I’m all for the withdrawal of government from economic activity. I accept that the motivation of profit drives innovation and that competition ensures the fittest and the leanest provide the market with the best and the cheapest. There’s no reason why government should run the phone company or a transhipment harbour. I disagreed with those who objected to those privatisations on ideological grounds. I see no advantage in that sort of big government.
But my distaste for excessively large government is not matched with a preference for ever smaller government. I disliked the idea of privatised hospitals. I have no objection to private hospitals being set up to focus their attention on medical tourism, say, or cosmetic medicine. But transferring the essential assets of the state to the private sector was, to me at least, problematic to begin with.
This is not a discussion about clean and correct governance. Privatisations can be conducted in a transparent manner after appropriate competition. I would still object to privatisations of state hospitals. The transfer to Vitals was neither transparent nor competitive. It was a back room deal sealed before a sham of a public process was even concluded and signed with frontmen hiding profiteers we may never identify.
There are several justified good governance objections to the Vitals sale but I will leave that discussion to other posts.
There are also several justified ideological objections to the hospitals sale. I don’t apologise for the use of the word ideology. I’m no red-flagged, hammer-and-sickled Marxist. But I do feel strongly about the European consensus evolved over the twentieth century that there should be effective state guarantees for universal provision of health. And I don’t mean basic guarantees to ensure people are not left to die on the pavement outside the A&E. I mean a full suite of excellent health services that are provided in a manner that makes the patient’s income absolutely irrelevant.
That, admittedly, is an ideal. There always are limits. But the European consensus is that with all appropriate controls on expenditure and waste that are possible, the only consideration of the health service infrastructure is the health of the patients not the return of the stock-holders.
The state has a function of providing basic public services: the nation’s security, access to justice, and then health and education.
The United States has a different philosophy on this. There is much to admire in the American reality but I can understand and accept the American way of providing health service as much as I can understand and accept their laws on gun control. Not at all.
Steward Health Care, the new acquirers of three of Malta’s hospitals, that used to be key elements of the chain of services provided by the state to the people of Malta and Gozo, are particularly extreme even by American standards.
The description “largest private medical network in the United States” gave people the idea here that this was some massive health service provider, sort of the McDonald’s of hospitals. This is one of many misconceptions that are going around. What makes them the largest network of its type is the relative rarity of health providers with a purely for-profit model even in the United States.
Take for example where Steward Health Care started from. They bought from the Catholic Church in Boston, hospitals the Church could no longer afford to run. The Church’s hospitals were not free, as we would expect here, but they were not intended to make a profit. Breaking even was the most they aspired to.
Steward step in and transform the hospitals into for-profit activities. It’s a slow start and where the turnaround does not materialise in relatively short time, they had no problem closing down a hospital which was not giving them the return they were hoping for.
A wise guy on Facebook reacted to my post on this yesterday by saying I was misleading readers when I reported the hospital Steward closed down was financially struggling when they took it over. Some people can really be desperate to defend the indefensible. Of course it was struggling when they bought it. Can’t you see that’s exactly the point? That is indeed the transformation a for-profit hospital owner seeks.
Would you call Gozo General, Karin Grech and St Luke’s anything but financially struggling? We don’t think of them as such because we never even expected state hospitals to turn a profit. We worry about Air Malta’s finances say, or Gozo Channel’s. Though state owned we expect these companies to run on reasonably sound financial bases. But we never think of state hospitals as money making activities.
And yet here we are.
Let me illustrate what we’re looking at. Gozo General Hospital is now the property of Steward Health Care. Steward Health Care is the property of Cerberus Capital. Cerberus Capital is in great part the property of Stephen Freinberg. Stephen Freinberg is a political ally and funder of Donald Trump elected to the Presidency with the key promise of abolishing Obamacare.
The owner of three hospitals that used to be part of Malta’s state-service provision is ideologically dead set against even the very basic safety net for the poor and the destitute that Barack Obama futilely introduced in the United State.
This is not just about how correctly or incorrectly the transfer of ownership was made. This is about the basic national interest which, pardon me if I sound positively socialist, includes the basic health and welfare of everyone, without exception.
The government’s guarantee that services would continue to be provided for free for local users is no comfort. Whether it is the individuals that pay for the new for-profit costs or tax money to cover the difference, we have introduced the cost of other people’s profit in the expense of providing universal healthcare. And we have to pay for it without any benefit to us.
Nor is it of any comfort that the government claims that in its heavily redacted contracts we have never really seen it has imposed obligations on the hospital owners. Steward Health Care has had no qualms ignoring its regulator in the United States. Why should it comply here? Its owner Cerberus has had no problem ignoring the inquiries of UK MPs over its predatory tactics fleecing and abusing people owing them money. Why should they behave differently in Gozo?
I may disagree with ideological socialists and communists on most things. But objecting to the Americanisation of our health service and shifting the paradigm from health to profit is, in my view, not just perfectly legitimate but a moral obligation. Who will protect the vulnerable if not?
But where’s the left?
It’s not in the General Workers’ Union that checked and confirmed collective agreements would remain in place under transfer of business rules and pronounced itself satisfied with the deal.
It’s not in the Labour Party that continues to prop the corporatist proto-fascist government that entered into this deal with people so right-wing even Tea Party Republicans avoid them.
It’s not in the so called permanent activists that found no reason to comment about the acquisition of our hospitals by these profiteers but found the fact I was employed by a Maltese company owned by foreign owners with off-shore structures an appropriate topic for public controversy.
For you see we actually do have red-flagged, hammer-and-sickled ideologues here. In the evenings they throw bananas at Andrew Borg Cardona (because he likes them?) and by day they work for gaming companies, because that is an obviously principled and socially caring career choice.
It is not just that Joseph Muscat’s gang can get away with corruption because of the population’s indifference when the economic going is perceived as good. They can also get away with the dismantling of a European welfare economy and the disposal of our public sphere into private hands.
The aspirational, sexy, bling numbers that Labour has harnessed as its core support on the back of their egoism and indifference to the needs of the community do more than forgive corruption. They support the building of a society that ignores the most vulnerable, the poor and those that depend on the state for basic public services such as health and education.
And the socialists who are supposed to speak for them are at their gaming company’s Christmas party sipping expensive champagne.