Views on the Future of European Union

Dear Maria Joao, friends, comrades,

I am honoured by invitation to share my views on the Future of European Union with such an outstanding audience. I would like to focus on European Health Policy.

Europe is going through an unprecedented challenge by COVID19 pandemic. This is first of all a health crisis. Secondly this is economic, and finally, social crisis. It can challenge the European project as a hole.

From the very beginning the European project was about saving lives.

Unfortunately, many years until now development goals such as saving lives, promoting good health and longevity were out of the radar of big European policy. May you remember such mantra “Europe should be big on big and small on small.” Ironically now we all see, that health is a very big issue.

For decades health-related matters were considered by the EU almost exclusively as business of Member States or quasi markets.

“The EU is based on the subsidiarity principle. This means that EU should intervene only in cases where a Member State is deemed no longer to be able to cope with a crisis alone and requires assistance”- I am just quoting the interpretation of the health related matters of all legal services of three EU institutions.

But Europe is changing. In the 21st century Health became one of leading sectors of economy (see chart).

Source: Eurostat

The latest available figures (2017) show that employment in health is already almost twice bigger than in economic sectors that dominated European policy at the start of European integration (European Coal and Steel Community, Common Agricultural Policy).  But European politics are somehow frozen in the middle of 20th century.

As you all know, Eurobarometer shows that Europeans are demanding more pan European actions for health. Especially now.

And for a many EU citizens till resent days the European Union politics, which always spoke about single market, agriculture and other issues as newer ending stories in general (sorry to say) becomes similar to a flea market selling second hand goods produced 50 years ago. It is not so much attractive to many Europeans.

It is symptomatic that BREXIT talks may fail not because of disagreements on cross border healthcare and access to treatment, on research, education, IT sectors that are shaping modern world but… fisheries. Yes, we know that fishery is exclusive competence of the EU.

And now COVID19 pandemic triggered strong public health response on national and the EU levels as well as inspired rethinking of the role health plays in European politics.

As a member of PES family I am proud to acknowledge that progressives are leading debates on transforming the EU from being the block that cares just about free movement of goods, people, services and capital, the block that considers monetary and banking union to the Union were lives and health of all residents matter – to European Health Union (EHU).

But how can we describe the EHU, which concept is included into the idea of the EHU.

If you just look into the book “Everything you always wanted to know about EU health policies but were afraid to ask” ( Scott L. Greer and others), you can find there three faces of the EU health policy ( in the TFEU ) – a)first face is “public health” TITLE XIV, art. 168,( very week one), b) second face is possibility to include some public health requirements developing regulation of the EU single market Title VII art. 114, and c) the third face – fiscal governance, which affects MS healthcare and cure finances. And following legal, procedural, bureaucratical, and political constraints Titles such an internal market and others always prevail upon public health concerns. It is today existing constitutional asymmetry.

Despite consensus on the importance of good and egalitarian health as a big value in itself, in successive treaty revisions national governments have preferred to keep health and healthcare issues primarily at national level and so have provided only limited powers for EU action in pursuit of health. And it is till now, when we a proposing EHU, but not challenging those really existing legal and constitutional limits, enshrined in the treaties.

The S&D call of 7 May and the proposal of 12 May 2020 “A European Health Union – increasing EU competence in health – coping with COVID19 and looking to the Future” has opened a new chapter in European development. The call and documents that followed, inspired movement that already resulted in acknowledgment of EHU as an official EU policy.

If we will follow todays existing constraints and legal limits, and coping with COVID19, the two scenarios can be envisaged to develop EHU:

a) scenario “a”– measures to make progress in health concentrate on what can be done with existing legal, financial, and managerial instruments.

b) scenario ”b” –  fine tuning of existing instruments of health policy in parallel to the development of secondary legislation and establishment of new institutions.

But if we are looking into the Future and are thinking about more stronger role of the EU in health, we need to go further and then the third scenario is needed

c) scenario “c” – where the status of health policy in the European Treaties is strengthened, with provisions for a European Health Union incorporated into the Treaty on European Union, giving the European Union some shared competencies, while preserving the principle of subsidiarity as a core. And combining it with the instruments of the scenario “b”.

MANIFESTO FOR A EUROPAN HEALTH UNION is voice of citizens calling European Leaders to consider a scenario “c”.  By opting for scenario “a” or “b” Europeans would restrict the benefits they would obtain from deeper cooperation on health. The manifesto encourages an inclusion of The European Health Union into the agenda of the Conference on the Future of Europe.

The manifesto is already supported by more than 800 organisations and individuals including such renown figures/ our Comrades as Klaus Hänsch and Martin Schultz.

Those who are interested in the document and an explanatory memorandum please visit a website

Currently health is absent from main articles of TEU and appears only on Article 6 of TFEU. “The Union shall have competence to carry out action to support, coordinate or supplement the actions of Member States”.  This is restrictive regulation creating a risk that the idea of EHU will not last longer than such attributes of pandemic as face masks.

We need a more “healthier” face of an article 3 of TEU. Let us amend a part 3 of article 3 which starts with “The Union shall establish an internal market” by one sentence. It shall promote universal health coverage by establishing a health union.  And then let us amend part 2 of article 4 of TFEU specifying point k) about shared competence between the Eu and MS in the area of health.

Some of us would prefer slow development but without being ambitious there is a risk to miss a window of opportunity of evolving the European Union beyond internal market, beyond a paradigm that does not fits realities of the 21st century.

The former European Commission president Jacques Delors lack of solidarity in response to pandemic described as a mortal danger to the EU. Lack of solidarity in health is also a mortal danger. Let us be inspired by this insight.


Vytenis Povilas Andriukaitis