La aprobación de la Ley 15/97 "de Nuevas Formas de Gestión en la Sanidad", con los votos del PSOE y del PP, abrió el camino legal que permitía transformar el sector público sanitario en un mercado y, en consecuencia, en una oportunidad de negocio más. Con la aprobación, en diciembre de 2001, de la Ley de Ordenación Sanitaria de la Comunidad de Madrid (LOSCAM), no se hizo más que desarrollar en el ámbito madrileño lo que la Ley 15/97 ya había legitimado.

The enactment of Law 15/97 "on New Management Forms in Health Care", with the votes of the PSOE and the PP, opened the legal way allowing the transformation of the public health sector into a market, and therefore into yet another business opportunity. Enacting of the 2001 Law on the Arrangement of Health Care in the Madrid Community (LOSCAM) was just a development on the Madrid domain of what the Law 15/97 had already legitimated.

Some information on timelines: the PP won the elections in 1996, and so this Law 15/1997 (click for complete text in Spanish) was passed at a time when Aznar had a minority government with outside support from the Basque and Catalan nationalists. There was no need for the Socialists to support this law, but they did it anyway. In the Madrid region, the PP has been in power since 1995, under Alberto Ruiz Gallardón in 1995-2003 and under Esperanza Aguirre since 2003. Given that the Madrid parliament includes only the PP, the PSOE and the United Left, these PP governments necessarily enjoy an absolute majority of seats and can legislate at will. The Spanish text of the LOSCAM is here.

A partir del 2005, el gobierno de la Comunidad deMadrid aceleró el proceso de privatización traspasando a empresas privadas con ánimo de lucro la gestión y explotación, durante décadas, de 8 nuevos hospitales mediante el modelo de concesión; este modelo se aplica en Gran Bretaña, donde ya ha evidenciado graves inconvenientes tanto para los usuarios como para los profesionales de la salud, problemas que han sido reconocidos incluso por organismos como la Organización Mundial de la Salud.

Since 2005, the government of the Madrid Community accelerated the process of privatization transferring to private, for-profit companies the exploitation, for decades, of 8 new hospitals by means of a concession model; this model is use in Great Britain, where there is already evidence of great inconvenience both for users and for health professionals, troubles which have been recognised even by organizations such as the World Health Organization.

Here "concession model" refers to Public-Private Partnership or Private Finance Initiative, which in the UK is responsible for nearly bankrupting several NHS trusts, to the point that even the Liberal Democrats promise to limit the use of PPP or PFI as part of their platform.

Aprovechando la Ley de Acompañamiento de los Presupuestos para 2007, el PP acaba de dar un paso adelante más en esta estrategia mediante la aprobación de los mecanismos legales que permiten la conversión de los actuales centros sanitarios públicos en "entidades de derecho privado" así como la creación de 6 empresas de derecho privado destinadas a gestionar "la parte sanitaria" de los nuevos centros (aquella que, supuestamente, no se iba a privatizar nunca). Dicho sistema, que ya está aplicando el PSOE en Andalucía desde hace años, y que es similar a las Fundaciones Sanitarias creadas por el PP en Galicia, trata de eludir los controles propios del derecho público e incrementar la flexibilidad y precariedad laborales. Sin embargo, esta nueva forma de gestión nunca ha conseguido evidenciar una mayor eficiencia sanitaria con el paso de los años.

Taking advantage of the Law Accompanying the Budget for 2007, the PP has just taken a further step along this strategy by approving legal mechanisms that will allow the conversion of currently public health centres into "private law entities" as well as the creation of 6 public law companies intended to manage "the health part" of new centres (that which, supposedly, was never going to be privatised). This system, which the PSOE has been applying in Andalusia for years, and which is similar to the Health Foundations created by the PP in Galicia, attempts to circumvent the controls typical of the public law and increse labour flexibility and precariousness. However, this new management form has never shown evidence of higher health care efficiency over the years.

I am not surprised that the PP created "health foundations" in their Galician stronghold (though of late the regional government has changed to a left-wing Socialist+Nationalist majority), but I am frankly disappointed that the PSOE would introduce private management of public health centres in Andalusia which remains their stronghold to this day.

Conscientes de que la experiencia en otros países ha demostrado que la introducción del mercado en la sanidad sólo puede provocar el aumento de las desigualdades en salud y la consideración de pacientes y trabajadores del sector como meros instrumentos para generar plusvalías económicas, un grupo de profesionales del sistema público (médicos, personal sanitario y no sanitario), colectivos de usuarios y vecinos, así como las organizaciones CNT, CGT-MSE, Solidaridad Obrera, Ecologistas en Acción, Plataforma Sindical EMT y Sindicato Asambleario de Sanidad, hemos decidido constituir la Coordinadora Anti Privatización de la Sanidad de Madrid con el objetivo de aunar esfuerzos y organizarnos en defensa del sistema público sanitario.

Aware that the experience in other countries has demonstrated that the introduction of the market into health care can only result in an increase in health inequalities and the consideration of patients as workers as mere instruments to generate economic surplus, a group of professionals from the public system (doctors and health and non-health staff), associations of users and neighbours, as well as the organizations CNT, CGT-MSE, Worker Solidarity, Environmentalists in Action, EMT Labour Platform and the Health Care Assembly Trade Union, have decided to create a Coordinator Against the Privatization of Madrid's Health Care with the goal of joining forces and organizing to defend the public health system.

I just want to note how in the last paragraph when the partners are enumerated, the fact that most of them are trade unions is downplayed by talking about "organizations" rather than "unions". This is how far the narrative has shifted away from trade unionism, where maybe it is feared that playing up union involvement would risk being perceived as unionized public health workers protecting their privileges.