Without freedom there is no health

And this would give rise to debauchery: to the law of the West in the area of ​​health.

Something that, without control, would go against patients.

But let’s go to the beginning. What do we mean by freedom and health?

If what we defend is health in freedom, the concept is very broad, even ideological. It means that the health model itself is based on individual freedom as a structural principle and not as a concession. It is not “there is freedom in healthcare”, but healthcare is born free, operates in freedom and seeks to preserve freedom, not just health.

On the other hand, if what we defend is freedom in health, we start not from freedom as a basic point, but from the prior existence of a health system. And that means introducing the concept of freedom into the healthcare system.

In other words, talking about how citizens exercise power within a system that already exists.

In other words, free healthcare implies a new moral, philosophical and political framework.

Freedom in healthcare is more reformist and modern (in addition, it induces citizens to exercise their rights within the system).

Currently, no one advocates, at least publicly, a radical change in our healthcare system. Therefore, we will defend the model that argues that freedom can be exercised within an existing health system.

But to do this, we must also analyze very carefully what are the brakes that can limit this freedom and why they arise.

The origin of our system is clear.

Our current National Health System (because the debate on this option must focus on the public health system) has its origins in the dictatorship era. Specifically, in the sixties, with the creation of the Social Security Basic Law of 1963.

The Francoist regime then created a health model to protect citizens with suffocating paternalism, the fundamental foundations of which are still in force sixty years later.

This is the model that survives to this day and is based on the idea that the system is above the individual and is therefore not responsible.

And this manifests itself in an absolute lack of transparency and information for citizens.

We as citizens have been led to believe that if we ask, choose, or compare, we are not supporting. A moral discourse was constructed that places the citizen in the perfect role: grateful, obedient and, above all, silent.

And meanwhile, without noise, the system stopped being accountable to the patient.

He is responsible only for himself.

Congratulations on reducing the waiting lists, when all you do is manipulate the settings of Wait.

Reporting a mammogram done months ago within thirty days is called success.

He measures his performance not by what the patient feels, but by what is politically expedient for him to tell.

But the most dangerous thing about this trend is that it becomes normalized. Let society accept this as if it were an inevitable event. “It is what it is and what exists is the best in the world.”

This sentence caused more damage to health freedom than any decree.

We have become an anesthetized society. Trained to complain at the bar, but resigned to not demanding what belongs to her.

“Everything that brings freedom is stigmatized. Because freedom is uncomfortable. It forces you to give explanations. To compete. To justify results”

We give up asking for information, transparency and decisions.

And when someone suggests that, perhaps, citizens should be able to choose a hospital, a professional or a way of receiving care, the system responds with the magic word: “privatization”.

And all the alarms go off.

Everything that brings freedom is stigmatized. Because freedom is uncomfortable. Forced to give explanations. To compete. To justify results. And this is what many within the system have avoided for years. They want everything to stay the same.

When talking about health, the same argument is always used: there is a lack of resources. More money, more professionals, more investment.

And it is evidently true that we must invest more.

But something is worth debunking. This is not just a money problem..

It’s an energy problem.

Budgets can be doubled, thousands of new locations created, and even the last clinic can be computerized. And even so, the citizen would still be without freedom if the design of the system continued to be protective.

If the system is still in charge and not the patient.

Because a system that does not allow citizens to choose or change is a system that never has incentives to improve. Live comfortably. Self-satisfied. Armored.

Health freedom is being able to say: “if you don’t come, I’ll go with someone else, and that way I’ll force you to get better”.

How good would a thirty-day guarantee law for any diagnostic or therapeutic act be for this country and for patients?

We would see how public health would increase their productivity.

Freedom, in health as in any other area, is not preached. It is guaranteed through the creation of real alternatives. And today, in Spain, citizens have no real alternatives in the public system.

You cannot demand a second diagnosis if no one offers it.

You can’t look at a hospital’s complication rate to decide where to have surgery.

You cannot know how many days it actually takes to diagnose cancer in your community.

You can’t automatically switch teams when you feel abandoned.

All this freedom already exists in other sectors. But not in health, because in health there is an acronym that justifies everything: SNS. A word used as a shield to avoid responsibility.

“One thing is certain. A system that does not compete, that does not listen, that is not accountable, is a system condemned to its own exhaustion”

A word that is directly opposed to another, much more revolutionary word: citizen.

And this is not a question of ideology. The future of healthcare will not be disputed between public and private. Not between more or less budget. It will be decided whether we will continue to keep the citizen as a passive subject or finally place him as the axis of the system, with real power.

And having real power means having operational rights. Real rights.

1. Right to choose a professional.

2. Right to know health results compared by center.

3. Right to automatically change hospitals, public or private, if a reasonable period of time is exceeded.

4. Right to access all your clinical data in real time.

5. Right to be heard not as a favor, but as an obligation.

And that is freedom in healthcare

And if that bothers you, it’s because it means returning the system to its rightful owner: the citizen.

We are right at the tipping point. Aging, pressure on professionals, chronicity, technological revolution. Everything is converging. We could seize this moment to reshape the system around a powerful idea: responsible freedom.

Or we could, like so many other times, let everything slowly deteriorate while we repeat that “we have the best healthcare in the world”.

One thing is certain. Without freedom there will be no sustainability. A system that does not compete, that does not listen, that is not accountable, that does not allow alternatives, is a system condemned to its own exhaustion.

The real enemy is not the left, nor the right, nor the private sector. In fact, there would be nothing more progressive, more modern and more fair than giving power to the patient.

The real enemy is paternalism. A paternalism that makes the citizen a subject before the system. A system that, in addition, requires you to be grateful, when your financing comes from the citizen.

And the day will come when, if the system, to guarantee its survival, does not provide answers to the citizen, the citizen will demand to break the framework, start from scratch and will move from the demand for freedom in health to a new contract in which the freedom of the individual prevails against the system.

And then we’ll talk about healthcare in freedom.

*** Juan Abarca Cidon is president of HM Hospitales.