The waters of the healthcare system are running rough, like our rivers after one of the rainiest winters in our history data. The crisis, which was a foregone conclusion, sample some of the paradoxes inherent to the welfare state. In 1946, in a climate of optimism at the end of the Second World War, the WHO dared to define health as a state of complete physical, psychological and social well-being, and not simply the absence of disease. This is something impossible to achieve in this world. Unfortunately, good sense has not touched the Spanish Government, which in the Organic Law 2/2010, on sexual and reproductive health and the voluntary interruption of pregnancy, (article 2), continues to support the WHO's initial definition. To the welfare state is added the democratic logic: the candidates in campaign promise, and the citizenship demands.

In good economic times, the growth of the healthcare sector seemed manageable, and everyone was a winner. But the lean times are back and there is no money. Health care, the largest item on the budget, has to undergo a harsh slimming down. It is inevitable to cut benefits, and the leading nations in the development of free public health care are setting an example: England, Sweden, New Zealand. The crisis has reached our country, and it is posed in a dramatic way: co-payment, outsourcing of services, privatization of the management, hospital closures, non-payment to providers, etcetera. At the same time, I believe that this situation provides an unbeatable opportunity to rethink some fundamental questions that are hardly mentioned in the usual debates. One of the positive effects of any crisis is that a good dose of realism is always good for everyone.

Western medicine has achieved spectacular successes in the 20th century, which have led to a radical improvement in our living conditions. It has changed the way we face life and death. We no longer feel that we are helpless toys in the hands of a capricious destiny, like death row inmates whose sentences are extended every day, and we now consider ourselves masters of our own existence. Political utopias, inflated by the idea of progress, promise us paradise on earth: science is power, and it will facilitate our control. But the pathologies are still there, now associated with unhealthy lifestyles: sedentary lifestyles, junk food, obesity, smoking, alcohol, drug addictions, sex...

It would be necessary to recover some common sense principles, which would help to focus the health discussion . I subscribe to the formulation of the British Medical Journal: Death, illness and suffering are part of life. Medicine has a limited capacity, especially to solve social problems, and its internship is risky. Doctors do not know everything: they need financial aid to make decisions and psychological support. Patients and physicians are in the same boat. Patients cannot transfer their problems to physicians. Physicians must recognize their limitations. Politicians should refrain from extravagant promises and concentrate on reality.