The COVID pandemic has demonstrated the total failure of the Lombard health system invented by Formigoni, centered on the relationship of subsidiarity of the public part of the system towards the private accredited part. The Lombard private healthcare sector collects 40% of public health spending but is free to choose which sectors to invest in—particularly complex surgery, cardiology and chronic diseases—and which sectors to ignore: first aid, ER departments, not to mention prevention, seen as a dangerous competitor that removes profit-generating sick people from the system. For the most part, this accredited private health service waited almost two weeks before intervening. For over twenty years, public health in Lombardy has been managed with the same logic as private health care, while the material interests of the two sectors are exactly the opposite.
The more prevention is available, the more territorial facilities are strengthened, the fewer people are sick, the more public expenditure is reduced and the more the community saves. The first line of defense was abandoned to its own devices and was overrun. Ever since December, general practitioners had been reporting an increase in interstitial pneumonia, but the virus was able to spread undisturbed: general practitioners were completely abandoned, without any protective equipment and without any training. Preventive care is now little more than an acronym, lacking in resources and personnel, including those pertaining to occupational medicine, while specialist clinics have been sacrificed to a hospital-centric logic; epidemiology is an unknown science, and the use of swabs seemed aimed more at avoiding the identification of new cases than at finding the contacts of infected people in an attempt to trace the path of the virus.
Having crossed the first line of defense so easily, the virus hit the public hospitals that had suffered heavy cuts in the number of beds in the twenty years of Formigoni’s rule: the effects were compounded by the absence of intermediate facilities and the closure of numerous territorial hospitals and several hospital wards to make room for the proliferation of new private clinics. The result is well known: doctors forced to choose who to treat and who to abandon to their fate, COVID-positive patients transferred to assisted living facilities with the tragedies that followed, and thousands of sick people who died at home. Even worse, no red zone was declared in the Bergamo area, more than twenty million euros were wasted in order to open a useless field hospital at the Fiera Milano, and thousands of citizens are still in “house arrest,” waiting for swabs and tests that have not arrived for weeks and sometimes months.
This is the failure of a healthcare system that has been subjugated by private interests, focused only on the development of increasingly technologically sophisticated treatments aimed at a narrow and wealthy section of the public. This is a model unable to cope with a public health emergency, which would require an effective system of health surveillance, the active involvement of the population and a central role for preventive medicine and territorial services.
What is happening in Lombardy is a warning signal that goes far beyond regional borders and beyond the COVID-19 pandemic, which will certainly not be the last epidemic of our time. We need to fight for a public national health service, free of charge, supported by general taxation, capable of intervening effectively not only in terms of treatment but, most importantly, before people become ill. It means going back to the principles of Dr. Giulio Maccacaro, in full awareness that we are going to hurt enormous economic interests and that the fight will be a very hard one. But if we want to protect public health, there is no alternative.
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