For all of their differences (food being perhaps the first), Italy and France have much in common. While I’m grateful for the similarities of the romance languages and the ability to be quickly conversant, as a French speaker, after only a few months of study, another point commun worries me: how the countries’ respective public health systems are being primed for privatization (and the growing inequalities of care that result).
During my recent stay, locals complained about the long wait times, often exceeding a month, to see doctors, a fact of life that privileged citizens can skip by paying high consultation fees. An abandoned hospital in the village whose closure was forced by politicians eager to save on costs was the backdrop for complaints about how healthcare policy is out of touch with the needs of the Italian population, as the hospital was at full capacity prior to closure, serving the needs of the community who must now drive 30 minutes to the consolidated replacement.
All of this reminded me of similar complaints about the sécurité sociale in France, whether its lack of reimbursements, its administrative backlog, or its similar wait times and tiered payment system that caters to those who can most afford care. All complaints that frighten my American ears, knowing the dangers of the unjust privatized system at home that is the alternative.
Whether in Europe or at home, the trend (falsely compassionate) is to try to understand and empathize with those who, for various reasons ranging from education level to religiosity to financial interest, defend such unjust systems, whether in health, education, science, or other areas of public good. Doing the anthropological work to understand such reasoning is, we are now told, important for a healthy democracy and overcoming polarization.
As an anthropologist by definition interested in cultural logics, going down such rabbit holes is my natural inclination: why do some people feel that a privatized health system is better when it results in soaring costs for care and drugs and increasing inequalities of access?
More flexible thinking, of course, is always welcome, and making the effort to understand the logics implicit in opposing views is always good exercise. For such flexibility to be ethical, however, it should begin with the acknowledgment of our common needs, and the recognition of our right to equality. What a difference it would make to what is considered acceptable political rhetoric today if considerations about which system is best began: “All people have the equal right to equal healthcare.” Because at the end of the day, even talk of “social determinants of health” is moot if it does not acknowledge the inequality – the betting on certain human lives at the expense of others – baked into privatized health systems and essential for their success.