The Mexican national health system may go private

Mexico’s single payer health care system is one of many components of the nationalized infrastructure guaranteed by the revolution of 1910 and enhanced by the most popular president in Mexican history, Lazaro Cardenas (1934-1940). Others—natural resources and their delivery, the banking system, the railway system and redistribution of land to the tiller—have all been chipped away by subsequent administrations for the benefit of the wealthy. In later years the World Bank and the International Monetary Fund have insisted on privatization as a condition for desperately needed capital funding.

In the last half of the last century, the banks were sold (and bought, and resold) by the government; the oil and electric systems eroded through “joint projects” and foreign investment, and land returned to the old owners. Progressive unions have been put under attack, as have teachers. Now, with Vicente Fox Quesada’s government seeking to sell off natural gas to international conglomerates, and with transgenic corn and beans destroying the ages-old native crops, the forces of privatization have turned their attention to the Instituto Mexicano de Seguro Social (IMSS; the national health plan).

The severe crisis in the health care system has been brewing for some time. The IMSS is in disarray, plagued by lack of medicines, lab reagents, and advanced medical machinery (for instance, one has to travel to Puebla, four and a half hours away by bus, in order to get an angiogram, and the wait is as much as four months—this from Oaxaca, a city of over half a million people). Every once in a while, frustrated by shortages, some nurses will stand on the steps of whichever capitol building they happen to live near, and pour out small amounts of their own blood in protest.

There is no doubt that the IMSS is in trouble, although there is plenty of disagreement about the causes and the cure.

The rank and file (including the doctors, who, in this system, are workers, not managers) complain about corruption: diversion of supplies which are then sold to profiteers; severely delayed shipments, already paid for, that never seem to arrive; buying and selling of jobs with little regard to skill; etc. They are angered by the inflated salaries paid to politically appointed figureheads while their own earnings diminish when adjusted to inflation.

The managers blame the efficiency of the system: people are living longer, so that the number of pensioners has increased the strain on the pension fund, which has always been supported by the contributions of working members. By 2015, they says, the number of retirees will outstrip the number of workers.

The unions say that is just plain hooey; that if members were to receive decent wages, they could afford higher premiums, and the difference would more than make up for the increased drain on the fund. Management greed and political indifference is, they say, at the heart of the problem.

This summer, the government of president Vicente Fox, a member of the right-wing PAN party, submitted a new law for consideration by the legislature. The new law would cut back on pensions for members of the IMSS pension fund, remove some hospital services and clinic locations, and turn over much of the IMSS to private corporations (and, not so coincidentally, destroy the IMSS workers’ union). Traditionally opposed to privatization, the leadership of the centrist PRI party—with the largest bloc of votes in the congress—has backed the current PAN-authored law. With their help, it has been reported out of committee, and is now under consideration by the body as a whole.

The left-center PRD party, generally very sympathetic to unions and in favor of keeping the infrastructure nationalized, claims the reason for this sudden change of heart is a deal struck in the back rooms of power: PRI support in exchange for a promise by the Fox administration to drop a government inquiry into human rights crimes committed by former PRI president Luis Echeverria during the 1968 and 1971 student protests.

This is about the dirtiest deal I’ve seen since Fox let reviled ex-president Carlos Salinas back into the country in exchange for his organizing the campaign to discredit 2006 PRD presidential front-runner López Obrador, the current mayor of Mexico City.

As of last weekend, with enormous protests planned, some PRI legislators began to waver in the face of this reversal of principles; and when I wrote this a week ago the deal wasn’t quite as done as it first seemed to be. Fox’s special prosecutor did indeed issue an indictment, and request an apprehension order for Echeverria from a local district judge, who immediately (clearly without time to read the volumes of paperwork attached) denied the request. The prosecutor immediately appealed the case to the Supreme Court, but the new law may be in limbo for a while, and even if the Supremes reverse the lower court and the warrant is issued, a trial can take years. In the meantime, the PRI will likely reassess its position in light of the likelihood that Fox may have no quid pro quo to give them.

In any case, the IMSS is still in terrible shape, and the workers may still decide that the only hope for meaningful reform (not nationalization) is a general strike. For millions of Mexicans, without funds for private doctors, it’s a lose-lose situation.