The Minister of Health went to Parliament on Tuesday to give her accounts. Ana Paula Martins announced that the balance of the National Health Service (SNS) is negative at 1,035 million euros, a terrible figure, but better than the previous year. The debt with external suppliers is 1510.3 million euros. More consultations and surgeries are performed, but there are longer waiting lists. There are more people without a family doctor because there are more patients. The problems of Obstetrics/Gynecology emergencies will be resolved with regional concentration and closure of local emergencies – Barreiro is one of the cases that is left without this service. “INEM is much better”, said the minister seraphically.
The minister is therefore happy, as much as it may surprise us. And, of course, he did not talk about the way in which the State helps, in a systematic, gradual, integrated and legal way, to destroy the public health service.
Portugal grants significant tax deductions to those who use private healthcare services. Public and private expenses (why private?…), with consultations, surgeries, exams and medicines are IRS deductible up to 15% (with a global limit). Health insurance premiums are also included in the deductions “pie”. Companies can deduct workers’ health insurance costs from their taxes.
Why does it matter, for example, that the taxes of all of us, even those patients who only go to the public service, pay the co-payments for the medicines prescribed to patients who go to a private doctor? Why is this co-participation not supported by health insurance?
This has a clear effect: on the one hand, the State reduces revenue and, more importantly, encourages the consumption of private health services, degrades the credibility of the public service and, in addition, is complacent with poor management and the poor fight against fraud.
At that time, when SUS doctors retire, the State rehires them (which is prohibited for almost all professions) to maintain minimum operations. At the same time, the private sector recruits these same professionals, who accumulate salaries with retirement. Meanwhile, a significant part of public spending on doctors goes to private entities that supply these professionals to the SUS itself. The State pays more per hour, reinforcing a parallel market that takes away stability and quality from the public service.
Serious debate is not ideological. It is financial and systemic: can a State that faces difficulties in managing the SUS continue to give up revenue and stimulate private demand? Can it train doctors at public expense and passively watch their structural transfer to the private sector? Can you pay millions in overtime while subsidizing corporate health insurance? Can you accept that those who do not use private hospitals finance, through the tax system, the expansion of these services? Might you think it’s fair for those who don’t have health insurance to help pay the tax deduction for those who do? Can it allow those who depend exclusively on the SUS to see human resources, trained with public money, migrate to the private sector?
As long as the State indirectly supports the expansion of the private sector (which should live exclusively on its own money) it will continue to finance, with a lot of money from all of us, the destruction of the National Health Service.
The Minister of Health does not address this problem. Obviously.
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