The defense of public healthcare in Madrid
Interview with Dr. Marciano Sanchez Bayle
by Andy Coates, MD
December 15, 2012
Published by Portside
Madrid’s physicians, nurses and other health
professionals have been marching in the streets with
their patients for over a month, protesting the
government’s plan to privatize and sharply reduce
public health services.
Spain’s National Health System (SNS), established in
1986, fulfills a mandate included in Spain’s national
constitution. Article 43 guarantees healthcare to all
Spaniards, including the right to adequate public
The attack on the SNS is led by the government in
Madrid. (Administration of the SNS is decentralized;
each of Spain’s 17 semi-autonomous regions sets health
budgets and priorities.) At the beginning of November
Madrid moved to privatize ten percent of public health
centers as well as the administration of six hospitals
– half of the hospitals in the region. Of the hospitals
to be privatized, all were recently built.
The response: an unprecedented and massive mobilization
of people in Madrid, now making mainstream news across
the world. Caregivers and patients together have joined
protests at every public health clinic and hospital in
Madrid. Marches have involved hundreds of thousands.
Caregivers have gone on strike and stopped traffic
outside their workplaces.
The Partido Popular, in power nationally as well as in
Madrid, also proposed to convert La Princesa Hospital,
a tertiary care center serving about 300,000 patients
annually, into a specialty care center for patients
over the age of 75. In addition to mass meetings and
sit-ins at La Princesa Hospital, a petition in protest
gained over 200,000 signatures. The Mayor of Madrid,
herself a member of the Partido Popular, signed on. The
government has retreated from its plans at La Princesa
Hospital yet the struggle continues.
Last week a group of patients, nurses and physicians
disrupted a speech at the Madrid regional Assembly,
where the government’s economic counselor was
explaining the hospital privatization plans. In this
short news video, Dr. Marciano Sanchez Bayle chants for
public healthcare beside a woman who unfurls a banner,
the first to be led out by police. Note the Assembly
members who stood to applaud the protesters.
Here is a short interview I conducted with Dr. Sanchez
Bayle of the Federation of Associations for the Defense
of Public Health (FADSP) this week. He practices and
teaches pediatrics in Madrid. ==========
Q: Many of us in the United States have difficultly
imagining health care delivered by a public system.
Would you please describe how patients in Madrid get
their medical care?
A: In Spain the health system is public and coverage is
universal. This means that when a person thinks he or
she has a health problem, they go their public health
center. There they are attended by a doctor and/or a
nurse who will make the appropriate decision whether to
diagnose and treat, ask for diagnostic tests, refer the
patient to a specialist or admit them to a hospital.
Of course, if the situation is serious or occurs
outside regular treatment hours, patients can go to a
hospital emergency room. Hospitals are also mostly
public. Thus far all of these services are free,
including the tests. A patient does have to pay a share
of the cost of their prescriptions, however. On a per
capita basis, the Spanish system is four times less
costly than in the U.S. Yet we achieve much better
outcomes, according to basic health indicators.
Q: How has the government proposed to change this in
A: The proposal in Madrid is to privatize some of the
hospitals and health centers, turning them over to
Q: How will this affect patients?
A: There will be an immediate and significant
downsizing of personnel, resulting in diminished access
to care. It will undermine the quality of care. It will
substantially lengthen waiting lists.
In addition, these changes will result in what we call
risk selection, whereby private entities will seek out
the most profitable pathologies, i.e. those persons who
are less sick. As a result, people will face more
obstacles to getting the care they need, following the
Tudor Hart law of inverse care – medical attention will
be dispensed in inverse proportion to the needs of the
These will be the short-term results, because it is
clear to us that the Partido Popular, the conservative
party, hopes to install a health care model based on
private insurance. The disastrous results of such a
model as the United States, are well known.
Q: What will it mean to doctors and nurses?
A: First of all, there will be fewer of them employed,
with layoffs and fewer facilities to practice in. For
those remaining, it will result in overwork and a
worsening of professional working conditions.
Q: Please describe the protests that have emerged in
A: It would take a very long time to fully answer your
question because there have been such a multitude of
actions. Briefly, it has produced a strike by the staff
of the centers — doctors, nurses, administrators,
auxiliaries, etc. — which has been organized according
to a rotating schedule, e.g. specific days a week.
Health worker sit-ins, sometimes joined by patients,
have also occurred. These started first in the
hospitals, then in the health care centers. These
protests have been going on for 30 days.
In addition, massive demonstrations have been held in
Madrid, some with more than 100,000 people,
professionals and patients. Every day there are
demonstrations blocking traffic in front of the health
centers. Last week an action was carried out under the
slogan “Hug your Hospital,” in which human chains
circled all the public hospitals of Madrid.
The most interesting thing is the supportive reaction
of the citizenry. People are very committed to the
defense of the public health care system. Of course, we
Spanish continue to have a bit of the guerillero and
anarchist spirit in us, so to speak, and many
initiatives have been sprouting up like mushrooms.
Q: What is the significance of the La Princesa Hospital
in this struggle?
La Princesa Hospital is located in the center of
Madrid. It has 600 beds and a high level of
specialization. It is the referral center for many of
the peripheral centers of Madrid and beyond.
The attempt to convert La Princesa into a geriatric
center was the spark that lit the movement: the unions
of the center started a sit-in which still continues.
The sit-in has mobilized more that 90 percent of the
facility’s workers. Citizens in the zone it serves have
also joined in. The hospital’s governing council
negotiated with some of the doctors, i.e. department
heads, and the two sides arrived at an agreement which
doesn’t seem bad. Yet the struggle to withdraw all the
measures that affect health care in Madrid, including
this issue, continues.
We have been hearing about many protests against
austerity in Europe, in Spain, in Madrid. What is the
justification used by the government to move to
privatize the public system?
The government says that it’s the crisis and that there
is no money, but it’s a lie. They have allocated
215,695 million euros to bail out the banks, and with
these measures they say that they will save 7,000
million euros in health care. What they want to do is
to use the excuse of the crisis to privatize health
care, to put it in private hands in order to make a
profit on the health of the people.
A: What is your view of this demand for austerity?
I have already said that they want to take away
peoples’ rights in favor of the banks and private
Q: Why did you disrupt the Madrid Assembly? Who was
A: What we did was to try to demonstrate within the
Assembly professionals’ and citizens’ rejection of this
blatant act of aggression against health care. The
elected representatives should not have deaf ears to
the opinion of the immense majority. Keep in mind that
the Partido Popular, now in government, didn’t include
these measures in its election program. They gained
their votes through trickery and are now attacking our
public health care system.
Q: What else would you like to share with people in
North America about this struggle? What can we do to
A: The right to health care is a peoples’ right and
should be defended as such. What is happening in Spain
today may seem far-off to the people of the United
States, but the world is globalized and interconnected.
Every advance or retreat which happens in one part of
the world has a repercussion for us all. Help can come
in spreading word of the struggle so the problem is
known, and also demonstrating solidarity through
demonstrations in front of Spanish embassies and
sending signed protest letters to entities and people
in the government of Madrid.
Solidarity is very important, not only for those who
receive it but also for those who practice it, because
it makes us better people and benefits our common,
[Dr. Marciano Sanchez Bayle, a spokesperson for Spain’s
Federation of Associations in Defense of Public Health,
is also president of the International Association of
Health Policy. He practices and teaches pediatrics in
Dr. Andrew Coates will be president of Physicians for a
National Health Program in 2013. He practices and
teaches internal medicine in upstate New York.
[Many thanks to the author for submitting this to
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