When Ecuadorean President Rafael Correa took office in 2007, he promised to make his country’s public health care system the envy of South America.
After years of wrangling funds for the country’s Ministry of Public Health, Correa lived up to his promise. Under the Citizens' Revolution, Ecuador’s public health care system is today one of the top-ranked in the region.
Ecuadoreans now find themselves at a crossroad, ten years after Correa made his promise. They can either continue building government-run public health care or let the market decide the fate of the country’s sick.
“Privatization — for us poor people who are from the working class areas, who use free medical services provided in our constitution — would be like a death sentence,” health activist Jose Veloz told teleSUR in a recent interview. “It’s that simple.”
Lenin Moreno and Guillermo Lasso will face off in the second round of Ecuador’s presidential election Sunday.
Moreno, representing the ruling Alianza Pais party, wants to continue expanding the country’s public health care system. A political supporter of Correa and the Citizens’ Revolution, Moreno said his administration will make free, high-quality medical services for Ecuador’s poor a “top priority.”
Lasso, representing the right-wing CREO party, wants to privatize the country’s public health care system and turn it into a “free trade zone.” A wealthy banker fiercely critical of Correa, Lasso said his administration will prioritize business owners who want to pay fewer health care taxes.
Moreno and Lasso couldn’t be more opposed on health care, along with other platforms.
For Veloz, who organizes health fairs and day clinics in one of Quito’s poorest neighborhoods, Moreno and the Citizens’ Revolution offer the best public health agenda.
“We are convinced that change is here. We do not want another change,” Veloz said, commenting on Lasso’s “Let’s Go for Change” campaign slogan.
“This change is what we want. The change of the Citizens' Revolution, which gave us hope, life, a future. And we continue that change for the good life of our children, our grandchildren. I say yes to the Citizens’ Revolution. Yes to thousands of health care projects for the benefit of the people.”
Lasso, however, believes privatization is more efficient and will bring down costs for Ecuador’s “middle class.” He argues that the quality of health care will improve once private companies are in charge of treating patients. He also says he wants to bring down patient waiting times by 50 percent.
“There must be a decentralization process in health, and we should not necessarily expect the government to have US$1.2 billion to build the hospitals that are missing,” Lasso said during a campaign speech earlier this year. “A local or international entrepreneur can do that work much better.”
In order to understand Ecuador’s polarized debate over public vs. private health care, it’s important to know what the country’s medical system was like prior to 2007 and what it has become since.
Before Correa and the Citizens’ Revolution, the role of the MSP was much smaller than it is today. Private medical companies ran most hospitals. Health insurance groups held a monopoly on the market. Doctors were given hefty rewards from pharmaceutical companies for prescribing certain kinds of expensive medicines.
Although taxpayers paid less money for public health, the quality of service was nowhere near the level it is today. Ecuador had one of the highest rates of preventable diseases in Latin America, according to the World Health Organization, due to the fact that most people couldn’t afford to visit a doctor.
“In our previous health care system, our relatives would die in front of the emergency room doors,” Veloz said, commenting that many people were denied treatment for not having enough money to pay.
“For those lucky enough to make it inside, many would die in hospital beds because there wasn’t power or equipment in the hospitals.”
After 2007, the MSP and the Ecuadorean Institute for Social Security began playing a much larger role. In accordance with the Indigenous Quechua principle of “sumak kawsay,” or “good living,” the government added a clause in its constitution guaranteeing free public health care for all.
For those who have paid into the IESS system through payroll deductions, all medical costs are free. Along with not having to pay deductibles or co-pays, no one can be denied treatment because of their age or pre-existing conditions. This is not the case in most Latin American countries, where the elderly or chronically ill have a hard time getting treated because of their background.
In 1995, the Ecuadorean government used 3.4 percent of its gross domestic product on public health care. Today, it uses over 9.2 of its GDP for free MSP and IESS services.
In 2006, Ecuador’s investment in public health care was estimated at US$400 million, El Telegrafo reported. In 2007, when Correa took office, it went up to US$568 million. In 2014 it increased to US$2.4 billion and by 2015, it reached US$2.5 billion.
Since taking power, the Alianza Pais government has constructed over 46 health centers and 12 hospitals throughout the country, the MSP reported. All of these facilities provide free medical services.
The leftist government has also increased the number of free consultations from 20.3 million consultations in 2007 to 39 million in 2015, according to El Telegrafo.
The benefits of the expansion of Ecuador’s public health care system are certainly evident.
A 2014 Bloomberg survey of overall health care efficiency, factoring both cost and quality, listed Ecuador 20th in the world, Cuenca Highlife reported. The United States by contrast, ranked 46th.
Correa's tenure has also witnessed a continual rise in life expectancy for both men and women, which is 73.5 and 79 respectively as of 2015, calculated by WHO. Life expectancy for both genders increased by three years over the period of 2000 to 2012, surpassing the regional average increase of two years.
Ecuador currently has one of the highest life expectancy rates in Latin America. Prior to 2007, the South American country had one of the lowest life expectancies in the region. Tobacco use, obesity, heart disease and other preventable diseases have also significantly decreased since 2007.
“Public health care privatization would be catastrophic because it would reverse all of our gains,” Veloz said.
“That’s why the people will not let Lasso take away all that we have gained. We will not allow him to take away our right to free health care. He has the money to pay for private care. We don’t.”
All latest polls predict a win for Moreno, who led Lasso by more than 10 percentage points in the first round vote.