Demonstrators defending public health care against the privatizing project of the Community of Madrid are about to become a regular feature of the capital's landscape. The white coats of staff sanitary constitute a kind of tide that regularly invades the center of the city.

The health care workers denounce, in the streets and in the courts, this privatization, which, they argue, threatens to sacrifice our modest welfare state on the altar of obscure capitalist interests.

The government invokes the usual arguments of efficiency and rationality, inexcusable in lean times. In turn, civil service examination denounces the dismantling of the public attendance in the service of mercantilism: in the midst of the deep crisis we are going through, it sees this health policy as a painful amputation. No sooner had we succeeded in joining the select club of welfare states than the right wing comes to deprive us of these social services; whether this inhuman policy obeys the imperatives of Brussels, big business or the ruthless inclinations of our leaders, it does not matter. A clamor of indignation is sweeping the streets.

In Spain it is very difficult to debate the major issues of health policy -or education- without ideological contamination: this is understandable, given the economic importance of both budget items, the most voluminous of the public accounts. But this difficulty reflects our inability to discuss with serenity and a minimum of objectivity. In parliaments, the media and social forums, more insults and disqualifications are exchanged than reasoned arguments.

Without pretending to go into the substance of the present discussion, I would like to refer to a couple of issues that are striking.

As far as the Government is concerned, beyond the reasons it invokes to justify privatizations, it should be criticized for the unhappy health policy of Esperanza Aguirre at the head of the Community of Madrid. She discarded the creation of a network of neighborhood outpatient clinics, as advised by health logic and the programs of study commissioned by her cabinet, in order to build large hospital complexes, much more profitable from the point of view of image. This network of hospitals has become unsustainable. Given that eliminating or regrouping services and dismissing the surplus staff implies a high political cost, which the Executive does not want to assume, it has opted for semi-privatization. The awarded companies will inherit "the brown" and will proceed to the inevitable readjustment. Behind a cascade of grandiloquent verbiage or convoluted technicalities there are often simple realities such as this. We are talking about Madrid, but the wastefulness of the public expense is not exclusive to that community.

As for civil servants, status is ambiguous. They are suffering the painful effects of the crisis; for the fourth consecutive year, their salaries have been frozen, which implies a loss of purchasing power of around 15%. And yet, they prefer to bear this cutback rather than lose the employment, as has happened to four million workers during these years. In society as a whole, the status of public employees remains privileged.

It is very important to see how they approach their own healthcare attendance . Let's consult the MUFACE's report of 2012. The group that enjoys health care at position of this public body was composed on December 31, 2012 by 1,541,820 people, of which 967,894 were holders (i.e., civil servants) and 573,926, beneficiaries (relatives of the holders). For their health care attendance , these 1.5 million members can choose between the Public Health System or the private sector. Which one do MUFACE members choose? 81.92% (1,257,449) opt for private healthcare (MUFACE has signed agreements with five healthcare entities) and only 18.08% (277,538) prefer the public system. employment wrong the term "prefer": in many cases it is a forced option due to the absence of a private center in the vicinity of the place of residency program of those affected. The group of public employees is, on the whole, in a privileged status : they choose private services with public financing.

Health civil servants, who are dependent on the autonomous regions, cannot use MUFACE services and must go to the public health system. How can it be explained that, unlike national civil servants, they refuse private health care? Are they made of different stuff?

It is possible that this health staff intuits that the private management of its centers of work is going to translate into greater demands, since the productivity of the public sector leaves much to be desired. If this is the case, I do not think it would be a bad thing if hospitals were to introduce a greater labor discipline . A more efficient organization of work will result in better patient care.

The public-private contrast grossly simplifies the discussion, and distorts it. What citizens demand and deserve are efficient public services and not stale ideological debates.