by Silvia Casabianca

Created on: September 12, 2009

Evidently, a health care reform is urgently needed.

And many things could be said about why and how. However, we need to agree that what is very wrong, terribly wrong about the health care system in the United States is the extent to which illness has become a business and health a merchandise to the point that only a few can afford health services. This is not a sign of "progress."

Earlier this year, the late Ted Kennedy said that when Congress finally votes on health care legislation, a century-long struggle will reach its climax, and we will end the disgrace of America as the only major industrialized nation in the world that doesn't guarantee health care for all of its people."

On the other hand, it seems obvious that the main HMOs and insurance companies are pulling strings to prevent the reform from being voted because they see their profits are in great peril, especially if a public option is approved.

However, it is vital to create a system that is less expensive, visibly more efficient and with an important component of preventative medicine. This new system shall grant access to health care to all the people, because health care is a right.

In a way, the health care reform debate is a re-run of sorts for me, but in the opposite direction.

Following the winds blowing from the North, my country enacted in 1993, 'la Ley 100' (Bill 100) which transformed the way in which people accessed health care in Colombia. If previously a patient could go to public hospitals and receive free or inexpensive care, the Ley 100, changed the system to one of competitive private managed care organizations that established co-payments. A system that in many ways even if modest was a carbon copy of the HMOs instituted by the U.S. in the 70s.

By the time I graduated as a medical doctor (1972) three clear health care options existed in my country: government-run health services, private health care and a mixture of both where the government subsidized low-cost health services offered by private institutions.

With Ley 100, Colombia became the first middle-income nation that privatized formerly government-run options, provoking strong opposition from doctors and patients. Previously, we had a social insurance that aimed at providing coverage and equal access to basic health care for all workers. When managed competition was incorporated with the reform, it was defended as a necessity that would improve the efficiency and quality of health care. Coverage actually improved in

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