By Kathleen Bohné
Below you will find two excerpts from the Mar. 6 edition of “La Semana” newsletter. To read the complete articles and subscribe, please visit www.themexpatriate.com
“There is no medicine more expensive than the one you can’t get.”
Irene Tello & Denise Tron (Operación Desabasto)
Timing is everything. When the López Obrador administration took office in 2018, one of the first initiatives on the agenda was a reform of legislation governing public procurement, which AMLO suspected was a potential magnet for corruption. As part of this reform, the massive government acquisition of drugs and medical supplies was to be completely overhauled and centralized in the Department of the Treasury and Public Credit (OMSHCP). As part of the anti-corruption crusade, three of the largest distributors of pharmaceuticals in Mexico were also vetoed from participating in government contracts. By the second half of 2019, reports of shortages —particularly of specialized oncology drugs— began to appear. And by early 2020, when ominous scenes from Wuhan foreshadowed a coming pandemic, thousands of complaints were being logged across Mexico at public pharmacies where patients were told they could not fill their prescriptions. A weakened system was about to confront the biggest supply chain catastrophe in modern memory.
“When a patient is going to receive a heart transplant, he or she is connected to a life support system while their heart is removed and the donor heart is put in. In the case of medical supplies, it is tantamount to the government removing a patient’s heart without even having a donor heart ready.”
This is analyst Xavier Tello’s striking image of the scope of Mexico’s drug and medical supply shortage problem in his book La Tragedia del Desabasto. The shortages have been a public relations headache for the AMLO administration and caused suffering and economic ruin for many Mexican families.
As I have been researching for this article, the vastness of the topic has brought to mind the challenge faced by an astronomer who combs the heavens, searching for planets beyond the solar system. Too distant to be seen by any telescope, she can only infer a planet’s existence through indirect observations, recording its effect on the star it orbits. In the case of the “desabasto” of medical supplies, we can observe its impact on the country, even if concrete data on the problem are obscured.
According to a comprehensive report on healthcare from 2017-21 released by Colectivo Cero Desabasto on Mar. 2, there has been an average 40% increase in out-of-pocket medical expenses for Mexican families from 2018-21. Public healthcare spending in Mexico has long been lower than in other economies (5.5% of GDP) and as of 2018, Mexico was already leading OECD countries in out-of-pocket medical expenses at 41.4% of total healthcare spending, compared to 11.6% in the U.S. in 2020. The platform cerodesabasto.org has received 7,996 reports of medical supply shortages from patients and healthcare professionals between Feb. 2019-Dec. 2021 and complaints made to public health departments have jumped: in 2017, IMSS received 686 complaints, in 2021 they registered 11,367. These are just a few of the indirect statistics shining light on the scope of the crisis.
In order to understand the root causes of this problem, we have to start with an aerial view of the Mexican healthcare system. Mexico has a hybrid public and private healthcare system which purports to provide universal coverage. The majority of public healthcare is provided today by IMSS (Mexican Institute of Social Security) to employees in the private sector (51% of the population), and by INSABI (Institute for Health and Well-being) for the unemployed or informally employed, though six states opted out of INSABI when it replaced the Seguro Popular in 2020. Government workers are provided with healthcare by ISSSTE (Social Security Institute for Federal Employees), Pemex (Mexican Petroleum), SEDENA (Department of Defense) and SEMAR (Department of Marines). The dissolution of the Seguro Popular and transition to INSABI left many Mexicans behind: between 2018-2020, citizens without access to healthcare grew from 16% to 28% of the population…
To vote or not to vote?
In the past three weeks, a number of government officials have been chastised by the National Electoral Institute (INE) for promotion of the Apr. 10 recall referendum vote (“revocación de mandato”), including the mayor of Mexico City, Claudia Sheinbaum, who is also AMLO’s protegée. According to the constitutional amendment governing the referendum: “all broadcasting of any form of government promotion in media outlets must be suspended” during the “veda electoral” that started Feb. 4 and remains in effect until the date of the vote. In Mexico, campaigning prior to any election has a time limit and the period of “campaign silence” usually goes into effect within days of an election.
Sheinbaum was undeterred and in a press conference stated: “we will continue to talk about what they won’t let us talk about.” According to Sheinbaum and other Morenistas (members of the MORENA party), the promotion of the referendum by the INE has been lackluster and this is why they are committed to spreading the word about this act of “participatory democracy”…
