We welcome public recognition of the need to reform our healthcare system. We welcome, in addition, the terminology in which it is made, in terms of merging the three subsystems to strive for more efficient use of resources. Nationalization has not sparked anyone, for example, a specter that continues to cause confusion. But we need to start having a real public discussion on this topic.
Well, as I have argued for decades, the health reform we need involves a daunting political agreement with the participation of citizens, and of course all health actors, to arrive at incremental negotiations (not a magic and immediate consensus). But the problem should not be limited to confronting resource-focused companies (or, to put it plainly, money).
Understand it well, private, economic and political interests are part of the problem and they should be part of the negotiations. But the central axis should not pass from there, let alone precede even a formal proposal that does not yet exist.
The crux of the matter, sorry to remember, is health. Effective, timely and equitable access to health care for our people. How to modify some of the issues in our healthcare architecture, with their vices and virtues. It’s not about tweaking everything or forcing anything overnight.
The potential reform assumes the permanence of the three subsystems (public, private, and social business) but with greater clarification, which means progress in coordination and regulation (which is already in place in a partial and deeply flawed way), with the goal of strengthening your resources. The general idea is mutual benefit, not “zero-sum” competition.
To give a simple example: if one sector has an underutilized CT device and another sector has a professional trained in its use, then both will benefit from its supplement. But above all, and this is the most important, patients will benefit.
Of course, the change may mean adjusting some perks, but the ultimate goal should always be the patient’s health care, not the (viable) profit benefits of the company, union political representation, or even the terms of work of doctors and other health professionals.
This is all part and should be taken into consideration. But the purpose is health, and it is also understood not as a vague and laudable end goal, but rather as a complex process of healthy production, which must be permanently incorporated into the design of the desired reform and subsequent public policies.
Primary care, prevention, rehabilitation, medicines, surgical interventions, hospitalizations, medical specialties, etc., as the problem often does not go through a lack of resources, but through the efficient use of resources. The resources we already have, but they are scattered in a few shortages and wastes.
To be clear, we can take the argument to the extreme: Without shifting a single weight from its present location, many changes in management, logistics, control, monitoring, etc. can be made leading to increased efficiency.
Or put it the other way around: if resources are simply redistributed (and even increased) without modifying the healthcare structure, management strategy, and work culture, the same problems will multiply (and even get worse).
It should be striking that the trade union leadership of social work and businessmen in the private sector are taking a defensive stance, to demand money and defend their way of dealing with the epidemic, while recognizing the need to reform the system. Let’s talk about public health, then, not (only) economics and politics.
Ignacio Katz, MD (UBA)
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