Talking about healthcare in Spain is like telling a story that begins in black and white and ends in high definition, with plenty of plot twists along the way. In the past, when you fell ill, there were not many options: you recovered or you did not. There were no major hospitals or specialist services; instead, you found healers recommending herbal infusions or treatments that would horrify us today. If you were lucky, you lived near a convent where the nuns treated ailments with more fervor than medical knowledge.
Before the twentieth century, healthcare was fragmented. The elite, of course, had private doctors attending to them in the comfort of their homes. Everyone else, those without such good fortune, resorted to charity hospitals or simply trusted their bodies to overcome illness with a little help from nature. Epidemics decimated entire populations, and life expectancy was low, not only because of a lack of knowledge but also because of poor hygiene.
Everything began to change with industrialization and, above all, the creation of the first social security systems in the twentieth century. Although medical care was basic, it was recognized that a modern country could not prosper if its population continued succumbing to diseases already eradicated or at least controlled elsewhere. In the 1940s, the creation of the Compulsory Sickness Insurance scheme (SOE) planted what we might call the seed of modern public healthcare in Spain. But, like everything in this country, things moved at a tortoise's pace.
Access to healthcare gradually became more democratic, but the differences between urban and rural areas were obvious. If you lived in Madrid or Barcelona, you probably had access to a decent medical appointment, but if you lived in some forgotten village in La Mancha, your chances of receiving specialist medical care were as remote as finding life on Mars. It was an age of transition, of medical advances, but also of brutal inequalities.