Ad hoc Coalitions and Local Causes

As liberalization directives have been revised every three to five years in order to prompt market opening, competition and concentration have intensified, thus increasingly impacting not only workers but also the nature of the services provided to the public. While large international coordination seems to know an ebb tide, a trend towards intense local mobilization at an earlier stage with the objective of preventing liberalization has been an ongoing phenomenon over the past decade. Among the ‘usual suspects’ such as the unions or left-wing movements, such broader coalitions have also involved local communities and ad hoc citizens’ groups.

Healthcare has been a sector where the contestation vis-a-vis privatization has intensified over the past few years. Healthcare has not been impacted by EU liberalization policies in the same way as utilities and transport sectors. The Directive on patients’ rights in cross-border healthcare from 2011 aims at opening the boundaries of national healthcare systems by offering guarantees to patients who seek health services in other EU countries to be reimbursed at home (Sect. 3 in this chapter). Most crucially, however, the exponential rise in the demand for affordable healthcare within European societies combined with the erosion of state revenue has made the funding of healthcare a major issue for all governments. EU integration has contributed to tightening this financial straight jacket through various routes—including the convergence towards The European and Monetary Union (EMU), and more recently, the response to the 2008 financial and debt crisis (this is analysed in greater detail in Chap. 6).Asa result, many governments have undertaken the restructuration and/or privatization of healthcare services and hospitals with negative consequences in terms of work intensification and service quality. Such policies have been vigorously contested by coalitions of local or national actors. In Britain, a platform called ‘Keep our NHS public’ which gathers various NGOs and groups, including the UK’s largest union Unison, was set up in 2005 in order to fight against the creeping privatization of the NHS. The launch statement claims that ‘At the heart of the changes is the creation of a market that welcomes profit-driven international corporations who answer to shareholders, not patients.’[1]

In Central and Eastern Europe, several radical government initiatives have met strong resistance. In Hungary, Poland and the Czech Republic in particular, governments have sought to privatize healthcare services and insurance in the course of the 2000s (Lorant 2009). In Hungary, a two- year-long campaign against the government’s plans to privatize healthcare facilities (hospitals) and services led to a referendum which took place on 5 December 2005. Sixty-five per cent of the voters opposed privatization and the proposed law was also turned down by the Constitutional Court (Hermann et al. 2012, p. 157).

The call for local or national referendums has become a new tool used by coalitions of workers and professionals’ unions, citizens groups and NGOs for preventing or reversing privatization in various utility sectors (Hermann et al. 2012, pp. 161-163). In 2008, for example, through a referendum in Leipzig (Germany) a citizens’ network branded APRIL prevented the planned privatisation of the local gas and electricity provider. Similar local referenda over the privatization of water and energy supply were held in Hamburg and Berlin (Blanchet 2015) and showed strong support of German citizens for the public management of utilities. In 2003, a majority of Slovenians rejected the privatization of railways and telecommunications in two referenda (Ibid., p. 157). In Italy, a national referendum was held in June 2011 which included two questions on water provision. Over 95 % of the voters rejected the proposal to privatize the water supply; they also opposed a change in regulations which would make water supply a profit-making activity. The movement against privatization was born in Tuscany with the creation of local committees after the takeover by the French multinational company Suez had led to a strong increase in the price of water distribution. The first Alternative World Water Forum which took place in Florence in 2003 also contributed to the emergence of the movement (Bieler 2014). In the more centralized France, such initiatives have sometimes come from decision makers themselves. In 2007, the municipal council of Paris, under the authority of the socialist mayor Bertrand Delanoё, voted for the ‘remunicipalization’ of the water supply after more than 20 years of private management by the multinationals Veolia and Suez.

  • [1] Keep our NHS public, ‘Launch statement. Keep our NHS public!’, available at, date accessed 12 May 2015.
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