* The difficulties of consensus
* A sea of tax contradictions
Congress is facing one of the main challenges of recent years. There are five projects to reform the health system already established: the initiative of governmental origin, the one promoted by three parties of its coalition (liberals, conservatives and La U), those presented by the independent and opposition sectors (Cambio Radical and Centro Democratic) and a fifth supported by some patient associations.
Despite the great differences between these initiatives, there are nevertheless some coincidences that could well serve as the basis for consensus, if this practice is really going to be used and the prevailing ideology is to be abandoned. In the explanatory statements of the different initiatives there is an apparent agreement regarding the need to introduce adjustments to the health insurance and care model in Colombia. It is no secret to anyone that preventive care must be made viable, improve efficiency in peripheral areas, collect information on the financial situation of the public hospital and emergency services, and achieve greater controls on the use of the budgets of the contributory and subsidized regimes. It is also clear that the majority have alerts on the bureaucratization proposed by the government and the danger of clientelization of the system.
On the other hand, various initiatives agree that it is necessary to emphasize the role of family and community medicine; bring the user care network closer through basic care centers; find expeditious mechanisms for access to specialists and highly complex medicines; review the direct transfer of resources to the network of clinics and hospitals; automatically liquidate entities that do not make efficient and transparent use of the budget; eliminate the differences between the service plans of the subsidized and contributory regimes; focus the action on the most vulnerable population groups; dignify the employment situation of medical personnel and even create a kind of fund-account that responds for debts to service providers in case of delays or serious contingencies in their recognition… Moreover, although they have different denominations in the projects , there are instances of execution, surveillance, sanctions and similar decision-making.
Now, there are also drastic and very marked differences between the five proposals. The first of these is that while Minister Carolina Corcho’s project aims to demolish the current model and implement a new structure, most of the other initiatives start from “building on what has been built.” In other words, maintaining the scaffolding of a system that has matured after three decades but applying fundamental corrective measures to the weaknesses and shortcomings already noted. Secondly, while the government project opts for a model with state pre-eminence in all its structures and creates multiple instances of decision (between technical and political) at the national, departmental and municipal level, the other initiatives maintain the scheme of free choice of the user between public, private or mixed institutions, without fragmenting or bureaucratizing the financial flow or decision-making.
In this sense, finding a middle ground between two perspectives that at first sight are diametrically opposed is not easy. Even more so when the main obligation is to project an efficient, coherent, functional health system in its governance scheme, financially balanced and, above all, capable of reaching any corner of the country and any stratum with quality and timely care.
This is precisely where a commitment from Congress is required to guarantee not only the broadest and most participatory debate possible, but also avoid the risk of limiting the discussions. On the contrary, public hearings, regional forums, reception of studies and the criteria of the experts have to mark the debates in commissions and plenary sessions. All voices must be heard. And above all, land the proposals in their fiscal aspect.
In an issue of such implication for each and every one of the Colombians, a vote to the letter cannot be allowed. Each senator and representative to the Chamber must be aware that any decision, however small it may seem, will imply an element that will impact, for better or worse, the exercise of a fundamental right such as health for 50 million compatriots, as well as the guarantee of the principal of all, that of life. A discussion, moreover, that must begin with the costs of the reform, which up to now has been sailing in a sea of contradictions.