At every hospital opening, members of Turkey’s ruling AKP government drop innuendos at the former U.S. President Barack Obama and say “our healthcare reform”. President Recep Tayyip Erdoğan has done the same thing again in the southern city of Mersin recently: “Obama tried to accomplish a healthcare reform that we have, but he didn’t succeed.”
The USA is the most unsuitable reference to compare the success in healthcare with. But this is another story to be discussed later.
The so-called healthcare reform that they present as the indication of success of big hospital constructions is an imperialist intervention in the strictest sense. Without being limited with Turkey, its coordination is regulated by the World Bank.
WORLD BANK’S INTEREST IN HEALTHCARE
In the period between the 1950s and 1970s, capitalism was living its ‘golden age’, the social state era. Health, education, and social security services were being provided by the state. In the period when socialism was at the peak of its prestige, this was a concession given to the working class to keep them within the system. People wouldn’t have had to spend money for their health, pension, and education, just like as in the Soviet Union.
Then, the conditions changed: The working class struggle in the West regressed, socialism fell into decline, international balances shifted, the utilisation of healthcare increased, and in connection with this, capitalists realised that they could profit from this area too. Now, it was the time for marketising healthcare.
At this very point, the Work Bank came into the play in the late 1980s. The title of its first report specifically prepared regarding healthcare is also significant: Investing in Health (1993). And it’s quite straightforward what it said: The state should get out of health; the private sector should get involved instead. The area should be given to private hospitals and private insurance companies.
The time to plunder has arrived.
More importantly, the World Bank was engaged in deploying foreign healthcare companies in the plunder of public health. It was the time that foreign hospital chains and insurance companies broke into the Turkish market.
They mounted many arguments to conceal their real intention: The state sector is inefficient, etc. All are a fabrication, baseless. But now that the shoe is on the other food, governments subcontract, and the public health is left to the mercy of monopolies.
DEVELOPMENTS IN TURKEY
This work that AKP polishes and boasts about on every occasion started in the year 1990. On August 16th, 1990, the World Bank and then government of the Republic of Turkey signed an agreement called Health Project Loan Agreement. The President was Turgut Özal, the Prime Minister Yıldırım Akbulut, and the Minister of Health Halil Şıvgın. All of them had their signatures under the agreement. This was the last round of the centre-right neoliberal ANAP government.
Upon the agreement, the World Bank granted Turkey a loan of 75 million dollars and Turkey too invested the same amount of money. The project was named the Health Project. It was protracted in 1995. In the AKP era, it was renamed to the Health Transformation Programme and brought up to today by 5-year extensions.
The external financing offered by the World Bank was determining in the implementation of the project. We have no knowledge of the developments after 2010 as they weren’t declared to the public, however, until then, the total amount of loans taken from the Bank for this and other relevant works (transformation of the social security system, for example) hit 1.5 billion dollars.
The money was disbursed for expenses in items such as payments for consultants employed by the concerned ministries (some of which are foreigners from the World Bank quota) and research (in subjects like a public expectation of healthcare services and distribution of income).
In brief, the World Bank made Turkey accept the project in its mind, burdened Turkey with debts for the implementation, placed its consultants into Turkish ministries, and got their wages paid with the loan it gave.
Now, the AKP presents this work as its own project. It is significant and accurate. This is an imperialist project and the AKP suits it well.
CONTENTS OF THE REFORM: MONEY, MONEY, MONEY
Community clinics offering primary care health services were shut down; alternatively, family practice centres, which were designed to collect contribution fees from the citizens, are opened. Preventive health services were left aside.
Formerly, financing of healthcare services were solely compensated with taxes. They added on the taxes a healthcare premium and a contribution fee for all sorts of health service. Today, every individual is insured, yet the people spend about 20 billion Turkish lira [≈ 5.4 billion U.S. dollars] for healthcare every year. There used to be no healthcare premiums; thanks to them, 5% of our gross wages (12% for the self-employed) is being seized under the cover of premiums.
In the past, hospitals were owned by the state. Today, there are 500 private hospitals. In 2012, these hospitals grabbed a good share of 17 billion Turkish lira [≈ 4.6 billion U.S. dollars] out of the healthcare market worth of 59 billion Turkish lira [≈ 16 billion U.S. dollars]. Thanks to the AKP. As for the state hospitals, they have turned into business entities. All are in debt; the Turkish Court of Accounts reports detect this and warn that the hospital system is unsustainable.
WHAT THEY CALL ‘OUR’ HEALTH REFORM
It is the money, the company, the monopoly, the competition, the market, the inequality.
It’s not theirs. Its patent belongs to abroad. It’s the harvest of the 1980 coup period.
It’s not something that is implemented only in Turkey. Imperialism has launched a simultaneous operation to release healthcare to the market all over the world. In England, for instance, there is no such thing as a ‘hospital’ today; hospitals are now ‘trusts’.
The healthcare reform is the lowdown of the AKP.
