The phrase “nothing is agreed until everything is agreed” is the one that best defines the present of Gustavo Petro’s health reform. This project still does not have a free hand in Congress to be approved, even if the Minister of the Interior, Alfonso Prada, has said that the agreement around it reaches 99%.
In fact, the future and security of health promoting entities (EPS) has been and is the point of contention that, in addition to the parties that make up the government coalition in the Legislative, is in the dialogues on the reform. The Ministry went on to say that it would eliminate them, then it would convert them into health providers and, after the reform was filed, they would continue but with only three functions. All gibberish.
Meanwhile, the cherry that was missing from the dessert was confirmed this Tuesday: the Liberal Party made the decision to depart from this reform, arguing that the conditions that they had raised since the beginning of the dialogues with Casa de Nariño “have not been reflected in writing a paper” and because they had not “managed to reconcile the lines that the party defends.”
A position that, although it was not made official, was an open secret that only those close to the director of that party, former president César Gaviria, knew about and that became visible with his absence at the meeting at Casa de Nariño last Monday. This was predicted by one of the speakers for the reform, who told EL COLOMBIANO that the 1% that Prada spoke of that is missing for the agreement was “a strong obstacle regarding whether the EPS are resource administrators or insurers. There was a strong bid.”
One of the articles that annoyed César Gaviria, and that has La U and conservatives pensive, is the one that states that the EPS “that are currently operating in the Health System will continue to do so for up to two years as long as they meet the conditions of permanence that applies to them”; it is in article 141. And there is another that says that those that “do not become Health and Life Management Entities must attend to and solve the requests of their users until they are liquidated.”
With this rejection, the National Government loses fundamental support in Congress, which, in white silver, translates into 13 votes in the Senate and 33 in the Chamber (of which there are four in the commission that studies the reform texts that have been settled).
What touched the EPS?
The presidents of the main associations of the EPS, Acemi and Gestarsalud, coincided this Tuesday in a forum on this reform organized by the Comptroller General of the Republic. There, both raised their main concerns about the articles of the Executive.
In the first place, they exposed resource management and financial risk management; on the other hand, the functions of health insurance and, likewise, the conformation of the networks of health service providers.
In this regard, the president of Acemi, Paula Acosta, said that “the bill does not take risk management into account, this will generate a large contingency for the nation that could end up as ‘black September’ (a phenomenon that occurred before Law 100 in which the annual budget for hospitals ended in September)”.
Likewise, the director of Gestarsalud, Carmen Eugenia Dávila, stated that “between 1975 and the late 1980s, a national health system was established for poor people and it did poorly for that population and for the vulnerable, now they argue that return what was wrong and continues to be wrong in front of the paying funds ”.
In fact, former President César Gaviria, in the statement that made it official that they were getting off that project, explained that the positions that, for him, were not addressed are the strengthening of insurance, the presence of the private sector, freedom of choice and avoiding inadequate financial risk management. Aspects in which the EPS play a fundamental role.
To these arguments, the professor of economics and health expert at the Universidad del Rosario, Paúl Rodríguez, adds that “the central point was the management of ADRES resources and ensuring that the resources are maintained so that there is someone else who order to review them”, as well as the famous regional health councils and the risk of corruption and politicization that their creation could entail. “The question is how bureaucratic these councils can be, which also had to be in a certain way,” Rodríguez added.
And now what with the project?
Undoubtedly, the fact that former President Gaviria and the Liberal Party move away from this reform attempt by the Government of Gustavo Petro is a blow to the president, to Minister Carolina Corcho and to the Historical Pact, for which reason the Executive will have a calculator in hand. and attached to the saints so that the Conservative and La U parties do not take the same path.
Until now, these collectivities have not made a decision. The president of the conservatives, Efraín Cepeda, said that they will decide what to do when they deliver the text of the paper; while representative Gerardo Yepes added that “each party has independence and the Liberal Party does not speak for everyone.”
On the sides of La U, its president, Dilian Francisca, stated that “it is a decision of the president (Gaviria) and I respect it. I made a commitment with the president (Petro) to wait for the articles so that the agreements are embodied and then define it”.
Without going any further, the relationship between the president and his coalition in the Legislature is further distanced and governability, until now, has been the price that President Petro has had to pay for keeping Carolina Corcho in the Ministry of Health.