Colombia’s healthcare collapse: How neoliberal austerity turns terminal illness into a death sentence
Original framing: “[Perspectives] Temporal rationing: a man with gastric cancer in Colombia” — The Lancet
Pepe’s delays are a direct consequence of Colombia’s 1993 healthcare reforms, which dismantled the state-run *ISS* (Instituto de Seguros Sociales) and replaced it with *EPS* (private insurers) under the *Ley 100*. This shift mirrored neoliberal policies across Latin America, where healthcare became a marketized good—leading to rationing by cost, not need. The 2008–2010 strikes by Colombian doctors, who protested against underfunded public hospitals and EPS corruption, predicted exactly this outcome: a system where diagnostic delays become a tool of class control. The *Lancet*’s framing treats this as a clinical anomaly, but it’s the inevitable result of a 30-year experiment in healthcare privatization.
Pepe’s story is not a tragic anomaly but the *predictable outcome* of a healthcare system designed to fail the poor—a system where neoliberal reforms, corporate rationing, and colonial medical hierarchies collide to turn illness into a class-based death sentence.
The *Lancet*’s framing obscures this by individualizing his delay, but the data, historical parallels, and Indigenous critiques all point to a single mechanism: a *privatized, underfunded* model that treats human life as a marketable good. The solutions lie in dismantling the EPS monopoly, integrating traditional medicine, and empowering marginalized communities to demand care as a right—not a privilege. What’s needed is not just better diagnostics, but a *radical reimagining* of healthcare as a collective, decolonized, and equitable system—one that learns from the *Nasa*’s autonomous councils, Cuba’s participatory models, and the legal victories of movements like *Dejusticia*. The trickster here is the myth of 'inevitable delay,' while the real work is exposing—and dismantling—the system that profits from it.