Isabel Díaz Ayuso, President of the Community of Madrid, frequently dominates national headlines, often positioning herself as a counterpoint to the central government or even her own party leader, Alberto Núñez Feijóo. Her political persona, marked by phrases like “I like fruit” or “Ayuso, pim pam pum,” enjoys significant notoriety. However, a closer look at data concerning public service investment suggests that this high profile isn’t translating into improved well-being for Madrid’s citizens.
The Paradox of Madrid: Wealth and Waning Welfare
Madrid is often touted as the land of “freedom” and “anti-communism” by its leader. Yet, it is also the region where university education is most expensive, housing costs are highest (without adequate compensatory policies), private health insurance is booming due to public sector delays, and access to public abortion services is severely limited. Furthermore, the metro service has seen no significant reinforcement in her six years in office, and support for those in need, through insertion income, has been drastically cut.
The sentiment that living in Madrid is becoming increasingly difficult is widespread. Despite a positive population balance driven by foreign arrivals and young people seeking education or first jobs, an increasing number of Spanish citizens are leaving for other provinces, according to recent INE data. This exodus occurs despite Madrid boasting the highest average salary in Spain (2,762 euros, second only to the Basque Country) and leading the country in high salaries due to its status as a business and financial hub. The question remains: can one truly live comfortably in Madrid?
Recent studies suggest the answer is increasingly negative. Madrid, while the richest region, spends the least per capita on public services, as highlighted in a recent report by the Valencian Institute of Economic Research (Ivie). This translates into longer wait times for medical appointments, inadequate early childhood care, fewer available teachers, and overcrowded public transport. Meanwhile, Ayuso’s administration has minimized all taxes within its jurisdiction, including those for the wealthy and millionaires, such as inheritance and wealth taxes.
Her policy approach is further characterized by a strong endorsement of private management for public services, particularly in healthcare, and a significant push for private universities and vocational training. A recent report on Minimum Insertion Incomes places Madrid at the bottom, with less than 1% of people below the poverty line receiving this aid, and a 95% cut in investment for this chapter (130 million euros less allocated since 2020).
Healthcare in Crisis: Soaring Waiting Lists and Privatization
The waiting list for a first specialist appointment in Madrid has escalated, nearing 800,000 people enduring months-long waits to see an ENT, traumatologist, endocrinologist, or ophthalmologist. Madrid exhibits the worst figures for specialist care, despite what critics argue are administrative attempts to manipulate waiting list statistics.
In terms of per capita spending, Madrid also fares poorly, allocating just 4.1% of its GDP to healthcare, significantly below other autonomous communities. Murcia, Extremadura, and the Canary Islands, for instance, dedicate substantially more public funds to healthcare per citizen. Since Ayuso took office in 2019, the waiting list for diagnostic tests has almost doubled, surpassing the psychological barrier of one million patients awaiting a procedure.
Moreover, Madrid is the autonomous community with the highest level of healthcare privatization, according to the Federation of Associations in Defense of Public Health. Ayuso’s administration allocates 11% of its budget to private healthcare companies, excluding non-medical services, with Quirón Group being a major beneficiary. Spending on indirect management contracts has seen an unprecedented increase compared to other regions: from 845 million euros when Ayuso arrived at Puerta del Sol, it reached 1,377 million in 2022, according to official data collected by the private healthcare employers’ association, Aspe.
This disinvestment in direct public management, which competes with multinational healthcare companies through the introduction of free choice, is pushing citizens towards private insurance. Madrid leads the ranking as the autonomous community with the highest penetration of private insurance, with 37.5% of its citizens covered, according to data from the Observatory of the Private Health Sector.
The Housing Squeeze: Unaffordable Rents and Failed Policies
Finding affordable housing in Madrid, especially in the capital and its well-connected surrounding areas, is another significant challenge. The appraisal group Tinsa identifies Madrid as the most expensive city in Spain, with an average price of 4,668 euros per square meter, followed by San Sebastián, Barcelona, and Palma de Mallorca.
The capital’s mayor, also from the PP, has resisted declaring Madrid a ‘stressed area,’ a classification that would allow for rent control under national law. Rents in Madrid, and most Spanish capitals, have skyrocketed since 2015. Seasonal rentals are further exacerbating the market, with demands of 10,000 euros for a three-month stay in areas like Chamberí.
Potential solutions could involve increasing construction and streamlining bureaucracy for developers (a law stalled after the PP voted ‘no’ in Congress) and, crucially, promoting Official Protection Housing (VPO). A significant portion of Madrid’s VPO was controversially sold off to vulture funds after the housing bubble, under the PP government of Ana Botella. Furthermore, during Cristina Cifuentes’s government, over 5,000 social housing units ended up in private hands at bargain prices.
Recent Ministry data from 2024 shows Madrid completing the most VPO units in absolute terms. However, it is also one of Spain’s most populated regions, with correspondingly high demand and need. While there has been improvement in this indicator, Ayuso’s VPO policies are still far from reaching a minimum recovery level, a trend observed across other communities. The sharp decline in completed housing units in Andalusia is also noteworthy.
Education: Underfunding and Segregation
The educational landscape in Madrid presents a similarly bleak picture. Madrid ranks last, by a significant margin, in per-student spending, followed by the Generalitat Valenciana. Conversely, it is second in agreements and subsidies with the private sector, allocating 18% of its education budget to it. Isabel Díaz Ayuso’s executive approved its Master Law in 2022, aiming to nullify many measures included in the so-called ‘Celaá Law’ to counteract Madrid’s educational policies of the last two decades.
President Ayuso has continued the neoliberal educational legacy of her predecessors: if Madrid were a country, it would be the second in all of Europe to segregate its students the most, only behind Turkey. The rich with the rich, the poor with the poor. Another practice has been to cede public land, sometimes for 99 years, for the construction of schools that had agreements before they were even built, despite these practices being expressly prohibited by law. Madrid’s governments ceded at least 45 plots under this formula for these purposes. In the student-to-teacher ratio, Madrid also fares the worst in Spain.
In public universities, Isabel Díaz Ayuso holds the dubious honor of being the president under whom the suffocation of campuses has worsened. In November, students and professors took to the streets to protest. While funding is cut for institutions deemed “colonized by the left,” this leads to unpaid bills, inability to improve campuses, or address new cycles, research, or invoices. Added to this is the continuously rising cost of credits, which is among the highest in Spain.
The president’s disaffection with public universities is particularly evident at the Complutense University, which will have to take out a loan (with corresponding interest) to meet its commitments, having lost 140 million euros in two years. Madrid now has more private universities than public ones (13 versus 6) and continues to add elite initiatives for elite students. This approach is costly for working-class parents and university students, as studying at a private institution can cost three times more than at a public one.
Mobility and Senior Care: Stagnation and Neglect
Regarding mobility, Madrid boasts the country’s largest airport and the most developed commuter train and metro system. The latter is considered one of the capital’s crown jewels. Housing prices also impact mobility, as people increasingly live further from their workplaces, leading to more commuters and pressure on a subway system that sees its population grow, partly due to foreign arrivals, yet without a proportional increase in train frequency.
From Ayuso’s arrival in 2019 to 2023 (the latest available data), the number of passengers has decreased, but so has the number of train cars. There have also been no improvements in frequency, which has remained at 4.1 minutes for these four years. In 2024, the metro company itself anticipates a record number of journeys.
Senior residences represent another thorny issue for the Ayuso administration. When the pandemic hit in 2020, these public and subsidized centers were caught with insufficient staff and poor training, as denounced by family associations and unions for years. This, coupled with policies of not transferring elderly residents to hospitals and chaotic management in the early weeks, made Madrid one of the regions with the highest COVID-19 mortality rates. Elderly people who wished and were able to leave residences during that period had to continue paying for their spot if they wanted to retain it. Most opted for this, as securing a place in a Madrid residence is challenging.
Indeed, a specific report on residences in Spain by the CSIC reveals that the ratio of available places for those over 65 is among the lowest in the country’s wealthiest region. Asturias, Castilla y León, Euskadi, and Galicia lead the ranking for availability.
Abortion Access: Ideological Stance Over Public Service
Abortion is another ideological battleground where Ayuso garners attention and headlines. Her refusal to provide data and establish the mandatory registry of conscientious objector doctors in public healthcare is reflected in the statistics. In Madrid (and Andalusia), virtually no women undergo abortions in the public system; the vast majority are referred to other centers.
Only 0.47% of voluntary terminations of pregnancy are performed within the public system, compared to 88.5% in Cantabria, 55% in Catalonia, or 74.8% in Navarra. Despite the rights enshrined in national legislation, the President of the Community of Madrid even told the opposition during a control session in the Assembly to “go to another country to have an abortion.”
In conclusion, while Madrid under Ayuso may project an image of economic dynamism and political assertiveness, the underlying data paints a picture of growing inequalities and a public service infrastructure struggling to meet the needs of its citizens. The emphasis on private solutions and tax cuts for the wealthy appears to be at the expense of the welfare of the broader population, raising significant questions about the long-term sustainability and social equity of this model.
