Protest in response to the commodification of healthcare in the era of the European Union’s new economic governance regime

In response to the 2008 financial crisis, the EU established a new economic governance (NEG) regime, which allowed the European Commission and Council to intervene to the financing and organisation of national healthcare services; as healthcare represents the single largest area of welfare state expenditure and service delivery. This thesis therefore addresses the following questions: 1) How have NEG policy prescriptions impacted the level of commodification of services and labour in Ireland and Madrid’s public health systems? 2) Since the beginning of the financial crisis in 2008, how have unions and social movement organisations active in these health systems politicised changes in public service provision and employment conditions? 3) How can we understand the choices of union and user groups organising in the sites of study regarding the scale at which they politicised policy changes related to the NEG regime and the scope of their demands? In turn, through a contextualised semantic content analysis of NEG policy prescriptions issued to the Spain and Ireland, this thesis first shows that EU executives have harnessed the NEG regime to promote the commodification of healthcare services and labour. Second, going beyond existing studies of NEG interventions in healthcare, the thesis then outlines the measures that the Irish and the Spanish central governments and the regional government of Madrid have adopted in line with these prescriptions and analyses their impact on healthcare services and labour. I show that the governments’ implementation of NEG prescriptions has institutionalised the underfunding of the health systems under study and promoted the corporatisation and privatisation of service delivery. Third, through a comprehensive protest event analysis of counter-mobilisations involving unions and user groups in the two health systems from September 2008 to March 2020, this thesis shows that the implementation of healthcare-related NEG prescriptions altered the movement landscape in each site of study – prompting trade unions and user groups to organise at higher scales and to broaden the scope of their demands. My study, however, also shows that resistance to commodification is a project and building powerful counter-movements takes time. Although the NEG regime was established relatively recently, this thesis shows that unions and user groups organising in the health systems have begun the work of constructing the oppositional networks necessary to challenge corporate and political leaders at the EU scale. My research on movement landscapes within these health systems will thus also serve future research by helping scholars to contextualise and understand counter-movements that may emerge in the forthcoming post-pandemic era of the NEG regime.