Puerto Rico and Health Care Reform

It would seem that the government of Puerto Rico had put all its eggs in one basket with regard to the monumental deficit carried by the famous “little card” of health care reform. For months, the country has witnessed intense lobbying for the inclusion of the island in the federal health care reform program, which would represent a multimillion dollar infusion into Puerto Rican health care programs. But the issue has become too thorny in the United States and all signs indicate that Puerto Rico will be left out of the federal reform bill — if it finally passes.

President Barack Obama has faced serious pit-falls in the process of achieving legislative approval for his promised health care reform. The situation is complicated by Obama’s loss of political power in Congress following recent Republican triumphs, as a result of which, this week, he played up the idea of a bi-partisan deal through an adaptation of the Senate bill, which would not include U.S. territories. This was a blow to the Puerto Rican aspiration for parity and the local government showed its dissatisfaction with the situation by going so far as to consider suing the U.S. government.

The situation is nothing more than a clear reflection of our political condition, in which we do not have direct input into the federal decisions that affect us. This is reality knocking on the door, and it comes just days before the White House Interagency Working Group on Puerto Rico will hold a public forum in San Juan as part of the work that should culminate in a report to the president of the United States at the end of the year.

Meanwhile, in Puerto Rico, it is time for the authorities to work on devising creative alternatives that would allow us to confront the deficit in our health care system, and propose and implement reforms that will provide greater coverage for our society. We cannot keep pinning our hopes on a process that is not within the control of the local government. In fact, there is no reason to separate the two initiatives, the lobbying efforts in the federal capital and self-management in Puerto Rico. At this time, the unionization of health care is beginning, and Secretary of Health Lorenzo Gonzalez already expects that the priority will be health insurance administration. We must not wait too long to deal with the issue of health care in Puerto Rico.