Debate. Libertarian delusions and the healthcare system

After PASO, the details of the La Libertad Avanza program for the health care system began to circulate with greater accuracy. In the event that Miley and her group come to power after October, or after a possible vote, the Ministry of Health will become a secretariat, part of the Ministry of Human Capital. This portfolio will remain in the hands of Eduardo Filgueira Lima, the nation’s undersecretary of health during Eduardo Duhalde’s administration and La Pampa’s former minister of health.

Shouting “too much is being spent,” Filgueira Lima spoke out against those “who live on the privileges that public funds give them, while the population does not have any benefits.” The first libertarian proposal to cut costs is to start by creating a provincial health insurance system so that each person can decide whether they want to manage their health care through prepayment, obras sociales or, in case they cannot pay. . these options, with government subsidies. The logic is that demand is financed, not supply, that is, each person goes to the medical center when he is sick. In a voucher system, a person receives a medical voucher for a certain amount. With him he goes to a sanatorium and is treated. Then the medical center sends an invoice to the state for the amount of the voucher and receives the money.

The second point is to move forward in the direction of absolute deregulation of the insurance system. This means that each person will be able to choose their own social work as they wish. The goal is for the health care market to adjust its benefits and values ​​in line with commercial competition between prepaid and social services.

Another item on the libertarian agenda is the eventual establishment of the National Agency for the Evaluation of Health Technology (AGNET), which will evaluate the cost-effectiveness of medicines, practices, and devices used in healthcare. The aim is that both prepaid and obras sociales are required to cover only those treatments and practices that have a good balance between their cost and their effectiveness.

Filgueira Lima repeats with these sentences the same mode of operation of his entire political space: to reveal the enemy, to show that he has flaws and to say phrases that sound good for a television base, but do not stand up to the slightest analysis. At the same time, he says that the health care system in Argentina is working poorly, and this is true. But he prefers to find the source of all evil in a state that spends too much and regulates too much.

We are going to continue our analysis of your program, but on the basis of diametrically opposite assumptions: the state spends very little on the health of workers and that its regulation is put in the service of the interests of a certain business sector. community. We are not going to exhaust this topic in this note, but in the next note. But we don’t want to stop expecting that if health funds aren’t enough, it’s because of the political decisions that governments have made in recent years, guided by the prescriptions of the Washington Consensus of the 90s with Menem, or the benefit to private companies during the years of government. governments of Kirchner and Makrista. Until the current government is put in place to follow IMF guidance and Massa becomes the visible face of the adjustment.

In principle, the discussion about the State. Every year, Congress discusses the next year’s budget. Part of this amount is allocated to health care, and, to a lesser extent, to the social security system and private companies. This amount includes benefits, the purchase of medical equipment, medicines, infrastructure, salaries, special programs, etc.

Anyone who visits a medical center, a national hospital or a district chamber knows that there is a shortage of medicines, there are endless lines, there are not enough specialists, and the situation with the building is deplorable. Taking this into account, Filgueira Lima says that the huge budget allocated to public hospitals is lost in the bureaucracy, in the pockets of some corrupt official. According to him, the allocation of the initial budget is a way to subsidize the proposal (money is allocated that will not be used later); That is why he proposes to subsidize demand (give every patient a voucher when they are really sick), and that each person decides where to use this voucher. That is, a public hospital competes with a private clinic and that the quality of medical care (and the market, of course) is the criterion on the basis of which the patient decides to be treated in one place or another.

Filgueira Lima’s proposal is based on a fallacy, as libertarians like to say. Because while it’s true that hospitals lack everything, the problem is that the budget is much lower than it should be. The national health budget amounted to 1.2 trillion pesos across all lines (infrastructure, medical technology, salaries). Added to this was the 2023 Federal Health System Reconstruction Plan, which projected $26 billion, an investment of just $1,635 per person ($26 billion for the 16 million people served by the public system). This sounds like a lot of money, but let’s look at just a few examples of how much some common therapies and practices cost. A complete vaccination schedule costs about $1 million. Treatment for type II diabetes costs $136,000 a year, drugs for a person with HIV $504,000; mental illness treatment never drops below $250,000; breast cancer treatments cost $68 million a year, and lung cancer treatments nearly $9 million. Given these figures, and considering that 16 million people are served in the public sector, the budget does not seem so exorbitant. We do not consider here the purchase and maintenance of equipment, mobile phones and infrastructure.

Let’s analyze the shortcomings of the voucher system using the example of situations that have arisen in countries that apply the system in health and education, such as Chile, Sweden, New Zealand, South Korea or Denmark:

1. In a deregulated market, if vouchers do not cover the full cost of health care, working people may not be able to access services.
2. Faced with demand subsidies, private companies tend to raise the cost of consultations and treatments.
3. The voucher system combines and encourages the deregulation of competition, the impossibility of health planning, and the reduction of investment by companies in populations with less consumer power (small towns or poor areas).
4. Although Milea and Filgeria Lima don’t like it, the voucher system involves a much larger government bureaucracy to manage and control.

As for AGNET, which will evaluate the use of health technologies. What is Health Technology? Essentially, these are medicines, devices and medical procedures that are used in the healthcare system. The CT scanner, the ibuprofen pill, the mammogram are all healthcare technologies. You might as well have a free, safe and legal abortion at a public hospital. When confronted with a new health technology, an assessment needs to be made to decide whether it should be implemented in a social, economic and cultural context. The evaluation agency will be responsible for asking and answering whether new drugs or medical procedures are effective, safe, and cost-sustainable. Currently, the National Agency for Medicines, Food and Medical Technologies (ANMAT) is responsible for determining whether a drug is effective, safe and can be used in Argentina. AGNET will be in charge of determining ostensibly according to scientific criteria, but in reality it will be cost-effective if new medical technology does not make treatment more expensive. AGNET will have the power to determine that a drug is not covered by a mandatory health care plan or a basic public sector benefit basket, as specified in section 2 of the bill. Thus, even if ANMAT confirms that there are scientific criteria that allow the use of a new drug or technology, AGNET can exempt the state or social organizations from including them in benefits. Of course, this will not prevent any patient from accessing innovations in the private sector. Of course, any patient with money. The project leaves open the possibility of privatizing entire health sectors in line with the principle of universal health coverage.

The last point, referring to the libertarian idea of ​​subsidizing demand rather than supply, means not only an economic decision, but also a political decision in the field of health. Following WHO recommendations, health systems aim not only to help, but also to promote and protect health and prevent disease. That is, it is proposed to influence the causes of diseases so that people do not get sick. The economic and human costs of disease states are very high for people (the sick person sees that it affects his emotional, social, social and work life), for this reason the plans are implemented in such a way that the health system intervenes even when the person is not sick. In other words, budgeting for health care is a strategy to prevent suffering for individuals and populations, as well as to reduce the cost of possible treatment. For example, the promotion and prevention of HIV/AIDS is carried out to reduce the likelihood of infection transmission, which leads to an improvement in the quality of life of the population and, as we have seen, to a reduction in economic costs. On the contrary, the libertarian proposal to subsidize this proposal means that the health care system leaves people to fend for themselves, does not act on the causes of diseases, and makes them pay for treatment.

In general terms, La Libertad Avanza’s health care offering can be summarized as “every man for himself (pay for your own care)”. But in any case, the key question remains unresolved: what do we do with the healthcare system? In order to answer this question, propose and justify a transitional health care program with the control of medical centers by workers, a unified and high-quality state system, combined with state laboratories and the issuance of patents, and justify this program, we will analyze recent years. health systems under the governments of Néstor Kirchner, Cristina Fernandez, Mauricio Macri and Alberto Fernandez. We will focus on this issue in one of the future notes.

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