Private medicine made its lobbying power feel. But the tensions did not disappear, in a scenario that reveals the shortcomings of the system
In just one week, the Government carried out two strong clashes with the business community. The first encounter was with the Techint group over the dismissals made in view of the extension of the quarantine. And the last one exploded for these hours with the failed attempt by the authorities to control the resources of the private health system against the imminent start of the peak of coronavirus infections.
Although the reasons are different in each case, the two conflicts brought to light a common problem: the anger of businessmen for managing the health crisis, a dispute that reveals tensions around the role of the State and the direction of economic policy.
In the case of health, what triggered the last fight were the signs of chaos detected in the purchase of supplies and the lack of resources. Faced with this worrying situation, the area minister, Ginés González García, announced on Wednesday in a videoconference with deputies a draft decree to declare health in the public interest and have broad powers to intervene in the sector.
The objective was to centralize beds, respirators and all kinds of benefits, following the example of countries that are taken as a reference, especially Ireland –who made private resources available to the state-, Spain and France. But the strong reaction of private health entrepreneurs and the apparent fissures within the government would have pushed back the minister.
Thus, what seemed to direct the system towards a model of greater state control over the private ones, finally took the form of a coordination table, whose first meeting will be next Saturday. González García confirmed this Thursday at the meeting he held with the representatives of the Union of Argentine Entities (UAS), headed by Claudio Belocopitt.
“The minister has told us that the appropriation of private establishments or the distribution of patients was never under study. The official reaffirmed that he only wants the Ministry to exercise the power of stewardship to coordinate -by jurisdiction- the available resources,” he said. Gabriel Barbagallo, Secretary of the UAS.
The new scheme aims to centralize information and the organization of resources through daily monitoring at a table in which employers will now participate. A change from the mechanism adopted so far under the health emergency, which involved the concentration of decisions in a committee of experts and the creation of an Emergency Operating Committee together with the City and the province of Buenos Aires. This is where the greatest focus of contagion is expected.
“The table is beginning to be structured to transfer resources from the private sector to critical beds and ambulances and it will be analyzed in each district,” he explained to this newspaper. José Sánchez, head of the Federation of Medical Emergencies.
Rebellious gestures in the private sector
The unknown is whether the provisional commitment will be enough to form a unified command, as the Minister of Health intended, and dispel the inevitable tensions with the private sector. During these hours, one of the sensitive points is the available number of beds. Ginés assures that today the system has 8,000 intensive therapy with instrumentation, 3,500 in the public sector and 4,500 in the private. His idea is to add another 2,000 and reach a total of 10,000.
A few weeks ago, the portfolio asked for data on availability from private clinics and sanitariums, but the employers replied that they had 80% of the beds occupied and that they needed a change in the protocols to be able to free them.
The request headed by Belocopitt pointed to the provisions of the Ministry of Health. In line with the WHO, the health authority recommends that all suspected patients undergo isolation in hospital centers. “This implies hospitalization, until laboratory results confirm or rule out the diagnosis. In confirmed cases, isolation will be maintained until the patient is asymptomatic,” says the government website.
Private parties, on the other hand, insist that they be authorized to refer suspects out of the hospital system and to grant critical beds to critically ill patients. The pressure took effect in the city, where the head of government Horacio Rodríguez Larreta approved a custom protocol a week ago.
Those signs of rebellion led Gines’ team to embark on the DNU on Tuesday. “All beds in the private sector are going to enter a single pool regulated by the national system and by delegation in the provincial systems, and the epidemic is going to be available, according to the health authority,” said the vice minister of Health on Tuesday, Arnaldo Medina, in a face-to-face meeting with the health unions.
The official had already anticipated them in two previous meetings, but this time he assured them that the decree was in the Legal and Technical secretariat, in charge of Vilma Ibarra. A version that was denied yesterday in that area and close to the Presidency. “There is nothing here,” they said.
Ginés ran into other difficulties along the way. The specialists in his portfolio acknowledge that they face a “global drama” due to the lack of supplies. “We have two red lights: the respirators and personal protective equipment, “they admit. For example, Alberto Fernández has not yet received a response from his Chinese counterpart to the request for a donation of 1,500 respirators.
And locally, the largest manufacturer can produce just 90 a week and already had 3,700 orders from private and overseas. For this reason, the minister decided to concentrate the purchase in the national state, which paralyzed the deliveries they were waiting for in private clinics and sanitariums. The idea now is for 250 to be produced per week, a volume that would remain low.
It is also not easy to get personal protective equipment. In recent days, the Government tendered 54 million camisoles, together with 30,000 swabs and 2.2 million disposable gloves.
The results were dire: on the first batch they avoided giving figures and have already asked the Ministry of Production to take action on the matter so that the textile industry starts manufacturing them.
In the other two items, meanwhile, 5,000 and 600,000 units were obtained in each case, 16% and 27% of what was necessary. Swabs are key to carrying out virus detection tests and gloves are in high demand. To get an idea, a patient uses 50 per day, so the purchase made would be enough to cover just one day of care of the 1,250 cases of coronavirus registered this Thursday.
“The pulse of the State and the market”
All this scenario of restrictions aggravated the tensions with the private sector and led to a tightening of the Ministry of Health, in the face of the perception of a hoarding of purchases by prepaid medicine companies and the resistance to having beds for patients in the sector. public, a possibility that generates rejection among employers for fear of generating a conflict with their own affiliates.
“Some private prepaid companies bought respirators, gel alcohol, essential resources at the request of their members, and the Government resolved to centralize it from the State so that everything is available, regulate it and not leave it to market freedom, and began to discuss how far That control was going, such as beds, “said sources in the sector.
The pulls actually started before quarantine. Back then, the sector had submitted an arsenal of demands to the Ministry of Labor that included the exemption of taxes, the reduction of employer charges, and a zero tariff on imports of capital goods, along with the creation of a “special employment contract”. “for medical personnel.
The Executive granted the majority of the claims: eliminated for three months the employer burdens of the sector, reduced Gross Income for sanatoriums and hospitals, reduced the Check Tax (on credits and debits) from 1.4 to 0.8% and eliminated in the last hours the import duties to the purchase of material, machinery and medical supplies. “We have accomplished many things,” they acknowledged yesterday at the UAS.
The reverse gear in the centralization of the system, meanwhile, was read as a defeat among the health unions. “It is very clear that there was a phenomenal pressure from the powerful health entrepreneurs to avoid management from the State and ended up in coordination and incorporation of the sector to the discussion table without advancing in a concrete way in the availability,” he told this medium Fernando Corsiglia, from Cicop.
Other organizations came out to support the Ministry of Health. “We do not seek to obtain any economic revenue, as we see happening with certain private medicine entrepreneurs, who in the midst of the crisis are reluctant to earn a little less,” said the Association of Doctors of Private Activity.
Alberto Fernández He was in charge of highlighting the contrast during a meeting in which he showed himself this Thursday together with his health minister and businessmen participating in the construction of 12 modular hospitals in the suburbs and the rest of the country. “I appreciate the generosity and solidarity of the entrepreneurs who are committed to society and their workers in this difficult context,” said the President.
The photo served to support Ginés after strong questions he received from the private sector. Within the government, likewise, there was an optimistic reading of the situation. Far from having been a “mistake” by Ginés, some believe that it was a threat to bring the private sector closer. “They asked them to ‘put your batteries on,’ collaborate, and if you screw up I will put your DNU in,” they risked.
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