Why is the Petro government so obsessed with health?

As this government enters its third year, its intention to modify the country's economic and political model is clear, distorting democratic rules and instilling activists and politicians allergic to corporate governance and solving real problems in state entities.

After two years of fiery speeches from the government and its coalition, Congress sank two bills seeking to overthrow the current health care system without presenting any serious studies or considering other analyses. In response to these failures, the Ministry and the Superintendency of Health conflated rules , interventions, and extreme control measures, and now they're issuing a decree to put an end to their task in a rude manner.

It's true that the system needed reforms, but nothing justifies its anti-technical dismantling, nor the resulting harm to patients. So why the obsession? Behind populist rhetoric, ideological reasons and political expediency emerge. See more: Health reform: lack of technical advice and other gaps in the project

They never accepted Social Security, nor do they want to accept it: Despite the fact that Colombia unsuccessfully attempted to organize a "National Health System" until 1990, leftist academics and politicians insist on a state-run health care model and dream of the Cuban system , ignoring the fact that Social Security has had an impact everywhere, including in Colombia, over the past 30 years. They can't believe that adjustments can be made to the current system without destroying it, or even that a transition process can be undertaken to minimize harm to millions of sick people. Since they don't like the house, they're demolishing it with the people inside.

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On the other hand, the project promoted and pursued by this government is that of a gigantic socialist state apparatus controlling everything, which renounces private initiative and the market. That is 'the change.' The spoils: Total health spending will exceed $100 billion by 2025 , which the ill-fated bills sought to ration. All the financial moves and interventions, plus the concentration of resources in a few hands, seem like a crusade to appropriate trillion-dollar contracts. In fact, the government already controls the funds and contracts of the EPSs that serve 62.5% of the population , and from the Ministry and the Superintendency of Health, they appoint interveners and boards of directors of their own accord, cut current contracts to initiate new ones, many of them direct, pay some suppliers but not others, and fail to purchase sufficient supplies and medicines.

Meanwhile, according to union data, some 3,500 private health insurance providers (IPS) and around 17,000 medical services were closed last year, while the sick are left in the lurch and their complaints are increasing. Difficulties with public funds have always existed , but now they are growing rapidly; even family members of public officials are demanding their resignations and pressuring oversight bodies to make new hires. Promoting a fair of favors and direct hiring leads to waste and the deaths of silent citizens.

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Who doubts the corruption in Colombia? But they don't understand, or don't want to understand, that putting billions in the hands of politicians and officials with little oversight, without seriously addressing corruption, will not improve the current healthcare system. As things stand, the time for complaining or highlighting the problems has passed. Unions and system actors, patient associations, and citizen oversight bodies have no other alternative than to file complaints and lawsuits directly against officials who abuse their positions and duties, who embezzle funds, or who openly misinterpret the law, and of course, against those deemed to be involved in or condoning corruption.

-Prioritizing certain populations improves their favorability: With Cuban advice and doctors, from 2003 to the present, the "Misión Barrio Adentro" (Barrio Adentro Mission) politically exploited health services and forced millions of Venezuelans to expect subsidies and services in exchange for votes. During the Petro administration, they replicated the Chavista model and launched the "Healthy Territories" program in 2012. According to their reports, this program developed "educational, promotional, preventive, and intervention actions in 85 areas of the city" and "activated and promoted community participation through the formation of social and community networks ." When Peñalosa took office, he dismantled the program and reported that it cost approximately $1 billion a day with appalling results. Furthermore, a large portion of its 8,000 contractors were not healthcare personnel or did not perform medical work.

Replicating "Healthy Territories," the Ministry of Health created the "Basic Health Equipment Program" in 2022 to finance it with the 5% it would have taken from the UPC. The Constitutional Court ruled that this program defunded the Basic Health Plan and warned that the Ministry did not present sufficient technical studies to justify it. Despite this, they set up 5,000 teams across the country, which by the end of 2024 would have employed some 80,000 contractors (10 times more than in Bogotá).

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In addition to the basic health functions they are supposed to perform, they register the population and carry out "other social interventions." This program is managed outside of insurance and the EPS, costs more than $2 billion, and appears to operate as a patch within the Promotion and Prevention programs. Finally, according to complaints, the government fails to adequately justify its expenses and there is opacity in its contracting. Given this background, it is hard to believe that it will not be used for electoral purposes.

-Healthcare as a gift, not a right: In 2015, the Statutory Health Law 1751 established that health care is a fundamental right. Furthermore, after years, Colombians have come to understand that they have rights, that they can demand them, and that they are filing lawsuits. It has been a long process that, although imperfect, continues. Now, with a grandiloquent discourse, the proposal is for the sick to "depend" on the authorizations of public officials. It is a 40-year setback in which they seek to exchange a fundamental right for "the will" of state employees and politicians.

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Who will complain when the same officials regulate, authorize, manage money, contract services, and police themselves in a context of high corruption? Who will control officials and administrations without independent oversight bodies, as is already evident? None of this is rhetorical, because if today, even without full control of the system, they fail to respond to the deterioration of services in intervened EPSs, or to the disaster of teachers' health, or to the lack of medicines, imagine the subjugation the country would be in when they achieve their goal . Not even the Cortes seem to be able to get stubborn officials to back down in the face of capricious increases in the UPC.

In short, controlling billions of dollars in resources and contracts at will, making citizens dependent on the will of officials and politicians, and registering the low-income population to modify their electoral favorability before 2026, explain the obsession with taking over the current Health System. FRANCISCO DE PAULA GÓMEZ, Expert in Public Health and Social Security