Doctors have staged a strange strike. The cancellation of the three days of mobilizations that were still on the agenda has strengthened the perception that the doctors are aware of two things that are incompatible with each other. The first, which justifies their discomfort, is the justice of a good part of their demands. The second, which leads them to a certain resignation, is the impossibility of obtaining a satisfactory response from the administration, beyond vague promises to be fulfilled later and without a fixed calendar. For practical purposes, the salary increase of their payrolls will be the one agreed at the sector’s negotiating table after the signing of the last agreement, to which all the groups joined, with the exception of Metges de Catalunya.
The strike has served to make visible, once again, the structural problems that are undermining the quality and morale of an entire system that came to light in the eighties and that worked reasonably well until the middle of the first decade of the 21st century. But for decades now, the actors in the sector – administration, managers of publicly owned and subsidized centers, collegiate entities and various lobbies, including those of users and patients – have warned of its financial unsustainability and its progressive degradation. And they point out that two things are needed to reverse this trend: more economic resources and structural reforms that allow for the organization of services, equipment and benefits with a different perspective and in another way. There is a lack of money – in 2020 the Cercle de Salut, in a study coordinated by Guillem López Casasnovas, estimated the lack at 5,000 million euros – but it must be spent in another way.
At least that is what the professionals –with or without a white coat– directly involved in this fundamental pillar of our welfare state say unanimously. The problem is not diagnostic. Analysis works and prescriptions for all tastes have been piling up for years. Politicians also tend to agree. But only until it is their turn to govern and assume the costs and discomfort that any ambitious reform entails. Because, let’s be serious, until the Sun revolves around the Earth, to make tortillas it will continue to be necessary to crack eggs.
These are days of euphoria for the approval of budgets. But it is precisely in the exuberance of public accounts where the mess in which public health lives is best observed. The budget allocation to the Department of Health has actually been a pure formalism for years. A chronic lie. By 2023 the increase is 9.6%, up to a total of 11,636 million. Magnificent news. It’s just that we already know that the real spending figure will reach 14,000 million by the end of the year. In 2022 and 2021, the gap between what was budgeted and what was spent stood at 4,000 million; in 2020 there were 3,300 million more, and in 2019 the lag was 2,100 million upwards.
The official budget is a lie that is as necessary as it is recurring, which became more visible during the pandemic. The important thing to remember is that in the case of placing the public budget at 14,000 million per year –what is spent and not what is budgeted–, we could do the same as now, but it would not give us to mitigate the deficiencies that the system is accumulating. For this reason, the insistence on the formula of the two addends: money and reforms.
Let’s leave the detail of the latter to the specialists. But let us only point out the reasons that do not invite optimism about its realization. The changes, the real ones, require gigantic doses of responsibility, generosity and rigor on the part of all those involved. Let’s count three here: the sector’s own actors, the political and ruling class and also, on such a sensitive issue, the media. The former should abandon the logic of “what about mine” and the latter dare to assume the short-term political cost that a reform that deserves that name always generates. And third parties, those of us who explain things, stop being an uncritical speaker of the demagogic “they are going to kill public health” or “we are all going to die” in the face of any attempt at reform. And instead bet on the data, the critical look and the abandonment of simplicity. All of this is probably asking too much. In fact, it is an almost impossible astral conjunction.
