The Spanish State’s “Nationalization” of Clinics Resembles Privatization

The entrance to a public hospital in Barcelona draped with banners protesting cutbacks. Photo: Chris Gilbert.

We hear it throughout the English-language press, both mainstream and progressive: “The Covid-19 crisis led Spain to nationalize its private clinics!” It would be great if it were true. Moreover, since governments like to say that we are “at war” with the coronavirus, shouldn’t a war involve more than just confining people in their houses, while asking them to wear face masks and wash their hands? After all, wars usually involve taking control of the economy – the private sector included – to attain victory over enemies, presumably even viral ones.

On March 15 of this year, Spanish health minister Salvador Illa announced that private health facilities and their resources would be at the disposal of the autonomous regions’ governments. Note that there was no reference to the transfer of property. Rather these resources were to be (potentially) managed by regional governments for a finite period. The Spanish state has 17 autonomous regions, and the impact of Covid-19 would be quite varied among them, as would be the role of private institutions. As it turns out, private sector facilities played an important role in Madrid and Catalunya, the autonomous regions most affected by the pandemic.

It is important to recognize that the public health system throughout the Spanish state has been losing funding for the past two decades. Private sector medicine has been growing, and public health is increasingly outsourcing many procedures and tests. This is, of course, a covert form of privatization. As we will see, the alleged nationalization of the private clinics, because of the hefty remuneration they received, fits with this pattern of outsourcing or the transference of funds from public coffers into private hands.

For example, in Catalunya private institutions received 43,400 euros for every COVID patient that passed through their ICUs. This has reportedly left the ASPE, the private medical association, quite content. In Navarra, the reimbursement was close to 24,000 euros for each patient who spent 21 days in the ICU. In the Basque country, there was a dispute between private medicine and the government who allegedly wants to “underpay” them. There is little information about Madrid. Nevertheless, ASPE said earlier this summer that, in the whole Spanish state, its maximum claim will be 246 million euros, and it understandably looks to Catalunya as a model arrangement.

Since the above figure amounts to somewhere between 10,000 and 20,000 euros per hospitalized COVID patient in the private sector, we can see that private participation looks like business as usual in a context where privatization and private-sector outsourcing is the norm. So why do people love to repeat that Spain “nationalized” its private clinics? Of course, for the left, it is one way of doing opposition. If you live in a country run by overtly reactionary politicians such as Boris Johnson or Donald Trump, then you might brandish the Spanish government’s exemplary approach as a way of criticizing your own country’s inadequate response.

There is a certain logic to this. Nevertheless, at a time when the pandemic has spurred shortsighted nationalist responses everywhere (and especially a blithe disregard for the responsibility of rich countries of the Global North to the poorer ones of the Global South) it is highly problematic for the left to fall into the same trap, by turning a blind eye to the real situation in the Spanish state. More revolutionary and more internationalist would be to recognize that the logic of privatization and the rush to profit-making off of societal problems pervade in the Spanish state too.

The pattern of how capitalist countries respond to the crisis – namely, by putting private profit over shared wellbeing and overemphasizing individual responsibility while avoiding controls on profit-making activities that are the key sources of contagion – operates here too. As with so many aspects of the present crisis, the real challenge in this case is not to look for some hidden explanation, but rather to see what is before our very eyes.


Chris Gilbert is professor of political science in the Universidad Bolivariana de Venezuela.