Empty Deckchair Blog - Letter to Mr Giles Paxman

A British immigrants view of Spain http://emptydeckchair.com/blog/ 

FAO Mr Giles Paxman, HM Ambassador in Spain

Dear Mr Paxman,

I am writing to you regarding access to public health care by pre-retirement age British citizens resident in Spain. This  an issue which affects many of us who have made our homes here. As I expect you are aware, a binding bill was tabled in the “Congreso de Diputados” (Congress) in early May which, if approved, would complete the universalization of free public health care. It removes the residual connection to the Social Security system effectively making access to health care a right of residence from the 01/01/2011.

The current system may most accurately described as virtually universal with very few people currently being excluded. The Government, in a recent report to Congress, estimated the figure for 2008 to be between 90,000 and 180,000 people. They also identified EU residents as being one of six principal groups currently excluded from public health care. The principle reason for this situation is that they have not made a contribution to the Spanish Social Security system. The Social Security system, however, has not contributed a single euro to provision of health services since in 1998, when the general taxation became the sole source of funding. I feel our exclusion, therefore, is purely arbitrary: we are legally resident here, pay the taxes that help fund the system and our health needs are no more or less than any other group of people. Additionally, from Article 43 of the Constitution of 1978 onwards, Spanish legislation regulating access to public health care emphasizes “equality of access” as a key characteristic of the system.

A similar, albeit non-binding bill, to extend the right to health care to all Spanish Nationals and foreign residents was approved unanimously by Congress in September 2009. The Government has since responded positively indicating that they intend to  make the necessary changes but without committing to a date. No major party in Spanish politics attempts to defend the current system because it is quite simply indefensible.

It is clear that Consulates around the country are making a considerable effort to help and support British Citizens resident in Spain through these difficult times. In addition to the series of Road Shows, only yesterday, a Super Surgery was held in Alicante, in co-operation with NGOs, to advise on accessing health care. The commitment of Consular staff to help on practical, day to day level is obvious and appreciated. I hope that a corresponding effort is being made to represent interests of British citizens to the Spanish Ministry of Health with respect to the current initiative in Congress. Clearly, if this bill is approved it will not only  bring to an end an unjust situation but simplify the the current bureaucratic maze in which some of us now find ourselves. A outcome which, I believe, will be welcomed by everyone concerned.

Kind regards

Spain edges closer to free health care for everyone Spain is a country in which nothing happens quickly and this is certainly the case with progress towards a fully universal and free public health care system. Since Article 43 of the Spanish Constitution recognized the “right to health care” in 1978, the country has inched its way to a position in which, according to the Spanish Ombudsman in February of 2010, 99.4% of the population are covered under a complex set of laws and administrative mechanisms. In early May a motion was presented to the Congreso de Diputados (Congress) which would require the Spanish Government to finally bring this long running saga to an end by extending the health care system to those approximately 200,000 people currently excluded from it. If the motion is approved, free public health care will become a reality at last for all residents (including foreigners) of the country from the start of next year. The motion explicitly removes the connection to the Social Security system as a condition of accessing the health services. This initiative has been led by Gaspar Llamazares who is President of the Health Commission and spokesman for the IU (a small left wing party) in Congress. On the 29th September of 2009, a similar motion but non-binding motion, was approved unanimously by all the political parties (PP, PSOE, IU etc.) requiring the Government to guarantee access to health care for all Spaniards and foreign residents. The Government was also invited to explain the measures it proposed to take to achieve that goal. Their response was supportive indicating that they planned to instigate the recognition of universal and free health care but without crucially committing to a timetable. The current motion may be seen as an attempt to nail the Government to a specific date – 01/01/2011. Now, since lots of motions are presented to Congress, voted on and then simply ignored by the Government, this one could be heading towards the wastepaper basket too. However, there are reasons to be cautiously optimistic; Everyone who is anyone in Spanish politics agrees that this needs to happen – Government and opposition alike. It is commonly described as an “outstanding debt”. Spanish lawyers are the largest single group (around 60 – 70,000) currently excluded from the system. They have been lobbying for this change for some time both at national and regional level. In Valencia, for example, the College of Lawyers website has template letter of complaint addressed to the Sindic de Grueges (The Valencian Ombudsman). This is typical of the demand made by lawyers around the country. Does the Government seriously want the Spanish legal profession on its case ? The cost, estimated at under 150 million euros, represents less of 0.25% of the total 60 billion health care budget. In practice, the cost is likely to be a lot less since a raft of legislation passed by many Regional Governments over last two years has resulted in more and more loopholes in appearing in the system. The legislation passed at regional level has created inequalities across the country. In Galicia, for example, universal and free health care is now a reality whereas in Valencia EU residents are have had their health care withdrawn. These variations are impossible to reconcile with a system which guarantees “equality of access”. The end product is an administrative nightmare and a legal morass. The current system is simply unworkable. One problem, of course, is that Spain would also have to extend its free health care system to all EU residents living here and this may prove to be a step too far. A reply from the Government is expected before the end of June. I´ll look forward reading what they have to say. Sources: The vote in Congress Sept 2009 http://www.europapress.es/salud/noticia-congreso-exige-gobierno-garantice-asistencia-sanitaria-gratuita-todos-espanoles-20090929195303.htmlA The Government response in April in which they agree but without specifying a timetable: http://www.bolinf.es/wp/?p=20004 The motion tabled in Congress on 10/05/2010 http://www.bolinf.es/wp/?p=20612