Costs of Political Intermediation and Sustainability of the European Social Model in Health Care: the Dutch Example

1. The European Social Model can be Safeguarded only by Agreeing to Reshape it

Europe will not emerge from the Great Crisis to take up where it left off. Like it or not, and even if politicians, especially in Italy with few exceptions, do their best to reassure and treat their voters as small children from whom it is always advisable to hide the ugly truth (and voters do little to have somebody tell them), it would certainly not be possible to revive the old industrial society, its certainties, its rhythms, its stable and standardised prospects. Even the European social model, the economic, cultural and institutional accomplishment of twentieth-century social covenants and the identity flag of the European Union in the world, cannot be preserved in its essentials if we don’t undertake timely and far reaching reform s capable of ensuring its sustainability and equity over time.
This state of affairs belongs to the order of facts rather than opinions. Both advocates of a return to the stabilising and redistributive role of public spending after the sprees of the last two or three decades and defenders of the widest possible market self-regulation will have to consider the consequences of structural changes that have taken place in the social organisation, in the structure of labour relations, in international competition, and the consequences of technological, cultural and above all demographic changes that today separate us from the sort of Europe that existed in the second half of the twentieth century. It is not simply a dispute pitting those willing to maintain and develop a strong framework of social protection against the most merciless partisans of social Darwinism. Even those who believe that the European social model deserves to be preserved in its objectives and its essentials and those who believe liberal democracy should ensure the highest degree of equality of opportunities or social solidarity need to understand certain facts. They must understand that the widest possible preservation of the structures of the twentieth-century welfare state in its original form and with their historically consolidating tools are no longer appropriate means to the end, and even risk becoming a source of unjust unintended consequences, especially but not only in intergenerational relations.
Indeed, insisting on the defence or reconfirmation of the old system of safeguards and its well established rules may even cause an irreversible financial crisis for every social safety net, so as to make its dissolution inevitable in the medium term. That is, when all the present decision makers, politicians, industrialists, union leaders, have left the scene having got off scot-free, because only a few historians will seek to re-establish their responsibility, for the sole interest of a specialised audience.
The substantial dissolution of the universalistic European welfare system could then also be remembered as a crucial step in the real “downfall of the West” that seems to be unfolding today in a very different and opposite way to that originally stated by its early traditionalist theorists at the beginning of the twentieth century. In the direction, that is to say, of a further and final decline of liberal and individualistic Western democracy in favour of models of more authoritarian and organic global world organisation, increasingly less concerned with combining economic development with individual freedom and human rights, separating the two sides of the modernisation process until now considered by most of Western culture as naturally interconnected.
Responsible leaders, instead could, and should, discuss the desirable measure of redistributive intervention in public spending, compatibility, tax burden, equality or inequality in relation to need, merit and talent, and according to criteria of equity, effectiveness, growth or economic stabilisation. They should also discuss the quantification of the total expenditure to be allocated for social protection. In any case, whatever the general options in economic policies they should rethink the welfare structure from its foundations and its composition in the new actual situation.
Concerning the issue of retirement, in fact, where the stakes and interests involved, although subject of bitter controversy, are relatively understandable even to quite a large audience, the debate has been going on for years.
The political and even sometimes academic debate often tends to mix very dissimilar issues, as if they were different sides of the same ideological or principle-related argument. It should not be considered off topic, therefore, to underline that in a liberal perspective the debate on education policies, for example, should have very different contents and objectives. This is particularly so given that the socio-economic aspect of the matter is overlapped by an ethical-political one. This concerns citizenship education, the scope of parental responsibility, whether or not it includes an authoritative predetermination of the ideal or religious affiliation of children (also in light of the New York Convention on the Rights of the Children, and especially of those already naturally able to exercise a certain amount of fundamental freedom). It also concerns the role of public institutions protecting these freedoms and the free development of individual personalities. These assets and values are inalienable and should be solely and exclusively related to the individuals directly concerned, even if children are not personally and directly able to make a choice.
This debate is often completely overlooked in Italy, sometimes also, though usually without similar malice, in countries less subject to the daily challenges of religious fundamentalism and their political intrusiveness. In education however the role of public authorities cannot be measured solely or mainly as a purely socioeconomic question. Discussing public and private schools in fact often means a more concrete discussion of secular or denominational teaching, Republic or faction school, integrated or communitarian school, free or indoctrination school (though today indoctrination is more subtle and sophisticated in denominational schools, as it is in the media, far from the coercive practices of the past, that today are confined to other parts of the world).
Anyone who believes that the role of guarantor on the part of the public authorities in this field is superfluous, parents being the best interpreters of their children’s interests, should note how scarce or nonexistent the interest in citizenship education, or in civic matters in the broadest sense, is likely to be, in the eyes of many Italian parents from those large sectors of Italian society (perhaps the majority) whose attitudes were formed subsequent to when Dino Risi released “I mostri” a film that today appears to be a prophetic description of Italy at the beginning of this century. Many of those parents certainly want “what is best” for their children. In order to achieve this, however, they are probably far more inclined to incorporate them into what former presiding constitutional court judge Gustavo Zagrebelsky calls “i giri giusti” (the right circles), than help them develop a critical mind and cultural personality of their own.
In education in other words, unlike what is typically the case in the health care field, the problem does not lie in information asymmetries between supplier and purchaser of services, or in the real opportunity for the user/consumer/customer/citizen to make informed choices. Above all it lies in citizenship education and in ensuring that the directly concerned individuals have the greatest freedom to develop the full potential of their individual personalities in the face of the power, or claim, of others to predetermine and condition them (of course, “for the best” of those concerned, but in the subjective interpretation of those pro tempore exercising parental authority).
In any case, in the field of education policies, the issue of cost sustainability arises in a different way, as the essentially demographic factors that threaten the welfare system are not an issue, nor are those, both demographic and technological, that affect the future of health care. Rather the contrary is the case, given the progressive decrease in the school population in many Western countries.

Giulio Ercolessi: This article is a July 2010 expansion and updating of the contribution carried out by Giulio Ercolessi in the international conference “Per una politica sanitaria europea / Health Care Policy and Fundamental Rights in Europe” organised by the European Liberal Forum with the support of the Critica Liberale Foundation in Rome, Villa Spalletti Trivelli, 27th November, 2008.

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