Our clear opposition to the implementation of differentiated autonomy places us
among the defenders of national unity and of the unitary state, but ouropposition to the project is motivated by the conviction that the proposed reformof regional autonomy violates the principle of equality , accentuating socialdifferences and the exploitation of the lower classes; concern for questioningthe unity of the state and the nation is foreign to us. What is called intoquestion through this intervention on the structure of institutions and access tofiscal resources is the equal right of people living on the territories managedby the Italian State to enjoy equal possibilities to satisfy their needs and toaccess the enjoyment of services such as health care, home education, theenjoyment of civil rights and equal conditions of well-being.As anarchist communists we take the utmost care to allow the best possibleconditions of equality, and therefore of freedom, to all citizens and residentsof the territory managed by each state in anticipation of a possiblerevolutionary transformation and abolish homelands and borders: this is ourreformism. Hence the need to oppose with strength, commitment and decision everyaction by class adversaries aimed at worsening the current situation of exploitation.This objective can only be pursued by analyzing the consequences of thedifferentiated autonomy of the Italian regions covered by the government proposaland the ways in which it is proposed to implement it on the merits of the varioussubjects covered by the transfer of powers.The health attackWe gave an account of the text of the bill approved in the Council of Ministersin the previous newsletter, outlining the application process in its variousstages and we refer to that article.[1]In analyzing the effects that arise fromthe bill on differentiated autonomy, we will start from healthcare because thisis the largest expenditure item of the Regions which uses and manages the mass offunding transferred today by the State. Furthermore, healthcare is one of the keysectors, together with the pension sector in a phase in which an ever-increasingshare of the population needs access to the service because of advanced age, dueto the growing incidence of occupational diseases from strenuous and harmfulwork, due to satisfy the need for assistance in the prenatal diagnosis anddelivery phase, especially at a widespread level throughout the territory.In this matter, the greater skills required by Lombardy, Veneto and EmiliaRomagna definitively disengage from the other Regions those which are today atthe top of the supply of health services not only in terms of quality andquantity, but which provide health services to other Regions againstreimbursement of services , amplifying the inequalities of a NHS, todayuniversalistic and fair only in theory, but which in fact provides unequal andunbalanced services in terms of quantity, quality and cost. It is true that thefounding principles of the NHS have long since dissolved, even without anyrecourse to differentiated autonomy; it was enough to make the concurrentregional competence operational in terms of health protection for historical andstructural inequalities to deepen.Differentiated regionalism completes the work, legally legitimizing the gapbetween North and South in an irreversible way and measure, violating theconstitutional principle of equality of citizens in the right to healthprotection, contravening the objectives of the PNRR, which - let us not forget -is a lending operation of all citizens whichshould ensure a more equitable future, reducing regional and territorialinequalities.The implementation of differentiated autonomy in health matters definitivelytransforms the regions of the South into customers of the three Regions that haverequested autonomy. While the disservices and deficiencies are concentrated inthe first ones - suffice it to consider that the Central-Southern Regions (exceptBasilicata) have been and have remained for 12-16 years in the FinancialManagement Recovery Plan and that Calabria and Molise are still commissioned -already for some time the flow of patients from other Regions has been headingtowards them, making the sector an opportunity for business and profit.Investments in structures, personnel training, hiring, large hospitals areconcentrated in these three Regions, with the possibility of governing the labormarket with greater resources to attract medical and nursing personnel.In this context, the shift of the regional budget towards relations in agreementwith private healthcare through greater regional autonomy effectively contributesto dismantling the public healthcare system, contributing to increasing thesocial cost of health.Nor the intervention on the LEA services and services that the NHS is required toprovide to all citizens, free of charge or upon payment of a participation fee(ticket), - which should be contextual to the implementation of differentiatedautonomy, but not it is - it can help correct the hypothesized system. Theevaluations of the 34 indicators divided between collective prevention and publichealth activities, district assistance and hospital assistance demonstrate, afteranalysis of the 10 annual monitoring by the Ministry of Health from 2010 to 2019in cumulative fulfillment 2010-2019 as a percentage of points obtained on themaximum obtainable (2,250 in 10 years) than the three Regionsapplicants for differentiated autonomy are at the top of performance and that thegap with the other Regions will only grow.[2]It follows that differentiated regionalism in healthcare will increaseinequalities, because it will make the central-southern regions - which will havefewer and fewer resources to retrain their services - "customers" of the servicesproduced by the northern regions.Need for reforms and equity of benefitsThe demonstrated unfairness of the proposed reform does not mean that the systemcurrently in force is free from flaws, distortions and the need formodifications. if it is true that in many Regions there are problems ofgovernance and balance sheet consolidation, it is also true that there is nocredible health plan, that local assistance is non-existent, that home care isequally if not more so, that the network of general practitioners should bestrengthened, not to mention the serious shortcomings in the use of thestructures, built and abandoned to satisfy the need to do private health business.It must also be said that on a general political level it is wrong to usedifferentiated regionalism as a bargaining chip to reconcile the objectives ofthe Brothers of Italy with those of a short-sighted, subversive and timelesspolitical force, such as the League, which has remained of the northernterritories, offering her the scalp of everyone's health as a sacrificial scalp.If only because we are faced with a belated "enhancement" of macro-regions,located outside the center of the development of the European economy, asdemonstrated by the decline in investments in the Lombardy Region over the last10 years. It would be necessary for the political class as a whole to realizethat what is happening on an economic level has unhooked Lombardy and Veneto fromBavaria and from the economic nucleus of central Europe, directing theirproduction towards other markets.Wanting to support the economy by investing at the expense of the citizens of thewhole state, raking in the resources necessary to relaunch the economy of theseterritories by making them hubs of health services for the whole country,constitutes a regressive investment, destined to fail for the progressiveimpoverishment of customers (citizens of other Regions) who will be less and lessable to pay for services, because they are impoverished. If we add to this theshift of ever greater resources towards subsidized private healthcare, it isquite clear that profits will concentrate on elitist healthcare, on unequalservices, on the growth of everyone's spending on medical care directly andoutside the circuit public, with a consequent increase in inequality.Moreover, the mechanism is well highlighted by the analysis of the functioning ofthe health system in Calabria and by the reasons for its crisis already today, aswe have noted and documented at the time.[3]Instead, it is necessary to intervene to bridge the structural gap between theNorth and South of the country, modifying the criteria for allocating theNational Health Needs, i.e. the distribution of resources, increasing thecapacity of the State to address and verify the Regions, so that the services areuniform. The inspiring principles of federalism, aimed at fully applying theprinciple of subsidiarity and improving administrative efficiency, must first ofall safeguard the ability to redistribute income to allow all people to exercisetheir fundamental constitutional rights, in particular the right to healthprotection by preventing health care from becoming a public good for residents ina Northern Region and a consumer good for other Regions if their citizens needaccess to it.To achieve this goal, health care can only be public, supported by a progressivetax system that redistributes wealth in greater social welfare, in all fieldsstarting with the health service. Quality and efficient healthcare services mustform part of the state's redistribution of wealth, avoiding that the solution ofproblems connected with health protection becomes part of the spending sphere ofindividuals in relation to income capacity.The ongoing pandemic has demonstrated to everyone the importance of local healthfacilities, the presence of health facilities scattered throughout the area andnot just large hospitals, the need to plan the recruitment and training of healthpersonnel of all types and qualifications (from doctors to paramedics) to meetthe growing needs of an increasingly elderly population, combat disease and pain,and increase the possibilities for demographic growth, offering better servicesand well-being to all and on an equal basis.But if this is the goal, differentiated autonomy is the most wrong way to achievethe goal since it constitutes the denial of a society of solidarity, all the morenecessary today that the number of incompetent people is growing dramatically andthat those belonging to families below poverty line are approaching 6 million.And let's not forget that in situations of poverty, one of the first needs to befelt is the protection of health, as evidenced by the sharp drop in medicalchecks and analyses, preventive diagnoses and even the renunciation of treatment.[1]Tell me where you live and I'll tell you what rights you will have, Publishedon 1 February 2023 by Ucadi in Issue 167 - January 2023, Newsletter, Year 2023.[2]See: GIMBE Observatory Report n. 1/2023, pp. 10-11[3]On the failure of the health service of Calabria, Published on 16 November2020 by UCADI in Newsletter, Year 2020, Number 139 - November 2020.The editorial staffhttp://www.ucadi.org/2023/02/21/autonomia-differenziata-la-sanita/_________________________________________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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