The capital was abuzz with activity. Cars horns honked and brakes squealed as drivers waited impatiently in the snarled traffic of the morning commute. I passed through the metal detector at the office entrance and walked briskly into the conference room on the first floor. The room was filled with government health officials who had gathered together with one goal in mind. They had come to discuss how to implement a new program that might be able to improve the health of the country’s poorest and most vulnerable citizens.
Unfortunately, this “capital” was not Washington, DC, where I am doing my GHC fellowship this year. It was Tegucigalpa, the capital of Honduras, where I was assisting with the implementation of the Salud Mesoamerica 2015 Initiative (SM2015) as part of my job at the Inter-American Development Bank (IDB).
Meanwhile, back in DC, the infamous morning commute was quite calm. In contrast to Honduras, most government officials were not working at all. They were told to stay home and await the end of the government shutdown, when Congress would finally approve a budget to pay their salaries and provide much needed services. The US government was shut down because one small faction of congressmen and senators demanded that the Affordable Care Act (a.k.a. Obamacare) be repealed. Not adjusted, not improved, not tweaked, not replaced with something better…repealed.
This incident left me with a few thoughts:
1) It’s time to step back and broaden the debate about health care in the US. I think most of us would agree that our health and the health of our family and friends is vitally important. We have to decide as a country if we believe that everyone, regardless of income, race, social class, etc. should have affordable access to medical care. If the answer is yes, then maybe it’s time to establish access to healthcare as a constitutional right. Several Latin American countries, such as Brazil, Colombia, and Ecuador[1] have already done so (and over 150 other countries globally), and it has helped to focus these countries’ resources and energy on finding a way to make universal health coverage a reality. A constitutional right to health care would change the debate from “repeal Obamacare!” to “improve Obamacare so that it serves its purpose of guaranteeing access to care for all.”
2) Implementing any large project is always a challenge and requires constant assessment and improvement. In my (admittedly very limited) experience, the biggest challenges to the SM2015 program are managerial and political. Converting policy to practice takes a lot of organization and planning. It requires changing how people, organizations, and even whole industries work and think. We cannot expect any program to be rolled out perfectly from the start. SM2015 is being implemented in three phases, and after each phase the problems and shortcomings are analyzed and improvements are made for the next phase. As we are starting to see problems arise with the implementation of the Affordable Care Act (ACA) insurance exchange websites, we should keep in mind that challenges are expected, what really matters is that they are quickly identified and overcome.
3) Finally, the government shutdown has reminded us that every government has its faults, difficulties, and room for improvement. In the traditional model of international development, knowledge, resources, and technical assistance flow from high-income countries to low-income countries to support political, economic, and social development. But there is much that high-income countries can learn from developing countries. Many Latin American countries, for example, have made strides in improving the health of their populations by employing community medical teams, consolidating various health financing institutions, and requiring private insurers to cover certain basic health services (which the ACA will do). If Americans confirm their commitment to affordable health care with a constitutional right, there are countless international experiences from which to draw ideas that best fit our context. We sometimes look east across the Atlantic or north to Canada for best practices, but let’s not forget to look south.
The opinions expressed in this post are, obviously, my own, and do not reflect the opinions or policies of the Inter-American Development Bank.