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00:00Good morning, ladies and gentlemen. Thank you for tuning in, as always.
00:05This is where your 1 plus 1 newscast begins.
00:09The country has woken up today, dismayed by the tragedy that happened at midnight
00:17in a disco in the capital.
00:20A famous disco in the capital, the Jet Set, which is located in front of the brewery.
00:28Correct. The Independence Avenue.
00:31The Independence Avenue is a place visited mainly by upper-middle class people.
00:40There are many famous people from all walks of life.
00:44From sports, art...
00:46From politics.
00:47From politics.
00:48And from communication.
00:49And from communication as well.
00:51And it so happens that the roof of the disco collapsed
00:55in the middle of a huge party,
00:57sponsored by well-known artists.
01:01Ruby Perez, the famous Dominican merenguero, the artist of the night.
01:04Exactly.
01:05Who is still unknown, what happened to him.
01:10And many other personalities who are there.
01:13The most famous names are mentioned,
01:17there are many ordinary citizens who were caught.
01:23The state, the relief organizations,
01:26quickly mobilized, they are there.
01:29They have police officers, even the national army.
01:35Of course, the volunteers of the Civil Defense, Red Cross, 911.
01:43There is a public health mobilization
01:46of all these organizations,
01:48trying to get people out who have been trapped
01:54inside the rubble of the building that collapsed.
01:58A building that was recently remodeled.
02:02There is a lot of fabric to cut,
02:04we have to find out the causes.
02:05But for now, the efforts are all aimed at Red Cross.
02:10Exactly, the victims.
02:12That must be the priority at this time,
02:15a very unfortunate tragedy.
02:18And the preliminary figures speak
02:21that there would be a mortal balance
02:24of about 12 people dead and 45 injured.
02:29It is a figure that you know that as the day goes on,
02:33they are increasing.
02:34I hope they increase the number of people rescued.
02:38In a first balance,
02:40they said they would have managed to get
02:42about 37 people out alive.
02:44And they have been distributed in a hospital network.
02:48Most have been taken to Marcelino Vélez,
02:50but there are others who have gone to different centers.
02:55What is important?
02:56Well, the issue of attention, exactly.
02:59That, please, Adalberto Grullón,
03:01this is a context in which we do not speculate,
03:04that we think about the families,
03:06that right now you see some images of this support.
03:09The whole environment is full of families
03:11who are in great despair,
03:13because not all have been able to have,
03:15so far, accurate information
03:17about what has happened to their families.
03:19And there is no accurate information
03:21about everything that has happened.
03:23The authorities are working,
03:25they are even issuing bulletins.
03:279-1-1 has issued two,
03:29already in the course of today,
03:31to give a panoramic of what has happened,
03:35but there are no details.
03:37Look at the moment, Adalberto,
03:39and kind viewers,
03:41right at that moment,
03:43is when the tragedy occurs.
03:45You see Rubi there on the stage.
03:47I don't know if the video has sound,
03:49the production,
03:51but it would be interesting,
03:53because a person just says,
03:55look at him there,
03:57there he fell off the roof.
03:59It's terrible.
04:01It must be said that the Spaiyá family,
04:03the owners of Yesé,
04:06have communicated with the victims,
04:08and they say what you were saying,
04:10that right now the important thing
04:12is to focus on the victims.
04:14Yes, that's what the protocol says,
04:16and that's what the relief organizations
04:18are doing right now.
04:20We have to be attentive
04:22to the information.
04:24It's a tragedy that generates
04:26national concern.
04:28The truth is that the country is like,
04:30the capital is like...
04:32Yes, you can feel the environment.
04:34Because there are well-known people,
04:36there are...
04:38It's full of people.
04:40Yes, imagine, Rubi Pérez
04:42is one of the most popular artists
04:44in the Dominican Republic,
04:46and in Yesé it's a tradition
04:48that on Mondays they always bring
04:50Dominican artists,
04:52and that's full house.
04:54There you are also seeing
04:56a video of the environment,
04:58right at that exact moment,
05:00from this other angle,
05:02the tragedy that we reiterated
05:04consisted of the collapse
05:06of the roof of Yesé.
05:08The truth is that this is a very special country,
05:10because on Mondays,
05:12on Mondays,
05:14on a Friday,
05:16we go there,
05:18every Monday.
05:20That's what you find out now,
05:22especially since we're not
05:24visitors to this type of place,
05:26but there it is.
05:28In situations like this,
05:30situations like this have happened
05:32in many other countries,
05:34including the United States,
05:36but here we don't have,
05:38I don't know of any precedent like this,
05:40a place of
05:42fun,
05:44as popular
05:46as it is,
05:48as popular and expensive,
05:50you have to pay to go there,
05:52and everything that is sold
05:54in that club is expensive, as they say.
05:56We will keep you informed,
05:59gentlemen, about the outcome of this.
06:01The authorities are also
06:03letting people know
06:05the places where people
06:07have been rescued,
06:09which, in their vast majority,
06:11are not in a state of grave danger,
06:13as has been said,
06:15and the relatives,
06:17keeping in tune with these media,
06:19will continue to find out.
06:21If you want, very briefly,
06:23because I have some names,
06:25I can give a quick reading.
06:27Marcelino Vélez
06:29Humberto Guerrero
06:31Daniel Veras
06:33Abel González
06:35Luis Atiles
06:37Darío Contreras
06:39Héctor Brito
06:41Elena Almanzar
06:43Martín Batista
06:45Cristian Marcelino
06:47Marcelino Vélez Santana
06:49Jesús Ramírez
06:51Gilberto Encarnación
06:53Luisa María
06:55Elisa Pérez
06:57Annie Aibar
06:59Marcelino Vélez Santana
07:09That list, of course, was given an hour ago.
07:11Yes, that has been increasing.
07:13It is likely that it has been increasing
07:15because it is daytime.
07:17It is easier to find people
07:19who have been rescued.
07:21Hopefully,
07:24emergencies do not collapse
07:26because here we have a huge crisis
07:28of a deficit
07:30of intensive care rooms
07:32in public hospitals
07:34and we also have a deficit
07:36of beds
07:38in public and private hospitals as well.
07:40Don't you think that
07:42the majority of
07:44private health centers
07:46have all the equipment
07:48that they need
07:50and all the facilities?
07:52The private centers
07:54that have
07:56real intensive care rooms
07:58with all the instruments
08:00and the conditions
08:02that this type of
08:04room or space
08:06requires.
08:08But, well, let's see.
08:10Meanwhile, that is what is happening,
08:12ladies and gentlemen.
08:14The worst is expected for many of the people who are trapped.
08:16Yes, there are still people alive
08:18under the rubble.
08:20People who were not able to leave
08:22and who are inside
08:24with snow injuries.
08:26Yes, one of the impediments
08:28was that in the parking lot
08:30there were many of the vehicles
08:32of the people who were there.
08:34So, part of the equipment
08:36of the authorities could not get close
08:38to the place.
08:40They have already gone.
08:42According to what has been reported in the morning,
08:44they have managed to mobilize it,
08:46but very early in the morning.
08:49Yes, a significant number.
08:51So that by ambulance it does not stop.
08:53Yes, by ambulance, no.
08:55And specialized teams are also there.
08:57Yes, of course.
08:59Because the country
09:01has been endowed with capabilities.
09:03That COE
09:05that sometimes some people question,
09:07is a very important achievement
09:09for a country like this.
09:11Not only in cyclonic times,
09:13but in situations
09:15of this nature.
09:17Because the director of the COE
09:19at the same time that he is coordinating
09:21the 911,
09:23that man is extraordinary.
09:25He represents a species
09:27in the process of extinction.
09:29It dawns, it stays,
09:31it lasts 3-4 days continuously,
09:33it has an open phone
09:35so that it wants to call him.
09:37And it gives him the phone number publicly.
09:39How extraordinary, how humanistic.
09:41And what a vocation of service.
09:43Someday we will have to pay tribute
09:45to this man and pay homage to him.
09:47And of course, where is he today?
09:49In the place of the facts.
09:51Directly leading
09:53the operation that is being developed
09:55and giving the relevant information
09:57to the citizens.
09:59Let's reiterate our solidarity, Alberto,
10:01with the relatives,
10:03the friends of the affected people.
10:05And please say again
10:07that do not speculate,
10:09that do not share information that is not properly verified.
10:11And please respect the dignity, Alberto,
10:13of the people involved in this situation.
10:15There are photos,
10:17there are images that are not earned,
10:19nothing is contributed by sharing it
10:21on social media.
10:23That is another advance of the Dominican Republic.
10:25The media, especially the formal media,
10:27have advanced a lot
10:29in handling
10:31situations like this.
10:33Because the blood,
10:35putting corpses,
10:37that does not help.
10:39There is nothing.
10:42And the media is already hesitating
10:44to make that kind of
10:46statements.
10:48They tell me there is a lot of news
10:50in addition to this,
10:52which I had a plan to comment on,
10:54but the circumstances have forced us
10:56to change the agenda.
10:58So we are going to pause
11:00and come back.
11:02We are going to talk about health,
11:04precisely about health,
11:06with the participation of Alba María Reyes,
11:08who is the General Coordinator
11:10of the Alliance for the Rights of Health,
11:12and with Bernardo Batías,
11:14a specialist in the subject.
11:16Both of them
11:18have been invited
11:20because they celebrated
11:22World Health Day
11:24and they were
11:26in front of an event,
11:28I think the only event
11:30that was held
11:32in the country
11:34as a commemoration of that day.
11:36Of course, on Saturday,
11:38the OMS
11:40and Public Health
11:42held a meeting
11:44in the Health Avenue
11:46to commemorate that day.
11:48Because the OMS
11:50celebrates World Health Day
11:52because
11:54a day like yesterday
11:56was created
11:58by the Pan-American Health Organization
12:00World Health Organization
12:02The WHO.
12:04A pause
12:07and we will be back.
12:09Thank you very much,
12:11ladies and gentlemen,
12:13for continuing with this
12:15One Plus One newscast.
12:17We have two special guests
12:19here
12:21in this One Plus One program
12:23in the foreground.
12:25Bernardo Batías,
12:27who is a health expert,
12:29and Alba María Reyes,
12:31who is the General Coordinator
12:33of the Alliance for the Rights of Health.
12:35Yesterday was celebrated
12:37World Health Day
12:39and you were in front of
12:41the event
12:43held
12:45at the Faculty of Economics
12:47at the Universidad Autónoma de Santo Domingo
12:49and made a series of reflections
12:51that we would like to share
12:53with our audience.
12:55That is why we invited you.
12:57Alba,
12:59what is the situation
13:01in which the country is?
13:03What are your concerns?
13:05Thank you Alberto
13:07and Melissa
13:09for the invitation.
13:11Yesterday we were,
13:13as Alberto says,
13:15at the Faculty of Economics
13:17at the OAS.
13:19An important place
13:21for the construction process.
13:23ADESA was born there
13:25on January 29, 2017.
13:27In order to
13:29communicate with the world
13:32in order to celebrate
13:34World Health Day
13:36yesterday.
13:40A commemoration
13:42that has been going on
13:44since 1950
13:48and from which
13:50universal access
13:52for all citizens
13:54is sought
13:56to quality health services.
13:58We met
14:00with dozens,
14:02hundreds
14:04of ADESA
14:06activists
14:08from different parts
14:10of the country
14:12to reflect
14:14and reiterate
14:16our concerns
14:18regarding the lack
14:20of quality
14:22that we Dominicans
14:24receive in health services.
14:28Recently we sent
14:30a message to the President
14:32Luis Abinadel
14:34where we expressed
14:36our concerns
14:38regarding
14:40where health is placed
14:42at the moment.
14:44Because from ADESA we understand
14:46that despite the announcements
14:48and the progress that the current government
14:50has made,
14:52many of which we recognize
14:54in that message
14:56that we sent to the President
14:58we understand that there is still
15:00a lot of coverage problems,
15:02a lot of quality problems
15:04in health services,
15:06shortages in public
15:08hospitals,
15:10lack of management
15:12or weaknesses in management
15:14in the health sector
15:16in the country.
15:18We continue with the issue of low investment
15:20despite the fact that
15:22it has been one of ADESA's flags.
15:24It is not possible to transform the system
15:26with such a low investment
15:28as the one we have
15:30in the Dominican Republic.
15:321.8% and they say
15:34that we are still falling
15:36in relation to 2019.
15:38Those are some of the things
15:40that we saw in yesterday's meeting
15:42with the leaders of ADESA.
15:44The issue
15:46of our concern
15:48with the Family Health Insurance.
15:50The issue of the co-payment
15:53was addressed by Matías,
15:55an ally of ADESA
15:57in this process of better understanding
15:59what is happening with the system.
16:01A big problem
16:03is the insurance
16:05for the Dominican population.
16:07Those were some of the ideas
16:09and reflections
16:11that we addressed yesterday
16:13in the meeting.
16:19In the note that you distributed
16:21there were serious concerns
16:23about the issue of primary care
16:25and the situation of the first
16:27and second levels of care
16:29in public health.
16:31They talked about privatization
16:33and how the process of privatization
16:35is growing
16:37and how expensive it is
16:39to access private health services.
16:41One is surprised that this is happening
16:43because the majority of the population
16:45is already insured.
16:47The insurance should cover
16:4998% of the population.
16:5198% of the population.
16:53Bernardo,
16:55what can we say about this?
16:57What has happened?
16:59If we have an almost universal insurance
17:01in terms of card,
17:03in terms of delivery,
17:05people still complain
17:07that the prices are high
17:09and that there is no coverage.
17:11Good morning.
17:13Thank you for being here
17:15and thank ADESA
17:18for giving me the opportunity
17:20to share
17:22and be part of this movement.
17:24I think that ADESA
17:26and all the social movements
17:28that are interested
17:30in transforming
17:32the health system
17:34have to be strengthened.
17:36Because I think that
17:38at this moment
17:40there is no other way
17:42than the social pressure.
17:44I don't see
17:46that on the side
17:48of the Congress
17:50there is a possibility
17:52of a deep reform process.
17:54I don't see it
17:56from the main actors
17:58that direct
18:00the institutions
18:02of the system.
18:04I don't see it from the executive power.
18:06The issue
18:08of health reform
18:10in the sense of
18:12what society requires
18:14is not part of the political agenda.
18:16For me, it is a very critical issue.
18:18And to ensure
18:20that it can be inserted
18:22in the political agenda
18:24with the responsibility
18:26and the depth that it deserves.
18:28Because there is
18:30a new bill
18:32of reform
18:34that when you read it
18:36is insubstantial
18:38in terms of the changes
18:40and the transformations that have to be made.
18:43I think
18:45that we are living in a point of inflection
18:47that is too deep
18:49for the system.
18:51And from the side of
18:53the main actors
18:55I don't see a perspective
18:57of change.
18:59And when there is
19:01that moment of inflection
19:03the citizen pressure
19:05is the only way
19:07that remains.
19:09That's why I think
19:11we have to support it
19:13and strengthen it
19:15and other social movements
19:17that are interested
19:19in transforming the system.
19:21But what is the problem
19:23of COPPAGO?
19:27What is the magnitude
19:29of that problem?
19:31Of COPPAGO?
19:33Look, what happens is that
19:35the system
19:37was originally structured
19:39under a logic
19:41that is to link
19:43health as a commodity
19:45and health as a right.
19:47And the logic of the market
19:49has been imposed.
19:53And as I said yesterday
19:55in a logic of the market
19:57where
19:59the state would have
20:01at least to regulate
20:03and it is a market
20:05without regulation.
20:07And COPPAGO
20:09so that people understand
20:11How is it a regulation
20:13if you have a national council
20:15of social security
20:17and you don't have a labor health superintendent?
20:19It doesn't work.
20:21But you ask me
20:23because...
20:25To explain to people
20:27when we talk about COPPAGO
20:29we are talking about payment of difference.
20:31The first element of regulation
20:33is that any doctor charges
20:36of difference.
20:38If the rate is discretional.
20:40It is discretional.
20:42And nobody does anything.
20:44It turns out that
20:46the contractual relationship
20:48between
20:50the ARS
20:52and the PSS
20:54for the payment of the benefit
20:56is not regulated either.
20:58It is an open market relationship.
21:00That is, the ARS
21:02and the PSS negotiate
21:04whatever they want.
21:06But in other countries
21:08there is a unique tariff
21:10that regulates the market
21:12with limits
21:14and minimums.
21:16Why can't we do that here?
21:18Yesterday I reflected
21:20that one of the problems
21:22that we have
21:24in the Dominican Republic
21:26is that the owners of the business
21:28are at the same time regulators.
21:30They regulate themselves.
21:32So in that business logic
21:34regulation
21:36is the least desirable
21:38for the business owners.
21:40The same system
21:42is penetrated by a large part
21:44of the business owners
21:46in the Dominican Republic.
21:48And that makes it difficult
21:50for us to have regulations.
21:52Some
21:54that in their tradition
21:56of life and commitment
21:58cannot be located
22:01as business owners
22:03have been blocked.
22:05For example,
22:07Pedro Luis Castellano
22:09in his management
22:11had interesting initiatives.
22:13One of the best proposals
22:15that I have known
22:17on the organization
22:19of the first level of attention
22:21with costs and everything
22:23and a way of structuring
22:25the basic package
22:27that should be given
22:29Pedro Luis Castellano's management
22:31on primary care
22:33in health.
22:35And that did not stop
22:37being a simple proposal.
22:39Because the big clinics
22:41are not suitable for regulation.
22:43And the governments?
22:45The parties?
22:47Especially the governments.
22:49Why?
22:51Why have they not assumed
22:53with responsibility
22:55that case?
22:57Pedro Luis Castellano
22:59was the superintendent
23:01of labor health.
23:03He made that proposal
23:05but as he has said
23:07it did not go from there.
23:09And there were other people
23:11in the system
23:13with a clear vision
23:15of what needs to be done.
23:17But it is never done.
23:19What happens?
23:21Well, I think
23:23there is a vision issue.
23:26I think that the governments
23:28that we have had,
23:30not only the current one,
23:32but it is an issue that drags on.
23:34I think that we have not had
23:36a government that has been capable
23:38of facing the big interests
23:40that are moving in the health sector.
23:44And if you do not have
23:46a government
23:48really with
23:50we say in the field
23:52with the pants on
23:54to face those big interests
23:56that Bernardo is talking about
23:58it is difficult to make
24:00the changes that we need.
24:04You have the National Council
24:06of Social Security.
24:08When the council says
24:10these are our proposals,
24:12this is what we want,
24:14this is what we understand
24:16and we propose to the government
24:18they disconnect
24:20and tell us
24:22this is the council,
24:24but whose task is it?
24:26If you are there for that.
24:28When we talk to you,
24:30we have to promote
24:32the transformation project
24:34of the social security law.
24:36They tell us
24:38this is an executive issue,
24:40this is not an issue
24:42of the National Council
24:44of Social Security.
24:46However, within the council itself,
24:48which was something we saw yesterday,
24:50and that is precisely part
24:52of that business,
24:54that is part of that control,
24:56of that commodification
24:58of the system.
25:00There is another element.
25:02Yes, go ahead.
25:06I think there is a vision
25:08of health,
25:10which is not our vision.
25:14This is a systemic issue
25:16that links politics
25:19and economy.
25:23A conservative state
25:25is not going to give you
25:27a health system
25:29under a progressive logic
25:31of broad coverage,
25:33universality, equality.
25:35A conservative state
25:37is going to reproduce
25:39a conservative health scheme.
25:41There is a close relationship
25:43between state and health system.
25:45The Dominican Republic,
25:47the majority of our country,
25:49Latin America,
25:51has a political system
25:53where what appears to be
25:55its weakness is its strength,
25:57which is political clientelism
25:59and the investment
26:01of economic sectors
26:03of power
26:07in the elections,
26:09in the political parties,
26:11to gain loyalty,
26:13to gain adherence,
26:15to certain economic interests.
26:17In the Dominican Republic,
26:19the health system
26:21that we have,
26:23in terms of social security,
26:25the big investors
26:27are bank investors.
26:31If you look at the main ARS,
26:33the main ARS,
26:35behind them there are
26:37powerful financial sectors.
26:39And if you look at the big clinics,
26:41the big clinics
26:44are those powerful economic sectors.
26:46And a large part of the financing
26:48of the campaigns
26:50are those powerful economic sectors
26:52that support them in the Dominican Republic.
26:54So there is an alliance
26:56between politics and economy.
26:58And when there is this kind of alliance
27:00between politics and economy,
27:04to make reforms,
27:06changes, transformations,
27:08that injure
27:10those businesses
27:12of health,
27:14is unthinkable.
27:16That's why,
27:18and what I'm saying
27:20is not an abstraction,
27:22I was 14 years inside the monster
27:24and I know of so many
27:26calls that were made
27:28to block
27:30initiatives from different sectors,
27:32from meetings where
27:34I had to participate directly
27:36with key actors of the system
27:38who said,
27:40I believe in primary care.
27:42But when they speak publicly,
27:44they say they believe in primary care.
27:46I'm not inventing anything
27:48face to face,
27:50in meetings,
27:52that don't believe in primary care.
27:54Because, for example,
27:56specialist doctors,
27:58most of them don't believe in primary care.
28:00But if you get into the subject
28:02you want to ask...
28:04There are economic interests
28:06that are allied
28:09with political interests
28:11under a clientelist system.
28:13That's the root of the root.
28:15When you go to the bottom,
28:17the bottom of all these problems.
28:19What can be done to change that?
28:21I'm talking about
28:23destructuring through
28:25popular pressure.
28:27There's no other option.
28:29There's no other option.
28:31Because the opposition parties
28:33don't believe in that
28:35and they had to govern.
28:37The primary care strategy
28:39was designed half a century ago.
28:41It's a matter of teaching
28:43in universities,
28:45in medical schools, in nursing schools, etc.
28:47Politicians talk about it.
28:49Everyone talks about it.
28:51And here in the Dominican Republic
28:53it's been impossible
28:55to sustain even
28:57what was once done.
28:59But everyone publicly believes in primary care.
29:01And in practice, no.
29:03Everyone believes in primary care publicly.
29:05And the investment is still
29:07very small
29:09in primary care
29:11by the Dominican state.
29:13What are we going to do?
29:15We're getting a lot of complaints
29:17that hospitals,
29:19especially in the first and second levels
29:21of care,
29:23are becoming more and more precarious.
29:25More and more equipment is missing.
29:27Personal.
29:29Basic supplies.
29:31Look,
29:33the law that we criticize
29:35has many
29:37interesting issues.
29:39If it had been applied,
29:41the system would have been different.
29:43That law,
29:45because it was like a forced pact
29:47where you study the law
29:49in depth
29:51and you have progressive ideas,
29:53non-progressive ideas.
29:55Law 8701, and if you read Law 4202,
29:57it's even more progressive.
29:59The law.
30:02I don't know if Law 8701 is progressive.
30:04But Law 8701
30:06gives the guidelines to what you're saying.
30:08In the article,
30:10I always get confused if it's 165
30:12or 167,
30:14where it raises
30:16a series of measures
30:18of reorganization and restructuring
30:20of the public network.
30:22There it raises it.
30:24And one of the first,
30:26the first chapter
30:28of that article is
30:30the design
30:32and execution
30:34of an investment plan
30:36for the improvement
30:38of infrastructure
30:40and technological elements
30:42of health centers
30:44in the different levels
30:46of care.
30:48With emphasis,
30:50says the same law,
30:52in the most depressed
30:54and poorest areas of the country.
30:56Says the same law.
30:58In a textual way.
31:00Yes, that there should be
31:02an investment plan.
31:04First point.
31:06Second point.
31:08Right there, says that article.
31:10It has to
31:12redefine
31:14a model of hiring
31:16health care providers
31:18oriented
31:20to pay-as-a-result.
31:22That is
31:24in relation
31:27to doctors who are not going to work.
31:29Or that if they go,
31:31they only work an hour
31:33and leave when
31:35their schedule should be from 8 to 12.
31:37And already at 9
31:39or 10 there are no doctors.
31:41The law establishes
31:43pay-as-a-result.
31:45That same article
31:47says that there should be
31:49a reorientation
31:51of the financing
31:53of health.
31:55And the financing should be oriented
31:57to separate
31:59the attention payment
32:01to the person
32:03of the individual health
32:05and the collective health.
32:07And the collective health
32:09touches the public health.
32:13And still today,
32:15for example,
32:17the financing of the public health
32:19is paid on one side
32:21by SENASA and Social Security
32:23and on the other side
32:25by the National Health Service.
32:27There is a dispersion
32:29of spending
32:31and health resources.
32:33And there are other payments
32:35like, for example,
32:37vaccination.
32:39The IRS saves money
32:41for the vaccine.
32:43Because the vaccine is...
32:45Prevention.
32:47Yes, but most people go.
32:49For example, I go and take
32:52my children to get vaccinated
32:54to the public vaccination centers.
32:56And that is supposed to be
32:58covered by Social Security.
33:00And that money
33:02is saved by the IRS.
33:04I am giving an example.
33:06In such a way that
33:08what has to be done
33:10with respect to the public network
33:12has not been done.
33:14And it is getting more complicated
33:16because now SENASA
33:18the services that should be
33:20public are being hired
33:22by private networks.
33:24I will give you an example.
33:28There is a
33:30hiring model
33:32that SENASA has
33:34for the first level of care.
33:36And
33:38that hiring is
33:40to a private network
33:42that SENASA has to give
33:44services to the subsidized regime.
33:46When it is assumed
33:48that the service
33:50is via the
33:52UNAP.
33:54The primary care unit.
33:56That money
33:58should be oriented
34:00to strengthen the primary care unit.
34:02Not to
34:04financially bleed it out.
34:06And the money
34:08that goes
34:10SENASA is already
34:12orienting 72%
34:14of the subsidized spending
34:16to the private network.
34:1872%?
34:20Yes.
34:22It is a public information
34:24that I manage.
34:26Not a private information.
34:28And then
34:30what does that imply?
34:32That the public network
34:34will have less and less
34:36financial capacity.
34:38That happens because
34:40the public network has
34:42an inability
34:45But we are going to bleed it out
34:47more.
34:49It is a vicious circle.
34:51So we have to invest in the republic.
34:53We have to reorganize
34:55the republic.
34:57But the government says it is doing it.
34:59The director of the National Health Service
35:01has said that
35:03the government has
35:05remodeled and built
35:07around 700 centers
35:09for primary care
35:11in the country.
35:13But the problem here
35:15is not remodeling
35:17in terms of health.
35:19It is building.
35:21It is the same scheme.
35:23It is the reorganization
35:25of the model of care.
35:27It is not building
35:29on a physical level.
35:31It is supposed to designate
35:33trained staff, family doctors,
35:35nurses,
35:37promoters.
35:39How does that work?
35:41Alba.
35:43I have spoken too much.
35:45I like how he is today.
35:47He is in another role.
35:49He is asking the questions
35:51that the audience would ask.
35:53I sometimes say,
35:55Alberto...
35:57I like how he is today.
35:59What Bernardo explains
36:01brings us back
36:03to the topic.
36:05There is no interest in that
36:07republic functioning efficiently
36:10because that damages
36:12the health business.
36:14It damages it
36:16because
36:18as you have
36:20a strengthened republic,
36:22especially
36:24in the first level of care,
36:26what happens
36:28with private clinics?
36:30What happens with
36:32specialists who are part
36:34of the majority of that business,
36:36as Bernardo explained yesterday?
36:38We do not know
36:40and we have denounced
36:42that you go to a hospital
36:44with a second level of care
36:46and a basic service
36:48and you do not find it.
36:50The doctor tells you
36:52to go to the front and do the study.
36:54Go to the front and do the analysis.
36:56But the business
36:58that is in front of the hospital director
37:00or the specialist doctor
37:02who works in that hospital.
37:04It is a vicious circle.
37:06We go and we come.
37:08I think
37:10and Ades has insisted on that
37:12that here we have to change
37:14the approach of the system.
37:16And the priority
37:18must be
37:20prevention and promotion
37:22of health.
37:24And that is done in the first level, fundamentally.
37:26We have
37:28a system based on
37:30curing and attention to the patient
37:32in a priority way.
37:35And we have
37:37authorities
37:39that are part of that circle
37:41of those who direct the system
37:43who are business people
37:45of health,
37:47the vast majority, if not all.
37:49We are going to need
37:51to continue to press
37:53and continue to raise awareness
37:55to the community
37:57that primary care
37:59has to be the priority.
38:01Ades' proposal
38:03that health has to be placed
38:05as a priority in the national political agenda
38:07and that this happens
38:09by reviewing the investment.
38:11I think
38:13it is part of what can
38:15contribute to improving
38:17that situation
38:19of primary care.
38:21The government,
38:23the president,
38:25Luisa Binader
38:27has spoken
38:29about the issue
38:31that it has to be prioritized.
38:33And everywhere you hear that it is prioritized.
38:35But it turns out that in this year's budget
38:37the investment is less
38:39than the one we had
38:41in primary care,
38:43the one we had in 2019.
38:45What happens with that?
38:47The argument that
38:49the president has been asked about
38:51is that there is no money.
38:53And that they had the hope
38:55that with the fiscal reform
38:57they were going to dedicate
38:59millions of pesos
39:01for primary care.
39:03And that this was not approved.
39:05That is the excuse now.
39:07That there is no money for this.
39:09That the state does not have money for this.
39:13With the current system
39:15you can put
39:17all the money in the world
39:19for health.
39:21And we are not going to improve.
39:23Because
39:25it is money,
39:28but it is not just money.
39:30There is an issue
39:32of the model of care, as we have said,
39:34and of organizing the spending
39:36in a more efficient way.
39:38I am going to give you an example
39:40with respect to what
39:42Director Lama
39:44says about the investment
39:46in infrastructure.
39:48Here all governments have invested
39:50in health infrastructure.
39:52But what happens?
39:54Just as there is a gap
39:56between the high investment
39:58in health
40:00of the second and third level
40:02and very low investment
40:04in the first level,
40:06there is also a high
40:08territorial inequity
40:10in the investment.
40:12The centers
40:14that are built
40:16are mostly concentrated
40:18in the big provinces.
40:20The centers
40:22that are built
40:24in the capital city,
40:26in Santiago and a few other provinces,
40:28the municipalities
40:30and the primary care units,
40:32the municipal hospitals
40:34should be the priority
40:36of the investment.
40:38It is said in the same law, 8701.
40:40Why? Because as you invest
40:42in
40:44the primary care units
40:46and in the
40:48municipal hospitals,
40:50you are going to decongest the hospitals,
40:53you are going to improve the health indicators,
40:55you are going to improve
40:57the quality of the service.
40:59So,
41:01it is not about investing for investing.
41:03It is not about
41:05saying that
41:07we are increasingly investing in health.
41:09It is about where the investment is going.
41:11Where
41:13is the investment going?
41:15Where is the investment in health concentrated?
41:17It is an investment
41:19that is concentrated
41:21in managing the disease.
41:23A big part
41:25of the crisis
41:27that has always been
41:29historically,
41:31is because of the high costs,
41:33the cardiovascular
41:35diseases
41:37and the oncological diseases.
41:39There it goes.
41:41There was a time
41:43when I was a health manager
41:45that 20% of the affiliates
41:47applying the Pareto method
41:49consumed
41:5180%
41:53of the expenses.
41:55Today,
41:5720%
41:59consumes 80% of the expenses.
42:01Bernardo,
42:03time is running out.
42:05There it is.
42:07The topic is interesting
42:09and we are going to talk about it
42:11in the next program.
42:13Even in the context of
42:15tragedies like this one,
42:18the topic of health is again
42:20in the spotlight.
42:22In that context,
42:24it is the intensive care units.
42:26The availability
42:28of intensive care units.
42:30We are going to reiterate
42:32the thanks to Alba and Bernardo,
42:34to all of you.
42:36A very brief pause.
42:38There is the latest COE bulletin
42:40that talks about 15 deceased people
42:42and 101 injured.
42:44As we said before,
42:46it is being updated.
42:48It is believed that there are more people
42:50under the rubble,
42:52even alive people.
42:54It is complicated.
42:56Antonio Siriaco is here.
42:58He is my friend.
43:00He is our economic advisor.
43:02And our host yesterday.
43:04Thank you, Alba.
43:06Thank you, Bernardo.
43:12Ladies and gentlemen,
43:14you are seeing images
43:16of the work
43:18that is taking place
43:20in the place
43:22where yesterday's discotheque
43:24was bombed.
43:28We already have preliminary information
43:30that is different from the previous ones.
43:32In Millicent,
43:34the number of corpses
43:36of people who died
43:38has increased to 15.
43:40And more than 100
43:42people have been rescued
43:44and taken to different
43:46hospitals throughout the country.
43:48Is there any information
43:50regarding Ruben?
43:52Yes, there is very good news.
43:54Ruben Perez was rescued
43:56alive.
43:58Remember that morning
44:00we gave him the information
44:02that he was still among the rubble.
44:04But as part of the base
44:06that has had these works,
44:08Ruben Perez has been rescued
44:11alive.
44:13The information has been confirmed
44:15by his manager, who says he is fine.
44:17There is positive information.
44:19Another negative
44:21is that the death of
44:23the governor of Montecristi,
44:25Nelcy Cruz, who was in the place
44:27of the events, has been confirmed.
44:29Unfortunately, she has been declared
44:31officially dead.
44:33There is also Alberto Grullon,
44:35and I have the information from very early
44:37in the morning, the son
44:39of the Minister of Public Works, Eduardo Estrella,
44:41and his wife, who were in the place.
44:43And to this day,
44:45they have not been rescued.
44:47They have not been located.
44:49We do not have any information
44:51about what happened to them.
44:53But as with everything else,
44:55we are making an effort to locate them.
44:57That's right.
44:59And the director of the COE,
45:01which is also 9-1-1,
45:03has said
45:05that the authorities,
45:07the relief institutions,
45:09have the hope of finding
45:11many more people alive
45:13under the rubble.
45:15So the fact that they have not appeared
45:17does not mean that they died.
45:19No, they can still keep hope.
45:21That's what there is, ladies and gentlemen.
45:23The country is in mourning, it is sad,
45:25it is condemned,
45:27because of this news that has spread.
45:29Everyone already knows.
45:31At the national level, I suppose,
45:33in Montecristi, there is also a lot of sadness.
45:36There are places
45:38where the impact of this
45:40has been considerable.
45:42Here we have
45:44the owner of Los Martes,
45:46which today is going to be
45:48a piece of the sea,
45:50Antonio Siriaco,
45:52the economist.
45:54Well,
45:56with this situation,
45:58one always regrets it,
46:00because it is a national tragedy.
46:02But, well,
46:04the issue of the economy,
46:06the issue of the tarpaulins,
46:08is still on the carpet,
46:10and all that impact
46:12that the different markets
46:14are having.
46:16Have they minimized that?
46:18The president minimized it a little.
46:20The president, I think,
46:22as there are so many issues,
46:24even the issue of the 15 measures
46:26of Dominicanization,
46:28of the labor market,
46:30and basically,
46:32it has a lot to do with the migratory part.
46:34The president, immediately,
46:36on Sunday, in his speech,
46:38raised an important issue,
46:40but the issue of the tarpaulins,
46:42now that it is starting.
46:44Yes, but I mean that
46:46the reaction of the president
46:48is that they treated us well,
46:50a 10%.
46:52I think that, first of all,
46:54the Dominican Republic has to think
46:56that our main competitor
46:58in the American market
47:01is Mexico,
47:03and Mexico has not received
47:05a reciprocal tarpaulin
47:07from Canada so far.
47:09So, that means
47:11that, although it is true
47:13that they gave the same tarpaulin
47:15to the countries of the DRCAPTA,
47:17subduing Nicaragua,
47:19who received a reciprocal tarpaulin
47:21of 18%,
47:23it is no less true
47:25that we have to see ourselves
47:27as part of that competition
47:29and Mexico was not imposed a tarpaulin.
47:31So, that means
47:33that our exports, basically,
47:35from the French zone,
47:37which are the ones that compete,
47:39the ones that enter that market strongly,
47:4168% of them go to the American market,
47:43compete with those of Mexico.
47:45Clearly, then,
47:47we enter a competition,
47:49let's say, a disadvantage,
47:51in a competitive term.
47:53And in that sense, we have to be very careful.
47:55What I think...
47:57Don't you consider, professor,
47:59a capital injustice
48:01that a country
48:03that has such an unequal commercial relationship
48:05in favor of the United States...
48:07Yes, but it's the same with Costa Rica,
48:09it's the same with...
48:11But it's worth a lot with El Salvador.
48:13With El Salvador, with the DRCAPTA,
48:15the DRCAPTA...
48:17If there is one of the few free trade schemes
48:19that the United States has,
48:21right?
48:23That has a commercial surplus,
48:25then, clearly...
48:27And then you add more.
48:29And then a 10% is added.
48:31Now, when one analyzes,
48:33by countries,
48:35and there is a document
48:37that President Trump
48:39in the famous Liberation Day
48:41presented it,
48:43where are the commercial barriers
48:45that obviously impose
48:47the countries to the United States,
48:49in the Dominican case,
48:51they talk a lot,
48:54in the case of rice,
48:56that is,
48:58the 23,000 metric tons
49:00that were allowed
49:02as a kind of contingent,
49:04and from that contingent
49:06a rate of 99% is applied,
49:08appealing,
49:10in this case,
49:12to the OMC regime.
49:14So,
49:16maybe one thinks
49:18that that was also
49:20a reprisal in that case,
49:22that is in the Dominican case,
49:24but we do not know why they put
49:26a 10% to Costa Rica, to Nicaragua,
49:28to El Salvador.
49:30Professor, and with all these barriers,
49:32where is the World Trade Organization
49:34going?
49:36Look, the world that President Trump
49:38has set up,
49:40appealing to the strength
49:42of the United States,
49:44the power it still has,
49:46it is a world without rules.
49:48It is a world
49:50where even
49:52before the Second World War,
49:54it was talked about that
49:56emerging and strong countries
49:58entered a kind of vital spaces,
50:00that is, each one is going to distribute
50:02the spaces according to
50:04their proximity.
50:06And in a world like that,
50:08the one who has more strength
50:10is the one who dominates.
50:12Why has it been appealed
50:14to three large blocs?
50:16The North American bloc,
50:19and the Chinese.
50:21And basically Trump has,
50:23Trump does not believe, unfortunately,
50:25in the rules of the game,
50:27and the institutions that emerged
50:29from the year 2007.
50:31Professor, we are going to have to keep talking about this topic.
50:33Definitely.
50:35I said that while Trump is there,
50:37it will be a permanent source
50:39of information and news.
50:41Yes, and a lot of uncertainty.
50:43We are running out of time here,
50:45thanks to friends of El Evidente,
50:47continue with Teleantillas
50:49so that you receive more information,
50:51more details,
50:53about what has to do with
50:55the explosion of the roof
50:57of a famous nightclub in the capital.
50:59It will be until tomorrow.
51:01We will be back here
51:03with another installment of this
51:05Superdiario 1 Plus 1.