From PNHP Annual Fall Meeting, November 11, 2002, Philadelphia, PA
Speech of Dr. Carlos Trotta, MD
Argentina has a population of 37 million people living in a geographic area ten times larger than Japan’s. Argentina posted a trade surplus of 12 billion dollars in the first nine months of 2002.
Oil exports produces 6 billion dollars annually, but the rent thus generated is almost totally captured by the banks and financial institutions, by foreign oil companies, and by private firms. The money does not go toward social causes.
Our country has closely followed the demands of the World Bank and of the International Monetary Fund who have called us…“ their best pupil ” The IMF has forced privatization. In Argentina the national oil company, the national air lines, the water, the railways, the river and sea fleets, the telephones and the retirement contributions were all sold and became private enterprises. The result has almost bankrupted my country and has had a profound impact on our social, economical, educational and health areas.
Even after following the IMF advice, our present gross domestic product of 140 billion dollars is 23% lower than that of 1975 and has a foreign debt that consumes 23% of next year’s budget only for paying interests, not capital.
Our country produces enough food for 300 million inhabitants The agricultural sector exports 9 billion dollars coming from more than 23 million hectares of soybean, corn, wheat and sunflower. It annually exports 300 million dollars of beef.
Yet 53 % of our inhabitants live under the poverty line and 25% are indigent that is to say that in their homes the income is not enough to cover the minimum basic protein and nutrition needs.
Seven out of ten children in Argentina are poor.
These figures are greatly unfair for a country that produces and exports foods. They clearly show the consequences of a failed economic model.
We consider it a planned genocide because nothing, except a political decision, justifies that children’s mortality be 16 per 1000 (in Cuba it is 6 per thousand). In the province of Corrientes, it goes up to 30 per thousand.
The Argentine Pediatrics Association considers that 60% of this problem is due to avoidable reasons. More than 13 % of infants born in public institutions weigh less than 2.5 kilograms as compared to Sweden where the rate is less than 3% of newborns.
Cases of measles climbed nationally from 0 to 9,469 cases between 1996 and 1998.
Pathologies like dengue, malaria, leishmaniasis, trichinosis, Hantaan virus, typhus and tuberculosis have re-emerged or increased (the latter having increased 25% between 1995 and 2000 in the city of Buenos Aires).
It is getting more and more difficult to follow a proper treatment in chronic diseases due to the increasing cost of drugs
Life expectancy in Buenos Aires and outskirts, where 40% of the Argentine population lives is going backwards during the last ten years and has dropped 3%in males and 7%in females.
There has been an increase in family and social violence (the number of homicides has doubled during the last decade in Buenos Aires Province).
The suicide rate in teenagers has grown from 30 per 10,000 in 1991 to 64 per 10,000 in the year 2000.
It has been calculated that, daily, 40,000 people go through the garbage bins searching for food or for elements to recycle in the city of Buenos Aires.
The richer 10% of the population in Buenos Aires city earns 26 times more than the poorest 10%. In the 1970’s this difference, in Argentina, was only ten times greater.
Within this context and in opposition to what would be reasonable to expect from the government. It has not strengthened the social network; it has deserted its constitutional role of health warranter and its response is to lower the health budget (from 8% in 1996, to 6 % in the next year). Total health expenditures fell from 650 dollars per person per year in 1997 to 184 dollars per person per year in 2002 yielding to the pressure of multilateral lending agencies that demand contraction of public expenditures, control of monetary expansion and reform of the state itself which in the health sector means the gradual adoption of managed care tactics (Iriart, Merhy and Waitzkin).
These demands find a fragmented health sector, with strong inner struggles about distribution. This makes it specially vulnerable to these pressures.
We have neither a national health service nor a health insurance system
In Argentina the health sector is composed of three main subsectors-public, private and social security- that have been sequentially reformed wanting to impose an administrative financial logic, that is to say, new actors (i.e. insurance companies and other intermediaries), new forms of contracting (shift from a fee-for-system basis to a capitation-based system that concentrates the risk in the provider organization), and greater role of the private subsector.
The public subsector is financed by the government and provides services through the public network (public hospitals and community health centers) irrationally fragmented in municipal, provincial and national jurisdictions. After a prolonged process, many hospitals were decentralized in 1991 to force them into a self financial management.
The social security plans consist of a system of compulsory social insurance with financing coming from employer and employee. The government is expediting deregulation of the sector to foster competition between the social security plans and private (prepaid) health insurance companies. It only guarantees a basic benefit package.
The private subsector has two main sub-groups a) professionals who provide independent care services to members of the security plans and
b) health care facilities contracted by social security.
The abrupt and generalized empoverishment that Argentina is suffering as a consequence of these policies has had a negative repercussion on each of the previously named subsectors. The crisis generated by the policies of financial capitalism has spared nobody.
Nearly five million people have lost their social security as a consequence of the high rate of unemployment (already reaching 22 %) and to the fact that 40% of the people who receive a salary do not contribute to the system.
Private medicine has lost more than 12% of the subscribers or members since the beginning of the year 2000 and 20% have switched to less expensive plans.
More than 50% of the population goes to public state hospitals which are overcrowded. The State, trying to fulfill the obligation of managing them with the scanty budget imposed by the already mentioned economical policies has left the hospitals lacking medicines and the most simple things needed for the care of patients, even those as elementary as gloves and sponges.
There are long waiting lists of patients to be treated or operated on. Some of them do not even get to the hospital. They are admitted through the emergency room very late in the evolution of their problems with a lousy physical condition.
Doctors have already denounced our shortages before our judges and courts and even at the international level and some of our patients have died while waiting.
Obviously the physician a worker whose only asset is himself, suffers the consequences. He feels overwhelmed when facing the social and health problems brought to him by his patients. He must divide his time working exhaustingly in different subsectors to increase his income – in the city of La Plata, Capital of Buenos Aires Province, the most densely populated of the country, the average income collected from social security (which represents 80 % of its income) is 170 dollars. It is economically difficult (or should we say impossible) to keep updated going to meetings or buying didactic materials.
Generally physicians feels alienated- others decide how to treat their patients, and they do it with a strict criterion of profit. Physicians are frustrated because of our inability to provide proper care for our patients.
As I said before the government responses are not sanitary but only financial: reduction of costs, fiscal regulation, and a more or less hidden privatization.
I want to clarify what we understand by privatization:.
Even though , generally speaking, the word “privatization” refers to the selling or concession of some state enterprises to the private sector, we consider it a much broader phenomenon. We understand the word as meaning the process by means of which the logic of profit gets into the public field affecting its essence of property, provision or financing.
During the meeting that took place in Islas Baleares, Spain, in May this year debating public health, a final declaration was issued and one of its points says that the disassembling and privatization of public health systems are being applied by means of strategies disguised as apparently neutral proposals , like those of separating financing from provision and care making the health centers become enterprises, diversifying insurance or increasing the participation of the private sector . T heir aim is to divide and make private the most profitable areas of public health systems. This strategy known as public/private mix has shown an increase in inequality in every country where it has been applied, but mostly in Latin American countries. Our National States, very weakened by the neoliberal model are not able to minimally regulate the public/ private mix.
We believe that the public hospital which is deeply rooted in Argentina is the pet target of these policies and it is being submitted to a slow, silent and tortuous process of transformation through the lack of financing, the emptying, the outsourcing of services, the loss of prestige, and the flexibility of the contracts for health workers.
We center our action here, in the public hospital, but we realize that our resistance can only grow if we join with the other resistance demonstrations of our citizens.
In Argentina we have more than enough experience with this kind of neoliberal privatizing policies and their consequences in the social and health areas. That’s why resistance in Argentina is greater and a mobilized community expresses its rejection in various and creative manners.
We believe that the multiplicity of insurance plans which comes next in the agenda is a rather crude instrument for matching health care services with individual health care needs.
The group I belong to -CICOP- represents more than 60 public hospitals and community health centers and it has 8,000 professionals associated in Buenos Aires Province.
We understand that what is happening to health is part of a much greater package: the social area; that what is happening to us, health workers, is not disconnected from what is happening to other sectors of our community and that is why our fight must not be limited to the hospital or to the professionals.
We need the community in our fight to keep health as a right and they need us.
Every Monday, our professional union, has meetings with neighbors of our city. We make rounds inside the hospital showing them how patients are living, the precarious condition the hospital is in, and the working condition of the rest of the personnel and staff.
And they mobilize with us on the streets, and we claim for our rights in front of the Town Hall, in public hearings and we also caught the Health Secretary of State when he was trying to escape through a lateral door after visiting the hospital.
With them we occupied the hospital pharmacy claiming for the medicines that were not given to the patients because of absurd bureaucratic reasons.
Also with them we made a human chain of arms and we surrounded the hospital building in a symbolic embrace.
We get together with people from the university- for us public education and public health go hand in hand- hoping that working together our city can have its own plant to make cheaper medicines for all the population that needs them.
And we know that if our people, you and I, are not pressing them altogether, the resistance of the pharmaceutical companies will stop the project.
Every Saturday afternoon we also have meetings with assemblies of different neighborhoods to work in a health plan which includes new ways of participation, including community health educators and health councils of neighbors.
Every Saturday at 9 a.m.. we have a space on the radio, and we try to have the health subject permanently on the air and on the city agenda wanting to get a public discussion of our next budget.
We made stickers to place in every car that enters the hospital. We give away fliers. We have put signs in strategic places of the city and in football stadiums opposing privatization and support public health.
We have a web site on internet (www. elhospitalregional.com.ar)
We have taken our hospital case to our courts and we had a favourable verdict.
We have asked the students of architecture to collaborate in improving some areas of the hospital and the art students of Escuela de Artes Visuales (Art School) to paint allegoric murals on the walls of the central hall and of the emergency room.
Finally and not wanting to be boring, we got together with all the organizations in a Social Forum for Health that has just taken place at the School of Medicine in Buenos Aires with the motto “Another health is possible”
We know it is a long road but we know that we will finally get there, because in defending health we are defending life.
CICOP is trying to rebuild our health system supported by some fundamental issues:
Integrated health care equal and free for every body. Being a constitutional right for all the inhabitants it should be respected.
The State must create an instrument, a SINGLE PUBLIC PLAN whose mission will be to guarantee this right.
This SINGLE PUBLIC PLAN will converge all the available public resources, the public budgets and the resources of Social Security to guard them from the voracity of the financial investors putting it under the social control
WE KNOW THAT HEALTH IS A RIGHT OF OURS. WE ARE THE PEOPLE, AND WE HOPE TO JOIN WITH PNHP IN THAT DIRECTION.