Spain: Si, se puede! ‘White tide’ defeats Madrid health privatisation plan

By Dick Nichols

February 1, 2014 – Links International Journal of Socialist Renewal/Green Left Weekly -- Victories in the never-ending struggle against the sell-off of public services in southern Europe are rare. So when one comes along that is as big as the recent defeat of the Madrid regional government’s scheme to privatise hospital and community health-centre management we should celebrate it to the full.

The crowning moment in this 15-month-long battle to keep administration of six hospitals, four specialist centres and 27 community health centres public came on January 27, 2014. That afternoon a gloomy Madrid regional premier, Ignacio González, announced the suspension of the privatisationand Javier Fernández-Laquetty, his health minister and architect of the plan, resigned. In hospitals and health centres across Madrid the cry was: “Si, se puede!” (“Yes, we can!”).

This capitulation by the People’s Party (PP) government came only hours after a five-judge bench of the Madrid High Court of Justice had rejected the government’s appeal against its decision suspending privatisation of health service management until a full investigation of the impact could take place.

In its original judgment the bench had accepted the argument of the Socialist Party of Madrid[1] and the Madrid Association of Specialist Physicians (AFEM) that the case for privatisation had not been made. Its ruling said that the Madrid health department’s savings calculations were “merely approximate and hypothetical and might not correspond to reality”. Therefore hospital management privatisation might endanger people’s constitutionally guaranteed equality of access to health care (introduce “health apartheid” was the AFEM’s term).

Now all the Madrid government can now show for its blitzkreig against the public health sector is a closed cardiology institute, a hospital converted to medium and long-term care and a privatised central hospital laundry. While 3500 positions have been removed from the system, that loss is small compared to the jobs holocaust a successful implementation of Laquetty’s plan would have produced.

Behind the white tide

The Madrid High Court of Justice decision was the legal certification of a political victory. In the mighty battle for the hearts and minds of Madrid’s people, the opponents of privatisation triumphed in a region where the PP enjoys an absolute majority in the local legislature.

The victory was fruit of a campaign that mobilised health workers, hospital patients, trade unions, neighbourhood associations, left parties, anti-privatisation platforms and 15M (indignado) networks.

This “white tide” of health professionals and their supporters (so called following the example of education workers’ “green tide” against public education cuts) carried out 15 months of intense action: strikes, sit-ins, rallies, public meetings and seminars, petitioning, doorknocking of hospitals and neighbourhoods, protests outside the offices of the private outfits set to gain from the sell-off and solidarity pickets outside the Madrid High Court of Justice.

Jesús Jaen, spokesperson for the health workers’ and users’ platform Patusalud, described its impact in a January 28 article on the Público web site: “Through unity among health workers, patients and the neighbourhoods we built up a powerful social majority. It has been moving to take part in these tides, where the white coats mixed with the elderly and not a few patients who came in their wheelchairs or with their oxygen bottles. Here was the people in the broadest sense, forceful and determined to fight to the end.”

The white tide first appeared on November 2, 2012, when staff, patients and the local community at the Hospital de la Princesa began an indefinite sit-in in protest against the proposal to turn it into a geriatric centre. The sit-in also gave birth to the idea of regular mass rallies and health system-wide general strikes. The government reversed its decision on the Hospital de la Princesa, but by then it was too late—the tide was already spreading.

After its opening protest (November 18, 2012), rain, hail or shine the white tide in its tens of thousands mobilised on the third Sunday of every month in the streets of Madrid: its slogan was “Public health: don’t sell it, defend it” (la sanidad pública no se vende, se defiende). At the time of the government’s surrender it had conducted fifteen consecutive marches and rallies.

Community support

From its first two-day strikes (November 27-28 and December 4-5, 2012) it was clear the movement was drawing support from all levels of the health industry: “Something weird is happening”, nurses and cleaners were heard to say. “I saw my department head at the rally yesterday.”

The movement also won backing from specialist physicians who had set up AFEM in order to fight against the impact of health cuts on service quality in the public system. When the Laquetty plan became known AFEM called an indefinite strike of doctors that lasted five weeks.

Support only grew as the details of the sell-off took further shape: by April last year health workers had learned that part of the deal with the private outfits to be picked to get the work (without any competitive bidding) was that 3120 jobs wouldn’t be guaranteed.

However, the white tide also convinced a majority of the community that its fight was not just that of public sector workers defending their jobs. On May 13 last year, around one hundred community organisations and anti-privatisation platforms organised a community referendum on Laquetty’s plan: 94% of the 935,794 who took part signed to reject it—including Ana Botella, mayor of Madrid and wife of former prime minister and lead PP hawk José María Aznar!

Equally critical to the success of the campaign was its legal strategy. In February 2103, AFEM called what it dubbed a “non-strike day”. Its doctor members would work normally and be paid, but their salary for that day would be used to hire the necessary legal and research expertise to investigate if there had been any irregularities in the first round of Madrid hospital privatisations (2003).

That work helped prepare the basis for the case against the latest sell-off. On June 21 last year, a Madrid judge allowed a lawsuit against two former PP Madrid health ministers to proceed: for coercion, crimes against the public purse, document forgery, bribery, perverting the course of justice, fraud and embezzlement.

Inevitably, the PP soon started to feel sharp political pains. According to Jaen: “In a district like the [comfortable] suburb of Salamanca, hundreds if not thousands of people came up to us at the Hospital de la Princesa to let us know that ‘I didn’t vote PP so they would close my hospital’."

PP blunders

The Madrid victory was inconceivable without this extraordinary mobilisation, but it was also helped by the blunders of the government, run by the PP’s most right-wing elements (its “Tea Party”).

Initially, the privatisation was launched by former Madrid regional premier Esperanza Aguirre to show other PP regional rulers (“barons”)—and the national PP government—how to crash through the opposition to “externalisation” of public services (the word “privatisation” is banned from PP discourse). Aguirre brought in Laquetty from the Foundation for Analysis and Social Studies, the PP think tank run by Aznar, to be her battering ram for this assault.

However, Laquetty’s frontal attack strategy forced all public health workers into a single alliance—something that the more cautious approach of other PP administrations has avoided through divide-and-rule deals to “look after” certain classifications. This approach has facilitated the privatisation of ancillary services (laundries, kitchens, blood banks) and even hospitals in regions like Galicia and Valencia.

The Madrid government has also suffered from its high levels of arrogance, incompetence and overconfidence. Its attack on health costs began with a failed attempt to impose a euro prescription charge, a move that the Rajoy government opposed and which was ruled unlawful by the Constitutional Court. It also began a “private-health-is-quality-health” campaign, questioning the professional ethics of doctors in the public system and creating a cloud of suspicion about its quality and cost. Health funding was simultaneously reduced in order to create the very “unsustainability” that only privatisation could hope to cure.

The government’s initial document justifying the privatisation ran to a full eleven pages[2], and its figure for potential savings fell from €500 million to €200 million to €169 million as it struggled to measure up to the counter-analyses coming from AFEM and other sources.

Next, when asked how much the management privatisations would save the Madrid region, Laquetty said: “It depends on various factors, on the point in time the tendering for the externalisation takes place, it depends on the cost of the payment per patient that the tenderers ask for, it will depend on the amount of staff who want to continue working in those hospitals. I can’t tell you at the moment.”

Laquetty was left equally flabbergasted by the fully costed proposals done by the doctors and sympathetic health economists, which produced savings greater than any possible from the proposed management privatisation without selling-off any party of the public health system.

When the two former PP health ministers were charged on the basis of the evidence gathered by AFEM, González and Laquetty carried on as if this had no relevance to their schemes. Within three weeks contracts had been signed with three firms after a dodgy-looking “tendering process”.

However, just one week later, on July 10, the haughty PP team got its first cold shower when the Madrid High Court of Justice panel ruled that the privatisation had to be suspended. Their response was in classic PP vein—they immediately got a leading judge friendly to their cause to convene a meeting of the Madrid High Court of Justice full bench (50 magistrates). The scheme was to nullify the panel’s judgement through a procedural manoeuvre that would have allowed the sell-off to go ahead while all the legal cases against it were bundled into one mega-process and slowly dragged through the legal system.

Unfortunately for González and Laquetty, a majority of the Madrid High Court of Justice rebelled against this crude operation, returning the case to the five-judge panel, which reaffirmed its ruling.

During this entire period the behaviour of the Madrid government amounted to a series of free kicks for the clever media and legal tacticians of the white tide (and a gift to comedians as well). The tide’s response to such behaviour succeeded in convincing a majority that the Madrid health management privatisation scheme represented, in the words of an AFEM spokesperson, “not even a neoliberal model, but a mafia scam”.


The white tide won because it was based on the self-organisation of those affected, applying the experience of the indignado (15M) movement. As in the teachers’ struggle against education cuts in the Balearic Islands[3], the all-involving mass meeting has been the basic cell of decision making. Union leaderships while often deeply involved, have had to respect outcomes because of the authority these have with their own members.

The victory can only have positive benefits for the social struggle in the Spanish state. For a start, out the window goes the cliché that “protest doesn’t pay” when it blatantly has.

Second, the Madrid victory is deepening the crisis of the PP, with the latest polls showing the party losing Madrid, Valencia, Navarra and nationally. In this atmosphere, the call for discredited PP governments to submit to early elections becomes increasingly compelling.

What will be the increasingly embattled PP’s next move? For certain, with the party facing defeat at the hands of the PSM and the United Left (IU) in Madrid city and region, health privatisation is off the political agenda until after the next regional and municipal elections (May 2015).

But the privatiser always knocks twice, especially when the PP Madrid leadership past and present remains convinced of its case. In the words of González: “This isn’t a defeat. There’s simply a debate.”

Moreover, this privatisation has been stopped on the legal grounds that it has not been done according to the book, a decision that amounts to an invitation to any future pro-privatisation Madrid government to fill out the application forms properly next time.

For Esperanza Laguirre, who described Laquetty’s resignation as “a gesture that does him honour”, the Madrid High Court of Justice decision “did not enter into the core of the question, which is to determine whether or not a public service can be externalised. Rather, it has brought about a situation where “a legitimate government with an absolute majority” can only stand by while through misuse of the courts “the opposition can block improvements in public service management for a whole parliamentary term or more.”

In this context new health minister Javier Rodríguez, the anti-Laquetty, the “low-profile doctor who knows the industry and listens”, will doubtless be tasked with the unobtrusive development of plans for privatisation by stealth.

But he will not have it easy. The magnificent struggle and victory of the white tide has created the people with the xperience, consciousness and organisational know-how for future contests.

And what about the undeniable problems in the Madrid public health system that privatisation was supposed to fix? Let two doctors have the last word.

[The last 15 months] have seen an awakening in the people’s consciousness. What has to be done now is to put forward a real alternative, to understand that it is the responsibility of everyone, and not just protest when we see our working conditions put at risk. -- Ángel Serrano, doctor at Hospital Infanta Sofía

We managed to launch a message from the profession, one apart from ideologies, and to generate social hope. We managed to escape from individualism, we united with a single voice. We hope that the suspension of the sell-off is definitive. What we all need to do now is to begin to work so we achieve a health system that is cheaper and of higher quality. -- Patricia Alonso, geriatrician

[Dick Nichols is Green Left Weekly’s and Links International Journal of Socialist Renewal's European correspondent, based in Barcelona. A shorter version of this article appears in the February 5, 2014, Green Left Weekly.]


1 PSM, Madrid regional affiliate of the Spanish Socialist Workers Party (PSOE)

2 By contrast, documentation justifying infrastructure privatisations in Australia, for exemple, have typically been encyclopedic operations by consulting firms like KCMG, delivered with an air of having a monopoly of all possibly relevant information and insight, and requiring detailed deconstruction by experts sympathetic to the anti-privatisation cause. See Privatisation: Sell Off or Sell Out? The Australian Experience, by Bob Walker and Betty Con Walker, Sydney University Press.