Health Reforms in Latin America: Lessons for the U.S.?

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

Photo credit: World Bank Photo Collection / Foter / CC BY-NC-ND

While Washington struggles to implement modest health care reforms, a number of Latin American countries over the past decade have been changing their health systems in ways that may offer encouragement to advocates of progressive change in the United States.  Reforms in Brazil, Chile, Colombia, Mexico and others strive to provide universal care in circumstances that are, in some cases, much tougher than those facing proponents of Obamacare.  Some challenges and accomplishments include:

  • In Chile, after years of investment, about 73 percent of the population now uses the public health care system.  A Family Health Plan in Brazil, which accounts for US$2 billion of the US$3.5 billion of the government’s health budget each year, has contributed to expansion of health care participation to 70 percent of the population.  When Colombia passed a health care law in 1993, only 24 percent of its citizens had coverage; in 2007, it had reached 80 percent.  Mexico has gone from 40 percent in 2004 to about 70 percent.  (In the U.S., about 83 percent had access to health insurance as of 2010.)
  • Latin American elites, like their U.S. counterparts, have long resisted providing the resources needed to cover health care costs, either through workplace insurance or through paying taxes to support state provision of health services.  But Latin American experience shows that this reticence can be overcome.  Substantial taxes have been levied in recent years – such as a 7 percent health care tax in Chile – and, according to various databases, health-related spending has grown to almost 7 percent of GDP in Mexico, about 7 percent in Colombia, about 7.5 percent of GDP in Chile, and around 8 or 9 percent in Brazil.  (Health care spending accounts for about 18 percent of the U.S. GDP – about half from public spending.)

These Latin American governments have demonstrated that, Sí, se puede when it comes to reforming health care and challenging entrenched interests wary of change.  Spending is rising as a percentage of GDP, but expenditures remain a fraction of those in the U.S. – and the gap in quality of care is narrowing.  Latin Americans have expanded coverage at a time that access to good care in the United States remains a challenge for tens of millions of people.  The U.S. economy generates more than sufficient resources to guarantee health care for the entire population, but the Obama administration seems too weak to implement its tepid reforms on schedule – recently postponing an important mandate that large employers provide insurance coverage.  Health care providers in Latin America appear to be adapting to the new playing field, but their U.S. counterparts are lagging.  If Latin American leaders had advice for their U.S. counterparts on how to slay this dragon, it would probably involve taking note that reforms in the region invariably emerged from decisive leadership from the executive branch and, with the exception of Mexico, a willingness to increase tax burdens to expand coverage.  They would also note that, much like is evident in public opinion polling of Latino populations in the U.S., citizens of Latin American countries are overwhelmingly in favor of public guarantees of health services for all.

OAS Drug Report: Let’s Get Serious

The OAS Preparing their Report on the Drug Problem in the Americas | Photo credit: OEA - OAS | Foter.com | CC BY-NC-ND

The OAS Preparing their Report on the Drug Problem in the Americas | Photo credit: OEA – OAS | Foter.com | CC BY-NC-ND

The Organization of American States’ most recent report on the drug problem in the Americas – released last week in Bogotá – takes a fresh, analytical look at the issue and, by advocating discussion of new approaches, subtly signals the “war on drugs” so far has failed.  The report was mandated by hemispheric leaders last year at the Summit of the Americas in Cartagena, who “agreed on the need to analyze the results of the current policy in the Americas and to explore new approaches to strengthen this struggle and to become more effective.”  It takes an analytical approach toward drug-related problems in the hemisphere and includes a discussion of both the supply and demand factors of the drug trade.  (Click here to view the OAS documents.)

The report does not make bold policy recommendations.  It calls for greater attention to the public-health implications of the drug problem, but generally avoids advocating particular strategic solutions to the production, transportation and consumption of illegal narcotics, instead providing different scenarios for the evolution of the drug problem in the Americas.  It envisions the legalization of certain drugs, such as marijuana, in various countries, but makes clear that the OAS is not advocating legalization or decriminalization.  Instead, the report emphasizes the need for countries in the Western Hemisphere to work together to combat the drug problem and discuss new approaches.

The OAS’s unique status in the hemisphere – demands on its performance are high but support for its efforts  from key governments in the region is inconsistent – may not make it the best organization to take the lead on an issue as thorny as the “war on drugs.”  The increasingly clear consensus south of the Rio Grande is that the past couple decades of effort have been not been worth the cost in dollars and lost lives, and many Central Americans, in particular, believe the militarized approach has been disastrous.  Often criticized by U.S. politicians and bureaucrats, Secretary General Insulza was probably wise not to use the report to formalize the hemisphere’s rejection of Washington’s policies.  But moving the discussion to the analytical level – rather than parroting support for another Plan Colombia or Mérida Initiative – is a significant accomplishment in itself.  Rolling out the report in Bogotá, where talk of “new approaches” is also growing, probably helped strike the right balance between old and new.  In addition to platitudinous calls for regional cooperation, the OAS can demonstrate its leadership and relevance by channeling the criticism, the lessons learned, frustration with U.S. consumption, and regional governments’ prescriptions on the way ahead into a serious, constructive strategy for the hemisphere.  With this report, the OAS has indicated that it’s time to get serious about viable alternative solutions to this multi-faceted issue – and that clinging to old models and rejecting new ideas is no longer an acceptable response to calls for rethinking the “war on drugs.”