 Hello everyone and welcome to the 11th webinar in our series on the economics of coronavirus organised by the economics department at SAS and the Open Economics Forum. The Open Economics Forum is a student society at SAS that promotes heterodoxy, equalisation and democratisation in economics. And I just wanted to say thank you to everybody involved in organising today's webinar and the series as a whole, both at SAS and in the OEF. I know everyone's put a lot of hard work behind the scenes. My name is Oliver Tipton and I'm a master's student at SAS. And today's talk will be given by Aranya Dimakot, a lecturer in economics at SAS on the topic of healthcare crises in Greece. And I'm sure the topics come covered will be relevant to the healthcare systems around the world. Aranya, 25-30 minutes and then we will have time for questions for the rest of the session. Please write your questions in the chat box as we go along and after the talk we'll try to get through all of them. And before I begin, I just want to mention that you can find us on Facebook and Twitter where you'll find information about our previous and upcoming webinars and can join in the conversation there using the hashtag economics of Covid. I'll put the details in the chat box in a second. Yeah, and over to you Aranya. Thank you very much. First of all, thanks very much for the invitation to take part in this amazing series of Covid-related webinars. Thanks very much to the OEF, of course, for initiating this idea. And of course a great thanks to go to all the people behind the organization of this amazing series, not least to the OEF students in particular, Marie, Anna, Alice, Daniela and Oliver, that is the moderator today, but also to the economics colleagues, Sara and Yanis, that have been helping out with the organization as well. And yes, I'm going to, as some of the presenters in the previous webinars, I'm going to defy the guidelines of the no use of slides and I'm going to put on some slides that I think are going to help us to visualize some of the points I would like to be making and I'm going to be sharing them now. If that's okay. Okay, sorry one second. Yes, okay, I hope you can all see them. Okay, so today I'm going to be talking about Covid and healthcare and particularly the healthcare conditions and crisis, if you will, in Greece and I'm going to touch a little bit on the EU, but that will also only be towards the end. I'm going to be approaching the topic of Covid and the healthcare crisis within the Greek context from the starting point of Greece being portrayed as a success story when it comes to the containment of the pandemic. But then the point will be to trace out the reasons for that success, if you will, story or how successful it has indeed been. So it will be scrutinized, particularly in relation to the initial conditions of the healthcare system at the onset of the pandemic, which will necessarily be linked to the 10 years of austerity of severe austerity measures that preceded the Covid crisis and it would be through this length that we will then reexamine what is meant by the Greek success story when it comes to Covid. But before we start on these things, okay, bringing in the bigger picture, we all know it, but it's good to keep reminding ourselves. Yes, this is a global crisis with unprecedented in terms of life loss, in terms of reaching all the territories of the globe, in terms of life loss, in terms of uncertainty for future prospects with the economic crisis underway, particularly because of some of the containment measures that the pandemic necessitated, as well as alarming rise in unemployment at the global level. So yes, I mean, Covid is a first and foremost health crisis, but also a global economic crisis, a global shock, if you will, hitting from both the demand and the supply side and with unequally impact and responses throughout the globe, but yet unprecedented. Police measures being put down on the monetary, the fiscal side in terms of income replacement, particularly due to lockdowns and so on. And it is with these global pandemic unprecedented context that Greece has been portrayed in international media as a unexpected success story. It has been picked up by pretty much all the major journals around the globe. And in some cases, it has also been explained as the previous crisis helping the Covid contain. Now, this is the starting point and this is what this in this talk I would like for us to scrutinize and have a look at is this indeed a success story and what has this necessitated? Yes. So yes, the Greek success story when it comes to the containment of dispersion of Covid 19 and the low death rate in Greece, which is still, and this is all ongoing. So at the moment, it's still actually very low. It's one of the lowest within the EU with only 15.9 deaths per million of population. So yes, this containment has been primarily the outcome of the very early and very strict lockdown measures that were imposed by the government and followed by its citizens since the 12th or so of March. And again, what we will be doing is you look at what were the conditions, if you will, then necessitated this very strict and very early lockdown. And in so doing, I think important to from the onset differentiate between the late look at the relationship between response to Covid and the capacity of the system as a whole. Now capacity understood the very broad terms and I could down three dimension are interconnected, but still important to be differentiated and highlighted. So we have healthcare capacity. So essentially, and again, because of Covid, for example, there is a need for expansion of capacity on the healthcare front when it comes to preventive diagnostic and inpatient care. So testing, for instance, for Covid or testing for empty bodies as well as inpatient ICU beds and all that, which interlinked, of course, with fiscal capacity and fiscal space, meaning financial capacity, what capacity is there to finance this necessary expansion of the healthcare capacity, as well as, which is usually for state capacity and capability broadly understood as the capacity of the state for welfare provision broadly and healthcare hearing. And with that state capacity, we are going to be focusing on the public private nexus in the process of welfare and social provision broadly understood. Now these capacity, which is very important with all its dimensions to respond to Covid, can be better understood as, of course, a historically embedded process within, again, context specific countries, specific policy making cultures and norms. And of course, it can be understood within, if you will, a system of provision approach that is following Ben Fine's analysis by essentially analyzing the different interactions and reconfigurations of the different agents that are taking part in the whole process of social or infrastructural provision from the beginning, from the production until the end use. So these will essentially be determining the broadly understood capacity to respond to a crisis, okay, to an emergency. Okay, so to do that for the Greek story, I'm going to start with a very, very brief background of the Greek healthcare system. It was constituted, the national healthcare system was constituted in 1983. So quite late in relation to north-west Europe, and at a time where actually welfare systems in continental Europe were being attacked, in the face of Keynesianism, the advancement of neoliberalism, and private or shadowbound finance. That was the time where the Greek national healthcare system was constituted. It currently consists of 125 public hospitals that cover about 65% of capacity. The rest is private. When it comes to this, this is inpatient care. When it comes to public, to primary care, on the public sphere, it's quite lacking. And the space is occupied predominantly again by private mental practices. There are about 20,000, 22,000 private mental practices in Greece, as well as private diagnostic centers, about 3,500 mostly located, of course, in urban centers. The healthcare system has been traditionally financed by a mixture of taxation, of social security, insurance contributions by employers and employees that together constitute about 60% of the financing of the system, and the rest about 35 to 40% is actually through private resources, so it's private expenditure on healthcare, mainly out-of-pocket payments. Up until 2011, the Greek healthcare system offered almost full population coverage via several occupation-based funds. They were about 130 social security funds operative. Until 2011, the system was always and still is linked to employment, and it is through the workers' incentive to help care that their dependence and hence the rest of the population is insured. Yes, and all in all, Greece has always been characterized by quite fragmented and equal and privatized healthcare system. This is despite, of course, full population public coverage. It's been fragmented particularly because and unequal, particularly because of geographical imbalances with a big difference across the core and urban centers in the periphery, the rural and islands that have always had assortages when it comes to primary and secondary healthcare services. It's been unequal and fragmented again because of the too many social insurance funds which were offering different benefits packages and hence different healthcare coverage to different portions of the populations that were employment-related, and it's been quite privatized in the sense of the very high private healthcare expenditure, a lot of pocket payments that also include informal payments, with a primary and ambulatory care sector, if you will, that is more private than public, without, of course, having to wait for a very long time, for instance, for diagnostic tests. And at the same time, as part of this paradoxes of the system, we have to put down the very high number of doctors, licensed doctors in Greece. The one of the high is actually within the EU, even after 10 years of austerity, with about 600 and something doctors per 100,000 of population, while the EU average is 325, while at the same time, Greece has one of the smallest ratios of nurses per patient, as well as GPs. So there are very few nurses, very few GPs, a huge loads of doctors, of which, of course, a very small percentage is, forms part of the public healthcare system. And all of that, as we're going to see the 10 years of austerity that we're going to now have a look at, should be put into the social demographic changes that have been taking place in the last decades, not least shrinking population, an aging population with about 20% of the population being above 65 years of age. And of course, the refugee and migration crisis with flows coming from conflict torn countries in the Middle East, as well as Africa for the past decades, Syria, Iran, Afghanistan and so on. So within this background, and before, sorry, we turned to care austerity in 2010, Greece entered into a sovereign debt crisis. And since 2010, it has been put into three economic adjustment programs with the triplet, the Troika, as it is known, the ECB, the European Commission and the IMF. So three structural adjustment programs that led to a decade long austerity measures with severe consolidation and cross the board in terms of passing public spending with severe and very well documented social effects when it comes to increases in inequality and employment, poverty line, homelessness, social unrest, and so on, which then lead us to pretty much today, again, since 2010, that being like six elections increase, the latest in July, 2019, which gave rise to a new government by the Center Left New Democracy Party that has tried to like kind of like turn a new page for the country while putting forth the overall vision of their platform, whereby it is very clear who the engine of growth is, that's the private sector, what the role of the state is, that is to support private investment and private finance, while also of course alleviating particular classes that have been affected by the 10 years of austerity. And that is the government that has been leading the COVID response. Now, when it comes to the healthcare sector in particular, the 10 years of austerity, so from 2009, let's say until 2018, what we have seen is unprecedented horizontal cuts in the healthcare sector, as in all other public sectors that has been imposed with quick cost-saving as a priority between 2009 and 2019, the healthcare budget has been slushed by about 43% as a share of GDP. These corresponds to a decline from 6.5% of GDP to 4.89%, but we should keep in mind that during that period GDP shrunk cumulatively in Greece by 25%. And then, one looks at disaggregated data, there's been cuts when it comes to medical products, they've been charged by more than 50%, expenditure on hospital services has also been reduced by 43%. Despite the fact that health worker salaries have been very low in Greece relative to the rest of the EU, there have been huge cuts in 2010, 2012, 2017, again, there have also been reductions in number of health workers in the public sector, as well as in available hospital beds, and again, there's been a reduction as a part of raising revenues, a number of public beds have also been put aside for priority use by private insurers. And preventive care which has been extremely low in Greece has also been reduced considerably over this period. Now, besides, of course, spending cuts across the board, the three adjustment programs and increase also put forth through a series of structural reforms that have again been implemented urgently within this cost-saving environment. One of the biggest reform which is actually new and it has been proposed many times in the past has been the unification of the social security of these 130 social security funds and the establishment essentially of a unified purchaser of healthcare services and medicine that took place in 2011. With the large part also of the private sector entering into contracts with this unified purchaser to provide mainly, as we said before, primary and ambulatory care and paid on a fee-for-service basis. There have been key changes in pharmaceutical policies. We have, of course, reduction in medicine prices, e-prescription system, centralised procurement, the promotion of generic medicines, and the interaction of rebates and clobart mechanisms to both pharmacies, private pharmacies and pharmaceutical companies. And as part of the rationalisation of the payment of the hospitals, there's also been an introduction of the ERG hospital payment system, disease-related group scheme that has followed the German version. Now, it's not part of this talk to discuss the effectiveness of these reforms, but I would just like to point, to make a series of very small points in the process, because they will help us understand the state of the healthcare system as well as, of course, the impacts that are going to look in a bit. So the unification of insurance funds, it was mainly a cost-saving exercise. It's still based on entitlement principle. It's standardised and decreased the service coverage, and it was based on the assumption of employment, and we'll see what that means in a bit. There's been huge issues with the DRG payment system that I don't want to go into, into details. There has been, of course, the imbalances when it comes to staff levels and staff ratios, right, nurses, doctors and all that have actually been exergerated and workloads have been increased. And when it comes to changes in the pharmaceutical policy, as I said, expenditure on pharmaceuticals, particular of these reforms did not come without contestations from the private sector. And as they saw their profit margins going down through price reductions, medicines, which led to supply chains, restructions, and other export of medicines. As an example, for example, the Danish company in 2012, actually withdrew its pen injection insulin supply from Greece, as it found the price reduction unacceptable for only to reintroduce it once the company received a higher price. Now, when it comes to the impact of austerity, this has been very well documented. So again, I'm only going to go through them very, very briefly. But it is very important to note those and we're going to see why there's been serious deterioration when it comes to the availability, the accessibility and the acceptability of public health care services that has also led to the worsening of the pre existing inequalities that we talked earlier on. I mean, first and foremost, the unemployment related loss of coverage, again during the decade, long go of austerity, unemployment in Greece peaked at 27.5% in 2013, but has been growing and has stayed high throughout the period, which since 2011 2009 actually led to the loss of health care coverage for approximately 2.5 million people that is a quarter of the Greek population that essentially was left uninsured, which has a huge was being a huge barrier, of course, in access to public health care. At the same time, of course, there's been an increase in the economy of patients and an increase in unmet need that has been one of the highest in the EU still today. Now the quarter of the population being uninsured was a big problem that was resolved only in 2016 by a law passed then to essentially cover and ensure they had to cover to provide public health care cover to the uninsured. When it comes to infectious diseases, I mean, yes, there was a comeback of infectious diseases that have been they have been years ago, decades ago, like in the case of malaria, Greece has been malaria free, for instance, from 74, which came back in 2011. The same was with an isle fever that also reappeared. There was a 10 falling crease in HIV, a newly diagnosed HIV infections during the first seven months of 2011. HIV incidence actually doubled until from 2010 to 2011 until it returned back to previous trends after infection. And of course, huge increases to major depression and to suicidality along stagnation when it comes to maternal infant and child mortality. There is well documented evidence when it comes to the relation between total health care spending actually and mortality, all case mortality in the example that I have put down here, whereby while increases in total health expenditures have always been accompanied with incremental increases in total expenditure until 2008. Between 2009 and 2014, this relationship was reversed with all case with increases in all case mortality spiking, a component of course, with a compound decrease in total health care expenditure. The right to health has also been highly ignored in Greece. There were no human rights assessment ever within the structural adjustment programs. I mean, the adjustment programs were negotiated and concluded with very little transparency and very little leave any participation on the side of the people that were being affected by the measures. And again, to another development that took place in Greece, and it's still very important to feel in the gaps that were opened by the 10 years of austerity since 2010, the role of voluntary initiatives and informal health care networks has been overly significant. Solidarity, solidarity clinics, voluntary free clinics for medicines, as well as for patient coverage have been mushrooming around Greece to tackle both, of course, the refugee and migrant crisis and the economic ones. Okay, so this is then the setting through which we should start assessing the Greek success story. Yes. So the containment up until now of the COVID-19 took place within this particular setting within a country that has been torn with 10 years of austerity, a health care system that has been severely strong with cuts in hospitals and primary health care units under staffed under equipped under funded together of course, with an increasingly important population with a worsening health status and increasing unmet medical needs. So then from this point of view that we can stick lockdown that was observed in Greece has been can be seen perhaps more like an necessity rather than a political option. Of course, this was not the case in other countries, like for instance, Spain and the UK that had both suffered from austerity measures in their health care, health care systems and elsewhere in a previous decade. But this is I think the starting point of understanding and to then offer the link that I was discussing earlier when it comes to the capabilities of the health care system and of the state more broadly, besides the lockdown, which again, I'm not discussing these but poses very particular has very particular implications when it comes to who bears the burden of social reproduction during the lockdown, yes, where the family becomes back at the center of that and within particular gender patterns, the female members of households are taking up a great bulk of that burden on their shoulders. But besides the lockdown, I mean, the rest of the policy responses in Greece, which I'm going to turn out, and I'm only focusing on health care. As we're going to see, I seem to have been limiting when it comes to financial terms, if you will, which it is reflective of both fiscal space limits, but also priorities, where priorities lie when it comes to spending as well as to then, of course, this limited fiscal space has led to particular expansion of the health care capacity. When it comes to the hiring of staff in very precarious and temporary basis, together with increases in ICU bed capacity and diagnostic testing, those being particularly done the welcoming of the private sector, as we're going to see, which is another manifestation of the limited capability for state provision. In other words, the retreatment of the state is here and is seen by the ways through which capacity is increased and how the private sector is being brought into this picture. Okay, so to contextualize now these policy responses, I'm going to, I'm not going to cover the measures that were announced in Stingris last week as the easing of the lockdown. So up until the beginning of May, the government has allocated about 2,000 million euros to the health care system to address the pandemic. That was primarily for hiring of temporary staff or topping up with salary of existing staff. And for increasing ICU beds for protective equipment, which has been very much lagging as well as health materials and medicine. In terms of hiring, the government originally hired about 2,000 new doctors, nurses and paramedics that was extended by another student in the last couple of months. This was done, of course, on a temporary duration originally of four months, but extended, however, with a little prospect for continuation of those contracts after the pandemic is over. And these measures or these amounts, if you will, do not, of course, tackle the chronic understaffing of the public hospitals. Many of the staff of the current staff is actually temporary contracts. That according to some reports, I mean, the vacancies that are currently in public hospitals, 30,000, so hiring an extra about 4,000 health workers is not helping out with the system prior to the pandemic, and much less so in terms of responding to a COVID pandemic. When it comes to ICU beds, the onset again of the COVID crisis, one of the smallest numbers in the EU, there was a total of 565 ICU beds increase in February 2020, which corresponds to about six ICU beds per 100,000 of population with only 4,000 capacity of ICU at about four, and with Germany on the highest ICU capacity per capita at around 29 point something. Right. So we have, I mean, restarted from a very low capacity ICU wide. And that has been, of course, expanded over the course of the past two to three months. By the end of March, the total number of ICU beds was actually increased to 870, the majority of which came from the public while at the time 137 beds were also contracted from the private hospitals, which then leads us to really paying attention to the implications of the ways through which these capacities is brought into both when it comes to in the public display of other cases, as well as, of course, the wage, the ways in which the private hospital and clinics are contracted with what costs and what distributional implications. This has been a highly contested issue in Greece. Private beds have been contracted at a cost of 1,600 euros per day. And it has affinities, similar measures in the UK and the corresponding bailout, if you will, of private hospitals there. And a very similar pattern is seen when it comes to testing capacity for COVID and easy reliance and financing of private diagnostic centers. So at the start of the epidemic, Greece still, I don't know if you can see it in the graph here, still has a very number of tests performed overall. And the capacity was very limited from the beginning. At the onset of the epidemic, the bulk of the tests were only carried out by one lab in Athens. And of course, this capacity was increased in a number of sectors, made by medical schools and universities, independently of the government, which government locations for a million of which we discussed before. But these testing through private sector, whereby private labs have received funds from the government in order to run tests themselves, charging up to 300 euros per test. Yes. So this is how the policies took place, the response to COVID took place within the healthcare system. And besides, of course, the lockdown. In terms of the size, if you will, and as a comparative setting, which we should be very cautious about data from the health system response monitor, which is a platform set out by the European Office of the WHO, the European Observatory of Health Policies and Systems and the Commission, they've been created this, this platform has been created that kind of brings together all the different responses of policy responses of countries. And what we see here is that as of May the 6th, Greece has spent a small per capita amount in healthcare of 26 years, where Lithuania spent much, much more, as well as Estonia and Switzerland and all that. But of course, I mean, this is but in Greece, it has been leveraged by private institutions kind. Not the less, it kind of shows an indication of public spending and efficiency or not amount has been put forth. Together, of course, with alarming attention being raised when it comes to the indirect healthcare effects of COVID and how they should be addressed, particularly when it comes to the postponement and cancellation of non urgent and elective surgeries, as well as the postponing of diagnostic tests. And what means about particularly specific, specific groups of patients, cancer treatments, cardiovascular diseases and infectious disease among children and what policies should be put forth to make sure that we don't have delayed delayed care with, again, very negative implications. Yes, the EU, right. So, but before I go to the EU, let me just summarize the policy responses in Greece along the lines of this Greek success story. Yes. So, beside the very early and strict lockdown, the majority of the reforms that, sorry, of the response of the response policies that have taken place have been for the expansion of the capacity of the healthcare system have been done first, have had temporary nature when it comes to the hiring of human resources. And have relied a lot to the private sector without that necessary situation. And that is something that might have both short and long run implications that need to be considered. Now, with regards to the EU also, because I think I'm running out of time, I'm going to say only a very few things. There's only one slide here. There isn't much to say. The COVID pandemic has been a true global crisis, but once again, it has revealed a set of deficiencies within the EU. It has highlighted existing divides across member states. It has some conflicts along the national and the transnational sphere, right, within the union conflict divides when it comes to mutualization of debt, as well as it. It's the response of the end, the degree of decent transition and desynchronization of healthcare systems within the EU, with still very little coordination and no common system across the union for testing, for quarantine, for locking downs and this and that. It was the ECB that initially stepped up and created an emergency pandemic plan. As a buyer for government debt to stimulate and help out the different economies and the EU, and particularly the European Commission after the hugely so criticism, has been easing up the rhetoric, particularly the rhetoric map rather than the actuality of mobilization of funds for the the combat of the pandemic at the at the European level, but those funds from billions to trillions and all that have primarily been national level measures that are being undertaken by different nation states, as well as whatever is from EU money, which are still operational. We'll most probably be in the form of loans rather than grants, which again raises the issue of redistribution of divides and disagreements as well as refusal for risk sharing and debt sharing within the EU. And that is pretty much all for me, I'm going to close only with one last bit I would like to mention, which is being confirmed in Greece and I think it might be extended further as a post pandemic issue. It seems that the reconfiguration of the private public nexus when it comes to this capacity of health care provision, but welfare provision more generally is going to be tipping towards the private sphere, particularly all sorts of different public private partnerships are coming into perhaps stay and it's not only for welfare, I think it's also built as a combat with green finance and all that. And hence we kind of see the limited state capacity to respond to crisis and to pick up the space in the provision of social and welfare policies. And that would be all from me. And then there is just a set of references for whoever is interested in some of the of the main papers that have been covering this debate. Yeah, so if everyone could put their questions into the chapels, we'll get to them. But while people are thinking of some, I guess I'll get them all rolling. You talk about how there is now unified health care and unification of insurance funds, but the actual system itself is quite fragmented geographically and public and private. But what we've seen in this country is at least is there's been shortages of things that are now needed much more than they were a few months ago, such as ventilators and equipment. And this country has had trouble sourcing those and providing them to the health care system that it's supposedly in charge of as a whole. Is there much trouble in greed when the unification is about purchasing of health care rather than about this system itself? Yes, I think on that front there are similarities between the UK and the Greek system, despite the fact that the UK one is much more privatised than the Greek one. Even the sole purchaser of health care services from the public and the private sphere and being the sole provider of those services. Yes. Again, I mean of course these are all historically and country specific processes that we need to be looking into. But in principle, let's say the degree of manoeuvre, the capacity for manoeuvre, the capacity to mobilise resources, yes, physical but also a human, to deal with an emergency, let's say, has to very much to do with the interaction of different actors that themselves may belong in the public, in the private sphere, but also in the third sector, in the voluntary sector, let's say, the interactions of the different agents in the whole chain of provision from production until the end, yes. So essentially issues that have to do with ownership, who owns the production, issues that have to do with accountability, who controls the provision, issues that are financed in these things, are part and parcel of how you can mobilise a very complex system, let's say, to respond to a particular need. And I don't know if I'm answering your question. But this kind of sortages, geographically as well, have been observed pretty much everywhere, but then the question is the reason that can be sorted, they can be quickly tackled, sorted and with what distributional implications always. Because one thing is to expand capacity through the use of private hospitals, but then we should always criticise at what cost that is and what does that mean for the public provision as well. And the same applies, of course, to PPE, to protective equipment, to ventilators, to all sorts of different medical equipment that are necessary in dealing with different healthcare emergencies. So we've got a question from Kevin who asks, why is the death rate so much lower in Greece than the UK, given both countries have suffered badly under austerity? Have the Greek public been better at self-isolation or are the other factors at play as well? Yeah, no, the Greek public is not better at self-isolation. The fundamental difference in Greece and UK has been the fact that the Greek lockdown happened much, much earlier than the year. And it was much stricter. It was not self-imposed. There were strict regulation rules of when to go out. You had to fill in particular forms when you were going out and there were strict police monitoring of those people outside. But so it was strict, so it was imposed, and it took place much before, much before rave to the UK. So Greek lockdowns started, I mean slowly, started with a constellation of some events before even a first death was recorded in Greece, yes, and then schools were locked down on the 12th of March after only a few deaths have been reported in Greece. Yes, so essentially the lockdown which really slowed down the spreading happened at a time where the severely understaffed and under-equipped hospitals never reached their capacity limits, which is something that for instance, happened in Italy, in Spain, and in the UK as well. So the difference is it has to do with the timing of the lockdown rather than whether the individuals can stay more in than some individuals can stay more than others. It was the timing and the fact that it was monitored strictly. Yes, you've got another question from who says, thanks for the informative talk. I wonder whether, apart from the re-balancing in favour of the private sector, the pandemic is opening up space for discussion on the possibilities of reversing austerity, particularly in the healthcare sector? Yes, I don't know the answer. I mean, I would hope so. I would really like that, but I don't know if this is where we're going. I mean, to open discussion for reversing austerity, to open a discussion is something that entails very drastic changes in the organisation of social provision in general, social and care provision. And I don't know if this is where we're going, okay? To me it seems that this is not where we're going, okay? I mean, I don't know. At the beginning of the of the COVID pandemic I was actually a bit more optimistic of viewing this as an opportunity to reconsider the reorganisation of production social reproduction as well as production in social organisation, but I don't know this is where we're going and it actually needs lots of mobilisation from the bottom rather than the top, because what you see within the EU in particular is a very it's a very nation-based response as opposed to a union-based response, and you also see it at the global level. It's a very nation-state response as opposed to a global response. Even for the most the poorest countries in the world they didn't have all sorts of different negotiations to see if you will be able to pose the payments or the repayments of debt, you know, for a few months to help them out. So I really don't know if, I mean I would hope for it, but I don't know if there is scope for reconfiguring the positions of the different actors in the in the chain of provision. I really don't know. Next we have a question from Anna who asks what is the current fiscal space for Greece and how does it differ from other EU countries due to the conditions imposed by the Troika? Okay, these are at the moment, these are untactored waters, so I really don't know at the moment. Reason being is that the EU has scrapped, has used the exception clause, and has allowed states to not follow up with the 3% of deficit limit, 3% of GDP. This has been scrapped because of exceptional circumstances. In the case of Greece, for example, what has been abandoned by, with EU of course, support has been, we no longer have the 3.5 surplus target, this has been gone and we are allowed to have deficits and all that. And again, despite the original missteps of the EU, they've also been stepping up and discussing about much faster state aid policies and hence, you know, the allowance of countries to accumulate deficits. Now what does that mean for the fiscal space for Greece in particular and in relation to other countries? I don't know at this point. I mean at this point it is clear that everyone is accumulating deficits. Yes, not only because of the big measures that are being taken outside the healthcare system as well, again, predominantly when it comes to the nationalization of private wage bills that has never happened before, yes, the covering of the private sector wages during lockdowns and extended lockdowns. So there seems to have miraculously, countries seems to have found fiscal space that they never had before. They would have never considered, I mean, this is an income replacement, okay, due to lockdown, yes, but we still don't know how this is going to play out. I mean, the future forecasts are like, yeah, really bad, okay, we're talking about a huge global recession much bigger than the 2007-2008. And I don't know what that would imply in terms of fiscal limits, in terms of debt accumulation, in terms of debt crisis in the months to come, okay. This is still to be seen. There is radical uncertainty. So to follow on from exactly that, Mark is asking a question about the unprecedented spending. He asks, with the unprecedented spending among European inflation, it follows that there is a risk of a bound in inflation. In the past, this is usually, the usual response has been higher interest rates. However, that would make current government debts more dangerous. Do you think an inflation jump is likely, and he, which you've already sort of answered, he asked, do you think there's a chance of debt crisis? But he specifically talks here about Argentina and countries like that are at critical levels. So I guess there's still a chance. What's the difference between, say, the global north and the global south in the debt crisis and what is getting at it, I suppose? Very difficult questions, Mark. Okay, inflation, when it comes to inflation, I personally don't think there's actually inflation. To the contrary, I think there is a problem with inflation, despite all the borrowing and the spending, because the COVID crisis is also unprecedented in the sense that it is a demand and supply shock. Okay, it's not only a demand shock, meaning depressed consumption, it has to demand at the national and the global level, because of lack of loss of income. But there is also a supply shock, because we are here talking about a disruption of the production process big time. So we're not producing and prices are going down, we're not consuming and prices are going down. So any kind of boosting that is going to come through that boring I don't think inflation will be the first element of concern for anyone and I don't think that inflation if anything, the current are for inflation to be with the set of issues. Okay, now when it comes to debt crisis, global south and I don't know, I really don't know. My view of the matter is as follows, okay, there isn't a framework for sovereign debt crisis resolution, there's never been one, yes. Which countries debt become unsustainable in spite of course in the IMS, the scientific measurement processes, right, stability analysis and all that, east to some great extent, not only the outcome of the projects and exercise, but it is also the outcome of particular political configurations, particular power structures within, yes, the global sphere, if you will. There will be debt crisis, that is for sure, right. I mean, again, revenues, public revenues are shrinking, okay, because production has been disrupted, yes, the supply chain has been disrupted and people are not getting paid because they're not working because they are in lockdown and it's not an increase, I'm saying in all sorts of different countries throughout. So revenues have been going down and at the same time, yes, public spending has been has been increasing, so there will be increasing, increasing deficits and most probably increasing debts as well, okay. There will be a crisis, debt crisis and the question is, because it is of a global nature, is to then see how this can be a result, yes, at the global level, if you will, what will happen if you have a few countries with debt problems, as opposed to only one here and one there, yes. I don't know, I hope I'm answering these questions, yeah. Yeah, I think that's all we've got time for. Would you like to say anything to Summer or to people? I mean, I think we kind of like covered up pretty much everything. We'd just like to say once again, thank you so much to the OEF and to our students for organizing this series and for inviting me and thanks so much for all the participants that have been that joined us in this in this seminar. Yeah, awesome. I'd just like to say before we go, the next webinar is tomorrow at three o'clock at the same time and it's on Corporations and Co-Fed Bailout Saviors with Karolina Albers from the University of Cambridge and Bauer RCL from the University of Manchester. And again, check out our social media on Facebook. Thank you. Thank you.