Faced with past experience, there is no doubt that the proposal made by local libertarians is leading to an abyss of social exclusion and inequality that is trying to disorganize the Argentine health system, which is working well and which has given a very positive response to the health crisis and tensions. that we had to deal with during the last Covid-19 pandemic.
Dr. Eduardo Filgueira Lima, health expert on Javier Milea’s technical teams, invites us to go back more than 30 years in his proposal to reform the Argentine health system. A model that failed in the UK, Colombia, and more than 20 countries in Latin America and Southeast Asia in the 1990s.
The libertarian model proposes a transition to a health insurance system with on-demand funding and the removal of public funds from hospitals, leading to privatization, limited medical services and benefits, reduced public hospital beds, and job insecurity. medical workers; and presents it as the fundamental basis of health policy to be rolled out by the future government of Milea (as well as nuanced right wing candidate Patricia Bullrich) of the Nation’s Department of Health.
To simply explain the interests behind this proposal, we must consider some fundamental aspects. It is important to ask ourselves a series of questions that will allow us to build a reasoning that clears doubts and exposes the appearance of effectiveness that is being attempted to be established.
What society do we dream of? What is the role of the state in social policy? How does health affect the development of society? Who should take care of the elderly, the children, the poor and the vulnerable? How would our country deal with the health crisis and tensions in the face of a pandemic like the one experienced in recent years by covid 19, with a fragmented state system?
Human health is much more than medical care or sanitation; It is a series of events and actions that will directly affect the quality of life of residents, their development opportunities, their inclusion in the production and economic process, as well as their social and emotional life. Human health is a key element of local economic development, social harmony and political stability and sustainability, inextricably linked to a model of social justice based on income redistribution, social empowerment and active participation of the population. The state and citizens in the guarantee of these rights are all aspects that the libertarian model despises. Health is also enhanced through job creation, productive development and social investment as strategic pillars.
In Argentina, about 15.4 million people have only public health insurance, which is likely to increase after the implementation of liberal economic policies that reduce employment and, therefore, the loss of insurance coverage that they offered under obras sociales and the ability to pay for them . private medicine in sectors related to trade and small and medium enterprises, which will push these sectors towards the public health system.
So, What does this health insurance program mean?
Here it is necessary to make some considerations. First, there are obviously two models regarding the role of the state in relation to politics in general and social policy in particular. That is, to promote the current active state, which promotes the expansion and full access to social rights, or to propose a small, weak state, delegating the solution of social issues to the market. It is clear that the function of the market is to generate economic profit, and it will provide medical services and benefits to the most profitable places and populations.
The market model seeks to firmly penetrate the field of care through the so-called “universal health insurance”, turning health into a commodity, and the treatment of diseases into a highly profitable activity. Thus, in addition to the allocation of public resources that should finance comprehensive health care, the system is directed towards practices and benefits that do not meet the needs of health care, and funding is mainly affected by payment of intermediaries, as well as diagnostic procedures and technologies. related to non-priority health issues.
Second question: Who is responsible for the health of the population and especially the most vulnerable?
State through funding proposals, that is, to fund the work of care centers, medical teams, territorial approach; in short, to bring health to the population; or the question of health is an individual responsibility, when the state finances the demand of a person through a “book” where it is promoted: “you take care where you want (within the framework of a basic and reduced basket of providers and practices) and the state pays for you.” The health INEQUALITY paradigm, since those populations that are the most vulnerable and therefore those with lower levels of anxiety and less purchasing power will benefit the worst due to barriers to entry that will be created by economic, cultural and geographic types between others. since in some regions of our country there are only public health care providers. Denying or hiding the inequalities and asymmetries that exist in different regions of our country is a preconceived notion.
The third issue under consideration relates to the benefits that will constitute the “basic basket”, and which are consistent with medical practice, diagnostic and treatment methods (including medicines), to which “beneficiaries” who have a “health insurance card” and this will cover some, but not all people’s medical needs, and beyond that basic coverage, the patient’s “pocket” will be the one who will have to respond to access more complex benefits. In addition, the establishment of a National Agency for Technology Assessment (AGNET) is being encouraged to be responsible for evaluating the inclusion or absence of practices in the “basic basket of benefits”. This health insurance program has shown in other countries, such as Colombia, a high level of litigation and prosecution due to lack of government response.
The fourth concept relates to public sector financing and the deployment of a prevention and health promotion strategy. The proposal supports the transfer of responsibility for financing public executives to provinces and municipalities from the nation and promotes a system of self-government and the collection of benefits for social and prepaid work as a way to recover costs and real resources. Preventive measures or rehabilitation with a territorial approach are not provided. Consequently, the state is moving away from its active role in protecting, strengthening and holistic, comprehensive, universal and fair compensation for people’s health, placing responsibility for health on the individual, increasing the gap in health inequalities for generations. barriers to access, deepen fragmentation and segmentation of the health care system, underfund public providers, and encourage market intervention in health financing schemes through coverage strategies closely linked to the commodification of health care.
A simple review of the failed health reform process under this model, carried out by Margaret Thatcher in the National Health Service (NHS) in the United Kingdom in the 1990s, shows the inefficiency and impracticability of this proposal.
* Pediatric University Professor. Director of Samic Hospital “Rene Favaloro”. Member of the People’s Health Forum.
