The elevation of coronavirus to pandemic status makes health the inescapable choice for today’s Ministry Positions column, even if agriculture would also have been a strong candidate with farmers on strike all week until Thursday. Nevertheless, it is not the aim to expand unduly on coronavirus here because any details supplied at the time of writing will be outdated by the time this newspaper is read – the number of confirmed cases will surely have mounted and the precautions taken been multiplied.
The coronavirus crisis falls into by far the most experienced hands in the Cabinet – and also its most senior member (twice as old as his Economy colleague, for example). Ginés González García, 74, is a rare example of a health minister who is actually a member of the medical profession as a Córdoba-trained surgeon (although a native of the delta town of San Nicolás, the venue of Expoagro). He had already been the minister from 2002 to 2007 throughout the Eduardo Duhalde and Néstor Kirchner presidencies, making his mark from the start by organising outpatient treatment for all below the poverty line and lacking health coverage, around 15 million people at that time. But upon succeeding her husband, Cristina Fernández de Kirchner immediately replaced González García – not because of any dissatisfaction with his performance but because she was reportedly convinced that the rotund then-minister had the wrong physique du rôle for promoting healthier lifestyles. He was sent across the Andes to be ambassador in Chile for the next eight years.
González García does not owe his March news prominence solely to coronavirus – in the state-of-the-nation speech of President Alberto Fernández on the first day of the month the headline-stealing announcement of the legalisation of abortion flagged his portfolio above all others, since the government conceptually views this reform as a public health issue ahead of a woman’s right. The minister is far from being a newcomer to a cause he has advocated from the moment he entered government – so passionately that back in 2005 the chief military chaplain Bishop Antonio Baseotto wrote him a letter in which he quoted Saint Luke chapter (17) and verse (2): “It would be better for him to have a millstone hung around his neck and to be thrown into the sea than to cause one of these little ones to stumble.”
Yet it could be argued that the biggest challenge facing González García is not the worldwide pandemic, nor abortion reform, nor the long list of diseases more endemic to Argentina than the so-called “imported” coronavirus – topped by dengue these days and also including Chagas and the Junín virus among others – but rather a problem which is far more bureaucratic than medical. This is the fact that Argentine healthcare is organised on an almost mediaeval guild basis totally out of sync with the incredible advances of this century. It’s a fragmentation at all odds with the economies of scale required by modern medicine both at hospital level – each traditional immigrant community has its own, for example – and even more at the level of the trade union-run healthcare funds.
These obras sociales number no less than 292 covering some 14 million people (of which over a half belong to a dozen or so). This institution expanding trade unionism way beyond its natural terrain might seem to have “Peronist” written all over it but was in fact the creation of Law 18,610 (including compulsory employee contributions) under the highly reactionary military president Juan Carlos Onganía in 1970.
This does not end the gross imbalances in the Argentine health system. Doctors have notoriously doubled nurses in Argentine hospitals although the ratio has improved somewhat in this century – nevertheless, against a total nurse population of some 180,000 nationwide there are nearly 30,000 students in the Medical Faculty of the University of Buenos Aires (UBA) alone, with almost 10,000 registering every year.
While some medical graduates become rich and famous, far more end up underpaid after long years of being exploited as residents while all too many have to look for work elsewhere. Despite this enormous excess, doctors are lacking in much of the hinterland since the vast majority prefer to live in the big city. One might think that, having provided them with a free education, the State would feel entitled to tell them to go to where they are most needed (as is the case in Russia, for example) but this does not happen. Talking about the hinterland, this was not helped by the decentralisation of health (along with education) in 1991-1992, thus abandoning any aspiration to setting national standards – most provinces have not managed to strike the right balance between general hospitals, centres of high complexity and outpatient care.
It must be stressed that the problems are basically organisational – Argentine medicine as such is world class and the envy of many more developed countries.
Public health was never a state concern in pre-Peronist Argentina, which does not mean that there was no progress beforehand. There were doctors in colonial Argentina (e.g. Miguel O’Gorman from Ireland), hospitals were founded in the 19th century (such as the British Hospital in 1844) and some idea of the progress made in the last third of that century may be gleaned from the fact that whereas 14,000 porteños perished in the yellow fever of 1871 (leading to the creation of Chacarita Cemetery), only 50 died when bubonic plague (the Black Death itself) arrived in 1900.
Juan Domingo Perón created the Health Ministry in 1949 under the widely respected Ramón Carrillo (1906-1956), who reduced child mortality by a third and tuberculosis by three-quarters. Following his coup in 1966, Onganía decided that the State had no place in healthcare, eventually entrusting it to the trade unions of all people. The ministry made a comeback at the tail end of the 1976-1983 military dictatorship in 1981 but turnover was high with no minister lasting any length of time before González García with the exception of Alberto Mazza (1993-1999) under Carlos Menem after health had already been decentralised. Health lost its ministerial status in the last 15 months of the Mauricio Macri administration with Health Secretary Adolfo Rubinstein making an embarrassing exit over an abortion protocol issue in the very last month of that presidency. There have been a total of 26 ministers in the 55 years of this portfolio.
Health may have been decentralised in Argentina, but it is now globalised in the face of the coronavirus pandemic.