Chronicles from Quarantined Italy
by Simone Grecu
Italy, March 13th. Just a few weeks after the first outbreak, the Italian people find themselves in an extraordinary situation, maybe second only to World War Two. But what happened? Why has Italy found itself so weak in face of the coronavirus emergency? As Justus Spott has already shown, the novel coronavirus has several “personal, ideological, medical as well as economic and in turn potentially political consequences”. This short article will focus on the Italian case by giving some insights on the past and the present of the Italian healthcare system, the challenge of the virus and some early lessons for socialists and anti-capitalists.
A Long History of Cuts and Privatisations
After years and years of cuts to public healthcare, the Italian Republic has found itself unprepared for the coronavirus emergency. During the past 10 years, there have been about 37 billion Euro of cuts under both centre-right and centre-left governments. Countless hospitals have disappeared during that time. Just in the Lazio Region – the region that includes Rome – 16 hospitals have shut down. At the time there has been a gradual shift from a single-payer system to forms of private employer-based insurance. This represents a move in exactly the opposite direction of what socialists in countries like the United States are currently fighting for. Some of these measures were taken by neoliberals, true believers in the superiority of the private sector; some others were imposed by EU budgetary constraints; most often both factors coincided.
There has also been a more hidden but equally sinister change to the comprehensive public Servizio Sanitario Nazionale (National Health Service), founded in 1978 when the Italian mainstream was much further to the left. In 1992 the Unità Sanitarie Locali (USL, Local Health Units), the bodies tasked with the administration of health and social services, changed their name and functions: they became the present-day Aziende Sanitarie Locali (Local Health Companies). Still public bodies, but now with more autonomy and a corporate mandate.
Later, in 2001, a constitutional reform gave the regions additional powers to administer health services, though essential levels of care are still decided by the national government. As a consequence, the Servizio Sanitario Nazionale was fragmented into 21 pieces (19 regions + 2 autonomous provinces), with an inconsistent and unequal quality of care.
Hints of War Economy: A Kind of “Corona-Statism”
With the arrival of coronavirus, which is infecting more and more people every day (by the time I’m writing the virus has infected more than 12.000 people and killed a thousand, with 80% of the infections in the three regions of Lombardy, Veneto and Emilia-Romagna), the government enacted a lock-down of the most infected regions at first and later extended it to the entire country. Schools, universities, bars, restaurants and most shops are now closed. Only supermarkets, pharmacies and first necessities shops are still open. Most of the workers are still required to go to work, even in non-essential sectors (due to the influence of the industrial employers on a certainly not workers-friendly government) and they must do so without protective masks. The response of the working class was quick: there are now reports of strikes in several factories.
Apart from this, the Italian state has shown its “muscles” in a way not seen in at least 30 years: it has sent about 25 army technicians to the only Italian lung ventilator factory to aid and quintuple monthly production; it will hire 20.000 doctors and nurses to help fight the emergency (under precarious conditions no doubt); and most importantly, it gave the (hypothetical) power to the Protezione Civile/Civil Protection (the public body tasked to cope with the emergency) to seize hotels, hospitals and vehicles from private owners if needed.
Lessons for Socialists
The emergency is still in progress, and it’s difficult to predict how things will evolve during and after the current crisis. There are a few things that have already become evident though:
- The fragmentation of the healthcare sector is detrimental to public health, especially if the danger is coming from a virus that spreads as fast as this one. This was especially evident in the first stage of the emergency here in Italy, adding chaos to an increasingly difficult situation. It is also clear that privatized healthcare simply doesn’t work. Profit-oriented institutions (whether they are private or arms-length public bodies) cannot effectively provide free care and services over a wide territory.
- The state, even a capitalist state, still has the power to seize the means of production. While such a statism is not socialism, this represents a step in the right direction.
- Socialist Internationalism differs from capitalist cosmopolitanism or capitalist nationalism: the coronavirus crisis exposed the ideological veil of the profit-oriented, capitalist structure of the European Union, as well as the gruesome Social-Darwinism of the British Tories; conversely, after the emergency in Wuhan, China and Cuba are offering aid, doctors and medical supplies.
This pandemic is still in an early stage and we don’t know how it will evolve. Surely it will change much; how healthcare is organized; the balance of power between states and regions. We should hope it will change those things for the better.