Among my memories as a union leader, some have resurfaced for some time now until they became obsessive after the metalworkers' renewal agreement of last November 26th. Back in the spring of 1987, I was general secretary of the CGIL chemists (the union's acronym – Filcea – was so sweet and graceful that an official adopted it as the name for her daughter). In that role, after a very difficult negotiation, I stipulated an agreement with Montedison establishing the first new generation pension fund, Fiprem, which then paved the way for Fonchim.
The initiative caused me some problems with the secretariat of the CGIL and more generally within the apparatus to be failed in the sacred principle of public welfare. Then in the field of supplementary pensions, within a few years, a balance was found (a few months after the signing of the Fiprem I even entered the confederal secretariat as head of social policies) so much so that in 1993 the last act of the Amato Government was to launch the legislative decree n.124 which fully regulated the sector.
On the other hand, my irreducible refusal to genuflect at the foot of the law n.833/1978 establishing the National Health Service was never forgiven (Enrico Berlinguer had spoken of it as "a well of socialism"). Up to the point of giving my support to article 9 of the first version of legislative decree n.502/1992 which provided for the possibility of experiment, within the healthcare system, associated forms of users, converging in a mutual or any similar collective experience.
This new subject, organized and consortium member, would have been transferred a part of the resources (or even the entire quota, if it was intended to implement a more extensive operation) that the National Health Fund reserves for each citizen as a per capita share , as an economic quantification of the right to benefit from health care. I remain of the opinion that the proposal of the Amato Government (to whose definition I had contributed and which gave me the opportunity to write the essay "La salute liberata" for the Mill in 1997) was not only in harmony with the innovations that interested the major European public systems, but represented a valid field of experimentation and integration between public and private.
Unfortunately such was the crawl space raised that a few months later the Ciampi Government passed a corrective decree which buried forever the proposal of a possible market in the protection of health. In the meantime, I too had taken the trouble out of the CGIL, after a motion signed by 25 important executives had called me to order. That time, like a great gentleman, Bruno Trentin saved me. But I understood that the bell would never ring again. But that's a whole other story: I have nothing to complain about the CGIL.
I find it strange though the current spread of corporate welfare, especially with regards to health protection, in the absence of a regulation at least equivalent to that envisaged for pension funds. As far as I can remember, the only Minister of Health who tried in vain - and not very well for me - was Rosi Bindi in 1999. Then silence, while the sector was expanding. Because we can be happy with this turning point that collective bargaining has taken, but some reasoning of a systemic nature should be done.
Recourse to corporate welfare - especially in the crucial case of healthcare - does not address and therefore does not solve an underlying problem: be it employers, be it workers and their families but, there are millions of people who pay twice for the same services (with taxes and out of pocket). We know that over 60% of large Italian companies provide their employees with private health care. Another aspect worthy of attention concerns, even before the renewal of the metalworkers, the presence (66,8%) of supplementary health insurance funds in the national sector contracts. Before 2001, the presence was practically halved (35,4%), while there was a strong acceleration between 2006 and 2012.
As for other private welfare interventions, also in this field, companies are more willing to grant social benefits – that they enjoy incentives and tax advantages - rather than salary increases. The same approval also applies to workers since the presence of benefits and corporate welfare services is higher in companies with a high unionization rate (over 40%). Of course, company-wide social benefits end up favor insiders and permanent employees.
However, it would not make sense - we argue - to impose an equality equal to the disservices of the public model (La Mutua Fiat, a very efficient structure, was dismantled by popular acclaim after the hot autumn in the name of equality). It is equally true, however, that it will never be possible to build an alternative system based on the fragmentation of interventions, which now represent a still partial response to a profound social unease caused by the weight of the tax authorities and the inefficiencies of the universal public system.
But there really is a need for a new actio finium regundorum between the public and private roles in healthcare. In Italy, public health expenditure is not only growing compared to GDP (with worrying future scenarios); so is the private one (over 2% of GDP, approximately 30 billion) largely supported out of pocket by families and companies. An expense very often addressed - as reaffirmed in the Green Paper "Work and welfare of the person" presented by Adapt - to purchase goods and services already guaranteed by the public system.
Hence the need arises a rationalization, establishing which sphere of intervention and for which subjects the services guaranteed by the NHS should be ensured, leaving the rest to collective and individual private initiative. In essence, it would be about to organize, in the interest of health protection, service efficiency and cost savings, public welfare and that ensured through private instruments.
