It is now known that the NHS is experiencing a systemic crisis, worsenedfrom government to government, which increasingly resembles a plannedmetamorphosis. The institution of the NHS dates back to 1978, a periodin which capitalism was already being reorganized in a neoliberal sensein the rest of Europe. This testifies to the "peculiarity of the Italianlaboratory of the seventies". The NHS was in fact born from the synergybetween trade union and workers' struggles, feminist and studentdemands, and from the shared vision of "health as a social and politicalfact (social in its genesis and political in its resolution)". Bothuniversalist ambition and democratic demands converged in the NHS, byvirtue of which a decentralized model was opted for, close to the realproblems of the population, and with a privileged focus on prevention.Thanks to these factors, the Italian NHS remained an international pointof reference for many years.But the current situation appears very different. Today the NHS isfragmented into many small regional health systems, increasinglyabsorbed by market logic, and shows its inability to guarantee effectiveequity of care to the population. The reasons for this decline arenumerous and complex, and only partly attributable to neoliberal austerity.If on the one hand the institution of the NHS has overcome thepaternalistic model of the Mutua, on the other hand it has strengthenedthat process of "monopoly of care", whose genealogy Foucault traces backto the 18th century in the West. The healthcare institution hasgradually swallowed up the entire scope of care. The very definition of"health" and "disease" has become the prerogative of the dominantclasses, no longer an expression of what populations and differentcultures develop. From an instrument of political redemption, healthcarehas become a system of disciplinary and homogenizing power. As Illichpointed out, the rigidification of healthcare institutions has deprivedthem of their conviviality, that is, the possibility of sharingknowledge and/or living with other people's knowledge.On the other hand, with families "nuclearized" and deprived of thematerial and cultural possibilities to exercise care, the domesticenvironment has become an increasingly hostile place for the elderly andchronically ill. Hospitalization has increased exponentially, thanks toa distorted vision that sees "life extension" (at all costs) assynonymous with "health protection". In this cult of longevity, whichpermeates the underlying ideology of US-led techno-science, we glimpsethe ancient and crazy dream of immortality. Death ceases to be a naturalfact, it is just an accident, and as such it should not be accepted butfought technically. The therapeutic fury produced by thisnon-relationship with death, in which a certain obscurantist Catholicismstill plays its part, translates into the chronicity of many terminallyill patients. The tensions between healthcare workers, frustrated byhaving to "cure" patients without any prospect of improvement, and asocial fabric that can no longer take care of family members,plastically measure all the critical issues underway.It is on these structural critical issues that austerity - imposed byprecise political choices - has launched its deadly attack. In Italy,health spending has been in constant decline since 2011, with a spendingreview process of the health sector which already in 2012 the Court ofAuditors considered "the most advanced and complete experience of whatshould be a spending review process ". The public has been deliberatelyimpoverished to the advantage of the private sector, with the almostforced recourse to more or less direct outsourcing: let's think abouthow long waiting lists force people to turn to affiliated centers forinstrumental diagnostics (for those who can afford them) or how theshortage of doctors in emergency rooms is addressed by "tokenoperators". But market logic pollutes the public sector from within. Wealready see this with the DRG system, which assigns a "price" to eachpathology on the basis of which the hospital is paid. Hospitalcompanies, like any other company, are induced to grab the mostprofitable DRG, and to try to maintain, from year to year, equal orgreater quantities of that given DRG. Here Healthcare unmasks its newnature, which is not that of guardian of health, but of "incubator" ofdisease. The disease becomes to all intents and purposes a commodity,and the hospital is the factory responsible for its processing. It goeswithout saying that reducing the incidence of illnesses throughprevention is of less and less interest: both because it is not asprofitable and because it would be equivalent to depriving oneself ofthe goods from which the company derives profits (fewer illnesses =fewer DRGs paid). Lastly, because it would mean recognizing the socialnature of most evils, which would force us to question the entirecapitalist system. The political and bioethical impasse into which theNHS has fallen seems clear to me.And yet internal healthcare debates are few and almost exclusivelyfocused on the salary issue. But increasing funding is not enough toovercome this stalemate. What is needed first and foremost is collectiveawareness of how market logic is incompatible not only with the equityof care, but with the very right to health protection. Second, we mustabandon the current elitist-corporate approach of the medical class, andadmit that there is no truth, because there is not a single concept ofhealth. To do this we need to "re-democratize" the concepts of healthand illness, to frame pathologies no longer as the exclusive problem ofthe individual, but in their social dimension. Lastly, it is necessaryto promote the territorialisation of Care, actively involving mutualismsfrom below.Disseminating scientific knowledge and sharing the means to produce it,indeed restoring conviviality to it, is not equivalent to giving rise togurus or false cures; at least no more than is already happening (thinkof the murky nutraceutical sector). Spreading knowledge andresocializing Care is the only real remedy to make us less manipulableand regain control of the management of our lives.Riccardo Riccerihttp://sicilialibertaria.it_________________________________________A - I N F O S N E W S S E R V I C EBy, For, and About AnarchistsSend news reports to A-infos-en mailing listA-infos-en@ainfos.ca
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