Spain’s Socialist Party (PSOE)-Podemos government has drawn up plans to massively expand the role of the private sector in Spain’s health care services. The draft proposal, if implemented, would be the most significant assault on Spain’s public health care system since it was implemented in the 1980s after the fall of the fascist regime of General Francisco Franco amid mass protests and strikes in the 1970s.

The 27-page document, dated December 7, 2022 but leaked to the press in late March this year by Basque trade union LAB, proposes to vastly increase the role played by mutual insurance companies in Spain’s health care system. Mutual societies would become the backbone of the health service and would be responsible for the medical care of 90 percent of Spain’s working population.

The model agreement, sent to the heads of Spain’s 17 autonomous regions for approval, was negotiated between Minister for Social Security José Luis Escrivá and the Association of Mutual Societies for Workplace Accidents (AMAT). AMAT is a nationwide umbrella organisation of mutual societies, private companies operating under the aegis of Spain’s Ministry of Social Security to provide health services to workers suffering from work-related injuries or conditions.

The proposed legislation would hand all medical care for workers and the self-employed to mutual societies. This includes treatment for common illnesses and mental health problems, as well as rehabilitation, medical discharge, surgical interventions, diagnostic tests and other procedures. The current public medical system would become accessible only to pensioners and children.

The document states that “both institutions [AMAT and the Ministry for Social Security] are interested in improving the efficiency of management and control of temporary disability benefits stemming from common contingencies, and as such believe it necessary that the [mutual societies] cooperate with the corresponding public health services, allowing them to act upon any type of pathology, anything which would result in alleviating the burden of care and the waiting lists for the public health services, as well as reducing the unnecessary duration of [sick leave processes].” (Emphasis added.)

While couched in terms of improving “efficiency” and reducing “waiting lists”—now at record levels due to systematic underfunding, austerity and the impact of COVID-19 pandemic—the draft plan would lead to the privatisation of the country’s public health care service through the back door, and the degradation of working conditions and medical care for the Spanish working class. The public system would be gutted, medical care for workers subjugated to private companies linked to their employer, and sick workers forced back to work before they are medically fit.