Photo: The New York Times, retrieved

With rising child and maternal mortality rates, long-controlled infectious diseases scourging the country and a hospital network where things as simple as running water are a flamboyant luxury, our current situation can only be compared to that of war-torn nations. Actually, in 2007, while petrodollars still kept Chávez’ illusion alive, international health economist and public health advisor, William Newbrander, described fragile states as places where problems like mass migration, terrorism, international crime and reemergence of previously controlled diseases, are common. Sure, he was talking about Congo and Afghanistan, but today he might as well be describing anything we’ve mentioned on our latest posts.

We already know Venezuela is a fragile state, but is there anything we can do to change that?

Good news is, there is! Bad news is, we first need to oust Nicolás Maduro and his cronies out of Miraflores, no real changes will ever be possible with the same criminals ruling the nation. But let’s imagine for a minute that a transition actually happens in the near future; what do we need to turn a chronically dysfunctional health system into something that actually works?

Fragile states as places where problems like mass migration, terrorism, international crime and reemergence of previously controlled diseases, are common.

Well, we must solve the most immediate problems of the starving masses while reshaping the whole system, so development can be achieved in the long term. This is harder than it sounds, but here’s a walkthrough:

1. Gather information

Before we do anything, we need to know the real magnitude of the problems we face. It’s been almost a year since the last time the Venezuelan government published an epidemiological bulletin, and it cost Antonieta Caporale her position as Health Minister. Back then, we had a glimpse of how bad the diphtheria and malaria epidemics were, and we learned that 11,466 children and 756 pregnant women died in 2016. Although we lack recent data, it’s safe to say things are much worse now. We don’t have numbers on things like HIV+ patients in Venezuela (which some claim might be over a million), or how many of them are still receiving their increasingly scarce treatment.

The path to development is very long but without timely and regular epidemiological data, we will never be able to start the journey.

2. Make saving lives a priority

Once we know what’s killing us, and in what numbers, the first six months should focus on tackling the biggest problems using low-cost-high-benefit strategies. This is where long-discussed humanitarian aid comes in hand: the international community, whether by individual-country donations or through multinational institutions such as the World Health Organization (WHO), might guarantee that vaccines and essential drugs arrive at the country in big-enough numbers to stop the dissemination of infectious diseases.

In Venezuela, a large-scale deployment of vaccines to prevent measles, diphtheria, tuberculosis, rotavirus diarrhea, meningitis, pneumonia and yellow fever are urgently needed and could be easily provided through a humanitarian channel. Food packages, infant formulas for HIV+ mothers, condoms and drugs like antibiotics, antiretrovirals, epilepsy medication, antihypertensives, chemotherapy and hormonal treatments could also be delivered in large volumes via humanitarian aid. Surgical material required for emergency operations and reagents to reactivate clinical laboratories in the public sector could also be donated, or subsidized by international programs.

In most cities and towns, these interventions could be delivered in the existing healthcare facilities, but special attention should be pointed at neglected or displaced communities, such as prison inmates and indigenous groups like the Warao, Joti and Wayuu people, where the absence of a hospital network could require the deployment of both national and foreign missions to attend their most urgent needs.

The international community, might guarantee that vaccines and essential drugs arrive at the country in big-enough numbers.

These measures will help decrease child and maternal mortality, and stop most infectious diseases from being transmitted on the very short term, helping stabilize the government in charge. Just remember they’ll be led by donors and the international community, so they won’t actually reflect the government’s effectiveness and, although very positive for the country, these measures won’t be enough to guarantee long-term benefits, since they won’t help rebuild an effective and self-sufficient health system.

3. Medium and long-term response: rebuilding a broken system

Once the hemorrhage is controlled, we can start thinking about how to prevent it from bleeding again. This is the real challenge, the Venezuelan health system won’t do with a little makeup; it needs top to bottom reform and a committed government that makes this a long-term state policy. The objective is to improve regular drug supply while maintaining and expanding the existing infrastructure, to guarantee equity and sustainability in a five-year period.

Many things must be changed for this to happen, but there’s extensive research on the subject, and the ReBUILD consortium, a UKAID-funded organisation, presents a remarkably clear plan to do so. After working in countries like Zimbabwe, Uganda, Sierra Leone and Cambodia, they argue that actions must be pointed in three directions: improving  communities’ access to healthcare, creating incentives for health workers and creating functional institutions that encourage community integration.

Improving communities’ access to healthcare

The structure of human communities, from families to entire towns, is affected, mainly because crisis impoverishes the people through a direct loss of assets or economically-productive individuals. In the African context, this was usually due to an important proportion of the population being killed as a result of conflict, usually young males who provide most of the earnings of households. In Venezuela, this might be important among people living in violent areas, but it’s also a reality for many families split apart by mass migration. Poverty brings disease and, with it, an increased need of health expenses and a reduced ability to work, perpetuating itself in a never-ending cycle. In a post-crisis context, this situation could affect most of the population, making the reduction of healthcare costs a top priority.

This is a challenge we started losing even before Chávez got to power. Back in 1995, we were already one of the countries with the lowest health expense in the region. Out-of-pocket expenses (the money directly paid by users to the health system), on the contrary was among the highest in Latin America; by 2013, and still with high oil prices, things were worse: Only 3,6% of the GDP went to healthcare while out-of-pocket expenses skyrocketed to 65,8%, among the highest in the world. Chavismo made health much more expensive for the average Venezuelan, even before Maduro’s terrible administration.

Poverty brings disease and, with it, an increased need of health expenses and a reduced ability to work, perpetuating itself in a never-ending cycle.

In order to overcome the health crisis currently developing in the country, this must change. The complete destruction of the Venezuelan oil industry makes things harder, but if a new government adopts a strict fiscal policy (backed by international funding), it might be possible for Venezuela to cover most of its people’s health expenses. Pittsburgh-graduate, public policy expert and Universidad Simón Bolívar professor, Dr. Marino González says a good starting point would be redirecting money from low-impact projects (say, some of the government countless misiones) to high impact, more needed areas like the national vaccination or diabetes-hypertension programs. Eliminating the pervasive gas and energy subsidies could also help boost GDP, and public funding of health with it.

This, however, will take time (yes, maybe a long time). We must look for alternatives to help millions of poor people created by the Revolution, a puzzle Cambodia solved: since Cambodian economy can’t sustain universal healthcare coverage, several funding methods are simultaneously used to reduce the money patients must pay for medical services. The most widely available, and arguably the most successful, are health equity funds (HEFs), a scheme mainly financed by several international institutions including USAID, UKAID, the World Bank and, in lesser extent, the Cambodian government.

HEFs are limited to the poorest in the country (around 18% of the population), and grant full coverage of all treatment, meals and transportation fees. Since their implementation in 2000, the percentage of poor people seeking medical attention has increased considerably and, as a consequence, child and maternal mortality rates have reduced.

Bringing back health workers

One of the most critical and complex aspects of rebuilding a health system after a crisis period is the lack of properly trained health workers. In some war-torn African countries, doctors and nurses were targeted by the enemy; in Venezuela, they’re fleeing by the thousands. The effect is the same: entire cities without qualified human resources, a condition especially dramatic in rural areas, where doctors don’t have any incentives to work. The situation is getting so bad that even bigger hospitals have been forced to close emergency services, as there are no doctors to run them.

In Venezuela, this means changing several laws. For instance, the mandatory rural service that doctors must do immediately after graduating in order to practice legally in the country.

Incentives to attract, retain and distribute healthcare professionals must be implemented. This can’t simply include short-term remuneration like higher salaries; incentive packages should include decent housing and working conditions, as well as recognition of the health workers’ roles and achievements.

In Venezuela, this means changing several laws. For instance, the mandatory rural service that doctors must do immediately after graduating in order to practice legally in the country should be revised. If we hope to bring back at least a small part of the highly-qualified professionals who have fled, or prevent more young doctors from leaving, forcing them to work for a lame salary in an isolated town, away from their families for a whole year… well, it sounds bad to me.

Médicos Integrales Comunitarios (MICs), the infamous doctors massively produced in pro-government universities could pose an alternative to this problem. MICs training has consistently been deemed insufficient for standard medical practice, but if their academic program is modified to focus on low-cost, simplified preventive medicine, they could be deployed in small towns around the country, allowing highly-specialized physicians to focus in reference centers. Existing MICs could be trained relatively quick and deployed in a short period of time.

Training Venezuelan doctors in foreign institutions should also be encouraged by the government, to form highly-skilled professionals that will eventually replicate their training in national institutions.

Creating functional institutions

Crisis prompts the formation of community-based organizations as a coping mechanism to solve the inefficiency of the government, and they should take part in the reconstruction of the health system to boost local leadership. The experience in places like Congo has proved that creating committees of respected community figures, working in coordination with local healthcare providers, promotes transparency, efficient management and maintenance of physical infrastructure.

To grant long-term sustainability, external funding will be needed.The International Monetary Fund (IMF) could lend money to the new Venezuelan government…

The Health Ministry could use these organisations and the health providers monitoring them to quickly detect relevant health problems across the country, developing a relatively low-cost and efficient epidemiologic vigilance and medicine-distribution system.

Most of these actions could take advantage of the existing infrastructure, and could be applied simultaneously to those aimed to stabilize the Venezuelan economy. This would allow the new administration to greatly improve quality of life in Venezuela without spending too much money. But to grant long-term sustainability, external funding will be needed.The International Monetary Fund (IMF) could lend money to the new Venezuelan government to help it pay part of the billionaire debt it holds with the pharmaceutical industry, regularizing access to drugs; its support, and the economic reforms it carries, could also increase the number of international donors willing to help, and eventually lead to economic growth, only then should we start building the much needed new hospitals and research centers.

Finally, the rebuilding process would probably extend for decades, but it should allow us to create a health system that reaches most of the population and offers attractive conditions to its workers, while sparing enough resources to form capable personnel, develop an effective disease surveillance system, prevent infectious diseases and sustain itself in the long term. Or in a few words, a system able to do all that we currently can’t.

Special thanks to Dr. Marino González for his contribution and advise in the making of this post.

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  1. I think the author is wrong about the mandatory 1-year service. That’s just selfishness. I can’t deny his self-interest point of view on this…he’s entitled to it…but that sure isn’t a game changer in bringing back ex-pat doctors or educating new ones.

    We should do the same thing in the U.S., but I think our internship systems covers some of that need.

    • Consider you are a Venezuelan-graduate doctor who left before doing rural service, you just finished a four-year specialization in the US or Europe, for some reason you want to come back but then someone tells you that before working at the hospital in your field, you must spend one year in a small town seeing general medicine patients… Wouldn’t you reconsider your decision?

      • They’re not going to not come back for that reason.

        They’re going to stay in the U.S. and Europe because there’s more money there.

        • Quick fact: the AMA and hospital standards do not allow VZ doctors and nurses to practice at those levels here in the USA. A neuro surgeon in VZ can only clean bedpans unless they get invited. (Foreign doctors receive little in the way of credential recognition)

          But, they can opt to take exams early and skip much if the mandatory work terms. (But not always)

          I’d still rather clean bedpans in the USA than suffer starvation and witness daily malnutrition of newborns in VZ.

  2. “Post Chavismo” …. Haha. Good one!

    Look, Cuba has the finest health care available to all its citizens, and provided for free! I have been told this by no less health care authorities than Michael Moore and Colin Kapernick. So it us true, and anyone that disagrees is a racist. Period. And Venezuela is also the best. Danny Glover says so, and i liked him in a movie, so he knows what he’s talking about. If you disagree, you are racist.

    You need to protest the illegal and immoral imperialist racist Gringo hegemony economic war against the good people of Venezuela. Once the unfair and illegal and racist sanctions against El Salami’s (spell?) $1billion bank account are lifted, your healthcare problems will be solved.

  3. Step zero: change Vz culture in the right way, then everything else will get taken care of. Without a change of culture all the other steps will not make any difference.

    • Step before-effin-zero: Start putting the blame where it belongs: The fu**ing tyranny that deliberately destroyed Venezuela as part of an invasion from the cuban communists and stop whining that stupidity about “how the people is mean and rotten and doomed forevur waaah waaah”

      Jeez, chavismo has to be the only gubmint in all hostiry that doesn’t have resposibility or guilt for ANYTHING AT ALL, dammit.

      • Excellent point. No guilt at all is the nature of socialism. Over 100 million dead sucking Karl Marx’s ass, and no one compares him even to Charles Manson. My civil argument with Juan Carlos Gabaldon is that he appears to be falling for, or even promoting, a well-known socialist trap: “Look how terrible things are for the poor! We MUST have equity and balance! The Government MUST establish a program for health care and order doctors and tell them what to do, and everyone has a ‘right’ to health care! Would you let a little baby girl die when you could save her life with a $500,000 cocaine withdrawal program in an incubator [so she can live a crippled life addicted to a drug her mother took]? Only a beast would look the other way, and that’s why we must overthrow the evil capitalist pigs and bring love and compassion [and slaughter not just anyone, but everyone who disagrees with us].”

        I’m going to follow “Gringo from another land” and put myself in a corner to cool off for a few days. It angers me to see a man as capable as a fifth year medical student, as dedicated to still be in Venezuela, as motivated as to write articles – obviously a good man – get led astray by the socialist non-thought devious beguilement that has all but destroyed his country. A strong and self-sustaining health care industry is built the same way General Electric and IBM were built. The same way good doctors in the U.S. are in the top 5% wage earners and people will pay $3,000 dollars an hour for their knowledge, service, plain old simple Balls of a Man, and dedication to repair bodies that can still be repaired.

        I’m off to sulk in my corner. I may buy a copy of that vile “Das KMapital” just so that I can BURN it!

      • “Step before-effin-zero: Start putting the blame where it belongs: The fu**ing tyranny that deliberately destroyed Venezuela as part of an invasion from the cuban communists and stop whining that stupidity about ‘how the people is mean and rotten and doomed forevur waaah waaah'”

        Wrong; el pueblo will continue to elect and support Kleptocrats unless they completely change culture. Deep disrespect for others’ rights, hate for the rule of law, and envy have high costs.

        Blame continues to rest on all participants — the thieves, the apparatchiks, the proletariat, all.

        • The “pueblo” only “elected” chavismo in 1998, and even that election result could be at doubt, given the brutal amount of money at stake that was invested into paving its way to power.

          • Say it another way: el pueblo will revolt against anyone except hard core marxists. El pueblo still agrees with every policy of chavismo, just not the results. Empirical truths are rarely pleasant.

          • You tried to go to the tangent.

            People will stop “agreeing with marxist policies” once the media tells them to stop agreeing with them, period.

            That’s how chavismo managed to brainwash lots of people during this time, communist propaganda hammered ni their heads 24/7.

            2-3 years of broadcasting those shorts made by globovisión where they rightfully showed that chavismo was guilty for everything bad in Venezuela will make people hate communism with every fiber of their being.

          • The “people” only “agrees with marxist policies” because they’ve been brainwashed by communist propaganda broadcasted 24/7 by chavista-controlled media.

            2-3 years of Ravell’s globovisión shorts and news through all the media will be enough to make people hate chavismo for the rest of their lives.

  4. Nice post with a comprehensive, logical plan to tackle a destroyed Health Care mess. Tragically, nothing ain’t so easy in Kleptozuela, not even if Chavismo is kicked out one day.

    “..we first need to oust Nicolás Maduro and his cronies out of Miraflores, no real changes will ever be possible with the same criminals ruling the nation. But let’s imagine for a minute that a transition actually happens in the near future; what do we need to turn a chronically dysfunctional health system into something that actually works?”

    What the author here and many, many people fail to understand is that after the Nicolasno, after the Tareks and Cabellos and Rodriguezes and Mademoiselle Varelas are kicked out, if ever, there’s a Shitload of Stinking MUD taking over. Granted, this SSM filthy group can’t be bad as Chavismo, as cruel, as criminal, but they sure aren’t saints. Extremely Corruptible, when not already corrupt.

    To actually accomplish in practice the pretty things Juan Carlos here wisely proposes, there must be a good dose of HONESTY and Hard Work, above anything else. There would be some doctors and a few MUD politicians with good intentions, but sooner than later the MONEY necessary to implement this wonderful plan would start disappearing, as it always does in Kleptozuela, and especially now that Kleptozuelans are more accustomed to STEALING than ever before, after 20 years of hands-on intensive practice. It takes planning, hard-work, purchasing equipment, parts, materials, lots of maintenance, some new and rebuilt infrastructure, decent salaries to attract qualified personnel (8/10 doctors and nurses are GONE for good, never to return). The massive Electricity and Water problems, even the transportation problems would also have to be tackled to improve Health Care. With what money after the next MUDcrap steals the billions it will steal, Chinese Loans or the FMI? Good Health care is VERY expensive. (Ask anyone especially in the USA). In most developed countries, in Europe, it works only because they STEAL a lot less than the MUD will STEAL, and because they do something Kleptozuelans don’t even know about: the pay LOTS of Taxes.

    Therefore, sorry to burst any bubbles but most great ideas and good intentions like these will go to waste under any MUDcrap of the future. In the 2030’s or 20150’s, after Chavismo, the remaining MUD will be even worse. Health care and other important matters can hardly get any worse, but the recovery would be much slower and cumbersome by future corruption than many might think. Young men as JC here have a real tough battle ahead, IF they stay honest, and IF they stay in Cubazuela’s hell in decades to come.

  5. There are two basic valid points in this article. One is that some view to the future is needed. The second is that an impoverished country is a health liability. One major factor is poor diet – much talked about on these august pages. I looked at the headline and thought it would be really interesting to read an actual PLAN. I wished it had addressed the agricultural sector, but hey, a plan is a plan.0

    Reading down through the article is a bit sickening. I have a great deal of respect for doctors and nurses. But their economic and business acumen is often lacking. The compassionate angle of providing health care to those who have no economic resources to pay for it is understandable, but it is charity, not government. To emphasize the role of government is socialist. Doesn’t that ring a bell? Government squeezes out the private sector, even with free market capitalism, interposes an unnecessary middle man who must also be paid, and imposes rules and regulations and restrictions that make it even more difficult to achieve a stable profitable sector of the economy. Great Britain has enormous governmental / socialist problems to solve. Right now, the best they’re coming up with is banning knives! Here’s this sentence out of the article above: ” … but if a new government adopts a strict fiscal policy (backed by international funding) …”. My answer is a simple “No.” I am not funding your health, got it? YOU fund it!

    From the article about that British “ReBUILD consortium”: “… effective health care and reduced health costs burdens, through the production and uptake of a coherent body of high quality, policy-relevant new research on health systems financing, human resources for health, and aid-architecture in post-conflict countries.” You’ve got to be insurreptitiously considering the adjudicate of a transmutation of humorphilic constructions involving the heritage of linguistical presentations in new formats. Translated: you must be joking! If you think non-speak language is saying anything! That entire sentence is just garbage. It says absolutely nothing. “… through the production and uptake of a coherent body …” whut?? How about a coherent sentence? I’ve read papers in finance that are 80% equations that at least say something.

    “Gather information”. That comes straight out of the playbook of the mind-numbingly idiotic “system analysis”. Well, duh! A plumber knows you have to look at the problem before you begin to fix it, and he isn’t stupid enough to believe anyone would require an explanation of how that is part of a “sophisticated analytical system designed to ameliorate deteriorated conditions resultant from disproportionate and systemically malfunctioning paradigms.”

    (This article really ticks me off. I’m sure the author is trying, but chasing down “give me money” governmental solutions is “antithetical to functionality”.)

    Two points make it worth reading, the principal one of which is to reestablish free market capitalism to get a real economy going, to improve living conditions. It would have been nice if emphasis in the article were to fund legitimate government programs such as fumigation, clean water, electricity, swamp drainage, and the like (functions which, like roads, cannot be undertaken by a limited community). Had the article focused on something concrete like those programs, like the program which brought about the near eradication of malaria way back a century ago, which was the subject of an earlier article on CC pages, then it would have fulfilled a useful purpose in establishing some concrete planning. As it is, the article is just chasing after words and money with references to far-distant and far different countries, societies, cultures, and conditions.

    Sorry, but the cure to socialism is not more socialism. Get a Milton Friedman economist to talk to you. and stick to the practice of medicine on individual patients.

    I really am sorry to post this, but you can’t have a cook trying to fire an 18″ gun on a battleship, and you can’t have a plumber doing your electrical work, and you can’t have a socialist running your “government”. Those things should be spoken out against.

    • I’m sorry you consider the article sickening, and I’m sorry you consider universal healthcare a socialist policy. I can however, understand that you are not willing to pay for other people’s health, it’s a valid point. Nevertheless you must remember we are talking about improving the overall health level of an extremely impoverished country. If you don’t figure a way for the millions of poors created by chavismo to seek and get quality healthcare you will never be able to control infectious diseases for instance, and child and maternal mortality, two of the most precise indicators of development, will never go down.

      International help, charity or whatever you wanna call it will be needed wether we like it or not. Can we depend on that for the long term? Of course not. Only with economic growth, and cutting money from useless programs (like chavista missions) or subsidies (like gas, electricity or CLAP boxes), we’ll be able to achieve sustainability.

      Also, as stupid as it might sound to you the need of knowing the magnitude of the problem we are facing, this is a huge challenge in Venezuela, a place where the government systematically hides epidemiological data. A plumber may know he has to look at the problem before fixing it, but if someone covers his eyes with a bag, he must call it out and find a way to see again.

      The concrete programs you expected the article to focus in are not part of what it takes to create a functional health system, they are a consequence of having one. I don’t pretend to design the attention programs that Venezuela needs to control and prevent most of its main health problems, actually most of them already exist. The real issue is that none of them works, because the very basics of the system are flawed.

      Finally, is not only ReBUILD and “socialist Great Britain” who suggests most of this measures, you’ll see practically identical suggestions in Newbrander’s paper which was sponsored by USAID and based (mainly) on the American experience in Afghanistan.

      Anyway, thanks for taking your time to read the whole thing.

      • Juan, your problem is, your big “plan” is to have other nations pay for it, when these nations have their own health care crises.

        Good luck with THAT!

        You’re a typical Venezuelan…you want others to foot the bill for this complete revamp of the VZ health system…yet you’re bitching about the one year of rural service doctors have to perform in the underserved areas of VZ.

        I mean seriously, dude. You gotta be fucking kidding.

        You cite the torture of VZ doctors having to spend a WHOLE YEAR away from their families fulfilling their obligation.

        Look at a map, and look what kind of insurmountable travel distances we’re talking about!

        Look at a map, okay?

        You’re not living in China or Russia with huge distances, but did you know we also have AIRPLANES these days, so you don’t have to walk it?

        With “doctors” like you representing the future of VZ, VZ is fucked.

        But this isn’t exactly groundbreaking news.

        • “You’re a typical Venezuelan”

          You are a typical American- arrogant and probably at least 20 pounds overweight

          “With “doctors” like you representing the future of VZ, VZ is fucked”

          Do you know how to do ANYTHING besides run your fucking mouth?What the fuck have you ever done that comes even close to what the author does to contribute to the conversation and situation at hand?

          • Funny how you attack without marshaling reason first, accusing others of doing exactly what you do that you say is wrong. Your sole purpose being here appears to be to attack Ira – judging from your web handle – unless that is a web-transvestite disguise of some sort you think is cute.

            Ira is not afraid to speak his mind. I do have trouble seeing where he’s coming from. And he has points to make. You, on the other hand, haven’t made a point yet, and I do wonder where the heck you’re coming from.

            Venezuela is not a large country, really, in terms of population. It’s approximately 43rd. Mexico is much bigger. Venezuela aligned with the Allies in WW II, informally. I have not heard of Venezuelan troops being sent to other countries to aid them. I haven’t heard of a Venezuelan army presence in Iraq or Syria, or of troops stationed in Germany or Italy. Maybe some military aid was offered to Colombia, fighting the FARC.

            Ira’s point is that the superpowers send their men to foreign lands to fight foreign wars for years at a time. More than just one or two Venezuelans want to see U.S. Marines “intervene”. No thought there about how hard it is for them, and for their wives and children and parents, to have them so far away from home that they’re serving in another country?? Why would it be so hard for doctors in Venezuela to spend a year in rural areas? In their own land?

            Personally, I think any kind of mandatory service for doctors is a socialist mandate to the private sector, so I’m opposed to it. If doctors want to get together and have their private sector volunteer program to earn Brownie points, and give out merit badges for a year’s service, then I’m fine with that. I think Juan Carlos Gabaldon has very good point about sending MIC’s – but I am still very opposed to his idea that it should be mandatory as some government function.

          • Should be” “I do NOT have trouble seeing where he is coming from.” Sorry, bad roof=preading my.

        • Well, all I can say is that luckily for the States, you are not a typical American. The US is an amazing country exactly for having millions of guys not like you.

          • The U.S. was built by men exactly not like each other. Men not afraid to speak their minds and fight for the right to do so. Look at it from a medical point of view: if you assist a body to be strong, free and independent, you do good. Why would you want to try to make one body like another one, when the two are obviously distinct? Ideology?

            I do want to make it clear before going off to my corner, that I admire your dedication in studying medicine. Years of study, a lot of courage, all to help and assist when called on. May you and your patients be healthy and prosperous, but please, stay away from socialist points of view. Economy and politics are not your area of expertise, but read some Milton Friedman and other noted free-market economists in your spare time. They studied a lot, too.

          • Hey, Juan:

            I’m a pretty typical American. I voted for and still support Trump. Seriously…

            You really don’t have a handle on America at all, do you? You live in this fantasyland where you WANT the U.S. to be a liberal paradise, but it sure ain’t. I’ll meet you in Kentucky or a few dozen other states so you can get to know the “real” America.

      • I have some news for you:

        Regardless of why you may think us Gringos invaded Afghanistan, it didn’t have a fucking thing to do with helping Afghanistan and its people. And should it? Why should the U.S. and its partners give a damn about this shithole?

        It was about Osama and terrorism, and protecting the western allies from that scurge.

      • I read it again. You do have some planning in it. The relief medical supplies are ready-to-go. That’s probably the medicines, vaccines, and supplies you need most. I don’t have a problem with that, even if it is “government funded”.

        Without getting into fancy language and examples, you have your head packed full of “doctor stuff”. You may not realize it because you’re used to it, but it takes a lot of balls to be a doctor (even for women). What bothers me is the “government MUST” stuff on the long-term plan. You do not have your head packed full of economics – I would guess. I don’t see how anyone could be a fifth year med student and have at least one degree in economics. “Government must” is Venezuela’s problem.

        If I wanted medical advice, I’m sure you could give it. Why won’t you take the advice of an economist? I mean, you talk about incentives and pay, and surprisingly make some leap to the socialist “universal health care”. That’s a popular phrase, and to me, just one more Marxist lie. I have a cousin who’s a nurse, and she nearly bit my head “clean off” explaining that emergency rooms are open 24/7, and are most crowded on the weekends when “people” show up trying to get free drugs, drinking beer in the parking lot, and nurses hate the shift. There is no such thing as “no medical care” in the U.S.. We in the U.S. are going into spasms trying to undo the damage done by the socialist “Obamacare” fiasco.

        When you get your “universal health care” you get a monopoly, and that has been, in practice, the elimination of competition which leads to people lazing around behind a desk avoiding work because they’re demoralized because they don’t have freedom of choice, they know it’s unfair, the line of patients who’ve been waiting for a month don’t have a choice, and the people who are supposed to come up with new cures and treatments and all don’t have a choice of where to work and don’t have incentives because everything MUST go through a huge, wasteful, incompetent “government bureaucracy” operated by people who don’t have a choice either.

        Don’t hand me a scalpel and tell me where to cut (I might faint, tremble, miss, cut a nerve, an artery, cut the wrong person), and don’t base your long-term stability of health care on [universal] bureaucracy assuming your wishes will make sound economics.

        There was a recent story of a woman in for a routine surgery being hooked up to an IV bag with formaldehyde because someone made a mistake. Doesn’t that make you sick? I mean, doesn’t it feel like your heart just sank down to be next-door neighbor to your stomach? That’s the feeling I get when I read about IMF money and government must all in connection with a stable and self-sustaining health industry.

        How did the health care industry – because that IS what it is – function before Chavez? Just guessing, you must be around 30 years old, so you probably don’t have much practical personal actual experience with it, but you may have researched it because you used it in a comparison. I know the U.S. isn’t Venezuela (yet), but things here are moving towards privatization, a lot of it in reaction to the “government” intrusion into the private sector of health care.

        • You make very valid points Gringo. As you said, I’m not an economist so I’m sure I’m missing several things in the article.

          I have no problem at all with the existence of a private health sector that gives people the opportunity to choose, actually its existence should be encouraged to complement and lighten the weight placed on the public sector. I just think that many people won’t be able to afford medical expenses even after a change in government. If a new admnistration wants to improve the health level of the country as a whole, and keep it high, we must reduce out-of-pocket expenses for these people.

          I appreciated the feedback on this post, so thanks for that too.

        • It’s been a while since I have read as stimulating and thought-provoking interchange of ideas as that between Juan and Gringo, above. I hope I am speaking for many others as well as myself, when I say thanks to both of you.

      • Two points..
        1. I get the feeling that the young people writing these articles, witnesses and chroniclers to the horror of chavismo/communism, do so while wearing a Che T Shirt…
        2. Health Care is a vastly complex issue, but try to substitute the word T Shirt with Health Care and see what you get. IE

        “Everyone is entitled to a T Shirt” Easy, T Shirts are cheap, and can be provided to an entire country fairly easily..
        “Everyone is entitled to Health Care” Not Easy, some people need very little health care and others need a lot. What is health care? Vaccines? I’ll bet no one would argue with those being made (via government policy) cheap and easy to get with no distinction made between rich and poor. Open Heart Surgery? That’s expensive to provide, who pays? Can the rich get it while the poor do not? If everyone has to get equal health care, how do you stop the rich from going to Miami, (or if commies Cuba) to get what they need and can pay for?

        T Shirts are easy to provide, health care is much harder.

  6. Sorry pal. The Maduro regime is not going anywhere. You can count on the young dictator living a long life at the helm of a decayed and desperate Venezuela, Castro style. Asi que estan mas cagados que palo de gallinero.

  7. “International help, charity or whatever you wanna call it will be needed wether we like it or not.”

    This is when I feel ashamed of being Venezuelan these days. And when I’m proud of having dumped that passport, keeping the EU and American passports instead.

    Juan Carlos, the only “charity” Venezuelans could hope for now, after they dug their own graves through massive PILFERAGE, would be a US Military intervention to save their sorry asses from the narco-tyranny. And THAT is already too much to ask. Venezuelans want everything done for them, huh? After they rob the world blind, after they amass fortunes and deal their drugs worldwide. After many criticize the “gringos” and the “yankis” and the “imperio”, or at least the “burguesitos” and the “sifrinos” as millions of Chavistas still do. TODAY. Then when they’re in deep shit because the stole all they could steal, they start asking for financial help, loans and more loans, to steal that too, and finally “humanitarian help and “charity” as you put it. Huh? To steal THAT too, or most of it!

    Dude, as someone above said, we have our own problems, especially in the USA with Healthcare costs. We PAY TAXES and a high cost Health Care with our HARD WORK. Venezuelans don’t work, all they do is steal, and don’t pat a CENT in taxes. So we must go there and saves their butts? Fuck no. Chupense esa mandarina. Querian Patria? You got it. You deserve it.

    While the RETARDS from the MUD keep begging for the same exact crap: “Sanctions”, the same sanctions that have kept Castrismo in power for 6 decades, and “Humanitarian aid”, the same aid Chavismo easily refuses year after year which cannot be imposed without military force. That’s I often think you deserve the Crap you got. For stupid shit like that.

  8. JC, thanks for a really excellent post/plan. Venezuela does/will probably always need Govt. help for its incredibly impoverished (67% critically/23% simply) poor. Pre-Chavez Venezuelan public health care was much as you recommend. Of course, the problem with Ven. Govt. major involvement is major corruption, not just the stealing of monies/commissions on imported medicines/devices/equipment, but stolen supplies/medicines/equipment at points of treatment, many times by medical treatment personnel themselves. Private sector solutions to Venezuelan public sector health needs will never happen–the vast majority of Ven.’s population will find it difficult-to-impossible to ever rise above the income level necessary to pay for most of their personal medical needs.

  9. The VERY first thing Venezuela is going to have to do is go hat in hand to the EU, US and anyone else who will listen and beg for money and know how. But know this: NO LONG TERM AID will be coming without absolute contrition on the part of Venezuelan politicians. They must acknowledge that Bolivarian Socialism is the problem. Which is a mighty feat, since nearly all of the political parties are Chavismo lite.

    I won’t lend so much as a worthless Bolivar to my wife’s family**. We GIVE them money, but nothing is expected to be repaid. That is not what Venezuela can expect. If the developed countries in the world are going to lend a hand up to Venezuela, they want something in return. The absolute DEATH of Chavismo.

    I don’t see it happening. I do see the eventual demise of Chavismo after the money runs out. But 20-33% of your nation ADORES Karl Marx and his piss boy, Hugo Chavez. The minute that Venezuela gets back on its feet as the aid comes pouring in, its going to be round two for those Marxist ass-clowns, who will remind their faithful that the reason they don’t have (fill in the blank) isn’t because Chavismo failed them, but was because Chavismo wasn’t given a fair chance. The problem being, these morons will believe it and vote for them yet again.


    **We have doled out well over $100,000 in cash and services over the last 15 years to (most of) her family, and we were glad to do it. Her family has appreciated every dime, as they saw right through this Chavismo farce from the beginning.

    However, there is a Marxist branch of her family that didn’t get a dime, since they saw our financial success as part of the problem. So, to avoid the hypocrisy of Marxists taking largesse from vile Capitalists, we decided that we would let all their Marxist friends offer aid and comfort. Despite the fact that they have since left/fled Venezuela, they intend to return once Chavismo has fixed the problems foisted upon them by the vile Uncle Sam. They see Marxism at the solution. They will keep voting for Chavismo, even if they were to starve to death in doing so.

  10. Juan Carlos,

    I agree with you on steps 1 and 2. The international community will pay for these out of charity and simple self-interest in stopping the spread of diseases across the borders.

    When you get to rebuilding the system, though you really do go off the rails, for the reasons noted by others. Most countries of the world have a hybrid (public and private) health care system. Before you start, you need to decide what you want to build. Do you want universal health care funded by taxes, such as in England or Canada? There are well documented problems with this, such as long waiting lists for many procedures. When there is no cost to the patient, there must be some other mechanism for rationing services. This is where “economics” come into play.

    Anyone who wants to grant health-care as a basic right has to face up to a basic problem. There is much more healthcare available technologically than we can afford to deliver economically. This is true, not just in Venezuela, but all over the world. If everyone got all of the technologically available healthcare there is, healthcare would consume the entire GDP of the world. Unfortunately, this is not possible, because we all need food, shelter, and other things in addition to healthcare.

    In practice, countries tend to look for the best balance of public and private care that they can afford and that fits their own culture. Inevitably, the wealthy will receive better care and more services than the poor. It is not in your power to prevent that. However, the public sector can assure that some bare minimum of healthcare is available to all. As the Venezuelan economy recovers, you can raise the level of what you consider a bare minimum.

    All I am asking is that you be realistic in your expectations of what you can and cannot do, and plan accordingly. Venezuela could be a crucible of innovation in supplying healthcare more efficiently and cheaper if you professionals plan ahead.

    Once again, you can count on international assistance only to address the very worst of the crisis. The world will soon turn it’s attention (and pocketbooks) elsewhere.


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