Wednesday, July 10, 2013

In Snowden less news: murder of a fireman and nationalization of Venezuelan medicine

As if the regime hadn't enough fronts open, it has decided to control the prices of the medical services offered by private clinics. And the insurance companies promptly approved saying that they will only honor the nominal prices. And yet this only hides the deep failure of the health system that the regime started to improvise for electoral purposes since 2003. The public system being such a failure, everyone tries desperately to get a private insurance so as to go to private clinics that work much better than the public sector even though much is to be criticized with them. The regime is upset and shoots the messenger, by bankrupting this one. It is that simple.

Controlling prices of private clinics in Venezuela at this point is an absurd. They are overworked. They are underpaid. Insurances companies, in particular the ones associated with the government public employees delay their considerable payments, if they even honor them (which has pushed many clinics on the verge of bankruptcy to suspend certain insurers and their patients, until the bill is paid). The result is that now private sector clinics look more and more like public hospitals used to look a few years ago, before Chavez was elected first.

In addition a high inflation and a scarcity of imports have hampered the daily operations. For example among the restricted imports there are plenty of medical kits and medicines. We learned, to pick one, that analytic labs, upon which most diagnostics depend, are working at half speed. Even basics, such as needles and the specific test tubes to collect blood samples for the different analysis are hard to come by.

The public sector is even worse. Hospitals are full of people in line because, simply put, they are waiting for hours, days and even weeks, for a doctor to show up or for an O.R. to open, or a machine to be fixed for a diagnostic. If the private clinics are overcrowded with people that are willing to bankrupt themselves it is because these people know quite well that if they wait for a putative turn at some hospital they probably die in the wait or reach the doctor much sicker than when they arrived.

Such a situation has broken down any ethic in the medical sector, from private clinics refusing to attend emergencies of the uninsured, to public hospitals with absentee personnel, when they are not satisfying themselves by sitting down with the patients because they do not even have what is needed for attending the most basic emergencies.

The latest scandal was the death this week of Caracas Firemen chief who had an accident on his motor bike, and was then taken to a private clinic but whose insurance did not approve entry!  Yes, the Caracas public fireman was on a private insurance. When that happened his relatives and friends had no other choice but to take him to a state hospital. They had the poor guy wait for several hours until they finally an O.R. was available. But it was too little and too late and the guy died in the elevator on the way to the O.R.

Reading the full account of the story can only bring tears to your eyes. Caracas firemen who should be heroes like it happens in other country are without "ambulances, nor insurance or paychecks".

The clinic, not to excuse them at all, rejected the victim. The reason was that the insurance did not clear because the government did a bad paper work job at switching the insurance companies, when putting the firemen of Caracas under a new insurance that covered them less, a ridiculous amount I would dare to say considering how dangerous is the firemen work. Not only that, but we read that the new insurance would be allowed to use some of the workers benefit to pay extensive bills, something that is illegal in the labor law of Venezuela so proudly dictated by Chavez for his reelection. But in a fascist regime such subtleties are simply ignored.

The victim could not be taken speedily to any health center because 54 out of 60 of the fire station ambulances are out of order. 54!

Of course, the regime has started "investigating" the clinic that refused service while Caracas mayor office went to close it finding a whole bunch of irregularities that his office should have detected years ago!!!!! And suddenly a long sleeping law on firemen service has been dusted off and sent in rush to the Nazional Assembly floor. No word on whether the public hospital delay of 6 hours to attend the victim will be investigated.
Can you expect anything good from that?

The hypocrisy of the regime on the health system debacle is simply staggering. The new health minister, Isabel Iturria, is a mere hack, maybe a true criminal, spending her time attacking the private sector of medicine to hide the colossal failure of the public sector that she inherited two months ago from another criminal, Eugenia Sader. While at the same time fudging statistics to hide the real number of AH1N1 cases and deaths in the country. After all official statistics in Venezuela, reported merrily by international organizations that cannot be bothered in checking them, aim to make the world believe that this hell is paradise. Paradise lost, indeed!


Added later: I realize that a casual reader may not know how the Venezuelan health care system works.

The public sector, the one where supposedly health care is free, includes two systems. The old one composed of public hospitals and "dispensarios" created before Chavez and never probably taken care of under Chavez, unless it is a hospital that his administration built or rebuilt, a tiny minority in spite of all the propaganda. And the parallel health system, created starting 2003 under Cuban directives. This one includes the famous to now infamous Barrio Adentro and the CDI which are mini hospitals of sorts. Corruption ridden this parallel system is simply unmanageable, contradicts too often the hospital system and is for all practical purposes working at half speed these days with maybe as much as half of the small Barrio Adentro modules closed. The public hospital system is so neglected that patients are routinely asked to bring even the bed sheets for the patients, and to have a relative spend the night so that the patient is not robbed of his medicine, food and health items (the fireman of the tale above was stolen of his belongings while he was laying on the pavement in the wait for an ambulance). Often surgeries are performed only after the patient ha provided a certain numbers of items from gauze to medication.

The private health sector in Venezuela range from small hospitals to major facilities but are all called "clinicas" or some related term, as the word hospital is reserved for the public sector.  It benefited of a steady grow and the best doctors until Chavez came to office. Since then many, too many of the brightest have emigrated. Meanwhile the developing insurance sector, propelled by by the willingness of people to fork big money to access proper heath care denied to them at public facilities has made the private sector which has stopped building major facilities, go from a resort like atmosphere in the 90ies to a crowded, noisy, even dirty public hospital feel of the same 90ies. Yet, the care dispensed there is sought, willing paid and still manages a decent quality considering all the impediments experienced. Refusal of care at emergency is still rather an exception than the rule though in smaller centers like the one the fireman was taken too it seems that such experiences are not unusual for the simple reason that they have no means, that all their emergency beds are taken all the time.


  1. Boludo Tejano12:17 PM

    Chavismo tells us that private health care is vastly inferior to public health care. So wouldn't the proper response to leave private health care alone to “twist slowly, slowly in the wind?”

  2. Justin1:19 PM

    I'm an American. I went to a public hospital in Merida, Venezuela called Hospital Sor Juana Inés de La Cruz around 10 o'clock at night for dehydration and diarrhea. I waited about 15 minutes to see a doctor which I thought was amazing at how quickly that was. There were about 10 patients in the ER, but I was given my own bed. No one spoke English and I didn't speak Spanish so my friend had to translate. At one point I swear there were 5 doctors around me just because I was an American. There were people waiting to be treated. At the ER they gave me 2 bags of fluid, a blood test, a stool test, and a medicine to calm me down. The entire time sitting there I was thinking how is God's name am I going to be able to pay for this. In the States where I have insurance an ER visit copay is $100 let alone an entire bill without insurance. When I left I asked do you accept credit cards? They looked me all confused and said it was free. I was shocked.

    1. There are areas that work better. Some hospitals are directly into the hands of the government and some are managed by local authorities. In general, certainly not always, health centers managed by local authorities tend to function better than the ones managed from the government itself.

      For example, the San Felipe hospital was one of the worst in the country until three years ago. Now, the new chavista governor put a lot of work in it and it is starting to be semi functional again. I would not mind being treated there if I had too. However, I see many CDI or Barrio Adentro modules that used to be open until a couple of years ago that are now closed. That is the problem, the lack of coordination, the apparent refusal to integrate the whole system where one hospital would control a few CDI who in turn would control a dozen modules that would act for very basic care and as a triage of sorts to send people to a CDI or a hospital according to the need and the services offered.

      Another case is Miranda. When Capriles was elected first, the regime took away all of Miranda health system. Capriles rebuilt one, albeit smaller for lack of resources and it is my understanding that it is working much better than the ones taken over by the regime. Also in Chacao which is the wealthiest of Venezuela district, they have enough income for a "salud Chacao" who gets people from all over Caracas while the regime is actively trying to sabotage it. Compare Salud Chacao with the government managed hospitals in Caracas and you will understand what I wrote.

      By the way, when was your Merida visit?

    2. Justin3:22 PM

      Last June 2012 was the hospital visit, but I was there in January 2013 as well but no hospital visit.

    3. You may be surprised at how degraded things became in one year.

  3. Anonymous2:02 PM

    I fear that this will soon happen in the US with the destruction of the healthcare system due to Obamacare.

    1. Trust me on that one: you are ways away from such a fate.

    2. NorskeDiv9:03 PM

      Exactly, Obama regulating profits of insurance companies and insuring 85% of premiums are spent on healthcare /= communism!

      You can have principled disagreements with healthcare reform, but equating it to Chavez just shows you're clueless. If anything, it makes it more possible for some Chavez type to come along in the future since who will believe those who already cried wolf once?

  4. The hospital says in their website that patients can pay in cash or check: Formas de pago aceptadas por Hospital Sor Juana Ines de la Cruz:
    Efectivo | Cheques
    Justin was lucky. Actually, luck does play a big role in medical attention. It depends on the quality of the human component. Merida has always been a pretty civilized place.

    1. And sometimes foreigners get a free pass, not only in Venezuela. A friend of mine once had a filling fall while in Paris. An expensive looking dentist patched it up for free telling her he wanted her to enjoy her trip and have a good impression of France. She had to have the full work back in the States but at least she could keep eating her way through her trip.

      Thanks for inquiring into the hospital cash policies, by the way.


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