It is imperative to find a solution. I do not believe that the Government of President Boric is in a position to resist the social crisis associated with the bankruptcy of one or more Isapri. And since it is established that the commandment requires the provision of the law, the incentive of Isapris is strong not to help the solution. And in Congress, as grateful as it seems to distribute foreign funds in compensation for the failed sixth retirement, I don’t see anyone willing to share their responsibilities in the destruction of the private Social Security System.
In the context of the bitter debate about the current Isapris crisis, I would like to share some thoughts that I hope will help find a common cause solution.
The bills presented (Short Government Law, Constitutional Reform and that which will capitalize the debt in favor of credit contributions) confirm the common diagnosis of the disastrous economic, health, social and systemic consequences that can follow from the application of the ruling of the Supreme Court. . And they also seem to have an objective approach to avoiding this disaster.
So why is the proposition that there is no sufficient solution? The government’s plan assumes that some Isapres will not survive the process, admits him and tries to prepare for that mission. Now, the plan of the Constitution Commission approved by the Senate, even if it seeks to avoid economic attacks that put the system at risk, the viability of the state is doubtful, given the reactions it has provoked. Moreover, to say that he is looking for “a big return” is not accurate, since any mission contemplating returns – if there are any – necessarily involves paying from future taxes or savings, that is, about the future. Contributions; the only financing for Isapri. Finally, the proposition of uncial debt in favor of creditor creditors is interesting, although it may not apply to all companies in the same conditions.
Thus, in order to find a solution, the proposals must be politically and financially viable. Obviously, it has any real ability to be implemented by the government – currently weak – or approved in Congress where no one has a majority. In addition, the proposals must be carried out to those decided by the Supreme Court without causing a financial disaster to the system, neither today nor in the medium term.
It seems to me that the Government’s short Bill does not meet all these requirements: its legislative effectiveness tends to zero in the absence of major change and, as it stands, it will not achieve its objective of avoiding the crisis. I like the idea of dividing the execution times of the ruling, separating the price impact from the timing of the events. I believe that any effective solution should incorporate this practice.
The reform of the Constitution Project – for its part -, even if it resolves the financial balance that was ordered by the Court, even if corrected from a purely technical point of view, has not been achieved, nor do I think it will be achieved, having enough legitimacy to be approved in Congress.
And the third proposal, about the capitalization of the debt, although it does not solve the financial inequality that occurs through the recalculation of future prices, at least it provides a way to address the payment of eventual repayments, without the premise of leading to bankruptcy. of by the team. But since it is a partial solution, its political viability clearly depends on it being incorporated in other ways.
So what are the elements that necessarily come together – in my opinion – to find a solution to this crisis?
As a preliminary and necessary matter, it seems to me that it is essential that the approved plan recognizes and incorporates the need for the system to be compensated financially in the short term. The impact on the future decrease flows from compliance with the recalculation ordered by the Supreme Court to generate serious distortions in the relationship between the revenue and expenditure accounts. Without a financial balance there will be no insurers and less income. Although it is true that new businesses can be created and others will survive, for those partners whose companies are in trouble, there will be no recourse or health plans and there will be a lot of uncertainty.
The financial balance must be sought on two fronts: income and expenditure. Future taxes will depend on maintaining prices as permitted by law. For this reason, the indicator that the Superintendence of Safety in March of each year must incorporate the development of costs, and also the income, so that the impact is divided into several periods, to avoid an uneven rise. price readjustment. On the cost side, it seems to me that the new regulations could generate the right incentives to target three items in the spending system: administrative costs, medical licenses, and health accidents.
As far as administrative costs are concerned, it would represent a great solution if, for example, instead of a permanently open membership model, this was only done during certain periods of the year, one or two months, and people had to stay in their Isapre for at least two years. . It could also adjust the ceiling for administrative expenses that exist in the legal case work and are promoted in electronic associations. Ideally, we should go for a single policy, with clear and universal coverage, plus a general economic mechanism (stop loss). With this strategy, developments can also be made to end pre-existing conditions and captures, generating a wage risk that allows free mobility within the system and, in addition, allowing free affiliation for all those entering the labor market. first . For maximum free mobility between systems, maximum financial compensation between public and private disciplines is required. I am in favor of this, but it seems to me that today neither has any political capacity.
There is a lot to be done about medical licenses. Perhaps the most important thing is to create a new management and administration model that ends the conflicts between occupational health and public health, freeing people from the unjust refusal of medical licenses and providing an institutional framework for all workers. We could also think of a scheme that regulates licensing by professionals to a single network, with protocols to be made for more common pathologies, with the requirement of evaluation from a specialty to an innovation license, etc.
In terms of spending health benefits, perhaps the most obvious measure is the incorporation of better efficient payment mechanisms, such as GRDs and health payments, making protocols for better health and quantitative issues around bonds, as was the case debating in the Senate. The Health Commission until last year.
Thus, either through the method of containing expenses, and through the method of equilibrium income, the method of equilibrium of the future economy can be obtained. Thus, in the medium term, the normal operation of the System could be achieved, correcting some of its efficiency problems and, at the same time, dealing with some of the most serious regulatory issues for decades.
It is imperative to find a solution. I do not believe that the Government of President Boric is in a position to resist the social crisis associated with the bankruptcy of one or more Isapri. And since it has been established as a mandatory law to require compensation, the incentive for ISAPREs is strong not to support the solution. And in Congress, as grateful as it seems to distribute foreign funds in compensation for the failed sixth retirement, I don’t see anyone willing to share their responsibilities in the destruction of the private Social Security System.
There is no doubt that the Health System needs a deep reform, and this crisis could allow progress in that direction. But I believe that it is not necessary to limit the opportunity to reason, allowing one or more Isapras to fail, since it would be an issue whose cost would be borne by the sick, the weakest and the most patient unfortunately. We have to move towards a higher reform of both health systems, but it will already be the subject of another column and, as we continue, also the subject of another government.