A few days ago, the Minister for Regional Affairs, Roberto Calderoli, announced that he will present a draft autonomy agreement to the regions of Lombardy, Veneto, Liguria, and Piedmont, which could be signed as early as September. According to this agreement, the regions—by retaining part of their local revenues, thus diverting resources away from the more disadvantaged regions—would be able to use these funds to increase the salaries of doctors and nurses and thus create “competition” with the areas that already struggle to recruit healthcare personnel.
We call this system by its real name: wage scales. Wage scales were a method of calculating salaries that existed in Italy between 1954 and 1969, which tied wages to certain parameters such as the cost of living in a given area. Paying higher wages in regions with a higher cost of living (such as those in the north) means ignoring the enormous structural disadvantages faced by underdeveloped areas like the South—such as the very lack of services—which force families to bear additional expenses. For this reason, and thanks to the wave of workers’ struggles in the 1960s, wage scales were abolished, also in the name of class solidarity that rejected all competition among workers. Today, in the absence of that kind of solidarity, and without a strong party representing the interests of workers and the popular classes, these wage scales will become yet another tool for dismantling the National Health Service in regions such as Calabria, Basilicata, Puglia, and Campania, which are already struggling to recruit healthcare workers through public competitions.
And this is not just a matter of competition between regions: what differentiated autonomy in general (the direction agreements like this are headed) would promote is the ability of private interests to establish ties and exert pressure or blackmail on local public administrators, who have fewer means than the central government to resist such pressures—and who, being more “personally” connected to both large and small local healthcare businesses, are more vulnerable to various forms of collusion. A paradigmatic example of how increased funding at the local level is already being used not to modernize public services but to benefit private interests is offered by Calderoli’s own region, Lombardy—the richest region in Italy. Lombardy has the highest concentration of major companies profiting from healthcare (San Donato, Humanitas, Gruppo Villa Maria, Kos, IEO, Maugeri, Gruppo GHC, Giomi Fingemi, Servisan, Multimedica), some of which have become multinationals, and it leads the process of healthcare privatization, having included in its new regional law the possibility of outsourcing Community Health Centers to private operators.
It is politically important to remember, in any case, that this is not a process initiated solely by the current government: it was the centre-left that laid the groundwork for all of this with the 2001 reform of Article V of the Constitution. Not to mention that the Democratic Party has counted among its ranks politicians who have openly advocated for “wage scales” as a way to “make the South grow”—for instance, Milan’s mayor Giuseppe Sala.
Communist Front of Italy and Stipaturi Collective, in opposition to both the government and the fake opposition, firmly call for the construction of a public health service that is national and no longer regional, with a fair distribution of resources among all regions, high quality standards, and proper funding; for the reinstatement of all staff and hospital beds cut in the past decade; for the abolition of the unjust and class-based debt imposed on regions under financial receivership such as Calabria; for the elimination of healthcare co-payments and any similar form of patient taxation; and above all, for the full incorporation of private healthcare into the public health system, since private medicine is incompatible with a functioning public service.
Calabria Federation of the Communist Front of Italy
Stipaturi Collective
