Towards a European Health Union: the legacy of austerity under the trial of Covid-19

The legacy of the Great Recession and austerity policies within the EU has come with substantial social costs, especially in the periphery. In this context, healthcare has been far from spared from the spending diet championed in the aftermath in the Euro crisis, echoing in countries fiscal policies mixes for years to follow. Within this context the paper analyzes the contribution of EU governance to the preparedness and its heterogeneity in facing the Covid-19 pandemic. On one hand EU economic governance and its austerity mandate, often embodied in the Country-Specific Recommendations has contributed to shape health and social spending in the Member States. On the other, the lack of substantial common governance in the health domain has taken a toll for coordination across the Member States especially in the early phases of the pandemic, particularly problematic in the interdependent and transnational context of the Common Market, whose many central features such as Schengen, the Stability and Growth Pact and the State Aid framework were temporarily scrapped as the crisis hit. The paper takes a comparative overview of the trends in health spending and services in the years preceding the pandemic, together with outbreak performance in delineating the extent to which inequalities remain in the absence of a Health Union. At the same time, the analysis considers how the Covid-19 case has further highlighted the unfitness of the current governance framework in the health domain, leaving the EU with limited coordination even in the core transnational domain of public health. In doing the work critically analyses health inputs and outcomes in the Member States and the role of the EU governance or lack thereof in contributing to the current debate on the dire need of a Health Union. In this context, the coordination effort in the context of the Covid-19 vaccine offers a first case of joint challenges and permaining heterogeneities even against the backdrop of common procurement providing some indication of the scale of divergences in national context both along the east-west and core-periphery fault lines to be tackled through transnational solidarity. Consideration on progress and difficulties in vaccine roll--out and containment are of particular relevance within the EU as credible exit strategies from the pandemic in the Common Market inherently depend on successful crisis management across all the Member States. Tracking the weaknesses and shortcomings evidenced by the pandemic response the paper pinpoints the reform needs within the health policy domain identifying through a preliminary policy evaluation the extent to which they are tackled by the European Health Union proposal and which gaps would nevertheless remain to be addressed. Against this backdrop the contribution delineates the limits of the competences of the EU in the current Treaties as a bind for short term developments in the health arena and a reform agenda for the broader debate in the context of the upcoming Conference on the Future of Europe, which itself has been the subject of extensive negotiations and delays.