Volume 17, Number 11
October 31, 2011
in this section:
Just what the doctors --- and the pharmacists, medical secretaries, lab technicians, teachers and others --- ordered. Physicians and their allies march from Santo Tomas Hospital to the National Assembly.
Starting with the Santo Tomas specialists, a doctors' strike grows within and outside the profession
Legislators end their session, doctors continue their strike
by Eric Jackson
Privatization has been tried in the health care profession. Maybe the 24-year-old yeye who betrayed his party to join Ricardo Martinelli's Cambio Democratico and was rewarded with the presidency of the National Assembly's Economy and Finance Committee, Ricardo Valencia Arias, doesn't remember. Surely the ex-Panameñista doesn't care --- his family has enriched itself at the public's expense, including by using political connections to jump to the head of the line to grab former Canal Zone assets, for many years. Along with fellow party-switcher Martinelista converts Nelson Jackson (ex-PRD), Rubén Frías (ex-PRD), Absalón Herrera (ex-PRD), plus Víctor Juliao, who was elected on the Cambio Democratico ticket, and Panameñista Miguel Salas, he approved Bill 349, a far-reaching privatization measure that would create a super-privatization council consisting of Ricardo Martinelli, the director of the National Bank of Panama and two American citizens --- Jimmy Papadimitriu and Frank De Lima. It might as well have been written by John Boehner's staff, on which Papadimitriu once served. It even makes repeated use of certain English words, "value for money" being the preferred buzz phrase. Voting against the measure in committee were Panameñista José Luis Varela and the PRD's Rubén De León and Benicio Robinson.
Bill 349 is not about contracting out little things that the government can't be bothered to do for itself. To be privatized under the legislation, a project or service would have to be worth at least $5 million and have a term of at least five and no more than 50 years. The main thing that President Martinelli contemplates is the creation of long-term contracts by which the government finances real estate developments: things like building a pharaonic Torre Financiera at public expense with a private landlord running it and collecting rent; things like Panama Bay waterfront landfills with privately-run but state-financed office towers and luxury condos; things like a "Government City" that would be a privatized cash cow for well connected developers.
However, there are endless possibilities, and in the public health care sector the Seguro Social administration that tried to impose a gag order on doctors let its plans leak out. For starters, the plan was to privatize public sector (both Seguro Social and Ministry of Health systems) kidney dialysis and nephrology services, the primary care program and anesthesiology.
The public system has been short of dialysis capacity for a long time, and the small group of private contractors to whom some of the work has been outsourced are notorious for their political connections and not particularly known for giving cheaper or better services.
Then there was Hospital Integrado San Miguel Arcangel (HISMA), an experiment that was approved by the legislature in 1998, during the Perez Balladares administration. The hospital began operations when Ricardo Valencia's mother, Argentina Arias, was in the legislature. HISMA was structured as a quasi-private foundation controlled by the Ministry of Health, hiring private contractors to provide health care services to the people of San Miguelito, Las Cumbres and Chilibre.
HISMA's first and most fundamental conceptual flaw was the notion that it's cheaper for the private sector to provide health care services than it is for the public sector. Actually, private sector doctors, technicians, nurses and administrators expected to be paid more than in the public sector. Initially it may have appeared otherwise, as contractors put in lowball bids to win contracts for services that they knew they couldn't provide at the agreed price, but figured that they could get paid extra by manipulating political ties or charging for things as "off the contract" extras.
The foundation rather immediately became insolvent and dependent on government infusions of money. There was scandal after scandal, and one by one the private contractors withdrew. Eventually HISMA had to be taken over and run like other Ministry of Health facilities.
It was also not long ago that open heart surgery was not available from the Panamanian health care system, public or private. It just wasn't covered, but it was available to those who could travel abroad and pay for it. The fundraising drives for cute little kids who needed heart operations were a part of Panamanian culture, and not all of them were scams. A 50-year-old bus driver with the same problem would just have to do without the surgery.
It's now possible to get a heart valve replaced in a Panamanian hospital, and one of the possible ways to ration that service is to completely privatize it, so that it's just available to those who can afford to pay. The government could also privatize peripheral vascular surgery on an extreme basis, so that somebody with severe thrombosis in a leg and lot of money could buy a bypass around the clotted up artery and walk more or less naturally again, while someone with a job that doesn't pay very much would be left with the option of an amputation and learning to walk on an artificial leg--- if she or he could afford the prosthesis.
And so it was that while the joint negotiating committee for all of the public health care systems' doctors and dentists, COMENENAL, was looking askance at Bill 349, the specialized doctors at Santo Tomas Hospital perceived it as a direct threat to them and their patients. Led by vascular surgeon Julissa Rodríguez, they walked off of their jobs on October 20, and as the days went by more and more groups of doctors, then medical secretaries, technicians and others, began to join the strike.
Meanwhile, teachers had their own grievances, some of them quite similar to those of the doctors. The public schools are some of the world's worst, and the government's response is to crush the teachers' unions if possible and reduce instruction to little beyond reading and mathematics. Improvements on even those basics is not a priority for those who figure that the public schools are for people who will be working with shovels and machetes and mops, while their own kids go to private schools. The harassment is so petty that ASOPROF teachers' union leader Andrés Rodríguez, an art teacher at Colon's Colegio Abel Bravo, was not allowed time off as his mother was on her death bed. The pressure from Education Minister Lucy Molinar got worse as his and other teachers' unions objected to the minister's insistence upon putting unqualified political patronage appointees in classrooms and administrative posts. The principal at Abel Bravo, for example, does not meet the legal requirements to hold that job and she got quite vindictive about Rodríguez's public declarations about it. There ensued a series of escalating job actions that included teachers blocking the principal out of her office:
So as the doctors' strike was growing, there were local school strikes and large teacher protests on Calle 50, not only about education issues but against Bill 349, which was called a move to privatize education. The law does not specifically say that, but it does generally allow that.
Valencia's committee passed the bill and sent it to the National Assembly floor for plenary debate and votes on second and third readings. By then the strike movement was growing at the same time that indigenous opposition to a new mining bill was mobilizing and the Martinelistas were caught in multiple land grab scandals at the same time. Assembly president Héctor Aparicio offered the doctors and the teachers a deal: end the strike and Bill 349 would be amended on the National Assembly floor to exclude health care and education from the privatizations.
But Aparicio had presided over sessions where Cambio Democratico deputies had boasted of their word being worthless, and defended the practice of politically motivated lies. Sure, he could say that this was mainly the vulgar deputy from San Miguelito, Sergio Gálvez --- but he was in the president's chair and didn't gavel Gálvez down, and moreover, he had made Gálvez head of the Budget Committee. The doctors in particular took Aparicio's "trust us" offer as a terrible insult. They demanded that the bill be sent back to the committee before they ended their strike, something that the legislature refused to do.
Thus on October 31, the last day of the legislature's regular session, multiple groups with various causes were on hand for the final hectic crush of legislation, and the doctors and teaches were there with reinforcements:
The legislators declined to send Bill 349 back to committee and at 8:17 that evening, complaining of disrespectful behavior by the doctors and their supporters, they ended their regular session. The doctors said that the strike would continue, but that they would review the situation and their tactics. Under the traditional rules of the legislature, all legislation not passed by the end of a regular session dies and must be re-introduced. However, this legislature is claiming the right to hold a special session to take up something left over from the regular session, starting on second or third reading. But it's the president, not the legislature, who calls a special session. Martinelli would be the one to either pick a worse fight with the doctors or back down and calm things down.
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