Greece, Europe's austerity laboratory

Noëlle Burgi is a political scientist and sociologist, a researcher at the Centre National de la Recherche Scientifique (CNRS), currently working at the Centre Européen de Sociologie et de sSience Politique (CESSP) of the University of Paris I Panthéon-Sorbonne. Her research focuses on the transformation of the state in Europe, neoliberal governmentability, the reconfiguration of the welfare state and its political and social consequences. Among other academic works and articles she has published in the Monde Diplomatique, Noëlle Burgi also edited the collective work:  “La Grande Régression. La Grèce Et L’avenir De L’Europe” (“The Great Regression. Greece and the future of Europe”). Noëlle Burgi talked to GrèceHebdo and Magdalini Varoucha (The English version of the interview published on Greek News Agenda).
 
Interview of Noëlle Burgi to Magdalini Varoucha

Since 2011 you have been striving for a collaboration between Greek professors, researchers and intellectuals, in order to form an international network researching the generalization of austerity policies in Europe, especially their political and social consequences. Where are we today with the implementation of austerity policies in Europe?

Austerity policies can be defined as a coherent set of measures leading to the decline of social rights that were conquered more than a century ago, when the welfare state was built. They seek to change the balance between capital and labor by deconstructing  the social systems legal frameworks that ensure social solidarity, substituting the founding principles of democratic coexistence with the mechanisms of competition. The consequences of austerity are always selective, affecting mainly public goods and services upon which vulnerable social groups and the middle class depend.

The 2008 financial crisis has undoubtedly been seized as an opportunity and a pretext by the European Commission, the European Central Bank and the most powerful countries in the euro area, starting with Germany, to push further, more quickly and irreversibly the hitherto gradual decline of social rights. Just as for the first time in Western Europe, elites and dominant institutions applied to Greece and to other debtor countries IMF’s widely discredited method of structural adjustment, the European Union was preparing, with the 2012 Fiscal Stability, Coordination and Governance Treaty (TSCG), the enhancement of the powers of the ECB and the Commission. These two institutions are now monitoring national budgets ex-ante as well as ex-post and can almost automatically punish any member-state that disobeys austerity requirements.

It is not by chance that the ECB President, Mario Draghi, said in 2012 precisely, that the welfare state was "over". Submission to the regulations bolstered by the Treaty was also intended to produce a deterrent effect by stigmatizing Greece.  Since 2012, there have been numerous and intrusive interventions of the Commission in the national budget programs. As a result, the states adopt "reforms" that speed up the disintegration of unconditional social rights, the deterioration of solidarity institutions (from collective bargaining and public hospital to national education) and the privatization of common goods, such as water, electricity and transport.

The collective work "The Great Regression" (which you edited) calls Greece the "laboratory" for the reconfiguration of European economic and social policies. Do you also see the rise of Syriza in power as another case of political experimentation? What do you see as being the main impact of the policies of Syriza for the Left in general, and for the anti-austerity movement in Europe specifically?

Syriza raised great hopes among the European Left because it embodied a consistent political and intellectual response to the prevailing EU norms;  the possibility to give people back their dignity and control over their fate, to refocus European choices towards a balanced and just economic and social development, to prove that another politics is possible and to change the balance of power with the emergence elsewhere in Europe, particularly in Spain, of similar social and political movements.

A coalition of powerful countries and dominant interests turned Greece into a laboratory, subjected to the imperatives of "internal devaluation", in total denial of the incontestable theoretical and empirical evidence attesting to the failure of the stated objectives of austerity (return to sustainable growth) and in blind disregard for the consequences of their policies, including the humanitarian crisis in Greece, the rise of social violence, strengthening the extreme right and xenophobia. This coalition decided, you know, to crush the movement supported Syriza in 2015.

In doing so, they also decided to administer a political lesson to the rest of Europe, especially to the protest movements of the Left with the wind in their sails. Greece was made an example of for the entire continent, intended to demonstrate that the hegemonic logic would in no way be questioned. The German-European ultimatum that "crucified" Alexis Tsipras on the night of July 12 to 13 in 2015, also served as a warning for France, Italy, Spain and Portugal, so that they would not deviate from the rigors of budgetary discipline. Simultaneously, it actualized the will of the German finance minister, Wolfgang Schäuble, to reduce Greece to a debt colony, but also, as pointed out by Joschka Fischer, to transform a European Germany to a German Europe, reviving the Machtpolitik (Power politics). All this has profoundly shocked the world, and of course the divided movements of the European Left as a whole. The whole struggle for recognition of the right to have democratic and social rights has to resume. In Greece and elsewhere.

What is future for the European project given the handling of the economic crisis, the retreat of the welfare state and the management of refugee crisis by European leaders? Is another Europe possible or are we moving towards a Europe of borders and identity politics?

Europe is threatened with collapse. The catastrophic management of the so-called sovereign debt crisis and the deep fractures revealed and /or caused by the flow of refugees from the Middle East, North Africa and sub-Saharan Africa, clearly show that Europe will be forced to choose between, on the one hand, the possibility of a breakdown due to the reintroduction of border controls and the resurgence of nationalism and, on the other, a decisive shift to federalism aligned with democratic objectives. The first seems most likely because the far-right xenophobic forces are on the rise, due to the persistence of the dominant economic, social and political logic.

The European dream is dying, if it is not already dead: the dream of creating a social and democratic space based on a cosmopolitan conception of identity and citizenship. In its place, Europe seeks to protect itself behind walls, barbed wire, military and police, trying to pass over to Greece and Turkey the management of migration flows and the responsibility for internal divisions of EU’s own making. This is not a new problem and it is becoming even the more serious. As Seyla Benhabib said in 2005, "negotiating the status of insiders and outsiders has become tense, almost warlike."

Translated by Ioulia Livaditi.

First published in French on GrèceHebdo (11.2.2016) and in English on Greek News Agenda (16.2.2015)


 

Austerity vs. The People's Health: How Greeks Built an Alternative Health System

Vijoleta Gordeljevic
 
"We don't earn anything, we only spend, but for each other," said a tall, middle-aged man as he entered the little room full of medicine where I was sitting behind a small wooden table, interviewing a 15-year-old volunteer at a solidarity clinic in Pireus, Athens. As he raised his voice, he added: "Write that down, say that we are no NGO that pays people for doing something good. We all do this for free; we do it because we have to." He closed the door and left.

Not only do the hundreds of volunteers involved in Greece's informal health structure consisting of circa 50 solidarity clinics & pharmacies earn nothing, they also do not get the praise they deserve. Like in May of this year when the Medical Association of Athens, instead of supporting the cause, decided to accuse solidarity health clinics of causing unfair competition due to the "unknown work relationship" between the clinics and their volunteer doctors. This was not only a slap in the face for those giving their time and effort to provide indispensable health services for free at these clinics, but also for at least 75,000 Greeks that relied on these services alone in Athens. As a response, the Social Solidarity Clinic & Pharmacy of Arta published a statement saying they pity those who think that solidarity clinics are illegal and that all it does "is have love and respect for the fellow man, nourishing hope for a better future, for a life with dignity."

Over this summer I was lucky to visit dozens of examples of such healthcare-related solidarity. I learned that not only do they provide the sick with medicine and health services, they also help reverse the alienation suffered by many due to unemployment by strengthening social values and practicing open communication and selfless giving.

 
Greece has lately been seeing its own version of the "economía solidaria"; a term dating back to Latin America in the 80s when a big segment of the population started experiencing economic exclusion due to debt and unemployment and decided to counter it through a cooperative, autonomous and self-managed provision of various services by their members. The same thirst for justice and self-management could be witnessed in the past five years in Greece. Here, austerity has forced self-organization in areas such as housing, food and healthcare. It is especially the latter that has resulted in a remarkable network, quietly saving lives every day whilst listening to announcements of more and more public services being compromised.

'An alternative was needed'
Just two years ago, various authors and journalists referred to Greece's newly-sprung clinics as underground clinics; places people started going to as they increasingly could not afford or access treatment at a private or public hospital. Patients with severe physical and mental problems, many with cancer, diabetes or depression had to neglect their physical and mental problems for months as they were not able to pay the steep private hospital fees.

The public system became inaccessible because of inhumane waiting lists as a result of being greatly underfunded on every level due to austerity. Now in 2015, as Greece's socioeconomic crisis has long become a humanitarian crisis as expressed by Prime Minister Tsipras and other Syriza officials on multiple occasions, these underground clinics have long become known as "social" or "solidarity clinics" and their existence is not even closely as secret as the former term would suggest. Even though they are considered informal and exist without any legal status, solidarity clinics have become the alternative and frankly, quite innovative form of organizing healthcare for the citizens of Greece -- by their own neighbors and friends.

Greater Athens alone accounts for approximately 20 of these clinics and pharmacies. Another 30 are spread all over Greece, including on its islands where public health cuts have resulted in particularly neglected patients. Clinics operate free, without the use of money at any point. The doctors, nurses and administrative assistants are volunteers, buildings are either donated by the local municipality or squatted, leftover medicine is mostly donated by locals and medical equipment tends to come from retired physicians.

What has started off as an emergency solution to the harmful effects of public health cuts has almost become a parallel health structure on which growing parts of the Greek population start to rely. It is a structure that places the idea of health being a human right at its very center. In times when healthcare has become more and more commodified, competitive and selfish, self-organized relationships of care and community demonstrate a way out. They prove that healthcare can work if it is organized and creatively crafted by those most affected.


Health care from the bottom-up, in the middle of crisis-stricken Greece and born out of dire need: How did all of this happen and how did a people decide to take health into their own hands?

The first solidarity clinic -the Social Clinic of Rethymno- was to open on Crete, the idyllic island that is especially popular amongst European tourists. The clinic describes its purpose on its website as supporting people who do not have access to free health, medicines and vaccines as well as highlighting the problem that a big part of the population is being excluded from basic health services. Whereas the clinic was initially founded to serve the influx of immigrants and refugees, it soon started getting demand from native Greeks. Those who came were from diverse backgrounds; most just recently lost their health insurance as a result of unemployment. More than 300,000 people fell into this bracket in 2014, making the total share of uninsured Greeks stand at around 33.2% of the population (not even counting immigrants). Even people that are part of the social security register and formally employed have increasingly been making use of the solidarity structure; a decrease in public spending for medicines by more than half, from ca. five to only two Billion Euro means that many are unable to afford co-payments for drugs of sometimes up to 70%.

Whereas Greece has surely never been a pioneer in health matters - it has always been able to guarantee access to care to those that needed it. Its healthcare has been a mix of social health insurance and tax financed services via its own NHS run structure; comprised of a fragmented, corrupted but nevertheless accessible system. And although quality suffered in the last years, the biggest difference now is not that good-quality services are unavailable, but that people´s incomes are too low to pay for them any longer.

'The right to health'
"It is not just money that is missing. People lost their rights," Nikos from the solidarity clinic in Peristeri told me, a neighborhood in northwest Athens. Nikos is referring to the right to health; a right that was taken away when physicians were laid off and when waiting times became unbearable. If the state does not have the finances to save its population´s health, its people will. As Nikos says "We just want back our rights. We will then fight for the budget, together".

The sheer existence of a solidarity structure makes clear that the times in which health was affordable are long over. The Metropolitan Clinic of Helleniko, by far the biggest solidarity clinic in Greece, reports patient numbers have risen by 375% from 2012 to 2013 with 15,000 patients asking for medical attention in 2013 alone and probably reaching 20,000 patients in 2015.

 
Meanwhile, the International Monetary Fund was reporting that all of this is part of its plan to "to keep public health expenditure at or below 6 percent of GDP, while maintaining universal access and improving the quality of care delivery." In other words, Greece suddenly needed to do more with much less. It was expected to take care of the health of 11 million people and a rising number of immigrants with only6% of its GDP starting in 2010. This has further decreased to roughly 5% in 2015. Most other EU countries spend at least double as much on health. State-run hospitals have had to cut budgets by as much as 50%, tens of thousands of physicians and other medical staff members were laid off as part of this "modernization" of healthcare.

'Patient-centered care'
In Patission, a formerly wealthy neighborhood in the northern edge of the city, I met Irene and Aleka, who both volunteer their time at the neighborhood´s Social Pharmacy which was founded by two pensioners almost three years ago. My question regarding their feelings about the future was met with head-shaking and ironic laughter. "The future? When Syriza got elected we believed the pharmacy would close, but the opposite happened, we are going backwards." They told me about their patients and the anger they sometimes share with the volunteers at the pharmacy. "People feel betrayed, cheated on and lied to. They feel so much anger". Irene, a former secretary for more than 33 years who lost her job 5 years ago and whose work as a volunteer helped her escape a depression, adds in quiet voice "Now after the news of the new memorandum, I feel I am losing my strength, my hope. I am looking for something small to grab but nothing seems to be improving."

She continued by telling about the pharmacy´s relevance and the 944 patients registered and how they have identified ca. 70 families in need of food assistance. Every couple of months those families can come to the pharmacy to pick up donated food and baby products next to the medical products they receive, helping them survive as many are unable to sustain their families since having become unemployed. Irene and Aleka do not only help organize food assistance, they are also aware of the emotional support the pharmacy provides. To my question of whether she thinks the people coming to the pharmacy come for more than just medicine, Aleka replied "Some people don´t want to be alone, they are understood here. We are all in this together."

It is exactly examples like this that demonstrate the clinic´s far bigger purpose than to simply provide health-related attention. In the process of trying to meet the basic health needs of the people in their communities, these clinics are cultivating democracy and justice, and they are planting the seeds of a more patient-centered health service, one that takes multiple social determinants of health into consideration.


'Beyond medicine'
Through my visits to dozens of clinics in and around the city I came to realize that solidarity clinics can be said to fulfill three main functions: Firstly, the obvious medical function through the provision of free healthcare services to a continuously increasing number of patients at their own locations as well as through a loose network of associate clinics, diagnostic centers and physicians.

Secondly, the function of a social support system, which attempts to assist patients in matters of food and shelter and thus, considers other determinants of health than just access to health services. This function also aids in strengthening social relationships through its inviting and participatory character, it assists people with the integration into social life and gives back dignity to those that felt excluded from society due to illness, unemployment or both.

And thirdly, a political function in which solidarity clinics advocate the right to health and show resistance to all those trying to impose limits on this right. Those are not only the institutions that forced austerity on Greece in the first place but also, national and international policies limiting access to healthy living incl. privatization of water, the country´s beaches or the ongoing commodification of health and health care. Having said this, solidarity clinics as part of Greece´s newly emerged solidarity economy go beyond achieving purely social aims: they aim to put right an injustice by expressing solidarity.

'Being part of something'
They are in the first place about providing medical help, but whoever spends a couple of hours within their facilities, will soon come to realize that their actual relevance encompasses a much wider field and probably an even more important one- companionship in times of crisis.

So regardless of what the near future holds, for the next year or two many of the clinics will continue to be there when no one else is. They will offer a new, innovative form of providing medical attention to people without the use of money and authoritarian principles. "No one will be left alone during the crisis", is therefore a sentence that now marks the websites and leaflets of multiple solidarity clinics and that captures well how the volunteers at the clinics are assisting their fellow people not only in the fight against an illness, but also in the fight against a system that limits their access to good health.

Making their patients "part of something" as Maria Spiliotopoulou - a historian and admin volunteer from the Social Clinic & Pharmacy in Omonia - told me is therefore the essential difference that distinguishes solidarity clinics from other initiatives present such as Doctors of the World. Whereas the latter without a doubt offers great service to the Greek people too, it represents a hierarchical service, where outsiders have come to help the poor and sick. Solidarity clinics in contrast believe in the actual meaning of the word; as Eduardo Galeano said "charity is vertical as it goes from the top to the bottom, while solidarity is horizontal as it respects the other person".

Those who treat and those who get treated have both been hit by the crisis, they understand each other's pain. This way, solidarity clinics do not only provide remedy to physical pain, but they give hope. They make all those visible that have felt invisible the past months and years, they offer social inclusion, companionship and love for the fellow man. Medicine is often just a practical side-effect.

Vijoleta Gordeljevic is a Health Economist & Global Health professional. She currently works as digital health consultant and freelance writer on topics at the intersection of health and politics.
She is also a member of the People´s Health Movement.


First published in Engish on "The Huffigton Post", 6-7.10.2015.

More than 100 Irish academics: Αusterity has ravaged both Ireland and Greece

Sir,

The Irish government routinely claims Greece should follow the Irish example: take its 'austerity' medicine and then experience 'recovery'. As academics in Ireland, we know this is a deeply flawed claim.

First, Ireland is a much more open economy than Greece – the recent increases in Irish GDP are largely based on exports of products such as pharmaceuticals, for which international demand remains buoyant.  The more closed structure of the Greek economy makes replicating this impossible.

Second, and more importantly, the benefits of this growth have not trickled down to the vast majority of Ireland’s people. Yes, unemployment has fallen, but net emigration has exceeded that drop. Furthermore, a growing proportion of work is part-time, insecure and even unpaid. Average wages continue to fall: it is estimated that one in four of the workforce earns less than a living wage. The percentage of children in deep, consistent poverty doubled between 2008 and 2013, to 12 per cent.

Workers and non-workers alike have suffered from rising taxes (including new property and water charges) and cuts to social services: the latest cut is a reduction in an allowance for many lone parents, a group already suffering extreme deprivation.

Third, the argument that this 'progress' has been helped by a negotiated restructuring of Irish debt is hollow: the 2013 deal on Ireland's 'promissory note' debt transformed soft (and cancellable) debt into sovereign debt – to be paid in full until 2053.

In summary, the Irish 'recovery' has been partial, unequal and, in many respects, illusory. It in no way constitutes a model for Greece or anywhere else to follow. Instead, we stand in solidarity with the Greek people as they struggle for genuine economic recovery for all, based on the write-down of illegitimate debt.


Sincerely,

More than 100 present and retired academics in Ireland, including


Andy Storey, John Geary, Bryan Fanning, Mary Gallagher, Margaret Kelleher, Gerardine Meaney, Dara Downey, Alice Feldman, Jane Grogan, Anne Mulhall, John Baker, Theresa Urbainczyk, Kieran Allen, Ailbhe Smyth, Julien Mercille, Marie Moran, Kathleen Lynch, Mariya Ivancheva, Theresa O’Keeffe, Judy Walsh, Mary Purcell, Maggie Feeley, Mary McAuliffe, Roland Erne, Katherine O'Donnell, Sean L'Estrange, Mary Alacoque Ryan, Mark Price, Kathryn Keating, Tom Murray, Amanda Slevin, Sharae Deckard, Michael O’Flynn, UNIVERSITY COLLEGE DUBLIN; Ciaran Cosgrove, Barbara Bradby, Norah Campbell, Sinead Pembroke, Jude Lal Fernando, TRINITY COLLEGE DUBLIN; Helena Sheehan, Eugenia Siapera, Jenny Williams, Paola Rivetti, Maeve O’Brien, Marnie Holborow, Karen Devine, Eileen Connolly, Antonio Toral, Kenneth McDonagh, Ellen Reynor, Mark O’Brien, Alexander Baturo, DUBLIN CITY UNIVERSITY; Luke Gibbons, Joe Cleary, Peadar Kirby, Ann Hegarty, Rory Hearne, Mary Gilmartin, Bernie Grummell, Colin Coulter, Laurence Cox, Sinead Kennedy, Robert Aiden Lloyd, John Reynolds, Pauline Cullen, Catherine Friedrich, Chandana Mathur, Michael Byrne, Steve Coleman, Jamie Saris, Sinead Kelly, MAYNOOTH UNIVERSITY; Rosie Meade, Piaras Mac Einri, Clare O’Halloran, John Maguire, Colin Sage, Lydia Sapouna, Féilim Ó hAdhmaill, UNIVERSITY COLLEGE CORK; Conleth D. Hussey, Eoin Devereaux, John Lannon, Lee Monaghan, Mikael Fernström, UNIVERSITY OF LIMERICK; Eithne Murphy, Lionel Pilkington, Paul Michael Garrett, Brian O’Boyle, NATIONAL UNIVERSITY OF IRELAND, GALWAY; Michael Pierse, QUEENS UNIVERSITY BELFAST; Goretti Horgan, ULSTER UNIVERSITY; Brian Hanley, independent scholar; Harry Browne, Alan Grossman, Michael Carr, Pat Hannon, James Rock, Michael Foley, Fabian McGrath, Jim Roche, Martin Hanrahan, Richard Fitzsimons, Edward Brennan, DUBLIN INSTITUTE OF TECHNOLOGY; Tom O’Connor, Brian McMahon, Cork IT; Kevin Farrell, IT Blanchardstown; Niamh McCrea, IT Carlow; Martin Marjoram, IT Tallaght; Tom Boland, IT Waterford; Justin Carville, Cormac Deane, Mark Curran, Paula Gilligan, INSTITUTE OF ART, DESIGN and TECHNOLOGY; Maurice Coakley, Barry Finnegan, GRIFFITH COLLEGE DUBLIN; David Hughes, ROYAL COLLEGE OF SURGEONS IRELAND
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