United States could learn from Mexico's health system

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Julio Frenk, who served as Minister of Health of Mexico between 2000 and 2006, spoke at University of California-Davis in April about Mexico's efforts to reform and expand its health care system. He chose to focus on the ethical principles that guided the architects of the new plan.

Mexico apparently has decided to do something about the 50 million of its citizens, most of them poor, who lack insurance and access to decent health care. The nation figures this will be an expensive, long-haul task and proposes to tackle the problem one piece at a time, starting with providing basic services to the poorest citizens. Frenk argues that, nonetheless, there is broad-based political support for hanging in there and getting the job done.

Why should Mexico do this? Frenk called it the "democratization of health." By this he meant all citizens in the nation should have certain rights guaranteed to them, and basic health care was one of them. He referred to this extension as moving from civil and political to social rights. The idea of health as a social right and not as a commodity to be purchased only by those with money, had been adopted formally two decades previously in Mexico but never implemented.

Rounding out the ethical system are five other key values that accompany the notion of health care as a social right. These include social inclusion (all human lives have equal value); equal opportunity (lack of health care holds people back from opportunities to lead full, productive lives); financial justice (people should pay according to their capacity and receive according to their needs); individual autonomy (free choice of services and providers); and social responsibility (for one's good health and the health of others).

The Mexican health care system is said to be a work in progress. Even if the government makes good on its promises, it will be some years before all citizens have guaranteed access to even bare-bones health care, and a while after that before it becomes good health care for all. Experience warns it will be an uphill battle to keep the major part of the funds from being siphoned off by corruption.

If Mexico can move along this path, it's interesting to speculate on the border fence it will have to build to keep hordes of undocumented Americans seeking low-cost health care from flooding its country.

Only they wouldn't build that fence. Because, said Frenk, one of their other declared values is, "it is unethical to limit access to health services on the basis of the migratory or legal status of any person."