The Economist - USA (2022-01-22)

28 TheAmericas TheEconomistJanuary22nd 2022

includesgovernmenttransfersandnon­

cashincome).

Thecountrynevershutitsborders.Vis­

itorscouldcomeandgowithouthavingto

brandisha negativecovidtestorproofof

vaccination.Mexicanofficialsclaim,with

somejustification,thatit wouldbehardto

sealitsporousfrontiers.Thegovernment

alsowantstoencouragetourism,which

generatesalmost9%ofthecountry’sgdp.

Thegovernmenttriedtoincreasehos­

pitalcapacity. Wards were convertedto

boostthenumberofbedsavailable.More

ventilatorswerebought,andmorenurses

hired.Theexpansionhelped,reckonsNora

MartínezGática,a doctor.Butsheaddsthat

thefocusshouldhavebeenonprevention,

notleastasthehealth­caresystemisalrea­

dyinpoorshape(seenextstory).

Similarly,anattemptearlyinthepan­

demictoteachmedicalstaffhowtodeal

withcovid­19peteredout.Protectivecloth­

ingwaslacking.JaimeSepúlveda,a former

healthofficialwhowrotea scathingreport

fortheWorldHealthOrganisationonMex­

ico’sresponsetocovid­19,saysmorebeds

werenotenough.Hethinksthehighmor­

talityinMexicowasduetopoortraining

andlackofequipment.

The government’s focus has now

switched,quite sensibly,to vaccination.

Around60%ofthepopulationhasbeen

double­jabbed,a sharewhichrisesto80%

forover18s.Some51%oftheelderlyhave

hadboostershots.MrLópezObradorini­

tiallyseemed unsure aboutwhether he

wouldgetthejab,butthengotit inApril.

WiththearrivalofOmicron,authorities

insomepartsofthecountryaremoving

awayfromMrLópezObrador’slaissez­faire

strategy.ThestateofJaliscohasmadeit

compulsory for bars and other indoor

spacestorequestproofofvaccinationora

negative test. In Tlaxcala people must

showproof of vaccination to go to the

supermarket.Ecatepec,a poorareaonthe

outskirtsofMexicoCity,hasbroughtina

fineof 864 pesos($42,orfivedaysofthe

minimumwage)forpeoplenotwearinga

facecovering(onemanhasbeenarrested).

Somemuseumshaveonceagainshuttheir

doors inMexicoCity, whilesomestates

havedelayedpupilsreturningtoschool.

“Mexicoshoweditsfacewiththepan­

demic,”saysLauraFlamand,ahealthre­

searcheratElColegiodeMéxico,a univer­

sity,who pointstothelackofuniversal

healthcareanda socialsafetynetinthe

country.MoreMexicansmaybemasked,

buttheyarenotsafeyet.n

Añosdelosmuertos

Covid-19,cumulativeestimatedexcess

deathsper100,000people

Source:TheEconomist’s excess-deaths model

1

500

400

300

200

100

0

2020 21 22

Chile

LatinAmericanaverage

Brazil

Argentina

UnitedStates

Mexico

Miserly Mexico

Governments’ fiscal response to covid-19

To Sep 27th 2021, % of GDP

Source:IMF *Average

2

Mexico

Argentina

Emergingmarkets*

Colombia

Chile

Brazil

Peru

50 201510

Loanguaranteesand other credit measures

Discretionary fiscal measures

HealthcareinMexico

Bills be damned

W

henmaríafernanda, a 15­year­old

in Tlaxcala, developed a lump next to

her right eye, her family assumed it was a

mosquito  bite.  A  few  weeks  later,  when  it

had  not  gone  away,  doctors  diagnosed

rhabdomyosarcoma,  a  rare  cancer.  The

family’s woes deepened when the hospital

she  was  referred  to,  four  hours  from  her

home,  lacked  the  chemotherapy  drugs  to

treat her. Eventually a charity stepped in to

help buy the medicine. “I don’t understand

why [the government] does not want to in­

vest in the health of children,” says Brisel­

da, her mother.

For the past three years public hospitals

in  Mexico  have  repeatedly  run  short  of

drugs, including those to treat cancer, high

blood pressure and diabetes. In November

President  Andrés  Manuel  López  Obrador

scolded  health  officials  for  the  shortages.

Yet they are caused by his policies. 

Mexico  has  long  had  a  fragmented

health  service,  with  public  provision  gen­

erally  tied  to  health  insurance  gained

through  employment.  Previous  govern­

ments have tried to make health care more

accessible, particularly to those with infor­

mal jobs. In 2003 Seguro Popular (or Popu­

lar  Insurance)  was  introduced  to  cover

roughly half of Mexicans. It was lauded as

an  example  of  how  developing  countries

could provide health services to the poor.

When Mr López Obrador came to power

in  2018  he  vowed  to  replace  this  system

with one that was both universal and free,

similar  to  Britain’s.  He  scrapped  Seguro

Popular and created the Institute of Health

for  Wellbeing,  which  he  said  would  cover

everyone and every treatment. He also said

he would root out alleged corruption. The

finance  ministry  became  responsible  for

buying and distributing drugs.

The reality has not lived up to the hype.

Despite the president’s promises, the new

system  does  not  cover  all  treatments.  Al­

though the new system had “terrible luck”,

in that it came into being at the same time

as the pandemic, it also has “terrible man­

agement”,  says  Carlos  Magis  Rodríguez,  a

doctor  and  former  bureaucrat.  The  first

person in charge of it was an archaeologist

with little experience in public health, but

who is friendly with the president.

What  is  more,  the  finance  ministry

lacks  experience  in  buying,  storing  and

distributing  drugs.  It  bought  some  1.2bn

items  in  2020  when  Mexico  needs  more

like 1.7bn each year, reckons Enrique Martí­

nez Moreno, an analyst. Drugs were bought

at  the  last  minute,  at  higher  prices,  even

though the new system is underfunded.

Mr  López  Obrador’s  reform  was  “bud­

getary  suicide”,  says  Julio  Frenk,  a  former

health  minister  who  was  behind  Seguro

Popular. Spending on health care rose un­

der  that  scheme,  but  within  clear  para­

meters to avoid nasty fiscal surprises. The

government  was  obliged  to  allocate  a  set

amount for each person enrolled. The law

also  set  up  a  fund  for  “catastrophic”  ex­

penses not covered by the scheme, such as

cancer treatment. By contrast, funding for

Mr López Obrador’s system is ad hoc.

Mexico  spends  just  5.4%  of  gdp on

health  care,  less  than  Uruguay,  Argentina

or  Venezuela  before  its  economy  col­

lapsed. The budget for 2022 includes an in­

crease  in  health  spending  of  15%,  com­

pared with 2021. But this comes after sever­

al years of austerity.

The  result  is  a  system  that  is  creaking.

The country has fewer doctors, nurses and

hospital beds than the average in the oecd,

a club mostly of rich countries. Many have

turned to private care: 41% of total spend­

ing  on  health  comes  from  Mexicans’  own

pockets,  the  highest  proportion  in  the

oecd. According to Ipsos mori, a pollster,

Mexico  is  the  only  country  it  surveys

where  trust  in  doctors  declined  between

2019 and 2021, from 71% to 66%. 

In  December  Mr  López  Obrador  de­

clared he would put the army in charge of

distributing drugs.Buteven if the soldiers

prove logistical wizards,they cannot mag­

ic pills out of thin air.n

MEXICO CITY

Mexico’s president tries to improve

treatment without paying