Cinco claves da reforma sanitaria de España

Estamos a sufrir importantes trocos no modelo sanitario conquistado en España que deu importantes resultados na mellora da saúde pública. Nestes días os grandes medios recollen a perda de dereitos neste terreo, que está a afectar de xeito especialmente grave á poboación inmigrante pobre.

Achegamos un artigo publicado en Periodismo Humano no que dan cinco claves da reforma sanitaria:

1.- La mejor defensa, un buen ataque: no parece casual el empeño del Gobierno de España por centrar el debate de las modificaciones al Sistema Público de Salud en la pérdida de derechos de las personas migrantes irregulares.

Frases como las vertidas por la ministra de Salud, Ana Mato diciendo “la tarjeta sanitaria es para los españoles” o del consejero de Sanidad de Castilla la Mancha, José Ignacio Echániz “no hay que olvidar que la sanidad gratuita ha sido fundamental para fomentar el efecto llamada. Mucha gente ha cogido una patera porque sabía que en España tenía la asistencia sanitaria garantizada“, o el propio portavoz de los populares en el Congreso, Alfonso Alonso con su “el sistema sanitaria no puede ser un coladero de inmigrantes”, ponen el foco sobre ese sector minoritario y desprotegido, pero fundamentalmente con escaso respaldo social. Las intervenciones de los partidos mayoritarios de la oposición parecen colaborar con la estrategia… ¿se habrán puesto de acuerdo para defender los mismos intereses?

Está claro, el Gobierno quiere que las miradas se desvíe hacia la población migrante y el éxito que ya está teniendo esa estrategia tiene dos fundamentos: A) desviar la atención sobre el real cambio y ataque a todo el sistema de salud. B) encontrar mayor respaldo en una idea muy instalada socialmente de que la población migrante es quien hace uso y abuso de los beneficios públicos como salud, educación, coberturas sociales, etc. Y en un clima de crisis como la imperante, para muchos sectores precarizados lo de “los españoles primero”, tiene un fuerte calado. Atacando la población migrante, el Gobierno ha encontrado la mejor defensa a su proyecto.

Pero veamos los números reales de la población migrante para ver la relevancia que la medida tiene en este sector: a fecha 1 de enero de 2012  había en España un total de 408.142 extranjeros no regularizados, pero de esa cifra 306.477 serían ciudadanos de la UE que no se han inscrito en el Registro, a los que habría que añadir otros 13.481 de ciudadanos de países miembros de la Asociación Europea de Libre Comercio. Esto significa que solo habría según estas cifras 88.184 ciudadanos potencialmente incursos en la infracción del art. 53.1.a) LOEX, es decir sin papeles.

Esto significa que el 79 por ciento de esas personas indocumentadas tienen un derecho inalienable de registrarse como ciudadanas comunitarias mediante una simple tramitación administrativa, y por ende dejarán de ser “sin papeles”. Apenas un 10 por ciento quedarían totalmente excluidas, una cifra que aunque siempre importante porque hablamos de personas, no parece justificar que el debate se centre en este punto. Parece que por primera vez más que usar la migración como chivo expiatorio, el Gobierno quiere vendernos “gato por liebre”.

2.- La tarjeta a los españoles…¿Y la salud?: en la misma línea de análisis, la exaltación de un supuesto patriotismo desvía la atención de los reales alcances de las modificaciones al sistema de salud, a la mera disposición de la tarjeta sanitaria por una cuestión de nacionalidad y/o “papeles”; cuando en realidad muchas personas españolas o migrantes “con papeles”, igual no podrán disponer del derecho a una cobertura de salud según sean sus circunstancias laborales y/o particulares.

El Art. 3 del Real Decreto 16/2012, tras desarrollar los supuestos para ser consideradas personas “aseguradas” establece que “en aquellos casos en que no se cumpla ninguno de los supuestos anteriormente establecidos, las personas de nacionalidad española o de algún Estado miembro de la Unión Europea, del Espacio Económico Europeo o de Suiza que residan en España y los extranjeros titulares de una autorización para residir en territorio español, podrán ostentar la condición de asegurado siempre que acrediten que no superan el límite de ingresos determinado reglamentariamente”. Es decir, habrá personas que pese a su “regularidad administrativa” e incluso su nacionalidad española, también quedarán excluidas del sistema sanitario público.

Y esto con un agravante. El Estado español no suele destacarse por su velocidad y mucho menos por el cumplimiento de plazos en cuanto a la elaboración de reglamentos se refiere. Entonces ¿qué pasará con esa limitación de ingresos?, ¿cómo se fijará las base de ingresos temporalmente y hasta tanto salga un reglamento?, ¿quedará en manos de la persona instructora de la solicitud?. Parece que las circulares internas cobrarán, como en casi toda la administración pública, más fuerza que la propia ley.

Asimismo atendiendo a que un 50 por ciento de la juventud española está en paro y nunca ha podido cotizar, y por ende excluida en gran parte de la posibilidad de ser considerada como “asegurada”, resulta un verdadero despropósito que el Real Decreto establezca que podrán reconocerse como “beneficiarios de un asegurado”, solo “el cónyuge o persona con análoga relación de afectividad, el ex cónyuge a cargo del asegurado, así como los descendientes a cargo del mismo que sean menores de 26 años o que tengan una discapacidad en grado igual o superior  al 65%. Es decir, se dejará sin ningún tipo de cobertura que no sea le mera urgencia a toda persona mayor de 26 años que no sea reconocida como asegurada.

Es más, la reforma resulta tan lesiva, que en la disposición final quinta se oculta otra “perla” de enorme gravedad: “se somete el derecho a Residencia de las personas comunitarias y sus familias,  si no están trabajando, estudiando o no demuestran recursos suficientes “para no convertirse en una carga para la asistencia social en España durante su período de residencia”. Es decir que las personas comunitarias, hasta ahora con una amplitud de derechos similar a la de la ciudadanía española, perdería no solo el derecho a la asistencia sanitaria, sino lo que es más grave aún, el propio derecho a residir en el Estado español.

Incluso, en el punto 4 del mismo artículo se reconoce “únicamente” el derecho de familiares como el del cónyuge o persona con relación análoga, e hijos, pero no el de las personas ascendientes. ¿Serán excluidas también?.

3.- El remedio y la enfermedad: otros de los hilos en los que el gobierno ha centrado su defensa es en que “ninguna persona se le dejará sin el derecho a recibir atención médica”, ya que podrán asistir a los servicios médicos de urgencia. Y aquí otra vez el doble rasero: por un lado servicios colapsados que obligarán a quien pueda a buscar una cobertura privada (¿el objetivo final de esta reforma?), y por otro tras este discurso (como ya vimos falso) de todas las personas migrantes a urgencias, otra vez recaerán las culpas de las deficiencias del sistema contra este colectivo.

Pero debemos ir más allá, el disponer solo de la cobertura de urgencias significa tener que pagar la medicación en forma íntegra, y el alto coste de los medicamentos con la precariedad extendida hará que muchas personas no puedan seguir sus tratamientos o cuidados necesarios para su curación. Esto significa en esencia tres cosas:

1 – Las personas infectadas de enfermedades de gravedad, caso HIV, tuberculosis y otras similares, estarán condenadas a una agudización de su estado de salud que cuando sea atendida, quizá pueda ser tardío para su propia vida.

2- El no poder tratar la enfermedad en muchos de los casos terminará en la necesidad de una hospitalización, y a nadie escapa de su conocimientos, que resulta mucho más económico atacar la enfermedad desde su raíz que los tratamientos posteriores y el propio internamiento.

3- En caso de enfermedades infecto contagiosas no tratadas, los riesgos de contagio al resto de la ciudadanía son potencialmente mucho mayores, y por ende el tan achacado “gasto médico”, puede llegar a cotas mucho mayores que las que se dice, se intentan reducir.

4.- Enfermedad de unas, enfermedad de todas: quitar el derecho a la salud a un sector importante de la población, nos afecta a todas las personas que vivimos en esta sociedad. Afortunadamente no somos compartimentos estancos, interactuamos, viajamos en transporte público, compartimos espacios en una sociedad que aunque aún presa del impulso individualista de las sociedades de consumo, en el contexto actual cada vez necesitará más de relacionarse, de formar grupos de solidaridad, y en ese interactuar los riesgos de contagio al haber potencialmente más agentes transmisores, será mucho mayor.

5.- Un principio sin fin: la pérdida de estos derechos han comenzado por algunos sectores, pero nadie puede asegurarnos hasta donde llegarán. Afectan de una forma u otra, directa o indirectamente, y la historia de siempre –y también la más reciente, por ejemplo con la reforma laboral- demuestra que esto puede ser solo un comienzo, y no reaccionar ahora tal vez convierta en tardío los esfuerzos de frenar esta locura cuando intenten ampliarla en apenas unos meses.

Fonte: tomalapalabra.periodismohumano.com/2012/04/27/cinco-claves-de-la-reforma-sanitaria-de-espana/#more-1309

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