da Leadership Medica n. 5 del 2000

Power: what we can do
Power: what we are permitted to do
Power: our power to do

The new Minister of Health between Power and Duty
Why did Prof Umberto Veronesi agree to become Minister of Health of the new government led by Giuliano Amato?
This is the question several doctors have been making to me in these days.
Nobody certainly doubts about the expertise of the illustrious Milan oncologist in the scientific and sanitary field.
Yet, everybody wonders about the power that can be given to a non-political Minister who has to act for a professedly political Government that will take a well-defined line in agreement with the previous Government chaired by D'Alema.
In addition, the new Minister Veronesi has to inherit a health-care reform that was strongly imposed on the Government and the Nation by former Minister of Health Bindi, undoubtedly a politician!
Now the Italian health will have to deal with the second phase of Bindi's reform, and everybody wonders what the new minister can do to modify it.
This reform is not a ship that, even though being cumbersome, can be made change its course. This is rather a train that is going on its tracks at full speed, after all bridges behind it have been made to blow up, and that, in order to change its route, should have to be stopped, made to come back to the station and make it leave from another platform.
Maybe this is right the reason why the Government wanted to change the leadership of the Ministry of Health and opted for a non-political Minister.
Even if the new Minister clearly understood what are the targets of the new Reform, he could do nothing to stop the serious irregularities everybody will have to deal with once the law is effective with all its decrees, rules and ministerial circulars full of paragraphs, sections, articles, and so on, all of them already approved and ready to become executive.
Only when the train reaches its destination, in the great square of the bossy State, will we realize that it is not possible to go back and that now we have to deal with a State medicine that, with the typical meticulosity of the Napoleonic Code, programmes, regulates, establishes and dictates everything, subordinating every medical act to a number of codes, codicils, articles and paragraphs.
In these conditions, what could the new Minister of Health do if he decided not to enforce some regulations of a law he did not wanted and certainly he does not share? Even though he decided to search for any quibbles to manage to come out of the muddle created, the “big bosses” would not allow him to change a word.Thus, there is nothing to do: this is a government that, even though not being completely deaf to citizens' complaints, is too ideologized to agree to modify the concept of State medicine, which is not merely considered a law for reorganizing the Health System, but rather as an ideological choice at the basis of its political convictions.

Amedeo Pavone