From the dream of universality to the collapse of cooperation. From international solidarity to the commodification of care and programmed dependency. What remains of health as a global common good?
Claudio, excellent post, it identifies the profound crisis of "global" health. However, your description of the Mexican case is very inaccurate. Private agents are not the main culprits of the malfunction of public health services. Rather, the governmental health sector was literally dismantled by terribly misguided and erratic state interventions personalized by the previous president Andrés Manuel López Obrador (AMLO), who had a vertical iron power over all issues during its presidency.
Obviously, the health sector before AMLO was far from functional (as you mention), but previous administrations made an ongoing effort to palliate deficiencies, to coordinate and regulate the subsystems, to rationally expand coverage and improve quality. The nucleus of the effort was the "Seguro Popular", reaching tens of millions of families, reaching agreements with private sector providers of services and medication. It was far from reaching Scandinavian efficiency, but it moved.
Unfortunately, AMLO cancelled it as soon as he was elected in 2018, allegedly because of "corruption acts" that was never proved (no demands against officials), it was just AMLO's banging on the table to show "who is the boss here", a constant attitude of this autocrat in many other issues. The Seguro Popular was replaced by a white elephant (INSABI) that collapsed in 2022. Since then there is a serious crisis of medication supply, generated by the capricious and improvised disruption of the previous system.
AMLO channeled his authority on health issues to Dr Hugo López Gatell (one of his favorite proteges), a very incompetent and authoritarian technocrat. The consequences: handling of the COVID pandemic in Mexico was among the worse in the world: 400 hundred thousand "recognized" deaths (over 800 thousand real deaths considering demographic evidence). More than 70% of the Mexican population lack even minimal public health services, which forces lower income sectors to pay for lower quality private services. Public health services in Mexico are agonizing.
The current president, Claudia Sheinbaum, was hand picked by AMLO. Her health minister is a well known and competent MD, but they inherited AMLO's disaster and lack the autonomy and power to implement changes, since AMLO still wields too much power behind the throne (he appointed all the main officials, legislators, governors of the ruling party, so they owe loyalty to him, not to Sheinbaum),
Thank you for your comment, Roberto. Your observations enrich the debate and add nuances that my text had not managed to unfold. I agree with you that the dismantling promoted by AMLO, particularly the cancellation of Seguro Popular and the failed INSABI experiment, decisively deepened the health crisis.
Rather than strengthening a true health policy, it seems to have responded to a political logic of power. Reports from CONEVAL and the Federal Audit Office point in that direction: coverage decreased, the shortage of medicines worsened, and, in the midst of the pandemic, excess mortality revealed the magnitude of the consequences.
My focus, however, was on another angle: the historical segmentation of the system and its progressive capture by private interests, phenomena documented by the OECD and the Belisario Domínguez Institute.
By centering on that structural dimension, I left in the background what you so rightly highlight: that government decisions often respond to dynamics of power that do not always align with the needs of the population.
I believe that neither perspective excludes the other, but rather complements it: the current deterioration stems from both erratic state interventions and long-standing privatizing processes. The challenge, as you well point out, is to imagine and build a truly universal system, capable of resisting both the improvisations of political power and the pressures of the market.
Claudio, excellent post, it identifies the profound crisis of "global" health. However, your description of the Mexican case is very inaccurate. Private agents are not the main culprits of the malfunction of public health services. Rather, the governmental health sector was literally dismantled by terribly misguided and erratic state interventions personalized by the previous president Andrés Manuel López Obrador (AMLO), who had a vertical iron power over all issues during its presidency.
Obviously, the health sector before AMLO was far from functional (as you mention), but previous administrations made an ongoing effort to palliate deficiencies, to coordinate and regulate the subsystems, to rationally expand coverage and improve quality. The nucleus of the effort was the "Seguro Popular", reaching tens of millions of families, reaching agreements with private sector providers of services and medication. It was far from reaching Scandinavian efficiency, but it moved.
Unfortunately, AMLO cancelled it as soon as he was elected in 2018, allegedly because of "corruption acts" that was never proved (no demands against officials), it was just AMLO's banging on the table to show "who is the boss here", a constant attitude of this autocrat in many other issues. The Seguro Popular was replaced by a white elephant (INSABI) that collapsed in 2022. Since then there is a serious crisis of medication supply, generated by the capricious and improvised disruption of the previous system.
AMLO channeled his authority on health issues to Dr Hugo López Gatell (one of his favorite proteges), a very incompetent and authoritarian technocrat. The consequences: handling of the COVID pandemic in Mexico was among the worse in the world: 400 hundred thousand "recognized" deaths (over 800 thousand real deaths considering demographic evidence). More than 70% of the Mexican population lack even minimal public health services, which forces lower income sectors to pay for lower quality private services. Public health services in Mexico are agonizing.
The current president, Claudia Sheinbaum, was hand picked by AMLO. Her health minister is a well known and competent MD, but they inherited AMLO's disaster and lack the autonomy and power to implement changes, since AMLO still wields too much power behind the throne (he appointed all the main officials, legislators, governors of the ruling party, so they owe loyalty to him, not to Sheinbaum),
Thank you for your comment, Roberto. Your observations enrich the debate and add nuances that my text had not managed to unfold. I agree with you that the dismantling promoted by AMLO, particularly the cancellation of Seguro Popular and the failed INSABI experiment, decisively deepened the health crisis.
Rather than strengthening a true health policy, it seems to have responded to a political logic of power. Reports from CONEVAL and the Federal Audit Office point in that direction: coverage decreased, the shortage of medicines worsened, and, in the midst of the pandemic, excess mortality revealed the magnitude of the consequences.
My focus, however, was on another angle: the historical segmentation of the system and its progressive capture by private interests, phenomena documented by the OECD and the Belisario Domínguez Institute.
By centering on that structural dimension, I left in the background what you so rightly highlight: that government decisions often respond to dynamics of power that do not always align with the needs of the population.
I believe that neither perspective excludes the other, but rather complements it: the current deterioration stems from both erratic state interventions and long-standing privatizing processes. The challenge, as you well point out, is to imagine and build a truly universal system, capable of resisting both the improvisations of political power and the pressures of the market.
Always grateful for your insights, Roberto.