A few days ago, the general director of the IMSS Zoé Robledo published an epistle entitled “Tuxtla to Miami, with all due respect” so that, using doctors Julio Frenk and Octavio Gómez Dantés -F&D- as vehicles, everyone could answer the question question What did we do?
I use the meaning of epistle, not as a letter or missive that is written to someone, but in a literary sense as “a poetic composition in the form of a letter, in which the author -Zoe Robledo- addresses or pretends to address a real or imaginary -F&D-, and whose purpose is usually moralizing, instructive or satirical”. From my harvest I add that it was directed to the world or to the characters that inhabit it and who do not think the same way as he does.
It all started with an invitation from F&D to retrace the path taken by the federal government and move towards a universal health fund that guarantees the same health services to all Mexicans, which appeared in a column titled “Medical Apartheid.”
The visionary Zoé, who has let his imagination run wild on the occasion of the 80th anniversary of the IMSS, forgetting that one is “the owner of his silence and the slave of his words”, gave interviews by way of mode, one of which served F&D for his proposal, which he did not like and wrote the next day that “the broth is drunk hot” illustrating with his epistle with the qualifying adjective “with all due respect” what he considered “should investigate more”.
Being F&D university students, the next day they published a reply entitled “From Tuxtla to Miami” and already, I suppose, without respect or ironically adding the question, and Copenhagen? The central point was to ratify that the health system that the federal government is building -destroying, I say-, the wage earners are beneficiaries and the non-salaried poor, “entitlements”.
Silence has now been the response -recurrent method of the federal government- to the arguments put forward by F&D. There was no longer satire or recommendations such as “I would recommend you do your research well.” I point out that in this situation, Zoé Robledo only addresses the current rector of the University of Miami, and not the Researcher of the National Institute of Public Health, Octavio Gómez Dantes. The correct thing would have been to say “I recommend” in the plural.
From Leon, Gto. this writer wants to draw attention to only two of the many assertions in Zoe’s epistle
Robledo that could be answered, if you want cold, like the gaspacho.
First epistolary assertion.- “What has never been done is historic. On February 6, 2023, with the banner of the diagnostic lifting of the health services in the state of Chiapas, things are different: it was thought, it was agreed, it was designed, in the company of Governor Rutilio Escandón, the first step was taken to the transformation of the health system and medical attention of the state”.
Questions to your statement: How long will it take to go through all the 1,774 medical units, from the Health Homes to the high specialty? Why are they going to travel? What is historical is the lateness of the supposed intervention? What did the federal government do in the 1,527 days it has been in government? What actions have they carried out from those published 1,312 days ago in the National Development Plan 2019-2024, where by the way, the SS-IMSS-Well-being did not even appear in the dreams of the national palace messiah? The INSABI, in force in Tuxtla and Chiapas officially since January 2020 -1,139 days- what did it do with the responsibilities granted by the General Health Law if it did not even have the diagnosis? Did the IMSS-Welfare officials not do the elementary work in these 4.2 years of government in office? How did they program medicines, doctors, nurses? What will they be able to do, even together, if Chiapas is one of the states that gives the least solidarity state contributions to health and the SS-IMSS-Benestar has no resources assigned either, only the promise of the tenant “there will be no shortage of resources.” Eye, they only have 656 days left? Will the 500 perhaps Cuban doctors who are now going south serve? Lastly, what role does the health authority responsible for general health play in its “arrangement” of health services, such as the General Directorate of Health Planning and Development -DGPLADES-, who label themselves as the main space for the design, development and implementation of innovations in health systems in Mexico?
Second assertion.- “Perhaps the news did not appear in Miami, but IMSS Bienestar is no longer just a Program, it is a decentralized public organization (OPD) published in the Official Gazette of the Federation on August 31, 2022. What never it was the popular insurance, and it was not because it was never a care institution.
Questions to your second assertion: If the IMSS, the SSA, the ISSSTE, the ISSFAM, the INSABI, the Social Protection System in Health were built after they passed through the Congress of the Union, sometimes at the initiative of the Executive and sometimes the last times by the Legislative, for what reason the OPD Health Services IMSS-Welfare did not go through Congress? Is it a creature not recognized -or unwanted- as such in the PEF 2023 program structure due to the blunder of the only federal government institution planned by law, INSABI? The Social Protection System in Health, known as popular insurance, created by Law at the proposal of the Executive, did it consider the granting of services in the 32 federal entities, and the transfer of money to the IMSS-Welfare in those places, such as Tuxtla and surroundings? , where primary care was given in clinics operated by this subsystem? Are they creating an integrated and uniform health system? Why, for example, the SS-IMSS-Bienestar of Nayarit refused on January 26 to receive medicines for the year 2023, in writing they indicate that superior orders due to the “uncertainty regarding the signing of the coordination agreement with INSABI and its institution; reason for which, please use this as evidence of rejection of the receipt of merchandise”? Is this how coordinated they will also be in the coordination agreements for the exchange and/or unilateral provision of health care services? Why in four years only 7 entities ratified them in 2022 and only partially? Why are the ordinary IMSS 2023 rates much more expensive than those published on February 8 for the rest of the system? Are they less quality inputs? Will there be second and fourth care? Lastly, will the MAS-Bienestar care model be applied in the ordinary IMSS and in the rest of the social security institutions or only in the deprived entitlements attended by INSABI or the SS-IMSS-Bienestar?
I am very much afraid, dear readers, that the answers will lead us to the same conclusion as F&D: a great call is necessary to rethink how to realize the right to health protection and the financing necessary to achieve it.
I conclude by answering Zoé Robledo’s question: What did we do? Until now, to destroy the national health system, it is urgent to retrace this path of the fourth disorder (sic).
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