Sumar's Muface Dissolution Plan Could Cost €800M More

Muface: €800 Million Higher Cost if Sumar Dissolves the Model

Dissolving Muface and returning its members to the public health system would cost €800 million more per year. This calculation comes from the Institute for the Development and Integration of Healthcare (IDIS): the bill would rise from €2.23 billion to €3.03 billion. And this is exactly what Sumar proposes. The paradox is textbook: the party most insistent on the sustainability of public services signs off on a measure that, according to these figures, makes the system more expensive.

This is not idle speculation. Yolanda Díaz has adopted the thesis long defended by Más País and Podemos: dissolving Muface (civil servants), Isfas (armed forces), and Mugeju (judicial corps) and returning all mutualists to the Social Security system, a group exceeding two million people when counting contributors and beneficiaries.

What Sumar Proposes Regarding Muface, Isfas, and Mugeju

The program is literal: "Inclusion, within universal health coverage, of persons currently receiving healthcare benefits under private health mutuals (MUFACE-MUGEJU-ISFAS). We will integrate this population, gradually, in stages, and according to a schedule, under the healthcare benefits of the public health system." The fine print adds another detail: the possibility for local authorities to purchase collective private insurance for their public employees will be eliminated.

Translated into numbers: 1,081,052 civil servants currently choose private healthcare through Muface —Adeslas, Asisa, or DKV— compared to 405,880 who opt for the public system. 73% of mutualists would lose their preferred option. The defense of the text is that public employees access the same portfolio of services as any citizen covered by social security, just through a different route.

The Calculation That Reverses the Sustainability Argument

Here appears the uncomfortable data point. According to IDIS, the Muface model is €800 million cheaper than the public alternative. With integration, spending does not fall: it rises. And the impact would be felt in waiting lists. The Ministry of Health calculates an average of 122 days for surgical operations and 95 days to see a specialist. Adding two million patients to the public system would add, according to the same institute, 30 more days: five months for surgery and four for a consultation.

CCOO does not buy the wholesale amendment. Their response is that they will "continue defending the system of health mutuals, such as Muface, Mugeju, or Isfas, but to do so, better funding must be obtained from the Government to provide quality services." In other words, the problem would not be the model, but the budget. And that budget is precisely what no one has resolved in the last decade.

DKV Threatens to Exit if Funding Does Not Rise by 40%

The mutual system is, in industry terms, in "serious risk." The private insurers sustaining the agreement —Adeslas, Asisa, and DKV— are accumulating millions in losses. DKV threatens to exit if funding does not increase by at least 40%, and CSIF, the largest civil service union, warns of the chain reaction: "Its departure would drag down all other mutuals." With the current agreement exhausted during its application period, renewal has become a standoff between insurers, unions, and the Treasury.

The paradox reappears: if the model collapses due to lack of funds, the exit would not be an orderly dissolution, but an emergency absorption of all those mutualists by the public health system. Without gradualness, without staging, and probably without planning.

The Proposal to Dissolve Muface Originated with Más País in 2019

The first party to put it in writing was Más País, which proposed the same measure in 2019. To the point that the current wording closely resembles a copy. Unidas Podemos did not include it in their program, but in 2021 registered a more timid non-legislative motion: that new hires should already be included in the general regime. The motion was rejected.

And the PSOE? Fluctuating position. Finance Minister María Jesús Montero has publicly defended the model. But in 2015, the Alternatives Foundation, a socialist think tank, proposed suppressing Muface and integrating its funds into national healthcare financing. Former minister Salvador Illa also believes the model needs review, and the PSC included the revision of the model in its Catalan program, an objective shelved after failing to achieve a governing majority.

What Actually Changes for a Civil Servant Mutualist?

It is worth clarifying the mechanics, because confusion is widespread. Muface, Mugeju, and Isfas do not manage pensions: they manage benefits, including healthcare and temporary disability. Pensions are handled by passive classes, and there was indeed a significant change there: since January 1, 2011, newly hired civil servants contribute to the General Regime instead of passive classes, a regime being phased out.

Nor is there automatic referral of patients to the public system. The change occurs when the mutualist themselves requests it for medical-hospital reasons and it is approved by a joint Muface-Social Security committee. For temporary disability leave, Social Security is more advantageous —75% of the regulatory base, with improvements that can reach 100%—, an incentive with which mutualism avoids long-term absences.

The Precedent of Mutuals and the Electoral Cost

It has peine before. MUNPAL, the welfare system for local government employees, was integrated into the General Regime starting in 1993, with Social Security assuming rights and obligations. And in professional mutualism, the problem is the inverse: about 5,000 lawyers grouped in the J2 Movement demand a pathway to the RETA (self-employed workers' scheme) to escape pensions of €300 or €400.

On the side of political calculation, some recall that mutualists will take this into account when voting and that employment in the insurers and contracted hospitals serving them travels in the same lot. An uncomfortable question also circulates: why do MPs maintain private insurance paid with public funds upon appointment, covering themselves and their families?

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With a €800 million difference, an extra month of waiting, and an insurer ready to leave, the question is not whether the model holds, but who pays the money. What if the problem was never Muface, but the €800 million no one wants to put on the table?