Bogotá — The health reform in Colombia has already begun its process in Congress, but the country continues to debate whether it actually proposes an improvement for the model or if, on the contrary, what it does is revive the failed model of the disappeared Colombian Institute of Social Security.
President Gustavo Petro, and his Minister of Health, Carolina Corcho, have emphasized that “health will cease to be a business and it will be a right”, or that “there will no longer be clients but people”, however, criticism of the project suggests that this scenario that the Government ensures will not be fulfilled if the current project is approved.
“The established health reform establishes how to guarantee the right fundamental that established the statutory law, reforms the “how” of law 100 of 1993, 1122 of 2009 and 1438 of 2011, therefore, it is clearly an ordinary law”, says Minister Corcho.
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However, his predecessor Fernando Ruiz, assures that the reform as it is proposed ends with health insurance, and warns that it can trigger a return to a model very similar to Social Security.
What was Social Security?
Law 90 of 1946 created the Colombian Institute of Social Security to provide social security services in health to workers in the private sector. The Institute, officially inaugurated on June 19, 1948, began to provide services for non-occupational diseases and maternity in 1949.
In the first decade, the ISS focused on its consolidation and geographic expansion. In the 1960s, the coverage of covered risks was expanded: compulsory insurance for accidents at work and occupational diseases (1964) and old age, disability and death (1967).
The 1970s saw important regulations and modifications, among which it is worth highlighting Decree 770 of April 30, 1975, which regulated the General Illness and Maternity Insurance and established a first system of expansion of family coverage for the medical care benefit for the family of affiliate and Decree 1650 of 1977 that determined the regime and administration of mandatory social security.
The 1980s were characterized by a crisis situation: externally, deficiency in the provision of health services; supply shortages; mistrust in the management of economic resources and financial decline of the entity. Internally, excess regulation, but with operational problems and a lack of uniform instruments for administrative development.
Law 100 in the 90s
With the previous panorama, the Political Constitution of 1991 (Art 48) and Law 100 of 1993 were reached. The Political Constitution defines social security as a service compulsory public service that must be guaranteed to all citizens and provided by public or private entities.
For its part, Law 100 of 1993 creates a comprehensive social security solidarity system that allows for the expansion of both pension and health coverage to the country’s poor population and, additionally, creates the private pension system and the minimum pension guarantee. .
In Law 100 of 1993 Other important efforts were made to curb the growth of pension liabilities that had been accumulating rapidlyboth for workers in the private sector and the public sector.
Indeed, the contribution rate was increased considerably (from 6.5% to 13.5% in 1996), after which employees and public entities that did not contribute began to contribute, and it was guaranteed that the ISS reserves were placed at interest rates market. All these measures contributed to stopping the increase in the global actuarial deficit of the system.
However, the model did not survive and, questioned by acts of corruption and doubts about the management of resources, it was opted for its liquidation.
Back to Social Security?
Fernando Ruiz, former Minister of Health during the government of Iván Duque, is one of the biggest critics of the reform and maintains that eliminating health insurance is a mistake.
“A system without insurance. How does it work? At this time, for each Colombian, $1.2 million a year is paid for health. That is little money. A cancer treatment costs between $30 million and $300 million. What the EPS does is take the money from everyone who contributes and invest it in the sick person. All this is called insurance and that is what we are going to lose with the Health Reform. Each one is going to confront the State, the Government and look to see how they get attention. We are going to return to a system very similar to the one from the 90s, an inequitable system with the poor on one side and the rich on the other. The poor will end up lining up at the CAP waiting for a file to be seen while the rest, those who can, will pay for prepaid medicine, which after the reform will surely be more expensive,” said Fernando Ruiz, former Minister of Health and Social Protection.
It is also the position of one of the main leaders of one of the opposition parties in Colombia. “The health reform presented yesterday is not that of ‘change’, it is that of the past. It is a return to the failed and corrupt Social Security of three decades ago,” said David Luna, a senator for the Cambio Radical party.
“Petro has a very difficult time on the health side. According to recent surveys, 72% of people in Colombia have a good or very good opinion of the health system. Let’s be honest, how the health system worked during the pandemic was a success, better than in Spain, Italy or Peru, let alone Venezuela or Cuba. Here what you have to do is focus the fights on where they should go, this battle is won in the Senate by making the Liberal parties understand, Conservative and from La U that if they are accomplices in the destruction of the national health system they will see punishment in the next elections. For the traditional parties to approve this outrage with which they are returning us to the old Social Security, I don’t understand who over 40 can agree with this. Before, she either had money or died of appendicitis because there was no way to get a doctor to see her. Law 100 was approved under the Gaviria government, I refuse to believe that César Gaviria is so selfish and wants to destroy his political legacy, ”said Alberto Bernal’s financial analyst.
“Social Security, which I defend for some things, was very good for critical cases, but on a day-to-day basis it was very inefficient and, furthermore, a source of corruption. They called me from Chile because they had spent the Atlantic Social Security budget for a year, in a month. I know what corruption is in health because I am terrified of that repeating itself,” said Cecilia López, Minister of Agriculture and former director of National Planning in an interview with RCN.