The idea of creating a universal healthcare system in Mexico is not new. Many experts have recommended it, and this column has also discussed it. The issue is how to do it. It is not about inventing a card and handing it out—for that, the voter ID or school IDs for minors would suffice. The matter is a legal and economic tangle.
On one hand, the Instituto Mexicano del Seguro Social is a tripartite organization, funded by government contributions, but also by employers and workers. These latter contributions are not minor. A significant share of wages is deducted from workers—or paid by their employers—through which they are supposed to gain access to the best public healthcare system in Mexico.
IMSS-Bienestar has nothing to do with that institution. It is a name they came up with to shift onto Social Security the disaster that was INSABI. As you may recall, Andrés Manuel López Obrador eliminated Seguro Popular, claiming he would build something comparable to Denmark. It was a massive failure, costing tens of billions of pesos, which ended up in this IMSS-Bienestar contraption—neither IMSS nor, most likely, “well-being.”
We also have the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, which also charges contributions to government employees, although in this case it might be easier for the state to absorb those costs. Finally, there are state systems, those of the armed forces, of Pemex, and others.
If one believes that a simple card will resolve this legal maze, they do not understand the issue. It is already difficult to enter IMSS clinics without its own ID; imagine people arriving with their “universal system” card and expecting the guard to let them in, to be admitted, and to have an appointment scheduled. All this without considering that it has long been difficult to receive care, which is why clinics attached to private pharmacies have proliferated. There is no doubt that at the secondary and tertiary levels, IMSS has first-rate facilities and personnel—but getting there can be impossible for many. If, in addition, tens of millions from IMSS-Bienestar and another large share from ISSSTE are added, you can imagine the strain.
Strictly speaking, for IMSS to treat patients from other institutions without compensation amounts to embezzlement against the institution, which is financed by employers and workers. If that care were paid for—if IMSS were reimbursed—it would be a different story. But that is precisely what Seguro Popular did. Perhaps now that they have realized the need for fracking and private investment in electricity, they might also understand the importance of that system. Eight years of senseless destruction, then.
They have not been able, in those eight years, to properly supply medicines and materials, despite spending money without limit. If they cannot even organize a consolidated purchasing system, one wonders how they could coordinate entire institutions.
We have not even touched on unions: IMSS personnel enjoy preferential treatment compared to beneficiaries—better salaries, better pensions—which do not exist in IMSS-Bienestar, nor in ISSSTE. State systems vary widely in quality.
Let me close with the crux of the matter: money. The Mexican government used to allocate about 3% of GDP to healthcare, complemented by a similar amount from the private sector and households. Over the past eight years, government spending has fallen, and families have had to increase out-of-pocket spending, at the expense of other consumption. In total, Mexico spends about 6% of GDP on healthcare, while South American countries spend around 9%, Europeans 12%, and the United States 18%.
A universal system is a good idea: restore Seguro Popular, fund it with three percentage points of GDP, and the issue would be resolved. Anything else is quackery.