In 1987 Paul O’Neill was appointed CEO of Alcoa, the largest U.S. aluminum producer. In his first meeting with financial analysts, O’Neill announced that his goal would be to reduce workplace accidents.
Analysts were alarmed. Had the company hired a hippie? Not at all, O’Neill had the right goal in mind. Each plant manager along with Alcoa’s workers had to find the optimal way to reduce accidents. Through this dialogue, they discovered where to make other operational improvements. Accidents decreased, productivity increased, and Alcoa saw its profits grow.
The central goal of the Mexican government’s coronavirus strategy has been to have enough free hospital beds. Both Mexico’s President Andrés Manuel López Obrador (AMLO) and his coronavirus czar Hugo López-Gatell have stated it.
Having enough free beds in hospitals was an essential step to be able to care for the sick, but as a central government objective it has led to aberrations. If a hospital director knows that he is going to be graded based on bed availability, he will tend to make it difficult to admit coronavirus patients. Stories of seriously ill patients rejected from various Mexican hospitals are well known.
Another aberration: the dead make room for more free beds. The fatality rate from coronavirus in Mexican public hospitals is very high, largely due to operational problems associated with lack of planning. There are Mexican doctors who only took a very brief course to learn how to intubate. The result: many patients’ lungs explode from excess pressure. If a patient dies due to medical negligence -or because he arrives to the hospital too late- he occupies bed space for a less amount of time than one who undergoes full treatment and who may require weeks of ventilator capacity to recover.
Faced with stories of high mortality in hospitals and the isolation to which admitted patients are subjected to, many Mexicans opt not to go to a hospital. They die at home. There is no strategy to incentivize people to go to hospitals early. On the contrary, at the beginning of the pandemic Mexicans were asked not to visit hospitals unnecessarily if they were not part of high-risk groups. The Mexican government rhetoric has not changed, even when it is known the high fatality rate among seriously-ill patients arriving to hospitals.
The Mexican health system has met the objective set: there are free beds. However, the original May 4th estimate that Mexico would record 6,000 coronavirus deaths has being topped. We are nearly the 60,000 deaths. Back on June 4th, Mexico’s coronavirus czar said that the 60,000 deaths scenario would be a “very catastrophic” one. This without considering that there is a grotesque underreporting in the official government data.
If the Mexican government’s goal had been to minimize the death toll and assessment hospitals based on their fatality rate, all the energy of the Mexican health system would have been directed towards this and Mexico would have had fewer deaths. Along the way, Mexico would have made progress by improving the country’s health system.
With tens of thousands of coronavirus deaths in tow, the AMLO government justifies itself with the same droning message, arguing that it inherited a health system in a disastrous state and that the Mexican population is obese. Weren’t these facts known in March when the coronavirus arrived in Mexico? Worse still, the AMLO administration chose this year to eliminate the Seguro Popular health insurance program. The new government replace it with INSABI a new centralized health care model promising to provide medical services as good as Norway’s. The new program was launched without having operational rules, that is, no one knew what to do. It has continued to be like this.
Even though Mexico’s coronavirus czar López-Gatell failed dramatically in his forecasts, his job is assured. He will even be given more responsibilities, like controlling COFEPRIS, the Mexican equivalent to the FDA.
López-Gatell fulfilled its goal: to have free hospital beds. The beds are there. Or so they say. The government boasts about hospital bed availability even when dead Mexicans continue to pile up. Avoiding deaths has not been their main objective. For the AMLO government a minute of silence in remembrance of the dead and declaring a month of national mourning is enough.
* Carlos Elizondo Mayer-Serra is professor at the School of Government and Public Transformation at Tec de Monterrey, in Mexico City. A Spanish version of this Op-Ed appeared first in Reforma’s newspaper print edition. Twitter: @carloselizondom
