The weekly newsletter of the Mexico Solidarity Project

Every issue archived online at mexicosolidarityproject.org

December 11, 2024 

 What does it take to be in good health?

Meizhu Lui, for the editorial team

Houston, Texas' CHI St. Luke’s Health-The Vintage Hospital, one of “The 20 Most Beautiful Hospitals in the U.S."

What do people need to be healthy? Ask anyone, and you’ll get the same answers. Clean water. Clean air. A home. Food. Safety. We can’t get these by ourselves. It takes government to provide sanitation systems, environmental protections, housing policies, living wages and security. If you think of health as a pyramid, these public health interventions make a solid social foundation for good health.

Safeguarding your personal health means you need a yearly exam with a health provider who can check you for ongoing conditions that can be treated. If you are severely ill or injured, you’ll want a nearby health facility with the equipment and personnel to save your life — hospital-based care is the tip at the top of the health pyramid.

In the US, in 2024, the public health budget was $11.5 billion. Contrast that with the money spent on public subsidies for hospital care in the Medicare and Medicaid programs — $1.7 trillion — and that’s not counting the dollars spent by those privately insured. The health pyramid is upside down!

What’s up? Under neoliberal economics, gone are the public hospitals, frequently understaffed and underfunded, but which served everyone regardless of ability to pay. Today’s private hospitals look like luxury Hilton hotels, high-priced and highly profitable to their investors.

Meanwhile, out in communities, people are breathing air that causes cancer, the only affordable food is heart-stopping burgers at McDonald’s, and the nearest hospital is so far away a victim with a stroke or heart attack would die on the way there.

In Mexico, we see similar dynamics at work. But today, as Carole Browner and Gustavo Leal Fernandez tell us, the Morena government is laying down a strong base to the pyramid by raising people’s standard of living from one end of Mexico to the other. Completing the pyramid one piece at a time? To be continued!

Taking a vacation!

Friends, it is time for our annual winter solstice vacation and as we do every year, we will take a 2-week break from publishing the Bulletin. After the Wednesday, December 18, 2024 edition comes out, the next edition will be out on Wednesday, January 8, 2025. Have fruitful, peaceful holidays and we will see you next year,

all fired-up and ready to go!

For a deeper dive into current news and analysis in English, check out our media website. And definitely see the new English podcast ¡Soberanía! (Sovereignty) with José Luis Granados Ceja and Kurt Hackbarth.  They entertain, while dismantling the lies and distortions about Mexico fed to us by the mainstream media.

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Redesigning Mexico’s Health Sector

Carole H. Browner is Distinguished Research Professor in the Center for Culture and Health, Semel Institute for Neuroscience and Human Behavior at UCLA. Her books include the prize-winning collection Reproduction, Globalization and the State: New Theoretical and Ethnographic Perspectives and Neurogenetic Diagnoses: The Power of Hope and the Limits of Today’s Medicine.

What was the health care system that President López Obrador inherited when he took office in 2018?

Carole H. Browner: Before 2018, Mexico endured almost 40 years of intense neoliberal restructuring, which much degraded the public health system built over previous years. The neoliberal era had produced one of the lowest health spending rates in the region — only 6% of its Gross Domestic Product (GDP) — far below other economically comparable countries. It had insufficient hospital beds, doctors and nurses. Especially in the rural areas, inadequate healthcare caused comparatively high rates of maternal and infant mortality and preventable disease.

In 2004, the right-wing PAN government and federal Health Secretary Julio Frenk Mora (now Chancellor of University of California Los Angeles) created the Seguro Popular, which provided limited insurance (only for certain conditions) applying the model of private insurance across income levels, with some public financing added. For twelve years under PAN and six more under the PRI, Seguro Popular persisted. Beset by corruption, it ignored the significant inequalities in patients’ access to doctors, clinics and other medical services. Its failure was absolute.

At the same time, the 1995 North American Free Trade Agreement (NAFTA) with the US and Canada greatly worsened the health of the Mexican people. NAFTA expanded the mass consumption of foreign ultra-processed products by flooding the market with soft drinks, junk food, and GMO ingredients, which generated high global rates of overweight, obesity, diabetes, and hypertension. These conditions contribute to half of all deaths and — importantly — contributed to the COVID-19 pandemic’s extremely high mortality.

Sign in Maya community in Chiapas, Photo: Thomas Aleto

What did AMLO hope to achieve?

Gustavo Leal F.: In his six-year term, AMLO didn’t have enough time to transform the neoliberal disaster he inherited. As was the case in many areas of Mexico’s Public Administration, corruption pervaded the health sector, including construction of hospitals where none were needed (many unfinished) and a payment structure of “kickbacks” to intermediaries.

Thus, AMLO's task was to halt that trajectory, and he did succeed in containing it. But he barely had time to begin sketching a newly designed health sector.

In 2019, at the beginning of his term, he took the undoubtedly correct, bold and relevant step of ending what was neither “Seguro” nor “Popular” and established what the new government team called centralization or federalization of the system. The team created INSABI — with not very good results. Later, AMLO started the IMSS-Bienestar program, which he handed on to the new president, Claudia Sheinbaum. The new program will expand to cover people without Social Security — informal workers — an enormous universe of up to 70 million Mexicans.

What were the people’s main complaints?

GLF: First — medications. Second — an end to long waits for medical appointments. The AMLO administration sought solutions but couldn’t satisfy those felt demands. In addition to the challenges of the pandemic, the team responsible for reform didn’t operate in a unified manner, and severe disagreements and clashes about focus often arose. Thus, AMLO himself designed the agenda for restructuring the sector. A major issue was professional treatment and payment of health teams, and another was getting medical supply levels up.

The AMLO administration had no effective strategy for providing primary health care as consistent with the 1978 recommendations of the World Health Organization (WHO). [Primary care is a whole-society approach that builds a continuum from public health measures to health education to end-of-life care and everything in between. Ed.] AMLO’s improvised restructuring, implemented within IMSS-Bienestar, focused on financing a health model of curative medical treatment — repairing damage to the people’s health due to previous neglect — rather than on preventive and public health measures with the goal of reducing disease, such as WHO called for.

It wasn’t surprising that AMLO leaned heavily toward the curative; 36 years of policies geared to making profits had left patients with a backlog of serious health problems. When previous administrations attempted to push them into the health marketplace, it hadn’t produced good results. Curative and preventive health are both essential in health care, and the people are entitled to both.

So, can President Sheinbaum now create a new functioning system?

CHB: Because the political climate has changed dramatically since 2018, Sheinbaum will be able to advance a new agenda. Many new health professionals at all levels have already been hired.

In her first two months, she created Health House by House, a program for the elderly and people with disabilities, modeled after her pioneering program in Mexico City. Instead of patients traveling for medical consultations, healthcare providers go to visit them at least once every two months. The program has already enrolled about half a million elderly people and 66,000 people with disabilities. To recruit doctors, the program offers long-term contracts, increased salaries, subsidies for living expenses and free post-MD education and training.

I’m concerned that Sheinbaum is not pivoting towards a system that emphasizes providing for people's health needs as early as possible. The Health Secretary, David Kershenobich, comes from an academic research background; he’s never practiced medical care that emphasizes prevention and early detection of disease. He doesn’t seem to be enriching Sheinbaum’s vision regarding primary health care because he simply doesn’t understand it.

So far, Claudia’s team is dictating health sector policy from above, as top-down “experts.” They are not shaping sector policy with the public, with citizen participation. To work well, the new health system must rest on a foundation of public input.

Under neoliberalism, the health sector was privatized. Will the system now be completely public?

GLF: The government will preserve its mixed character as a public-private national health system. Much national spending already goes into the private sector, so public and private intertwine.

CHB: Lifting people out of poverty is the best way to improve a population's health. AMLO's universal, publicly funded increases in pensions for the elderly and people with disabilities, stipends for students and minimum wage increases did just that. Sheinbaum also aims to strengthen women's economic security by establishing that all women will receive a pension at 60 years, regardless of work history, while for men the age will remain at 65. She will also continue the minimum wage increases that AMLO started.

What’s next?

GLF: I’m optimistic. The health agenda announced by President Claudia Sheinbaum aims to expand disease prevention programs, reduce wait times, expand IMSS-Bienestar, improve the supply of medications and equipment in rural areas, and allow individuals to use any public health facility, regardless of where they live or what health insurance they have.

But her agenda is still mostly curative and faces many challenges. In a couple of months, let’s meet again to see what has materialized. After all, Claudia is just 100 days in office.

Congratulations to Reflections writer Renata Turrent, who just became the new executive director of the national educational broadcast TV network, Canal Once (Channel 11). In her place, we are pleased to have Nancy Ortiz join us as a monthly contributor.

Transforming the Civil Service

Excessive bureaucracy is a major problem for most Mexicans — an excess of procedures, controls, and lines at windows that offer government services. These don't improve transparency or efficiency or offer better results. On the contrary, these steps or controls increase the possibility of error and lengthen our wait for positive or good-quality results.

The intent is often good — many controls are responding to the corruption and deception that Mexicans have experienced in many of our institutions, but, in reality, excessive controls haven’t provided better results; rather, mechanisms for bureaucratic corruption have increased.

When I first visited a government office years ago to request a certificate, I was amazed by how many people I had to go through to get a stamped letterhead — such an unnecessary expenditure of human resources! Last week I returned to the same offices, and nothing had changed much. I found impatient employees, arrogant officials and public servants who didn’t know that our constitution grants us the right to petition and that they, as civil servants, are obliged to attend to and respond in accordance with their powers. While some procedures have been automated, lack of transparency, bad manners and inefficiency often remain the way things are done.

One of my professors for my master’s degree said that when he was in London on a project, he’d proposed hiring supervisors to oversee the correct use of resources. The English people were surprised that in Mexico we believe it’s necessary to spend money to oversee the people who are paid to do a job. If we analyze it a little, we find that in Mexico we invest too much in supervising people just to ensure they do what they have to do. And we spend too much time documenting what’s done, and too many papers are drawn up and signed to justify every process because apparently no one trusts anyone. I’m not saying we should eliminate all supervisors or control systems, but that, in the interest of a profound transformation, we have to rethink how administration and public functions are conducted.

This is the challenge of the fourth transformation — to clean up bureaucratic institutions and make them more efficient. We have to rebuild the ethos of the public servant working efficiently, optimizing procedures, time and resources — and we should always promote the desire to serve.

Recent news reports and commentaries, from progressive and mainstream media,
on life and struggles on both sides of the US-Mexico border. Compiled by Jay Watts.

Kurt Hackbarth, Mexico Could Weather Tariffs. Trump Could Not Jacobin. As tariff threats — and even invasion threats — follow one after the other from Mexico’s supposed closest partners, it may be time to question the wisdom of putting so many eggs in the basket of a declining empire, one especially ill-equipped to deal with the transformations of a multipolar reality.

Yajaira Gasca Ramírez, Pirelli y CTM burlan acuerdos para cumplir condiciones a trabajadores POPLAB. Tampoco hay evidencia de la intervención de la Secretaría de Economía, encabezada por Claudia Cristina Villaseñor Aguilar, quien fue coordinadora de atracción de inversiones y se desarrolló como estratega de compras en Pirelli.

Mexico says Canada wishes it had its ‘cultural riches’ amid tariffs feud Guardian. Mexico’s president has said Canadians “could only wish they had the cultural riches” of her country as tensions mount between the two nations, caught in a feud over tariffs and trade exacerbated by Donald Trump.

Alonso Urrutia, Alma Muñoz Y Sergio Ocampo, Ordena Presidencia aumentar las inspecciones a las minas La Jornada. Sheinbaum condenó las condiciones en las que opera el yacimiento: “Lo vi hoy (ayer) en la nota de La Jornada; no puede ser que aquí se apliquen unas normas por empresas canadienses y en Canadá otras”.

Henry Salazar and David Bacon, How Can U.S. and Mexican Workers Build Cross-Border Solidarity? Labornotes. Since the North American Free Trade Agreement (NAFTA) was passed in 1993, the economies of the U.S., Canada, and Mexico have become increasingly integrated. Workers in all three countries have suffered as corporations have used trade rules to maximize profits, push down wages and benefits, and manage the flow of people displaced by these rules.

María José Soto Pallares, Será prioridad vigilar a las empresas para respetar derechos laborales: Napoleón AM. Reconoce Secretario General del Sindicato Nacional de Mineros que la inspección y el seguimiento será indispensable para que las empresas no caigan en la explotación laboral.

U.S. Troops Not To Enter Mexico to Fight Drug Cartels: Sheinbaum Telesur English. “There will not be an invasion. That is not a scenario we have in mind,” she told reporters who asked if Mexico’s Armed Forces are prepared for the potential incursion of U.S. troops during Donald Trump’s next presidency. Previously, he stated he is willing to bomb criminal groups in Mexican territory.

Sergio Ocampo Arista, Tres muertos en una mina de la canadiense Torex Gold La Jornada. Tres obreros de la mina Media Luna, propiedad de la empresa canadiense Torex Gold, fallecieron por inhalar monóxido de carbono en el área subterránea del yacimiento, ubicado en el poblado Nuevo Balsas, municipio de Cocula, la mañana de ayer, reportaron funcionarios del gobierno del estado y de la propia compañía; un cuarto minero se encuentra hospitalizado.

Alex Vasquez, Mexico Congress Mulls More Benefits for Delivery App Workers Bloomberg. The proposal to improve rights for courier and driver app workers was among the 100 promises Sheinbaum made in her inaugural speech on Oct. 1. When the proposal was presented later that month, Labor Minister Marath Bolaños said the bill would aim to impact around 658,000 workers and give them benefits such as protection against accidents, housing credits and maternity leave.

Alejandro I. López, Así es la reforma para regular el trabajo de repartidores por aplicación en México El País. La iniciativa, que se votará en la Cámara de Diputados a mediados de diciembre, formaliza la relación laboral entre los repartidores y las plataformas digitales para dar prestaciones de ley a los trabajadores por aplicación.

The Mexico Solidarity Project brings together activists from various socialist and left organizations and individuals committed to worker and global justice. We see the 2018 election of Andrés Manuel López Obrador as president of Mexico as a watershed moment. AMLO and his progressive Morena party aim to end generations of corruption, impoverishment, and subservience to US interests. Our Project supports not just Morena, but all Mexicans struggling for basic rights, and opposes US efforts to undermine organizing and Mexico’s national sovereignty.

Editorial committee: Meizhu Lui, Bruce Hobson, Agatha Hinman, Victoria Hamlin, Courtney Childs, Pedro Gellert.  To give feedback or get involved yourself, please email us!

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