On the edge of the cliff | THE COUNTRY America Colombia

Of the many bad weeks of these two years, the one that just happened was the worst, due to the final collapse of the health system. It means the triumph of incompetence over diligence, of ignorance over analysis, of arrogance over service to the public, of irresponsibility over seriousness, of chaos over order. The health of 50 million Colombians remains in the wrong hands. How do we get here?

1. Silver started…

Of the many bad weeks of these two years, the one that just happened was the worst, due to the final collapse of the health system. It means the triumph of incompetence over diligence, of ignorance over analysis, of arrogance over service to the public, of irresponsibility over seriousness, of chaos over order. The health of 50 million Colombians remains in the wrong hands. How do we get here?

1. Money began to be lacking some time ago in the health system, because the judges and the Constitutional Court, and some Minister of Health who was more generous than rigorous, decided that all treatments (or almost all), and all medications ( or almost all), had to be covered by the system.

2. Furthermore, there should be no difference between those who paid (contributory system) and those who did not (subsidized).

3. The system was a victim of its own success, since in the last 20 years the demand for services per inhabitant increased almost 40%, that is, the frequency of use by each Colombian. People trusted the system, and it had a good reputation. The consequence was an excess of demand that skyrocketed costs versus what had been planned.

4. Since the beginning of the century the population began to age more rapidly and to live longer than what demographers contemplated. With fewer young people and older people, the system revealed that the increasing costs could not be met with the contemplated contributions. The event was covered with taxes.

5. Then the problem of invoice validation arose, delays in the recognition of treatments actually performed, from which a good part of the cash problems of insurers (EPS) and providers (IPS) arose.

6. In health, unlike other sectors, technological change, instead of lowering costs, increased them. In particular, new medications more than surgeries or other technologies. As a result of intellectual property, new drugs against cancer, Alzheimer’s, etc., have increased the cost of health around the world. Since the judges decided to give everything to everyone, this resulted in financial unsustainability.

This is where the health system was when the current Government arrived. The animosity with a system that combined private and public agents led the Government to make a series of poor decisions:

a) The amount of payment per member for the EPS did not increase. The most conservative calculations show that the increase with the 2022 inflation rate was at least five percentage points less than that of health costs.

b) Did not make payments of the so-called “Maximum Budgets” (PM, a small additional amount per EPS member to cover services not covered by the benefit plan); until the Constitutional Court ordered to do so, in October 2023. Even then, the Government did not pay the full amount owed.

c) Withheld money owed to the EPS, especially for payments and services provided during the COVID emergency.

d) Reassigned many patients with chronic diseases to the best EPS (Salud Total, Sanitas and Sura), substantially increasing their cost, without increasing resources.

e) Made a sudden cessation of attention to systemic problems that have arisen since the pandemic, such as high-cost surgeries, procedures and treatments.

With this series of actions, the final blow was given to the health system. Believing, as the Government does, that removing the EPS solves the underlying problems is wrong. Without the EPS, other problems appear.

The burden of costs disappears and a period of inflation in the prices of treatments and medications is entered, without any agent exercising control. It would be like removing the Bank of the Republic and praying that inflation does not suffocate us. The audit of 15% of the benefits will be carried out by the Administrator of the Resources of the General Health Social Security System (Adres), which surpasses that entity; the remaining 85% will remain without audit.

Fiscal control must be carried out by each mayor (of which there are 1,120, the majority without capacity for this purpose), the governor or who knows who. In Colombia, at the end of 2023, around 1.1 billion health services were provided per year (around three million per day). Who is going to audit them and verify that they were actually services provided? If the reader imagines that corruption of biblical proportions could arise there, he is correct.

The real person responsible for the patients’ health disappears. The patient associations themselves ask that: Who are we going to complain to now? The obligations that fell on the EPS will be diluted among a web of public organizations and employees, without anyone responding, as is currently the case with the health of teachers; As people’s health deteriorates, medicines will not appear, which is the first time in 30 years, and treatments will not be provided.

The fiscal risk for taxpayers in the next five to ten years could be enormous. In the United States, the richest nation on earth and in history, they do not pretend that everyone should be covered for everything, against a public fund. There they know that this is unsustainable. It would have the consequence of sucking from companies and families an amount of savings, which is what the economy works and grows with. Something similar happens with pensions. There they do not intend to have a public system that pays everyone a pension, as it is unviable, even if the shortfalls are covered with taxes. There would be a risk of drowning households and companies with taxes.

These two systems, health and pensions, which are meritorious from the point of view of social justice, poorly designed would undermine the payment capacity of families, companies and the nation as a whole.

The economy would stagnate and be pushed into a vicious cycle of not growing, losing even more ability to pay, increasing debt, undermining the incentive to create wealth, trapped in those payments, ergo not growing, and so on.

That is the true definition of both fiscal and economic unsustainability, of the country as a whole. This is what they tried to avoid in Colombia in 2011 when Congress approved the constitutional reform of fiscal sustainability. The Petro Government’s health and pension reforms fail to meet that condition. Not even the richest nation on earth imposes explosive cost conditions on itself.

Why does Colombia believe it can do it? Due to lack of thinking through the problems and lack of telling each other the truth. For thinking with desire and not with your head.

You reach the edge of the economic precipice when you ask an entity, a person, a family, a company or a State for something that they physically and economically cannot provide. Pay: health + medicines + pension + free university + free housing + a 10-hectare property if you are a farmer + one money per month per child + one money per month per adult + one money for criminals, let’s see if they stop that + urban transportation free + free SOAT + free electricity + free water + whatever we can think of because this country is very unfair.

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