PUCL Bulletin, Oct. 2000

Heart Surgeon in Argentina kills himself-
blames globalization and privatization of healthcare

After a light lunch of apples and tea on a chilly afternoon last month, Dr. Rene Favaloro, 77, walked into the bathroom of his Buenos Aires home and shot himself through the heart.

The heart was an organ the world-renowned surgeon knew well. On a miraculous day in May 1967, the gifted Argentine, then on the staff of the Cleveland Clinic Foundation in the United States, had placed his long, delicate fingers into a patient's chest cavity and became the first to plan and perform a heart bypass operation--pioneering a procedure that has saved countless lives over the years since then.

But Favaloro, who had returned to his native Argentina to champion the cause of universal health care, had grown distraught, believing only the affluent were enjoying what he once called "the right to live." His peers, his family and his own writings suggest that he had come to blame globalization and the free-market revolution of the 1990s for "a growing callousness" toward health care for the poor. And his suicide, they say, grew from a failed struggle by one of the greatest minds in medicine to save the heart foundation here that he had built into a symbol of altruistic health care in the developing world.

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The elegant gentleman with the well-coiffed silver mane and the sure gait of a TV surgeon opened his Buenos Aires-based Favaloro Foundation in 1992. It was the culmination of a dream to offer the best-trained hands and most modern equipment to the grandes dames who could pay and the street urchins who could not.

The facility quickly became Latin America's most advanced and modern heart institute, conducting groundbreaking research as well as sophisticated organ transplants and coronary surgeries. It trained
more than 400 doctors now scattered around the region.

But as Argentina and much of the rest of Latin America made free-market reforms in the 1990s, government subsidies to Favaloro's foundation were slashed and private insurance companies reined in costs--even adopting from U.S. health maintenance organizations the controversial practice of paying doctors incentives to order less costly treatments. At the same time, millions of Argentines, pushed out of work by public and private downsizing, lost health care coverage altogether.

Favaloro refused to turn away the increasing number of uninsured patients whose conditions were so chronic that only his clinic could offer hope. At the time of his suicide, after unsuccessful pleas to
the government and private business for donations, his medical utopia stood at the brink of financial ruin.

* * * *

Favaloro blamed free-market economics in another letter, this one to his staff, three weeks before he put a .38-caliber bullet through his heart on July 29. Echoing a controversial speech he made before the American Heart Association in Dallas in 1998, he attacked globalization, adding that free-market reforms are "better referred to as a neo-feudalism that is bringing this world toward a social disaster where the rich are getting richer and the poor are getting poorer."

* * * *
Against that backdrop, Favaloro's suicide has deeply affected Argentina. It has caused soul-searching about the rise in poverty and the collapse of social services as the role of government has
diminished, corruption has soared and state companies have been sold off. His death also has reverberated internationally, underscoring one of the biggest challenges of globalization: providing quality health care in developing countries.

* * * *

For years, most Argentines received their health care from any of 296 union-related cooperatives. But today, 80 percent of those co-ops are in dire financial straits--collectively $2.6 billion in debt--as their clients have lost their jobs and been unable to pay their dues. Public hospitals, relied upon by about 44 percent of Argentines compared with 37 percent two years ago, are overburdened.

* * * *

The son of a poor carpenter and seamstress from the nearby city of La Plata, Favaloro spent his life pursuing medical breakthroughs and fairness in public health. After earning his medical degree, he lived in the rural town of Jacinto Arauz in the pampas during the 1950s to work with some of the nation's most poverty-stricken patients. In the 1960s, the lauded Cleveland Clinic in Ohio, which invited him to be a visiting resident, recognized his revolutionary ideas on coronary surgery.

There, he would make history by inserting a sinewy leg vein around a coronary obstruction. The clinic tried to woo him to immigrate permanently.

"We tried to get him to stay, but he loved Argentina--he would never stop talking about it," said Floyd Loop, a surgeon at the clinic and now its chief executive, who calls Favaloro his mentor. "He felt he was needed there. It was a calling, unfinished business he needed to get done."

* * * * *

His real objective lay in raising the bar of domestic health care. Although 80 percent of the patients the foundation accepted were insured, they were housed in roughly similar rooms as the 20 percent
who were not. But as more and more Argentines lost their health care coverage, the percentages shifted and the foundation fell deeper and deeper into debt.

By the time Favaloro shot himself, board members say, the foundation owed $70 million, largely because of uncollected bills. He was being pressured by his employees to be more selective about patients. But the passionate man with a temper not uncommon in brilliant surgeons exploded with a public memo to his staff only days before his death:

"I have always practiced medicine with a profound social pledge. For me, all patients are equal . . . . For this, I tell you that this foundation is for everyone. Every patient, paying or not, will continue receiving the same attention!"

His peers say they are sure Favaloro was trying to make a statement with his suicide.

(We quite agree with the last sentence that Favaloro was 'trying to make a statement' and that sentence is very relevant in India today. We have in our previous issues raised the question of Public Health System in India. India's policy today is following the foot steps of Argentina. Considering India's size we will need to sacrifice, who knows, how many Favaloros. We only know that our Prime Minister and his colleagues are running to Uncle Sam to assure that we are committed to globalization. -Editor)

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