Thursday, April 19, 2007

The future of medicine in Venezuela

There is an interesting operation undertaken these days by the government, a frontal attack against private medicine. The reason is quite simple: the government is unable, absolutely unable to build a comprehensive health care system and the very relative success of private clinics is a slap in the face, a constant reminder to the government that it cannot provide the services that clinics, even in remote small towns like San Felipe, can provide. Oh, private clinics do not always offer a great service, but in Venezuela if you can afford it you get private health insurance and if you cannot afford it you will still try to visit private clinics for some ailments, even if you need to borrow money for that. The curse of public hospital treatment is one undertaken for major medical problems when, well, you have no other choice but wait for days or weeks on end until finally someone pays attention.

Now, in all fairness that situation predates the arrival of Chavez into office. After a definite great medical progress in the 50ies, 60ies and 70ies, the sate has failed to keep building on its previous successes. With the continuous population growth and health care costs increase (whether you are commie or neo-con, medicine is more expensive today) the governments cannot keep up. Chavismo is no exception. But, instead of speaking the truth to people, instead of explaining that medicine is an expensive argument and all should chip in according to their means (Canada or Western Europe style) Chavez has embarked on the legend that medicine should and can be excellent for all and completely free. This is a very dangerous myth that is already coming back to bite him in the rear, and the reason why now he thinks that putting his hand on the private medical system could be a palliative for his failure to build good hospitals, or attract good doctors.

Because the main failure of chavismo is that the best doctors either work for the private sector or leave the country. Indeed, there are many good doctors that still do help in the public sector, by teaching or consulting a few hours a week for a dismal pay, compensating on their private practice. But very few of those are willing to embark in the political misiones which are left at the mercy of the second rate Venezuelan medics and Cubans. The people know that, and in spite of 4 years of Barrio Adentro you still find a lot of humble people in the hallways of private institutions. When you read Miguel or Katy writing about the return of measles in Venezuela, you get a pretty good idea how bad things are really in some of these health misiones.

But this latest attack is not only ominous but also vile. The hook, to justify this to the hoi poloi, to make them believe that if the government were to take over private medicine all would have access to it, is that they charge too much and thus their prices should be regulated. If they do not accept regulation, the implication of course will be a takeover. And thus all the fancy clinic of Caracas would become public hospitals to be shown to the world as the creation of the bolivarian masquerade.

That private medicine is expensive is true. That it is exploitative is not true because, well, medics cannot charge what they would charge outside of Venezuela. First, the market cannot bear it, incomes in Venezuela simply cannot be compared to foreign incomes, courtesy of years of unrealistic monetary policies. Second, the proliferation of insurance companies has put a restraint on some of the fees charged by clinics. In fact, with my health insurance I am very aware that I pay less for treatment than what I would still pay in the US even with an insurance. If it seems expensive for me is because in real dollars my income is not even the one of a specialized US worker.

But there is something even more troublesome and yet untold here. When a government who now openly discriminates on political preferences, who has declared that the army should be socialist and only socialist, a few are wondering who will have access to these clinics once they get into chavismo hands. some even suspect that some clinics will be reserved for the dignitaries of the regime such as some Cuban hospitals where only the party crème de la crème can go.

Weil resumes very well in this cartoon, the idea that only members of the Unique socialist party that Chavez is creating, PSUV, will be the ones allowed into the nationalized clinics.



-The end-

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