Homer Giles He is a doctor received in Cuba and studied at the Latin American School of Medicine in Havana. It is the first thing that stands out to whoever sits at your table. He was an official of the Ministry of Health during the last presidency of Cristina Kirchner. He looks at her, smiling, in the photo he chose for his Twitter profile. On his account, he shares posts from Axel Kicillof, Daniel Gollán, Nicolás Kreplak, “Wado” by Pedro and “El Cuervo” Larroque. It is from the kidney of La Cámpora, but for now it retains a low profile.
Giles chairs the Medical Work Institute (IOMA), the largest social work in the province from Buenos Aires that this week was involved in a conflict over the dismissal of six trade unionists who denounced corruption. It promotes changes in the institution, which could be experimental trials for an eventual redesign of the health system throughout the country.
Inseparable from the Buenos Aires Health Cabinet, Giles is a member of the Sanitary Sovereignty Foundation, an organization that claims to “promote a deep, national and popular view of health” and which is chaired by the Vice Minister Kreplak and has the minister as a consultant Gollán. Together with them, the head of the IOMA studies the law that aims to reform the structure of the health system, questioned by the unions of the CGT and private medical providers for being focused on managing funds.
Although the spokesmen of the Buenos Aires Ministry of Health told THE NATION that “Homer does not have any role in the possible future reform of the health system”, within the IOMA itself they did not rule it out. “The Cámpora is in the public administration, that is already known. Giles is part of Kreplak and Gollán”, they limited themselves to saying.
“All three are in the same line. They have a sanitary conception of health, which aims to begin to link and do things based on the popular majorities; to articulate the public, private and social security sectors,” he told THE NATION the deputy secretary of the Buenos Aires State Workers Association (ATE), Vanina Rodríguez, added: “We see the management with good eyes. We believe that health has to be public, free and of quality.”
Giles militates for a health system regulated and intervened by the State. While it’s gestating, shore up your IOMA coverage with a prepaid subscription. “He went to a known optician to get glasses for OSDE. The day something bleeds him, he will not go to a public hospital,” they shot in the La Plata medical circle.
Although in the medical entities that represent the professionals before the IOMA a kind of symbiosis is recognized between Giles and the Buenos Aires Health Cabinet, few consider it suitable enough to design a new system. “It does not have a great capacity to devise a reform, it does not have management capacity” or “the provision did not improve but there were complaints and cuts throughout the year and it handles the IOMA with many doubts”, were some of the qualifications of different referents that maintain an agreement with the social work and were consulted by THE NATION.
“It is the first time that the IOMA, which is autarkic, depends or acts in coordination with the Ministry of Health. Giles has stated, on more than one occasion, that they are the ones who tell him what to do and that he respects this verticalism”, affirmed a source that integrates, for more than 20 years, one of the largest medical entities in Buenos Aires.
For the referent of another smaller entity, the appointment of Giles as head of the IOMA was “strategically typed”. From that place, he assures, with 2.5 million members and the great population of the Province, it could pave the way for a national reform.
In the mirror of PAMI
Giles conducts a pilot test that is already underway. The first step? Emulate the Comprehensive Medical Assistance Program (PAMI), in which the clinics have their own body of doctors, to which a certain affiliation universe is assigned -for which they receive a fixed salary-, without the possibility of patients choosing where or with whom to attend. For this, it has a brand-new chief of staff, who was deputy director of the social work for retirees and pensioners during Christianity: Mariano Cardelli, investigated by the prosecutor Carlos Stornelli for alleged irregularities, such as having self-awarded millionaire salaries and hiring services with surcharges .
“There is no formal statement from the IOMA regarding the will to ‘pamize’, but they have given indications of this with the purchase of clinics, the search to consolidate a system of family doctors and the installation of their own polyconsultations in La Plata”, one of the sources detailed THE NATION, in reference to the inauguration of a hospital in Temperley -in August 2020- and two medical centers in the provincial capital, which opened in early January. All, intended for the free and exclusive attention of IOMA affiliates.
The centers promoted by Giles are repudiated by the majority of doctors, who are unable to compete from their offices, where they charge co-payments to face the low fees they receive from the IOMA.
“This is the most ideological management that I know. The only objective is to impose popular clinics, which have to do with the line of action and thought of La Cámpora,” added the same source. “Ideology predominates, and the service is left aside,” he continued, after indicating, in coincidence with the other doctors consulted, that the recently opened polyconsultations do not work.
“They cut the ribbon, but there is no one working,” the doctors said. At ATE, on the other hand, they backed the IOMA. “You cannot lift the blind from one day to the next and have free clinics work where there were private ones. They are in a transformation process,” said Rodríguez, the assistant secretary.
The possibility of the IOMA changes taking national scale is still uncertain. For now, “it’s just cosmetic,” according to doctors and trade unionists. The management accumulates debts, arrears in payments, outdated fees and few instances of dialogue with the entities. “IOMA has many conflicts and it has no managerial capacity to implement things. We do not know if this will end in the restructuring of the Argentine system, but we estimate that it will remain only in the speech, “said one of the sources consulted.
“We would all agree with a reform of the health system, which is broken and uneven. The objectives of the draft are not bad, but there is nothing concrete, and, when you scratch, it is nothing more than a fight with the unions over the boxes, “said an opposition source linked to the health field, and concluded:” It starts with the IOMA, the public and the private are unified, and La Cámpora keeps the boxes of the 262 union social works.