😷 Spain Questions Private Healthcare

Madrid | Issue #129

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Health’s bottom line

🏥 How a hospital meeting turned into a high-octane debate over private healthcare

It’s called business. Executives at private companies don’t normally blink an eye when they’re caught saying their company needs to cut back services to juice profits. It’s annoying for the customer, but hey, it’s bidness. But what about when the company is a hospital, and the services save lives? Yeah, things blow up.

• Welcome to Ribera Salud. The scandal began when a tape surfaced of the CEO of the healthcare company, which has a contract to run the public hospital in Torrejón (Madrid), telling hospital leaders to cut back on service and extend waiting lists to increase profits. Well, it’s now turned into a full-blown political row that could kill off the entire model of public-private healthcare in Spain. (h/t to El País for the series of stories on this.)

A recap. On Sept. 25, Pablo Gallart, the freshly promoted CEO of Ribera Salud in Spain (known as an “Excel guy” in the office), gathered about 20 managers at the Torrejón hospital. In the recording, he complains the hospital is losing money and then gets… creative.

• Less improvement, please. He tells them that in 2022 and 2023, they made “an effort to reduce waiting lists”. Now, he says, “All I ask is: let’s retrace our steps.” And then the money shot — he says they should use their “imagination” to spot which procedures don’t contribute to the hospital’s EBITDA and which ones do – and adjust activity accordingly. Translation: Fewer costly patients, more profitable ones. (One example: the hospital apparently rejected out-of-town dialysis patients.)

• Quitsville. Four senior clinicians who reported these orders through the company’s internal ethics channel — including the hospital’s manager and Ribera’s medical director — were promptly fired. They warned of “medical malpractice” and even orders to reuse single-use catheters up to 10 times; the company denies any wrongdoing. (Maybe one of these four leaked the tape? 🤔 Just saying.)

Why now? Because the French parent company of Ribera, Vivalto Santé, reportedly wants “quick gains” in Spain ahead of a planned sale of shares in 2026 and is spooked by France’s 2027 elections that could put at risk its home business. Torrejón has been losing money for years, despite Madrid pumping in an extra €88m since 2020 and another €32.7m “rescue” package this July to keep it afloat.

• Public-private partnerships. Under the “Alzira” model Ribera invented in Valencia in the 1990s (when Valencia was run by the center-right PP), the company gets a fixed per-capita fee from the region, regardless of how much it treats; it also gets a bonus for attracting patients from outside the area, and gets penalized for losing locals to other hospitals. Every euro it doesn’t spend on patients is a euro that can move to the bottom line. (In the meeting, Gallart explained that there is a direct “elastic” relationship between the hospital’s results and the waiting list. But to be fair: Torrejón’s waiting lists are still shorter than those at fully public hospitals.)

The politics. The left saw the tape and thought: Christmas came early 🎁! PSOE Prime Minister Pedro Sánchez called it “the PP model: turning health into a business and illness into a money-making opportunity”. Health Minister Mónica García says she’ll push a law to end public-private hospital concessions altogether.

• PP response. Madrid presi Isabel Díaz Ayuso (PP) is trying to have it both ways. She’s called Torrejón’s care “impeccable”, blames the scandal on “internal squabbles” and “out-of-context recordings”, and waves inspections showing “unbeatable” waiting lists — while also promising that any malpractice will be “eradicated decisively” and ordering more audits and inspections.

Your lying ears. Ribera’s French bosses now flatly deny having ordered anyone to do anything like lengthen waiting lists or reuse gear, say the leaks are political, and are threatening legal action. Gallart has stepped down from directly managing Torrejón.

• Is health just another “business line”? In many sectors, private operators really are better at squeezing out waste than the state. But Torrejón is forcing Spain to confront the uncomfortable: what if “efficiency” means fewer operations, more delays, and taking the profitable patients while nudging the rest down the road? And if the government decides to end public-private hospital concessions, can it really afford a quality all-public system? (We are not optimistic.)

More news below. 👇👇

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💬 Five things to discuss at dinner parties

1. 👀 Another machismo crisis hits the PSOE

Oh, look — the PSOE is facing another ethics crisis! Apparently everyone Pedro Sánchez has tapped for Secretary of Organization (the party’s no. 2/3 spot) comes with a side of, um, “toxic masculinity.”

• Both José Luís Ábalos and his successor Santos Cerdán have spent time in pre-trial detention in that sprawling corruption case we’ve told you about. Ábalos was also a big fan of prostitutes. And now Sánchez is trying to contain the fallout from another scandal involving the man once expected to replace Cerdán — after it emerged that the PSOE had failed to investigate reports of his also toxic behavior for months.

They call him Paco. Multiple testimonies accuse Francisco “Paco” Salazar — a longtime party figure and former senior adviser to Sánchez — of systematically sexually harassing the women who worked under him.

• Naughty. Salazar, closely linked to Sánchez’s inner circle (a great run for that inner circle lately!), allegedly humiliated younger female staff with sexually explicit comments, abused his position of power, and made the workplace a hostile mess.

• Grody. According to written complaints reported by elDiario.es, Salazar allegedly unzipped his pants in front of women, mimicked sexual acts in meetings, obsessed over their bodies and clothing, and made explicit remarks about their sex lives — all while reminding them of his proximity to power and his ability to ruin careers. Sounds like a nice guy 🏅!

So close! Salazar — set to join a “choral” Secretary of Organization team replacing Cerdán — resigned once the accusations became public. The PSOE later admitted that two formal complaints had indeed been filed months earlier through its internal anti-harassment channel.

• Um, whoops. Those complaints mysteriously vanished from the system. The party blamed a “technical error,” an explanation that did little to calm anger inside or outside the organization, or to really convince anyone.

Containing the fallout. Sánchez admitted this week that the PSOE made “mistakes” (😱), conceded there was an “unplanned error” in the speed of response, and took responsibility. The party now says it will fully cooperate if victims choose to file criminal complaints. Redemption road? So far, looks bumpy.

• Do what I say, not what I do. One week after calling Salazar’s behavior “vomitive,” government spokeswoman Pilar Alegría on Tuesday had to explain away a November lunch she shared with him — months after the complaints and his resignation. She now says it was an “error” and “shouldn’t have happened.” (You don’t say. 🙈)

• Slightly less feminist than advertised. The scandal has enraged many PSOE women, who are furious that reported abuses were ignored for so long by the party that brands itself Spain’s great feminist vanguard.

The opposition has seized on the scandal. PP leader Alberto Núñez Feijóo accused Sánchez of hypocrisy, arguing that Salazar’s rise and long stay near the center of power exposes a “double standard” in PSOE feminism: “The PSOE is a dangerous party for women.”

• Which is a bit…much. But yes, there’s definitely a whiff of hypocrisy in the air.

2. 🧑‍⚖️ The Supremos explain why they convicted AG García Ortiz, 19 days later

The Tribunal Supremo (aka the Supreme Court) got Spain all wound up on Nov. 20, when it announced it had convicted Attorney General Álvaro García Ortiz for leaking confidential info in the tax fraud case of the boyfriend of Madrid presi Isabel Díaz Ayuso — and then didn’t publish the sentence. “How dare they!” said those on the left; “It’s perfectly normal, “ replied those on the right.

• Now, 19 days and 233 pages later, the Supremos (“Supremes”?) have finally dropped the ruling — including a 53-page dissent — so we can all stop arguing about whether the Supreme Court is a lawfare death squad or the last trench of Spanish democracy and… okay, no, we’re absolutely going to keep arguing about that. But it’s the thought that counts.

What the majority says (5–2). According to the five judges who voted to convict (a mix of conservative and centrist blocs), García Ortiz did several naughty things — and even though no direct proof survived (more on that below), the court says the circumstantial evidence forms a “solid, coherent and conclusive” picture.

• The rush to get the email. After El Mundo published a (false) claim that prosecutors had offered Ayuso’s partner a deal and then withdrawn it for political reasons, García Ortiz urgently demanded the internal email chain — dragging the case prosecutor out of a football match — and had the messages forwarded to his private Gmail. One email contained the boyfriend’s lawyer proposing a plea admitting two tax crimes.

• The leak. Not long after, the PSOE-friendly Cadena SER published a story that included the text of that email. The court says the document was sent to the SER journalist “either directly or through a third party, but with the full knowledge and acceptance of García Ortiz.”

• Wiping his phone. On Oct. 16, the day after the Supreme Court opened proceedings, García Ortiz performed what the judges call a “conscientious, double” deletion of his phone and email contents. They note that this was not required by any data-protection rule and infer a deliberate destruction of potentially incriminating material.

Put together — the rush, the timing, the SER scoop, and a mysterious 4-second call from the SER journalist to García Ortiz that night — the majority says there is no “reasonable alternative explanation.”

…and what the two dissenters say. Left-wing Magistrates Susana Polo and Ana Ferrer read the same script and saw a very different movie.

• They argue the conviction rests on “mere suspicion” and violates the presumption of innocence. If many people had the email — including journalists and people close to González Amador — you cannot simply pick the AG as the most convenient culprit.

• They trust the journalists, who under oath said García Ortiz was not their source and that they had previous access to the email.

Political reactions. Choose your own apocalypse.

• PP uncorked the cava — The AG is a “delincuente,” several leaders repeated with gusto.

• PSOE replied, “We respect [the ruling], but don’t share it,” while Sánchez said the one who should apologize is Ayuso. 🤷

• Sumar/Podemos deployed the full fascism thesaurus — “mockery,” “auto-de-fe,” an “inquisitorial process without evidence”, and even “golpista.”

And now that we’ve all memorized half the Penal Code, can we please return to Spain’s true constitutional battleground: is chocolate con churros breakfast or merienda?

3. 📛 The day the pollster who was always wrong claimed he was always right

The head of Spain’s official polling institute is not supposed to be a main character. The job description is basically: keep your head down, count things, try to be accurate. José Félix Tezanos, the very partisan ex-PSOE executive Pedro Sánchez put in charge of the CIS, heard that and said: “Ni de coña” (just look it up!).

• This was destined to be hot. So when the PP-controlled Senate hauled him in Tuesday to “investigate” his management of the CIS, it was never going to be a normal hearing. It was Tezanos Live.

At least it started well. He arrived cracking jokes about doing “a survey on good manners”, then spent more than two hours behaving less like the neutral head of a public institute and more like a grumpy PSOE deputy.

• How do you pick your questions? Asked why the CIS doesn’t poll about the broadly disliked 2024 amnesty law that Sánchez introduced in order to get the Catalan separatist support he needed to continue as PM, Tezanos shot back that he also didn’t ask “why the leader of a certain party goes on holiday on a narco’s yacht”, referring to a 1995 photograph of PP boss Nuñez Feijóo with Marcial Dorado, a friend who was later convicted of trafficking drugs. Which is funny, but not exactly methodological analysis.

• Always? When Vox pressed him on why the CIS “never hits the mark”, Tezanos smiled and dropped the line of the day: “We always hit the nail on the head.”

• He did concede one “oops.” Reminded that in 2021 he described Isabel Díaz Ayuso as having a “limited intellectual capacity,” he insisted it “wasn’t an insult, just a disqualification,” which he now “regrets.” Sort of.

About that nail. As friend-of-Bubble Kiko Llaneras of El País has documented (yes, the very same Kiko Llaneras that Tezanos dismissed in the hearing as “an engineer, not a sociologist” 🙃), the CIS under Tezanos has overestimated the left in 41 of the 42 elections analyzed since 2018.

• Plenty better ones. Private pollsters like 40dB. and the El País poll-of-polls have been consistently more accurate, while the CIS lives in a parallel (inaccurate) universe where the left almost always does a bit better than in real life.

• It’s not just the numbers. Former members of the CIS advisory council — including old friends and heavyweight sociologists — have filed formal complaints and quietly walked away, lamenting the loss of neutrality and the “CIS de Tezanos” brand that now clings to the institution like bad cologne. One described it bluntly as “the least neutral institution in Spain right now.”

Back in the Senate, Tezanos went full drama. He accused the PP of running an “Inquisition-style” process — “Not even Torquemada would have thought of this” — and whipped out a sign: “Parliamentary immunity is one thing, but impunity to attack and slander is another.” Later, he produced another sign about political corruption: “88 people have entered Soto del Real prison: 87 from the PP and one from the PSOE.”

• Yes, it was subtle like that.

4. 🎤 It’s happened: Spain abandoned Eurovision

Sad news, dear gays readers! Our worst nightmare has finally come to pass: Spain has walked away from Eurovision. The country will not take part in the 2026 edition of the uber-popular song contest, nor will RTVE broadcast the final, after the European Broadcasting Union (EBU) confirmed that Israel will remain in the competition despite the ongoing conflict in Gaza.

• No vote, no way. The announcement came moments after an EBU assembly in Geneva declined to hold a vote on Israel’s participation and instead approved a new set of rules aimed at limiting political influence on voting.

• ¡Ciao! Spain, Ireland, the Netherlands, Slovenia all confirmed their withdrawal within hours (Iceland became the fifth country last night), plunging Eurovision into one of the deepest crises in its history (and thereby giving the U.K. and Norway a better chance).

The withdrawal had been brewing for months. RTVE’s board agreed in September that Spain would pull out if Israel was allowed to compete, arguing that the situation in Gaza and Israel’s use of the contest as a political platform made participation untenable.

• Spanish officials pushed hard for a secret vote on Israel’s presence, a request that was ultimately denied by the EBU. For RTVE, that refusal was the breaking point. The broadcaster said the move confirmed its fears that Eurovision is no longer a neutral cultural event, but one increasingly shaped by geopolitical pressure.

Government pressure also mattered. In recent days, PM Sánchez and several ministers openly called for Israel to be excluded from international competitions, drawing parallels with Russia.

• No way out. So, by the time the EBU meeting took place, Spain’s position was effectively locked in.

For Eurovision, the fallout is significant. Spain’s exit is especially damaging because it belongs to the so-called Big Five — the countries that contribute the most money to the contest and automatically qualify for the final.

• Spain puts around €350,000 into the Eurovision budget each year, and the loss of multiple broadcasters means millions more in missing participation fees and broadcasting rights.

• Audience reach will also take a hit. Eurovision regularly draws over 160 million viewers worldwide, and Spain’s absence — along with other markets — weakens the event’s appeal to sponsors, including its main backer, the Israeli cosmetics brand Moroccanoil.

Among Spanish fans, the reaction has been unusually clear-cut. While many regret losing the momentum Spain had built in recent years through the Benidorm Fest, most high-profile fans and commentators have backed RTVE’s decision.

• The dominant feeling is that human rights outweigh spectacle, and that withdrawing sends a stronger message than staying silent on stage.

• Some even announced they will boycott the 2026 edition entirely, regardless of whether another Spanish channel picks up the broadcast rights. For major fans, that says everything about how serious this rupture feels.

Eurovision was once marketed as a space above politics, born from the ruins of post-war Europe to unite countries through music. Spain’s departure makes clear that, for many, that idea no longer holds.

• In the meantime, we still have the Benidorm Fest coming up in February.

5.😡 Rosalía’s tour pre-sale sells out in under 2 hours and fans are furious