Tag Archives: austerity

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L’assalto ai sistemi sanitari universalistici

I tagli alla spesa sanitaria e le pericolose misure di compartecipazione sono da interpretare come i primi segnali del big bang dei sistemi universalistici europei, a favore di un irreversibile processo di privatizzazione. Tra qualche anno la crisi potrebbe essere considerata allo stesso tempo come prima imputata e prima giustificazione per un rovesciamento di principi, andato oltre il pur necessario contenimento delle inefficienze e il doveroso contributo al risanamento della finanza pubblica.

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Per coloro che vogliono distruggere il modello europeo di welfare, la strutturale debolezza del welfare americano offre un modello attraente. Primo: creare un ben identificabile gruppo di poveri “non meritevoli”. Secondo: creare un sistema in cui i ricchi ricevono pochi benefici in cambio dei tributi che pagano… Infine, come fece Reagan quando tagliò il welfare negli anni ’80, agire in modo da attirare meno attenzione possibile, mettendo in atto politiche le cui implicazioni sono poco chiare e i cui effetti si vedranno solo nel futuro.

[dropcap]N[/dropcap]erina Dirindin e Gavino Maciocco ci ricordano come tutte le strategie elencate siano osservabili nel Regno Unito. Il National Health Service inglese, primo sistema sanitario universalista, nonché fonte d’ispirazione per il Sistema Sanitario Nazionale, ha appena definito un mutamento genetico senza precedenti influenzato dal modello americano. La storia, come spesso accade, si ripete. Senza attirare la doverosa attenzione, il SSN torna a seguire l’esempio del maestro d’oltremanica, attivando un processo che potrebbe culminare con il sacrificio dei suoi principi di fondo: universalità della tutela e solidarietà del finanziamento.

In sanità la testa d’ariete del silenzioso assalto ai sistemi universalistici è costituita dalla misure di compartecipazione, conosciute ai più come ticket sanitari. Nel bel paese, ad esempio, dopo l’introduzione nel 2011 del superticket, ovvero di una quota fissa di 10 euro per ricetta a carico dei soggetti non esenti, sono previsti nuovi ticket sui farmaci e sulle altre prestazioni sanitarie per un importo complessivo di 2 miliardi annui a decorrere dal 2014.

I meccanismi di compartecipazione furono storicamente introdotti come strumento di controllo diretto sulla domanda, finalizzato a ridurre il rischio d’azzardo morale. In un sistema sanitario pubblico, infatti, il cittadino, non pagando direttamente i servizi sanitari, potrebbe determinare un aumento inappropriato della domanda, producendo costi insostenibili per il sistema. Le recenti modifiche introdotte nel Regno Unito e in Italia fanno emergere però la seconda finalità dello strumento, quella di finanziare la spesa sanitaria compensando i tagli delle politiche d’austerity.

In altre parole, la crisi impone tagli dolorosi alla spesa sanitaria e il conto, salatissimo, viene presentato ai cittadini, ai quali viene chiesto di co-partecipare al finanziamento della spesa. Conseguenze?

1. Eccessive misure di compartecipazione favoriscono lo spostamento della domanda dei cittadini con reddito medio-alto al settore privato, che non le applica. L’utente preferisce acquistare le prestazioni da produttori privati per una maggiore convenienza, o sul piano economico o sul piano dell’accessibilità (tempi di attesa). Lucy Reynold prevede, a ragione,  che una competizione basata sui prezzi tra fornitori pubblici e privati, alla fine sarà vinta da quest’ultimi e potrebbe provocare la scomparsa di alcuni dei servizi pubblici perché verranno meno le risorse per pagare i salari dei dipendenti.

2. L’effetto congiunto tra la crisi economico-finanziaria e l’introduzione del superticket ha imposto alla famiglie con reddito basso non esenti di rinunciare all’acquisto di alcuni servizi sanitari, determinando un inedito e grave problema di equità e di mancato accesso alle cure per i “new poor”.

I meccanismi di compartecipazione determinano quindi una fuga dal pubblico bilaterale: da un lato si consegna una fetta di popolazione al privato, dall’altro si preclude l’accesso ai servizi degli individui più vulnerabili, incrementando le diseguaglianze.

Ancor più grave, la vera finalità giustificativa delle misure, ovvero compensare i mancati finanziamenti alla spesa, è difficilmente raggiungibile. Il superticket, ad esempio, avrebbe dovuto compensare un mancato finanziamento di 830 milioni, ma secondo le stime ha prodotto complessivamente un gettito di solo 400 milioni circa. L’obiettivo di finanziare la spesa compensando i tagli è vanificato semplicemente perché se è vero che è aumentato il prezzo del servizio, è anche vero che è stato ridotto il consumo del bene.

Brillante la descrizione del fenomeno come “equivoco della doppia servitù” di Nerina Dirindin:

Si cerca di servire contemporaneamente, con prontezza e  celerità, due padroni e si finisce coll’ingannare entrambi. I due padroni sono da un lato il moderatore dei consumi, desideroso di limitare il (sovra) consumo di prestazioni sanitarie e dall’altro il cassiere del SSN, desideroso di aumentare rapidamente le entrate. Due obiettivi in contrapposizione: le entrate aumentano solo se le prestazioni sono consumate, ma se si mira a ridurre i consumi anche le entrate si ridurranno.

Il timore è che, seguendo l’esempio britannico, i tagli alla spesa sanitaria e le analizzate  pericolose misure di compartecipazione sono da interpretare come i primi segnali del big bang dei sistemi universalistici europei, a favore di un irreversibile processo di privatizzazione. Tra qualche anno la crisi potrebbe essere considerata allo stesso tempo come prima imputata e prima giustificazione per un rovesciamento di principi, andato oltre il pur necessario contenimento delle inefficienze e il doveroso contributo al risanamento della finanza pubblica.

Al contrario è bene ricordare che le politiche di welfare, nonché le politiche sanitarie, possano essere considerate come investimento, non semplicemente “malgrado la crisi”, ma “soprattutto in tempi di crisi”.

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london education cuts protest

Are Protests A Complete Waste Of Time?

As the NUS prepares for another round of protests on the 21st of November, one can only ask whether it is a waste of time or a vital action that may lead to positive results.

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20th October 2012 saw one of the largest protests in recent years. Titled “A Future That Works”, around 150,000 students, activists, politicians and other members of the public filled the streets to voice their disapproval and anger at the public cuts, welfare budget cuts and against austerity measures put forward by the Coalition government. Additionally the protest aimed to change the way politics works in Britain. Their objective is to create a nation which pays workers a living wage, where bankers do not get high bonuses, where the government ensures the inequality between the rich and the poor is shrunk.  These objectives are not new and throughout the years citizens have demonstrated against their government’s policies in hope of change. But does change ever come?

Undoubtedly some protests can have devastating effects on the governments. The Arab Spring is a perfect example of small scale marches turning into full-blown revolutions which resulted in regime change in Tunisia, Egypt, and Libya. Protests have also had a positive impact in America where slavery and segregation were abolished thanks to the protests and marches organised by Martin Luther King. Finally, Gandhi had an innovative idea of protesting – peaceful non-violent civil disobedience which led to the independence of India from the British Empire.

However, recently a large number of people have claimed that protests do not achieve anything and looking back over the last few years it is understandable why that is the case. Almost a million marched against the war in Iraq in 2003, yet the march did not prevent the invasion. Thousands of students marched against the rise in tuition fees, yet once again the results were unsuccessful. One has to also ask what the Occupy Movement has achieved over the last year except media coverage.

Evidently some protests and marches achieve their aim and some do not. Perhaps one explanation for this could be the cause of the protests. While most marches have some validity, one can argue that marching against authoritarian regimes and against slavery and segregation is far more important than marching against a tuition fee rise or austerity measures. In addition, some of the causes which have been successful are quite objective. Anyone with any sense of morality would agree that racism, slavery and life under a dictatorship is wrong and thus it was inevitable that change would eventually come. Austerity measures, education cuts and even the invasion of Iraq are issues which are less clear cut and can be viewed as rather subjective.

Does that mean that less important matters should be left untouched by activists and protesters?  Absolutely not: the secondary aim of marches is to illustrate the dissatisfaction of citizens against a particular policy and additionally to spread the narrative among the public who may not be aware of the damage these policies may be causing. This is exactly what the protests against the invasion of Iraq, against the tuition fee rise, and the most recent austerity march has achieved: the illustration of anger at the government and widespread media coverage attracting others to the cause.

Let us also not forget that student demonstrations can be very effective. For example, thousands of students took over the university as part of the uprising of the Polytechnic University of Athens. As a result the military junta stormed the university gates using tanks. The outcome was the killing of many students by the dictatorship, however, a few days later a nation-wide uprising took place against the junta. This demonstration resulted in the creation of the famous legislation known as the Students Asylum or Academic Asylum. This law was introduced to protect freedom of thought and expression on campuses in 1982, when memories of Greece’s repressive military dictatorships of the late 1960s and early 1970s were still raw.

So where does this leave modern day protests and marches? As the NUS prepares for another demonstration on the 21st of November, one can only ask whether it is just another waste of time or a vital action that may lead to positive results. From the examples given in this article it is clear that many marches do create change, regardless of whether it takes weeks or years. In addition these marches can achieve much more than transformation of the society. They can ensure the government is well aware that their citizens are not prepared to stand back and let the establishment make unpopular choices. Demonstrations keep the government on their toes and ensure politicians are always accountable for their actions. For these reasons, protest and demonstrations are vital ingredients of our political system and have an intrinsically important role to play in society.

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Photo credit: Selena Sheridan

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Ireland’s Referendum: Apathy Triumphs

It is utterly baffling that so many people failed to brave the rain and cast their vote, and it is infuriating that these will be the first people to complain when they don’t get their desired result.

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[dropcap]T[/dropcap]he Irish endorsement of the European Fiscal Pact was a hard fought campaign, with both the ‘YES’ and ‘NO’ camp sketching out the worst case scenario if voters did not listen to them. It will be to the benefit of Ireland in the long term that the ‘YES’ camp have won the day. Ireland is still in an incredibly fragile position economically, and the last thing they needed to do was spook the markets even further by rejecting tighter fiscal discipline.

The saddest part of the whole affair is not that it was such a close run result, but that it almost seems fitting to commend those who actually formed an opinion at all. Figures suggest that fewer than half of the 3.1m registered voters turned out to make their decision. This makes turn out, at best, 50% in some regions, and at worst, below 30% in others.

In the end, the right camp won out. This is Europe’s second chance at imposing coordinated oversight of fiscal policy and setting workable and imposable limits on structural deficits. Even Germany, the economic powerhouse of Europe and the champion of efficiency, broke the original rules set out in the 1992 Maatrstict treaty on state borrowing. Whilst this has been a popular argument for anti-Europeans, not least in the southern economies, this is not the time to look back in anger, but to acknowledge that something must now be done to shore up the single currency for the future.

For Ireland, a No vote would have effectively denied them all future bailouts from the troika of the EU, ECB and IMF. If Ireland is serious about returning to the bond markets in 2014, as is their stated aim, they may well need to continue on life support for the time being. Turning off the supply would leave this already ambitious target in serious jeopardy.

Having said that, one can certainly see why the ‘NO’ camp was tempting some voters to their way of thinking. Out of the so called ‘PIIGS’ economies of Southern Europe, Ireland have been courting the approval of the financial markets and their European neighbours. They have won praise by implementing deep austerity measures, cutting into their enormous budget deficit and recapitalising a near collapsed banking system. When they look across to their fellow strugglers and the possibility of Euro bonds writing off yet more Greek debt, it is not unreasonable to ask what all the hard work was for.

Also, Ireland deserve credit for offering their citizens a referendum, they were in fact the only European country to do so. Despite being in favour of gay marriage, Cameron was right to allow his party members to vote the way they wanted. Similarly, offering the people of Ireland a choice, and seeing the NO camp win, is still preferable to not having the vote in the first place. Allowing people the choice, and convincing them why they should vote for you, is how enlightened politics is done, otherwise, what’s the point of democracy?

Given the serious nature of this whole issue, and the amount of competing opinions trying to monopolise the media agenda, why did so many people decide it wasn’t worth their time to get out and vote?

The usual kneejerk response to this is that citizens are not well enough informed about the issues and therefore do not understand exactly what they are voting for. This is somehow the fault of politicians, failing to educate their citizens and making the information available.

These are not the days of trawling through dusty textbooks at the library, or booking an appointment with your local MP to learn about an issue. One or two clicks of a computer mouse will enable you to access all the information you need. Popular websites like the BBC or Guardian offer helpful Q & A sections, spelling out why each camp believes what it believes, and the likely consequences of voting either way.

Of course, some of us can get obsessive about politics, constantly updating twitter with BBC News 24 in the background, while others simply don’t have the time to devote to keeping abreast of all the latest news updates. This may be true, but what many political aficionados soon realise is that half an hour in front of the 10 o’clock news is more than enough for a healthy introduction to any debate.

Occasionally there might be an issue that baffles even the most interested news recipient. Scottish independence, for example, or Cameron’s Big Society, has highlighted how even a government can occasionally fail to spell out why their flagship policy is worth people’s time and attention. The Irish referendum was not one of these issues. The Euro crisis permeates our lives every day, from an in depth discussion on Newsnight to a glimpse at a Newspaper front page while queuing in a corner shop. It is therefore utterly baffling that so many people failed to brave the rain and cast their vote, and it is infuriating that these will be the first people to complain when they don’t get their desired result.