Wherever one tries to engage in a debate about the most likely causes of the high number of deaths from the coronavirus in our country, one always ends up encountering an argument that, like a magic balm, seems to justify everything. Healthcare cuts have been the most effective hoax or fallacy that an ideological sector of our country has been able to inoculate in its voters. Therefore, I am going to try to summarize in the best way and in the smallest possible space the necessary data analysis that a researcher should carry out to find an empirical relationship between cuts and deaths/infections. All the data here is readily available.
To begin with, the argument "because of the healthcare cuts during a decade of the PP" raises countless questions, among which I will choose the most basic and necessary to correctly expose the error of this premise.
Is it true that there were cuts between 2008 and 2019? Is more being spent now than before the crisis? With data in hand, the answers would be the following: yes and yes. Let it be noted that I am using data from the Ministry of Health.
During that period, the government presented cuts and budget adjustments due to the deficit results of the accounts in relation to the economic crisis of 2008. These adjustments resulted in a reduction in healthcare spending from 2011, the year in which the Popular Party came to power. The PSOE did not have the courage to undertake the measures because they were unpopular, leaving a decimated account as inheritance. Thus, these cuts meant a reduction of about 6,000 million ? in healthcare, to 65,694 million in 2013. Subsequently, the expenditure was increased until reaching the figure of 75,435 million in 2018. The curious thing about this data is that, in 2011, the total expenditure on healthcare amounted to 71,667 million ?, so we can say that, technically, the expenditure at the end of 2018 is higher than that which the Popular Party received from the socialists at the time. Therefore, cuts yes, but currently with more spending than in the best year of the socialist government.
If we delve deeper and approach the budgets of each Autonomous Community in the period 2007-2017, now that it is also indicated that it is their responsibility for having the powers completely ceded for a decade, we can observe several points.
1-Madrid increased its total expenditure from 6,500 million to 7,635 million ?.
2-The increase was 1,135 million, being the Autonomous Community that increased spending the most.
3-Neither Andalusia (led by the PSOE for 40 years) nor Catalonia, the two Autonomous Communities that spend the most along with Madrid, have increased total spending to the same level as Madrid.
Healthcare spending in 2019 for Madrid was 8,108 million ?, for Catalonia 8,828 million ? and for Andalusia 10,395 million ? (with the current government it has suffered the largest increase in a single year -6.78% -since cuts were applied in 2011).
But if this information is not enough, we can go to international comparisons to obtain more examples. And it is that, if the cuts are a relevant factor in the incidence of deaths, the following graph that compares Spain and Greece in a period of cuts is quite blunt in the face of such argumentative falsehood.
As we can see, Greece, with a greater healthcare cut during the crisis, enjoys a lower number of confirmed cases of COVID19 infections. In addition, an impressively lower number of deaths. If the premise of the cuts were valid, Greece should have contagion and death figures above those of Spain. But it is not so. The same happens with Italy or Portugal.
Is healthcare spending relevant in a better confrontation with the COVID19 health crisis? Better a public or private system?
If we go to the first countries to suffer the crisis, we can see that healthcare spending is not relevant as a unique and infallible premise, given that the situation has been resolved through other strategies apart from the causal relationship between spending and capacity. Obviously, spending is important for the development of projects or R&D&I, but it is not a determining factor as directly responsible for the number of deaths.
Thus, South Korea, with a population similar to Spain and a lower per capita expenditure (1,287 ? and 1,617 ?, respectively) has managed to keep its economy active and a number of deaths much lower than that of Spain, with 225 deaths and 10,591 confirmed cases. And we are talking about its peak of infections occurring before March 9, the date on which the Government of Spain established the beginning of the health crisis in our territory. Furthermore, to add insult to injury, its healthcare system is completely private.
On the other hand, and going to another country with a completely private healthcare system, we have the country that spends the most on healthcare worldwide: the USA. With a total expenditure of more than 2 trillion $, it has more than 600,000 infected (Spain 177,000) and more than 26,600 deaths (Spain 18,579). Its expenditure is 25 times greater than that of Spain, but despite this it has been unable to reduce the numbers to the level of South Korea.
Finally, we can go to the other only country with a universal healthcare system like Spain in the European environment: the United Kingdom. The British allocated 180,324 million ? in 2018 to healthcare spending, more than double the budget of Spain. Currently, it has 93,879 confirmed cases and 12,107 deaths. Numbers not very far from those of Spain despite having entered the health crisis later.
With these examples, added to that of Greece and South Korea, we can deduce a simple and plain premise, spending is not a primary factor in the fight against COVID19. Nor is it whether the system is public or private.
So, why have some countries obtained better results than others in the fight against COVID19?
All countries, whatever their healthcare system, that ignored the warnings have suffered the consequences. Those who accepted the challenge and took measures have acted more effectively in the face of the crisis. It's that simple. It's called prevention.
Prevention has been the card that has worked best against the coronavirus in countries like South Korea or the Czech Republic (there is an announcement published by the Czech Government itself of how they have avoided falling into the same errors as Spain), which acted by taking control, containment and protection measures at the beginning of the outbreak in their territories. In addition, as requested by the Director of the WHO, they stockpiled sanitary material and PCR to control the infected and protect the citizens. The control was carried out, above all, on asymptomatic infected who are the ones that propagate the virus the most by not being able to be identified as a vector of propagation and circulate freely through the streets. Prevention was the argument emphasized by Richard Horton, Director of the magazine The Lancet, one of the most important worldwide in the health field, in a BBC program. From his words I am left with this: "it is tragic and it was foreseeable. I am sorry to say it, but it was preventable". An argument wielded against the British government but applicable to any government after the events in China or Italy.
Finally, and by way of reflection, if we accept the premise that the Spanish Healthcare System was dismantled due to the cuts as stated by Podemos, among others, we would be assuming that the same Government would have committed a double negligence. No one keeps pressing the accelerator if they know that their brakes are broken and passes in front of a "dead end" sign.
Alejandro Pérez O'Pray Graduate in Political Science and Administration, UNED.
