Victories are rare in the ongoing struggle against the sell-off of public services in southern Europe. So when one occurs as big as the recent defeat of the Madrid regional government’s plans to privatise hospital and community health centre management, it should be enjoyed to the full.
The crowning moment in the 15-month-long battle to keep administration of six hospitals, four specialist centres and 27 community health centres in Madrid in public hands came on January 27. That afternoon, a gloomy regional premier, Ignacio Gonzalez, announced the suspension of the privatisation.
Javier Fernendez-Laquetty, his health minister and architect of the plan, resigned.
This capitulation by the People’s Party (PP) government came only hours after the Madrid High Court of Justice had ruled against the government. The court had rejected its appeal against a ruling suspending privatisation of health service management until a full investigation of the impact could take place.
In its original judgement, the court had accepted the argument of the Socialist Party of Madrid and the Madrid Association of Specialist Physicians (AFEM) that the case for privatisation had not been made.
It accepted that, if implemented, privatisation could well endanger people’s constitutionally guaranteed equality of access to health care (introducing “health apartheid”, in the AFEM’s words).
Now all the Madrid government can show for its blitzkrieg against the public health sector is a closed cardiology institute, a hospital converted to medium and long-term care and a privatised central hospital laundry.
About 3500 jobs have been cut from the system, but that loss is small compared with the jobs holocaust a successful implementation of Laquetty’s plan would have produced.
The white tide
The court decision was the legal recognition of a political victory. In the mighty battle for the hearts and minds of Madrid’s people, the opponents of privatisation triumphed in a region where the PP holds an absolute majority in the local legislature.
That victory was fruit of a campaign that mobilised health workers, hospital patients, unions, neighbourhood associations, left parties, anti-privatisation platforms and 15M (indignado) networks.
The campaign was known as the “white tide” of health professionals and their supporters, so-called following the example of public education workers’ “green tide” against education cuts. It featured 15 months of intense action: strikes, sit-ins, rallies, public meetings and seminars, petitioning, protests outside the offices of the private outfits set to gain from the sell-off and solidarity pickets outside the court.
Jesus Jaen, spokesperson for the health workers’ and users’ platform Patusalud, described its impact in a January 28 article on the Publico website: “Through unity among health workers, patients and the neighbourhoods we built up a powerful social majority.
“It has been moving to take part in these tides, where the white coats mixed with the elderly and not a few patients who came in their wheelchairs or with their oxygen bottles.
“Here was the people in the broadest sense, forceful and determined to fight until the end.”
The white tide first appeared in November 2012. Staff, patients and the local community at the Hospital de la Princesa began an indefinite sit-in in protest against the proposal to turn it into a geriatric centre.
The sit-in also gave birth to the idea of regular mass rallies and health system-wide general strikes.
After its first street protest, the white tide mobilised in Madrid on the third Sunday of every month. Its 15th consecutive march took place just one week before the government’s surrender.
From its first two-day strikes in November and December 2012, it was clear the movement was drawing support from all levels of health workers. “Something weird is happening,” nurses and cleaners were heard to say, “I saw my department head at the rally yesterday.”
The movement also won backing from specialist physicians who had set up AFEM to fight against the impact of health cuts on service quality in the public system. When the Laquetty plan became known, AFEM called an indefinite strike of doctors that lasted five weeks.
Support grew as details of the sell-off took shape. By April last year, health workers had learned that part of the deal with the three private outfits picked to get the work (without any competitive bidding) was that 3120 jobs would not be guaranteed.
However, the white tide also convinced a majority of the community that its fight was not just about public sector workers defending their jobs. On May 13 last year, about one hundred community groups and anti-privatisation platforms organised a community referendum on Laquetty’s plan: 94% of the 935,794 people who took part rejected it.
Inevitably, the PP’s political pain grew. Jaen said: “In a district like the suburb of Salamanca, hundreds if not thousands of people came up to us at the Hospital de la Princesa to let us know that ‘I didn’t vote PP so they would close my hospital’.”
The victory could not have occurred without this extraordinary mobilisation, but it was also helped by the blunders of the government, run by the PP’s most right-wing elements.
Initially, the privatisation was launched by former Madrid regional premier Esperanza Aguirre to show other PP regional rulers ― and the national PP government ― how to crash through opposition to “externalisation” of public services. (The word “privatisation” is banned from PP discourse.)
Aguirre brought in Laquetty from the Foundation for Analysis and Social Studies, a PP think tank, to be her battering ram in this assault.
However, Laquetty’s frontal attack strategy forced all public health workers into a single alliance. This was something that the more cautious approach of other PP administrations had avoided via divide-and-rule deals to “look after” certain classifications.
The Madrid government has also suffered from high levels of arrogance, incompetence and overconfidence.
Its initial document justifying the privatisation ran to a full 11 pages. Its figure for potential savings fell from 500 million euros to 200 million euros and then to 163 million euros as it struggled to measure up to the counter-analyses coming from AFEM and other sources.
On June 21 last year, two former PP health ministers were charged with coercion, crimes against the public purse, document forgery, bribery, perverting the course of justice, fraud and embezzlement ― all in relation to a previous wave of privatisation. Gonzalez and Laquetty, however, carried on as if this had no relevance to their schemes.
Such moments were a free kick for the clever media and legal tactics of the white tide facilitators. Their response to such behaviour succeeded in convincing most people that the Madrid health privatisation scheme represented, in the words of an AFEM spokesperson, “not even a neoliberal model, but a mafia scam”.
The white tide won because it was based on the self-organisation of those affected, applying the experience of the 15M movement for “real democracy” that broke out in 2011.
As in the teachers’ struggle against education cuts in the Balearic Islands, the all-involving mass-meeting has been the basic cell of decision-making. Union leaders, while often deeply involved, have had to respect outcomes because of the authority mass meetings have with union members.
The victory can only have positive benefits for the social struggle in the Spanish state. For starters, out the window goes the cliché that “protest doesn’t pay” when it blatantly has.
Second, the Madrid victory is deepening the crisis of the PP, with the latest polls showing the party losing Madrid, Valencia, Navarra and nationally. In this atmosphere, the call for discredited PP governments to submit to early elections becomes increasingly compelling.