These days we have been witnessing as spectators the deployment of a series of written press headlines, interviews on television and radio and an incessant flow of messages on social networks that envision, warn and even promise a dark future in the field of health, if the conventional of the plenary approve this week the draft of Norm (article 18).
The draft Article basically indicates that health should be understood as a right of which the State must be a guarantor not only through the provision of health care, but also in its role as a promoter of an equitable and dignified society in different areas (housing, food, work, etc.).
It proposes to organize health care in a Universal System in which both public providers (clinics, hospitals of medium and high complexity, hospitals of the Armed Forces and Order), as well as private institutions (university hospitals, foundations, laboratories, clinics and medical centers) and also medical consultations and other health professions converge.
The thread that makes this new way of organizing health care possible (provision) is anchored to two fundamental elements: on the one hand, “health intelligence” – that is, for that matter, the organization of care according to the health needs of the population – must be of a public nature, independent of the ownership of health care providers; that is why both public and private providers are accepted. On the other hand, the financing of health – the bag that we would use to pay for this provision – must be pooled and composed of what is collected through general or specific taxes, instead of it being only the contributions of each individual that bear the weight of such cost; because if something has become clear in Chile with financing based on quotes exclusively, it is that it affects and generates a deep inequality. While almost 80% of Chileans use Fonasa, the rest use private insurance (Isapres) or special insurance from the armed forces. While Fonasa insures the aging, poor and more burdened population of disease; the Isapres discredit their members when they age or get sick, as a senior executive in the sector indicated with full transparency a couple of years ago in the press.
But what is it? the public in health? The pandemic that still hits us has allowed us to remember and therefore show that the society that welcomes us does so from a penetrating inequality: the greatest burden of disease and death was and continue to have the sectors less endowed with economic, labor and cultural resources. But we have also been allowed to observe that, despite these differences with which the inhabitants of Chile stand in the world, we continue to be linked by natural phenomena that surpass social constructions. Although the example of the pandemic is extreme, in everyday life we always live intertwined, interdependent, connected by invisible channels: we are part of a whole, whether we like it or dislike it. The public manifested itself strongly in the pandemic context in the health response, and above all in two areas that have a lot to do with the reflection that we must all do when the media today try to muddy the work of the Constituent Assembly and the citizen groups that we have been contributing to this debate in the process.
I return then to the idea: the public was put on the vaccination campaign — yes, public because there was no discrimination between members of Fonasa or Isapres— since we have all benefited from it, through an effort that is nothing but public in nature – for the good of all – (note that in that effort institutions of various kinds, including universities, came together). On the other hand, the management of critical beds with integrated criteria, achieved emergency care and intensive care to thousands of citizens both in the network of public providers and in private institutions that had installed or installable capacity. How was this integration paid?: with public funds… in the spirit that the installed capacity should be at the service of a greater interest.
It is that same spirit that animates paragraph 12 of the draft on the Right to Health. Introduces whether a correction factor in health providers, so that there is equity and equal access to care Health, they must be conceived as institutions or non-profit professionals. This does not mean anything else that they should receive remuneration for their clinical services. joust –whose criteria will be discussed well after the Constitutional Convention and in which we must all be able to participate on equal terms – but without generating surpluses that perpetuate the privileges of some sectors of the population based on their income, and of some medical societies or professional health unions, accustomed to understanding professional practice as a synonym for profit.
Part of the fear that some media have expressed these days has been trying to put themselves “in the place” or the direct interest of the sick. This has been expressed, for example, by private dialysis centers, which still exist thanks to having managed to include these pathologies within the GES and, therefore, living thanks to public contributions, are presented as threatened by rule 18. In this case it is not the interest of the patients but that of the medical societies and dialysis service companies behind this business. Hiding behind the interest of patients as damaged and vulnerable as dialysis users is immoral and completely unethical.
No change of the magnitude that the “highlighted” social discontent of 2019 installed will come overnight. On the contrary, in health it will be a gradual, gradual, consensual change and with all the real forces acting on stage. First through the process of Harmonization within the Constituent Assembly, and then very long through the societal agreements that we give ourselves, building laws and other gradual and cultural mechanisms. Therefore, the same draft of the article in question must stipulate transitory paragraphs that allow such graduality: we cannot build a culture of the public without respecting all the actors, systematically favoring the installation of forms that allow us, in effect, to overcome inequities. No one will be left unattended in that process, let us not be intimidated.
Having already resolved what is public, suffice it to say that it is necessary for each of us to reflect on the private. Today consulting the smear campaign seems to be something like a “registered brand”, synonymous with good, prestigious, elegant and qualitatively superior to the public. This imaginary is nothing but the result of the impact of a culture and a politics that has derived from the constitution of 1980 and that so many decades later continues to have repercussions in a society divided into two great poles, as if it were a nature. Isn’t it the cornering of the public by the vainglory of the private that keeps us sick and sick? Let us not allow ourselves to be confused and let us be rational subjects at the service of the common.
The content expressed in this opinion column is the sole responsibility of its author, and does not necessarily reflect the editorial line or position of El Mostrador.
