When the consequences of the 2007-08 global financial crisis began to be felt in Greece, the upheavals were not perceived as a possible future within the EU. However, given the current expansion of austerity policies in Europe, this scenario is more relevant than ever. Nadja Rakowitz examines the healthcare system.
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On May 15 of this year, the newspaper Kreta’s Struggles reported on the joint suicide of two 17-year-old schoolgirls in Athens. In response to this shocking story, the Ministry of Health called on all regional health officials, as well as child and youth mental health centers, to pay closer attention to cases of self-destructive behavior among children. However, this response is hypocritical because the healthcare system is so depleted that it lacks the capacity to do so. This is certainly true in Crete, where there is currently only one child and adolescent psychiatrist for the approximately 625,000 residents of the entire public health system, at the child psychiatry department of the University Hospital of Heraklion.
Care and protection – a matter of cash
Ten days later, the newspaper published a follow-up article titled “All Facilities and Hospitals in Crete in the Red Zone.” The article presents a new study by the Panhellenic Association of Public Hospital Employees that illustrates the full extent of the healthcare crisis in Greece, using Crete as an example. The assessment revealed serious shortcomings in staffing and infrastructure at eleven healthcare facilities on the island. These shortcomings include closed operating rooms and limited functionality of critical clinics in all districts. Nearly all hospitals have between 10 and 30 percent of positions across various professional groups unfilled. Employees have accumulated hundreds of days of unpaid leave and vacation time over the years. Intensive care units and operating rooms cannot be staffed due to a lack of personnel. Specialists, such as anesthesiologists, must rotate from clinic to clinic just to keep operations running. The report is shocking.
Last year, at a conference in Crete, former Health Minister Andreas Xanthos – who now works as a doctor in a hospital again – discussed what this means for employees and patients. He noted that there are currently many functionally uninsured citizens in Greece. Although there are no institutional barriers preventing them from accessing the public health system, they cannot receive effective treatment unless they pay for it out of pocket. Xanthos summed it up: “We have returned to the time before the National Healthcare Service (ESY) was established, when people in our country needed money to receive medical care. The core values of the ESY have been thrown out the window.” Austerity policies have done a thorough job. How did this happen?
Establishing a public health system
In 1983, the National Health System of Greece (ESY) was introduced under the government of social democrat Andreas Papandreou. According to Andreas Xanthos, a physician and health minister in the left-wing SYRIZA government from 2015 to 2019, the ESY was based on “the principles of equality and universality, as well as the public and free nature of the services.” The ESY was financed through a hybrid system combining insurance and the state budget. Only insured individuals had access to the health system, though other systems existed for the indigent.
During the first decade, public health services expanded significantly: many new hospitals and health centers were established, numerous doctors and other medical staff were hired, and investments were made in infrastructure and equipment. However, as early as the second decade, neoliberal logic began to influence health policy, gradually strengthening the private sector: health insurance funds were granted the ability to enter into contracts with private diagnostic centers and hospitals, marking the start of a gradual privatization process.
As early as the beginning of the 2000s, the population had to bear high private expenses in the form of direct or informal payments, i.e., corruption. Spending on medications increased dramatically, and the private sector expanded considerably, especially in primary care and diagnostic testing. Nevertheless, as Andreas Xanthos summarized: “It was ‘open to all,’ but in need of improvement.” That was about to change dramatically.
Global economic crisis 2007 onward
It took a while for the consequences of the major global economic crisis caused by the bursting of the speculative bubble in 2007–2008 to be felt in Greece. By 2013, the crisis had fully hit Greece’s healthcare system. In a very short time, the welfare state was scaled back so drastically that at least 30% of the population – more than three million people – were no longer covered by health insurance and thus had virtually no access to healthcare. Anyone unemployed for over a year was removed from all social security systems, meaning they no longer received social assistance or similar benefits. At the same time, hospitals were closing, employees were being laid off en masse, and healthcare spending was cut to approximately 6% of GDP.
In early 2014, all 350 primary care centers of the state insurance system, EOPYY, were closed. This meant that all primary care in Greece had to be provided by hospitals or private doctors. Giorgos Vichas, an activist with Solidarity Practice in Elliniko, Athens, spoke in the 2015 documentary “Power Without Control – The Troika” about how “hundreds of people are dying all over Greece every month.” Hundreds every month in the heart of the EU because they received no medical care or could not afford it. The destruction of the healthcare system between 2010 and 2015 was as severe as that seen in times of war. Added to this were the hundreds of thousands of refugees and undocumented migrants already in the country, who also had to rely on the same ruined healthcare system for treatment.
Harsh austerity policies
However, this was not the result of the crisis itself, but rather the consequence of the harsh austerity policies imposed on the population by the Troika – the European Commission, the European Central Bank, and the International Monetary Fund – with the compliant support of Greece’s ruling class. The German Ministry of Health served as the official ‘domain leader’ for structural reforms within the framework of the so-called ‘Task Force Greece’ and designed and implemented cuts, closures, exclusions, and massive privatization. The resulting welfare state bore a striking resemblance to the highly privatized U.S. model. Under this model, not everyone has access to healthcare, and the quality of care depends on one’s financial situation.
At the time, however, what happened in Greece was not perceived as a possible future within the EU. Neoliberal politicians and economists promised that the economy, and therefore society as a whole, would recover after the ‘valley of tears’ and the harsh austerity measures imposed in accordance with neoliberal economic doctrine. The EU bourgeoisie recently reaffirmed and celebrated this idea once again when Mario Draghi, the ‘banker in the service of Europe,’ was awarded the Charlemagne Prize. Yet, even back then, historical experience from regions such as South America and Southeast Asia pointed against this. In Greece, too, there was practically no indication of a speedy recovery. Without a large, left-wing, solidarity-based movement in the country’s healthcare system, many more people would have suffered from a lack of medical care under these policies.
Troika policies under SYRIZA
As is well known, the left-wing SYRIZA government continued the Troika’s policies, except in the healthcare system. As Minister of Health, Andreas Xanthos enacted two significant policy changes. Since 2016, a law has guaranteed that uninsured individuals and those in vulnerable situations have free access to the public healthcare system and medication under the same conditions and rates as insured individuals. Additionally, after six years of crisis and social cuts, the government initiated the hiring of additional doctors, nurses, and other healthcare professionals for the public healthcare system. Additionally, the government planned a new, decentralized public primary care system to replace the closed primary care centers. This new system would consist of approximately 300 facilities staffed by family doctors and other healthcare professionals. It would also implement a model of holistic healthcare that includes prevention.
Widespread corruption was also to be combated. This was a major step forward for the 30% of the population who were no longer insured and for migrants who now had to be cared for by the state system again. Some primary care centers were established, particularly in large cities. Unfortunately, the SYRIZA government only had four years to implement such reforms under adverse conditions. Since 2019, the conservative New Democracy party has continued the neoliberal austerity course in health policy and celebrates its success.
Selling hope
The public debt-to-GDP ratio has barely changed, and the income and living conditions of most people have not improved, yet no one seems interested. According to TAZ, by the end of 2024, most people in Greece were barely making ends meet. Salaries in 2024 were lower than in 2009, and due to inflation, people have even less purchasing power. The situation in the healthcare sector is similarly bleak. The idea that austerity kills is still true. No changes are currently in sight.
Like the entire left, the solidarity movement is fragmented and scattered. The memory of the solidarity practiced for years – not only in the healthcare sector but also in many other areas of society – is likely still present among individual activists but has disappeared from public debate for the time being. Alexis Tsipras recently contributed to this trend with his 700-page book, “Ithaca,” about the debt crisis of the 2010s. In it, he makes no mention of the solidarity movement that supported his government. Tsipras is currently marketing himself as a new, supposedly left-wing hope with a new party. He certainly will not put an end to austerity policies. The left in Greece is likely well aware of that.