Von der Leyen’s Gambit: Turning Citizens into Champions of a European Health Union

As health policy is a hot topic in a COVID-19 world, it was hardly surprising that European Commission President Ursula von der Leyen opened her State of the European Union address on 16 September with four health proposals. In the pre-COVID-19 era, EU health policy would rarely have been the first item on the presidential agenda, but plenty has changed this year.

Beyond outsourcing to new agencies with new powers and crowdsourcing knowledge through a new major health summit, one proposal set out how the Commission would use its existing tools to potentially expand its future ones. At first glance, President von der Leyen’s commitment to holding the Conference on the Future of Europe on reviewing health competences may seem little more than hot air—just one of countless pledges during her 80-minute speech—but on closer inspection, this is an inspiring approach for affecting change.

A pledge to table an issue at a conference may sound conventional, but this isn’t just any conference. As one of the President’s commitments in her Political Guidelines just over a year ago, the aim of the Conference on the Future of Europe is to allow “citizens to have their say” as part of a “new push for European democracy”—meaning that it is an attempt to help address the supposed democratic deficit of the EU. This, according to President von der Leyen, is the perfect arena for the “noble and urgent task” of discussingthe question of health competences.”

While President von der Leyen opening her address with health policy may have been expected, her foregrounding the role of the citizen in these discussions was less so. Any increase in health competence will require a change to the EU Treaties; while von der Leyen herself is “open to Treaty change” resulting from discussions at the Conference, it is Member States, rather than citizens, who will have to agree.

President von der Leyen is well-aware of the perils of this task. The EU’s “constitutional crisis” of 2005, arising from the last attempt to change the Treaties, laid bare the complexities of transforming the two-tiered political system—a system which, in its pursuit of safeguarding Member States’ legislative independence, also obfuscates its own efforts to expand. She will also be aware that, as well as derailing the intended Treaty, the constitutional crisis dented faith in the EU project among many Europeans—something that her Commission is keenly working to improve. It’s the reason for holding this Conference, after all.

This is precisely what makes it a smart move to make European citizens the champions of increasing health competence in the Union. Seating a potential change to the Treaties at the foot of the European people will likely force the European Council to get onboard, in some small way at least. While a fully-integrated European Health Union might be out of the question for now, Heads of State and Government will be hard pressed to ignore citizens calling for increased health policy over the course of two years—particularly given that, as one of the von der Leyen Commission’s flagship priorities, this Conference will be a big deal. At the same time, citizen inclusion helps to tackle the democratic deficit head-on, (hopefully) mitigating the potential fallout of actually enacting a future Treaty change if discussions ever get that far.

Beyond von der Leyen’s speech, the Commission seems prepared to commit to more joint actions in health—on (bank) paper, at least. The European Council’s €1.7 billion for the establishment of the Health programme pales in significance to the Commission’s initial proposal of €9.4 billion. While it’s to be expected that the Council is more financially conservative than the Commission, the stark difference in these sums certainly shows that the institutions are not on the same page yet—making the Commission’s choice of Conference topic a good use of its influence.

While it won’t be a silver bullet, a Conference on the Future of Europe may be just what the Union needs to start encouraging change in health policy. As Member States resist making greater financial commitments to health policy at the European level, President von der Leyen has her eyes on their Achilles heel: their electorates.