This system is not salvageable, this system is not dignified and it is not sustainable. The only way forward in civilisational terms is an intergenerational solidarity social insurance, a single, universal health system for all the people of Chile. This is what the conversation should be about and should be assumed as an ideological question, but they insist on taking us to the technical terrain of the short ISAPRE law, a patch that makes them live regardless of who they let die.
By Natassja de Mattos
Back in 76′ Michel Foucault coined the idea that the formula of biopower is that of “making people live and letting them die”, associated with the biological question of the body and medicalisation. Behind this lie the practices of factual power that regulate, legislate, and govern the possibilities of living and living well, a matter that depends, without a doubt, on health. If health is provided, if access is ensured and quality services and benefits are guaranteed, then it is possible to live. If you exclude people from this right, prevent access to good services and benefits, and marginalise them from the possibility of enjoying good health, as well as violating their dignity and human rights, what you are doing, at the end of the day, is letting them die.
In Chile, more than a year ago, the Supreme Court issued a ruling in which it found that the ISAPREs (Social Security Health Institutions) charged their affiliates more, ignoring the table of factors that determine prices, making their calculations that ended up being excessive since 2020. In view of the above, in an act of complete justice, compensation in economic terms was demanded. When the calculation of the debt that the ISAPRE had with its clients was made, the amount was categorical: if they paid, they would go bankrupt and the resolution was to return the abuse in surpluses, in benefits, services and coverage. A structural financing crisis was revealed and there was a massive flight from ISAPREs to FONASA.
A discussion then began about whether to “make ISAPREs live or let them die”, and it was concluded that this was not good for anyone, and that if this happened it would be the ordinary people who would be affected in the long run. This is ironic by any standards since the inequalities produced by the ISAPREs are based on the same formula: make people live or let them die. These are the ones that sustain a strong system of inequalities through individual capitalisation to the detriment of a solidarity-based system that could strengthen FONASA (National Health Fund), which has the potential of a universal health system for Chile. As the writer Olivia Laing said: “The truth is that unless health care is universal, a person’s survival does not depend on their desire to live, but on their ability to pay”, and it is precisely this that underlies the creation and sustains the existence of the ISAPRE.
If these are paid for with the contributions of everyone, once again we are faced with an ideological debate that contrasts the positions of being a people of intergenerational solidarity or an individualistic people that save their skin. In October 2019 we seemed to have had enough of this radical individualism that supports issues such as ISAPREs and AFPs, and today in Congress, public opinion and the government are slowly cooking up formulas to save them, so as not to destabilise the system. And it is not that we have to destroy everything from one moment to the next -although sometimes it seems a plausible window of opportunity for the precise revolutions that will bring us closer to a dignified life-, but we do need to understand the need for a universal systemic guarantee that expands and strengthens structures such as FONASA for a true perspective of care.
Let us not forget that ISAPREs not only produce inequalities because those who can pay for them have access to better and better health, but they also discriminate among their clients (for that is what they are, clients), in that those who have a history of illnesses, are older or are women of childbearing age, are the ones who have to pay the most, reaching derisory prices. I would like to dwell on women of childbearing age, a matter in which lies a tremendous inconsistency, since the sectors most determined to make ISAPRE live, and hopefully the same as it has been for at least five decades, are those who most value a certain family formula and reduce women to their reproductive role as if that were their work and purpose in life. However, when it comes to their health care, they are punished for the possibility of gestation and childbirth when it comes to their health insurance.
This system is not salvageable, this system is not dignified and it is not sustainable. The only way forward in terms of civilisation is an intergenerational solidarity-based social insurance, a single, universal health care system for all the people of Chile. This is what the conversation should be about and should be taken as an ideological question, but they insist on taking us to the technical terrain of the short ISAPRE law, a patch that makes them live regardless of who they let die.
