The populist hijacking of the welfare state

Populist hijacking, according to ChatGPT, consists of appropriating social policies and conditioning them to partisan or clientelist criteria. Left-wing populism promises to expand the welfare state with a strongly redistributive discourse that may clash with fiscal sustainability, and right-wing populism defends social benefits but "only for those at home" and excludes immigrants or minorities. Both cases carry a great risk: the welfare state may cease to be universal and become a tool of political polarization instead of an instrument of social cohesion.

We give a real example, which we see has already come to light in the United Kingdom and Portugal, and which is already beginning to be discussed here: the collapse of national health systems and the structural and functional difficulties in guaranteeing universal, equitable, and sustainable health care. An aging population and a lack of sufficient funding to meet the new and growing needs of the population are a reality, and the visible symptoms of bankruptcy are excessive waiting lists, work overload, difficulties in retaining talent, and a lack of public trust. All of this generates inequalities and territorial imbalances that lead to hidden privatization.

It was only 40 years ago that the general health law, known as Ernest Lluch law, which was committed to providing us with a National Health System for everyone (funded by taxes) and for everyone (with universal access). It seems like a long time, but it's not that long, and those of us who have lived through the Transition know what we're risking if we put it at risk.

And this must be shared and made known to the population, not through populism or child protectionism, but by explaining reality and demanding shared responsibility in decision-making. And it's not being done.

The current threat is one of sustainability, of a lack of public resources competing to meet public services. But also of provocative and populist discourses that, as they are incorporated, cause governments to question and cut universal access to the services of a welfare state.

Sustainability certainly involves making structural changes and reforms that allow us to do more and better with what we have, but this is not enough. We need shared responsibility in decision-making, and a commitment to a new social contract in which the government, local governments, unions, employers, professionals, and citizens are jointly responsible for the adequate and balanced distribution of scarce resources. Where do we allocate them? To generate expectations and win votes, improve working conditions, improve accessibility and waiting lists, address unmet emerging needs, invest in equipment and infrastructure, research, and innovation. And at the same time, we demand rigor, transparency, and accountability in the governance and management of public services.

This reality is not relevant to parliamentary debates on health systems; there is no desire to talk about the risk of the health system going bankrupt because this requires decisions that don't yield votes. We continue to talk about building new hospitals and facilities when there are unmet health, social, community, and emerging needs. We continue to question the concerted action model, confusing the population into believing that concerted action privatizes healthcare, when it is a model for managing public services that allows for the pooling of resources, professionals, and knowledge through a territorial network of proximity and excellence for all.

Perhaps it is time to evolve from a welfare state (guarantor of people's well-being) to a welfare society (shared responsibility) with the participation and commitment of the entire society, building an environment where people can live with dignity, where generating decent employment is one of the priorities of social policies, with a social fabric.

The challenges of the future demand shared responsibility, and the necessary transformations require stability of strategies and values. We cannot leave it solely in the hands of governments with short-term electoral cycles. Reality unites, partisanship divides. From a quality public governance that guarantees universal protection, it is necessary to recover the value of a robust and committed civil society to preserve what we have. We cannot let populism hijack the survival of a health system for all.