Opposition Defends Maintaining Private Preeminence in the Colombian Health System

The political opposition in Colombia defends maintaining private preeminence in the healthcare system. Just as the complex parliamentary debates on healthcare reform have resumed, former President Alvaro Uribe, leader of the conservative Democratic Center, has revived his proposal for a National Agreement. This agreement aims to respect the involvement of the private sector in both healthcare and pensions.

The regional elections on October 29 left the opposition somewhat strengthened in Colombia, following a poor result for government-affiliated forces. In the weeks of analysis and reshaping of the political landscape, the conservative opposition has resurrected its initiative based on maintaining private management in healthcare and pension funds, essentially preserving the current system.

Public/Private debate on the table

In the coming months, the social reforms being pursued by the government will undergo new parliamentary debates, seeking a consensus that is currently far from being achieved for approval. Opposition forces are striving to preserve a healthcare model that Uribe himself helped build from the Senate 30 years ago, giving prominence to the private sector, even though the majority of resources are funded by the state.

Similarly, the former president and senator proposes maintaining the model of private management in pension funds, coexisting with the public sector, with few changes compared to the current model.

On the other hand, the government advocates for a change in the model, giving greater prerogative to the public sector. Thus, the healthcare reform supports public management, with the state directly paying hospitals and healthcare centers. In their model, existing private health insurance companies would play a more managerial role, losing a significant part of their role in the system, including as recipients of public funds.

In essence, the current debate in Colombia revolves around the classic duality of public versus private management. The current left-wing government aims, for the first time, to have the Colombian healthcare and pension model primarily driven by the public sector. In contrast, the conservative opposition, which has historically governed and shaped the country, fights to defend the existing model that clearly favors private management, albeit financed with state money.

National Agreement Proposal

Álvaro Uribe, former President of Colombia from 2002 to 2010, proposed negotiating jointly the reforms to healthcare, labor, and pensions as the basis for initiating a National Agreement among different political forces. The goal would be to achieve broad consensus to guarantee the stability of legislations.

“A National Agreement, to which President Petro has referred on several occasions, could include many topics or start in parts. For example, the proposed reforms currently under consideration by Congress would be better for the country if they were the result of a consensus among workers, employers, Congress, and the Government,” said Álvaro Uribe.

Regarding the healthcare reform, which is currently halfway through the legislative process, it has triggered one of the toughest discussions in Congress, even dividing forces initially aligned with the government. The differences were so insurmountable that they led to the departure of the Party of the U and the Conservative Party from the government’s bloc.

However, the most acute differences in the parliamentary debate occurred between the progressive coalition supporting the government and Uribe Vélez’s party, the Democratic Center. According to the former president, “establishing a monopoly of affiliation to state centers affects citizens’ freedom and the competition that contributes so much to the quality of service provision.”

The future of Health Insurance Companies (EPS)

The point generating the most controversy is the future of the current Health Insurance Companies (EPS), private insurers managing public funds to provide medical care to affiliates. Although the reform implemented that health insurance companies can continue to exist as health managers, for the former president, this possibility does not mitigate the “state monopoly” because, in his opinion, it diminishes the autonomy of these private entities and turns them into an appendix of the public system.

According to the former president, with the government’s proposal, health insurance companies would lose agility and become dependent on bureaucracy. He proposes a reverse relationship, prioritizing private management, combined with public intervention. However, this reality does not solve the government’s problems of access and the risk of corruption.

“Why, instead of creating that public monopoly, not maintain the mixed regime and allow associations of health centers to perform health insurance companies functions, without exclusivity? That is, citizens can affiliate with health insurance companies as they currently do, or with these state associations,” Uribe Vélez suggested.

Delays in State payments

Following the crisis generated in the Sanitas health insurance company, which, due to delays in State payments, according to the insurer, cannot meet its financial obligations to the pharmaceutical company supplying medicines to its affiliates, Alvaro Uribe has stated that “enormous damage is done to trust in the country by forcing the closure of private health insurance companies, whether national or foreign, which suffer government hostility through payment denial.”

Although Sanitas itself reported that the significant debt putting the insurer in difficulties began in 2020 due to differences in State payments and actual pharmaceutical spending, Uribe holds the current government that came into office in August 2022 responsible for the situation of private healthcare companies.

In this regard, it is worth noting that the Ministry of Health has certified that all health insurance companies’ payments are up to date. The problem, as confirmed, arises from differences between actual expenses and the money received for estimated pharmaceutical spending.

Defense of private pension funds

Regarding the pension reform, the scheme is the same: Uribe argues that the funds managing the individual savings regime should be maintained, rather than giving full control to the public entity Colpensiones.

To support his position, Uribe recalls that the funds “belong to the workers.” In this sense, the former president asserts, without providing concrete data to support his thesis, that “placing such a high percentage of their resources in public hands not only eliminates them but also, contrary to what is said, exposes the resources to disappearance due to inefficiency, waste, or corruption.” In this regard, Uribe claims that “pension funds have been more favorable than Colpensiones for workers” earning the lowest salaries.

For his model, Uribe proposes reconciling the two public and private systems, as they exist currently.

Labor reform and the role of strikes

Regarding the labor reform project, the former president states that the presented text turns the strike into a permanent instrument of agitation while transferring to the union the role of mediator between the employee and the employer.

“This reform is not needed by workers in large mining and fuel companies, which have achieved a lot in collective negotiations. But it is disastrous for medium-sized, small, and labor-intensive companies,” opines the former president.

For Uribe, the reform should focus primarily on increasing wages for workers. In this regard, he has advocated creating a special bonus for salaried workers when national economic growth exceeds 4%. It is worth noting that, in the current inflationary context, Colombian economic growth is only 0.3%.