it was very important to coordinate available beds, available ICU beds, and to put the maximum amount of effort toward trying to curb this virus. What the virus crisis has done, however, is to show to what extent this very robust system that Spain had, has been weakened over the past decade or so by two big trends. One has been basically cutbacks.

So in response to the great recession of 2008, 2009, 2010, the Spanish government, both the central government and regional governments have cut back on healthcare funding, reducing the number of beds, reducing the number of personnel, surgeons, nurses, at all kinds of levels. So that trend has really hurt the system, and it’s a crisis like this that brings that to the fore. The second big trend that has weakened the public healthcare system in Spain has been the constant steady push toward privatization, especially by conservative governments at the regional level, that have consistently pushed to take public facilities and privatize them, or to allow private for-profit companies to manage or take over public healthcare services.

And, what the crisis has done, it has revealed the weaknesses of the system. The system has been currently, is overwhelmed. One of the signals of it’s being overwhelmed is the high percentage of healthcare personnel that has come down with the virus. This is higher than in other countries in Europe. And what it has also done as a result, is it has put back into public consciousness the awareness of the need for a robust, strong, fully-funded public healthcare system in Spain.

Greg Wilpert: Now, the government in Spain is headed by the Socialist Workers Party of Spain, the PSOE. But in recent decades, that Party has been kind of part of the third-way, center-left trend in Europe, moving more and more towards the political center. Now, the PSOE is currently in a coalition or working together with the Juegos Podemos Party, which is much more leftist. But it too has kind of abandoned some of its more radical positions. So, how did the idea to nationalize or to actually manage the private health system come about? I mean, what was the debate, and do you think this will have a longer-lasting consequence once Spain gets out of this crisis?

Sebastiaan Faber: I think it’s good to see the state of emergency and the taking over the management of the healthcare system in a larger context of the Spanish government’s response to the crisis, which mirrors really the response of many other countries in Europe and even the United States, which has been to think about the crisis as an opportunity, or just to see the need for a large-scale public investment in society, in response to the crisis, especially to soften the economic blow, which is a radical departure from the response to the 2008, 2009 crisis, which was hysteria, cutbacks. The fact that Juegos Podemos is the coalition partner of the Socialist Party, I think has helped this response, has helped the Spanish government to not forget groups of society, those groups of society that were hardest hit by the previous crisis.

So I think definitely in the debates, which reportedly were extremely intense in the Cabinet over the past month or so, the presence of Juegos Podemos has helped push the government in the direction of more support, a stronger social network, more unemployment funding, including this takeover of the healthcare industry.

Greg Wilpert: And what has been the response in Spain that is in the general population to have this a change in the way the health system is being managed?

Sebastiaan Faber: Generally in Spain, the crisis has hit very hard. People are extremely concerned. The number of deaths continues to grow every single day. There is a lot of concern about all aspects of the care system, including, for example, elderly care. Spain is among the countries, the second country in Europe with the European Union, with the highest life expectancy. So it has had a very low birth rate for many years, which means that the population is an average again, or it’s an elderly population. So everybody knows people who are at risk or have been infected by the virus, and the situation in homes for the elderly have been also very alarming. So there’s a widespread awareness of the sense of crisis, of the need for intervention.

At the same time that, as I said earlier, the extent to which the crisis has revealed the erosion of what was once an extremely strong public healthcare system has convinced the general population of the need for strengthening again, that system properly funding it. And among the touching details, it started in Spain and has now spread to other European countries, is the ritual of a daily public applause for the healthcare workers in the public system, where people go out on their balconies at 8:00 in the evening, and applaud the work done by these people on the front lines of the crisis.

Greg Wilpert: Interesting. Now, finally, do you think that this change in management will be reversed again? I mean clearly they have already stated that this is just temporary. But what do you think will be the longer-term consequences, and will this situation go back to the way it was before?

Sebastiaan Faber: I think in principle, it’s set to revert to the status quo before the crisis. And there’s a couple of questions that have not been answered. As I said earlier, the trend has been for public healthcare services to be outsourced to private for-profit companies, which includes Spanish companies, multinational companies. And in a way, taking over the management of the private part of the healthcare system in the crisis is kind of a forceful outsourcing of that same capacity. But because the ownership of the private healthcare system is not put in question, so these multinationals are still the owners, they’re just now under management of the State government, means that it’s quite possible that those private companies will at the end of all this, present the central government with a bill for every patient, and every test, and every intervention ,they have done. And it’s not clear what kind of rates they might charge, and how this will be resolved.

So I think what’ll I need to happen once this is over, is another serious negotiation, or even fight, for the central government to defend the rights of patients and the right of the public system to be treated properly in this situation. I think, ultimately, it goes back to budget questions and policies, and there will, I think, be a push in Spain to at least, if not revert, then halt the trend toward cutbacks for public healthcare spending, and towards steady privatization of the healthcare system. Because if one thing has become clear in this, is that having split systems where each part kind of takes care of its own purchasing of masks, or its own purchasing of the respirators, is chaotic. And even the fact that national, the Nation States turn out to be not quite capable of producing their own healthcare supplies, including masks and respirators, has now turned out to be a real issue.

So I think in that sense, we’ll see changes in the way that people think about healthcare, and the way that governments think about healthcare.

Greg Wilpert: Okay. Well, we’re going to leave it there for now. I was speaking to Sebastiaan Faber, Professor of Hispanic Studies at Oberlin College. Thanks again, Sebastiaan for having joined us today.

Sebastiaan Faber: My pleasure, Greg.

Greg Wilpert: And thank you for joining The Real News Network.