Isapres debate: plan E

In a letter published on December 22, the former superintendent of Isapres and current director of the Institute of Public Health of the UNAB, Héctor Sánchez, states that the proposal to rescue the beneficiaries of isapres that we have been working with several parliamentarians, including Dr. Tomás Lagomarsino, who chairs the Health Commission of the Lower House, It would have “several problems to resolve and clarify.” As I was the one who initially proposed this formula, I take on the challenge.

The first thing is that the proposal focuses on safeguarding the benefits in the event of the bankruptcy of one or more Isapres, maintaining their financial coverage of health benefits and medical licenses, and also that they can continue to do so in the private providers they have chosen. This proposal anticipates other proposals that seek to rescue the Isapres companies, not their beneficiaries, giving a pardon that recalls the long, unprecedented and expensive rescue exercise that was given to the banks during the dictatorship.
The letter states that this proposal makes it clear “that a sector of the government parties has no interest in seeking a true solution to comply with the Supreme Court’s ruling without breaking the system.” The truth is that I do not know what the government parties officially think on this issue, but I want to be quite clear that this proposal was made public well before the ruling that Mr Sánchez points out, since the financial crisis puts at risk the breach of mandatory legal standards for these private companies and, as a consequence, it can lead to the bankruptcy of one and more Isapres, it has been incubating in its most critical symptoms since 2021, when another government coalition was in La Moneda. It is not the solution we propose that could bankrupt an Isapre, but, in the face of the bankruptcy of one of them, we offer a solution to its beneficiaries.
He describes the proposal we make as “flying lights to disguise a forced nationalization of health,” and points out that this “nationalization” would be caused by “compliance with the ruling.” Does the author of the letter want to propose that the Supreme Court’s ruling not be complied with? Or, that the judicial opinion is made more flexible or its form of compliance is adapted to the interests of companies? If so, the questioning of the author of the letter should go against the ruling of the Supreme Court, rather than against a proposal that is earlier, as we said, and that only seeks that people who are affected by the insolvency of the Isapres do not suddenly suffer the lack of coverage and financial protection. In other columns the author has also described the proposal as a “Trojan horse” and other qualifiers.
In letter c) of his letter, the author shows a total ignorance of the proposal that is being worked on. He states that “a plan E of Fonasa would replace the hundreds of plans of people who have different prices and coverage” and then caricatures with the qualification of “the miracle” and wonders how Fonasa can do it if the Isapres can not sustain it today. 

The proposal we make does not replace the contracts that each affiliate has with the Isapre that eventually goes bankrupt, but, in the face of this crisis, puts the State, through Fonasa as responsible for granting the agreed coverage of benefits and medical licenses in the same private providers, without dismantling such contracts. That is, it changes a bankrupt owner for another owner that is the State. Isn’t this the same as what is done in banking when a financial institution cannot answer to its customers? Who else but the State can ultimately and exceptionally assume such a responsibility?
This can be done by Fonasa, without net fiscal cost, since the proposal transfers coverage obligations to Fonasa and also allows it to charge the same as the person pays in their Isapre plan (mandatory and voluntary contribution). Surely, the author’s reasoning is that, if the Isapres have losses today, it is impossible for Fonasa to do so without more fiscal spending. That reasoning seems to ignore reality. In 2021, the open Isapres had a positive Gross Profit, which is the difference between income and their costs (health benefits and medical leaves) of Ch$97,421 million, but with administrative and sales expenses of Ch$314,182 million. Until September 2022, the open Isapres had a positive Gross Profit of Ch$41,627 million, which was withPlunged and generated losses, since its administrative and sales expenses amounted to $ 262,488 million. By eliminating or drastically reducing the administrative and sales expenses of the Isapre system, considering that Fonasa has an expense of 1% and not 10% or 12% as the Isapres have, the proposal is fully viable and neutral for the fiscal coffers.
5. The statement in letter d) of the letter is answered in the previous point. However, here are 2 additional aspects. The first thing is that the author contradicts himself with the argument of “forced nationalization”, since he says that “healthy young people would look for another solution”. Indeed, this proposal allows several things that cannot be considered a “forced nationalization”, for example, that someone decides not to go to Fonasa under these conditions and chooses to knock on the door of another Isapre and hire a new private health plan. The question there is: will it be under the same conditions of price, financial coverage and access to the same private providers that it had in the original contract; the same one that Fonasa would respect? There is also the possibility that someone chooses to go to Fonasa with the coverage of the general regime and the GES, and that, using their voluntary contribution, they take out a complementary insurance policy. The question is: will the total coverage you get be better than the coverage Fonasa would be forced to maintain?
The other aspect has to do with the fact that, since 2015, many of the high-cost benefits are financed by the State, with fiscal resources, in public, private or FFA and Carabineros providers, for all beneficiaries of the Fonasa, Isapres and FFAA-Carabineros systems, through the Ricarte Soto Law. The high cost in Chile is financed by the public system universally. If that is the case today, why would it cease to be so with this proposal?
6. In letter f) of the letter, it states that private providers would enter into financial crisis because Fonasa would pay other prices, unless prices are subsidized for Isapres beneficiaries who go bankrupt. The first thing is that the financial crisis of private providers, derived from the liquidity crisis of some Isapres, is occurring today due to the postponement of payments of these, the non-recognition of sufficient guarantees for the payment of debts, and is aggravated by the systematic release of guarantees by the Superintendence of Health (the snowball!). The second thing is that the proposal does not consider tax subsidies, since the affiliates would maintain the obligation to pay the prices of their plans, which, as we have already shown, would allow financing health benefits and medical licenses, if there were not the very high expense of administration and sales of the Isapres. 
Finally, I believe that the focus of this debate should be on how to protect the beneficiaries, especially those who have the most needs, against a financial situation that was already critical before the Supreme Court ruling, and now against the inescapable obligation to comply with a judgment of justice. It is unacceptable to pardon an industry that in the last three decades transferred profits to its shareholders for more than 1.3 trillion pesos, about US $ 1,685 billion. 
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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.

Original source in Spanish

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