Do you agree with the analysts that, according to the National Development Plan, what is coming, under this government, is the over-dimension of the state over the dwarfing of the private?
Yes, totally. The PND always has three main components: the bases of the plan, which is a fairly long, academic-style technical document. Another is a normal article of any bill. And the third is the investment plan for the four years of government.
Start there…
In this investment plan, in the last six or seven governments, you always see all the expenses that are going to be made, let’s say, not the State or the Government, but society, in all sectors: infrastructure, social development, education , health…
Which are very large expenses, obviously…
For what then the Government in the PND has to specify obligatorily will be the sources of financing of the Government, approximately half; characteristics of the sources of the territorial governments, of 10, 15 percent; and international sources, in addition to those from the private sector, a very strong component, 30 percent more. In this PND, this component is almost non-existent. It was the first thing that caught my attention.
Very strange?
It is that the private invest in roads, hospitals, aqueducts, housing. How are we going to do to meet such an ambitious goal in terms of investment if the Government does not want private parties to intervene? Another thing that worried me a lot is that one of the extraordinary powers that the Government asks Congress, specifically, is to reorganize all the entities and the productive apparatus in order to meet the goals of reindustrialization, under a framework of environmental protection… As if to say, we want to nationalize everything again. That leaves one concerned.
Article 339 of the Constitution orders that the PND contain two parts: the first, the formulation of social, political, and environmental projects of all kinds; the second, the precise formulation of the large public investments and works that have to be mentioned in a multi-year budget, so that there are not those famous white elephants that abound in the country due to lack of financial planning. Do you think then that the PND suffers from this flaw?
Yeah. I was referring to this multi-year budget in the previous question, since the sources are conspicuous by their absence, especially the private ones. In addition, in the process in Congress, this list of PND works is a very important issue, because congressmen always want to include projects for their regions, or for their electorate, or whatever. As it is, there are no characteristics of the large projects in which the Government wants to bet.
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In other words, it is confirmed that this plan is abundant and exuberant in the first part, and very poor in the second…
As it is.
And that, in turn, opens a flank of great constitutional weakness when it comes to the Court?
Yes, because it is a direct constitutional mandate.
The President is furious because they tell him that he is a dictator. He replies that instead he is a Democrat, who is ceding everything to Congress. However, both in the PND and in the health reform, he asks that they approve extraordinary powers. I have counted twelve in the first and six in the second. There is one that amazes, and that is that the President of the Republic can carry out budgetary operations and modify and complement public health regulations. So, in the end, is he or Congress the one that is going to put an end to that project?
When I read that I couldn’t believe it. Shows a high level of improvisation. It may be that they see that what is embodied in the health reform project is going to have problems in the future, especially if one makes such a drastic change in the model as the one proposed. It would have to include a transition period with clear rules that it will last such years, with a clear budget, that it will invest in high-cost patients in such a way. None of that is, because we can’t or they didn’t have time to do it. They improvised on that piece.
So they put those powers to the President…
Yes, to do that in the future. It is absurd, because it is saying to the people: look, here we are doing a health reform, but during the next six months, the Government and the President can do another one, and without going through Congress, because what it says there is that the President may modify all the norms of reference to health and the budget.
If they give him extraordinary powers, the democrat who is not going to end up putting the full stop is going to be him… What other extraordinary powers that the President is asking for have surprised you?
basically that the President is asking for powers to reform, create entities and fund-accounts. Of which the Government has many, historically, to manage certain accounts…
Examples?
They are funds that manage money for certain priority purposes for the Government: the Peace Fund, which was created back in the 1990s and still exists, and with that the National Rehabilitation Plan was financed. Later there have been many, such as the funds with which tragedies, earthquakes, winter have been handled…
There have been extraordinary powers in almost all governments. But how many?
Funds have always existed. But in this PND… all the governments have requested one or two extraordinary powers to be able to carry out a reform of the State without having to go through Congress. What surprises me is that in this case the faculties are many, and of three types.
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How appropriate?
Well, there are some to carry out all the budgetary modifications, of objectives, of functions, of linking and creation of entities for all kinds of purposes, and of funds-accounts. So, for example, the President will be able to make the necessary budgetary modifications to finance the operating expenses of the entities, acquire a free or onerous title to the infrastructure and many to create entities and funds. The other thing that is quite surprising, because they ask for special faculties for certain regular things: the alternative uses of coca, of cannabis; create a transfer system for low-income populations. In other words, for regular things that they can regulate without asking for extraordinary powers.
And why do you think they are asking for that?
It worries me because, for example, to make transfers, to grant subsidies, the Government can do that however it wants, unless it is thinking of something more fundamental. It’s quite surprising that there are so many extraordinary abilities.
Constitutionally, in addition, it is required that extraordinary powers have to be precise, not generic…
Exactly. Because if not, then it is giving legislative power to the Government and the autonomy of Congress is lost. When extraordinary powers are requested for the President here in order to purify and modify the current regulations to establish the instruments that are required to implement the policies of reindustrialization and strengthening of the popular economy, because they are giving him powers to measure himself with the economic system , with regulation, with reindustrialization, with the way to strengthen the popular economy.
I mean, do what you want…
It is that at the moment of truth these powers end up being very similar to a state of exception, in which the Government can legislate by decree, which any democracy must avoid. That is why, as you rightly say, they must be so precise.
Does Anif have budgeted how much the health reform would be worth?
No, no, no, María Isabel, that is impossible. They don’t even have a clue. The first thing that the Treasury is already saying is: how much is this worth? In other words, to build I don’t know how many primary care centers, one for every 20,000 inhabitants, I don’t know what, to get specialists, that…
But it turns out that the law requires that when a project of this magnitude is presented, which has to do with a large budget, there must be an endorsement from the Ministry of Finance, which until now we have not seen…
That we have not seen The finance minister already said publicly in an interview that any health reform project had to be consistent with the fiscal framework and with the government’s fiscal goals. I don’t think anyone has the accounts of how much it will cost. And we at Anif can’t make those accounts either because there’s nothing to base it on.
And even more, Dr. Mauricio, in some article of that chaos that is the drafting of the reform, one reads that all this change arose from whether there is money in the Treasury or not. How are we going to say that we are going to demolish what there is, and build something completely different, ah, but that began, at the stage in which the transition took us, from whether there was money or not money?
That’s why I tell you that they themselves don’t really know what is going to happen, and they put in these extraordinary faculties to be able to fix things later on along the way. Which is the worst thing that can be done, and much more in a sector like health. It is that here we are not talking about any other sector. We are talking about that at this moment approximately 15 percent of the Colombian population is undergoing treatment for some high-cost disease, diabetes, kidney problems, COPD, cancer… And what about all these people? No, it’s that we’re going to create some centers and then we’ll see how we care for them… This is something that really leaves one, pardon my expression, with their hair standing on end.
A transition period, between the current system and the future, is estimated to be about ten years. For example, the magazine Cambio calculates that this has a cost of at least 40 billion pesos, two tax reforms. Does that amount seem exaggerated to you?
The calculation does not seem exaggerated to me, but the sum does seem very high to me. Today we already spend 70 billion pesos a year on health in Colombia. By far it is what the country spends the most on, more than pensions, more than the Military, more than everything. Add another 40, well, first, where are they going to come from? And second, it’s an outburst. I have spent my whole life making public policy and looking at things here and there, and health has followed me from the beginning, by pure chance; And I have no doubt, in those thirty-four years that I have been working, that the greatest achievement of equity and social policy that Colombia has had is health. Before 1993, and I lived through it, health was a handout for the poor and health insurance in Miami for the rich. That was health. Today it is a right for everyone, and we have achieved that with a huge effort. The same satisfaction figures from the ministry show that 80 percent of the people, of the patients, are happy with the service they receive, regardless of whether they are contributory or subsidized. That is to say, those of the subsidized feel a satisfaction equal to that of those of the contributory. We went from a handout for the poor to a right. And that has cost us money, effort, work in 30 years.
And that is why we spend 70 billion pesos a year on it…
So that they come to tell us that they are going to destroy it, because health cannot be a business, and that patients are not clients and I don’t know what else, without taking into account the reality of what is happening. And, furthermore, getting into a fiscal vacaloca that we don’t know how it’s going to turn out. That is already really the cover.
MARIA ISABEL RUEDA
Twitter: @MIsabelRueda
