On August 22, 2000, President Hipólito Mejía called me at his home and told me, “Barsano, I want you to take care of a promise I made to Dr. Peña Gómez.” I replied, “What do I have to do?” And he told me, “make social security a reality.”
The story ends with my appointment as Coordinator of the Health Sector Reform Commission (CERSS), together with a commission of recognized doctors to support this process.
This group was joined by Arismendi Díaz Santana and Iván Rondón, who assumed a leading role. The law had been stalled in Congress for more than 13 years.
CERSS had many resources from two loans (WB and IDB) to reform the health sector and we managed with both organizations that part of these be used to cover the expenses involved in working on the new law.
Dozens of meetings were held with more than 20 organizations (businesses, doctors, unions, financial entities, public entities, international consultants, and social security officials from Latin America and Europe).
Finally, eight months later the law was agreed upon and approved (87-01) on the basis of individual capitalization, the most relevant achievement of the last two decades.
23 years have passed and social security has serious problems. Primary care, one of its pillars, is still in its infancy. The hospitals, which would be decentralized entities and financially self-sufficient, continue to lack resources and good management. The Ministry of Health never became a regulatory entity, as planned. And many criticize the excessive earnings of the AFPs and ARS and their poor service to the insured.
The layoff, which would be resolved a year after the law was approved, is still in force, driving thousands of businesses to informality that are not listed on the TSS. For these workers, their only option is to join the Senasa subsidized regime.
I do not question that the private AFPs and ARS earn money, but certain limits and regulations must be imposed so as not to commercialize the SS. And the medical services to the insured improve them substantially because there is mistreatment and abuse, especially with the prepaid ones.
Today I wonder? When will this law be modified and if the problems described above will be resolved? Otherwise, the current individual capitalization system could collapse.
In Chile, a majority opposes the capitalization system of the SS and I am beginning to doubt whether we did the right thing here.