Lhe creation of the Mexican Social Security Institute was one of the greatest achievements of the post-revolutionary governments. In the midst of World War II, the Mexican State decided to follow the route of several European countries in the construction of institutions that guaranteed one of the most precious rights in the national legal order then, and of course, even now.
The promulgation of the IMSS Law in 1943 was also a defining moment for the country, because despite the opposition that arose at the time, the Institute quickly managed to become one of the most important elements in the national imagination, giving meaning to of social cohesion in many sectors of the population, given the increasingly wide range of services to which one had access once affiliation was achieved.
Despite its strength, the IMSS has gone through different crises, determined mostly by insufficient economic growth and the scarcity of resources to promote it; This is coupled with a permanent inability of the economy to generate jobs that give access to entitlement, but also contribute to funding it via worker-employer contributions.
Access to social security is so important that not having it is an indicator of poverty for millions of people. To illustrate the foregoing, it is enough to cite the fact that a girl or boy who lives in the Mexican rural sector or is part of one of the original peoples and who simultaneously lives in a house with a dirt floor and without social security, faces 95% probability of being located among the population in poverty.
In recent years, significant efforts have been made to expand coverage and enroll people. Thus, for example, opening up the possibility for domestic workers to join; or the protection of people whose partner has the same sex. But it is evident that these advances, while relevant, are still insufficient to ensure that all people can benefit from this institution.
In this sense, the discussion that should take place now around the IMSS has two fundamental aspects: how to grow its infrastructure and affiliation mechanisms, so that regardless of the employment status of the people, the right to habitation is an opportunity for all those who would you like it that way? And the second, how to build a great national system of social and health protection, of which medical services and social and economic benefits are two of its fundamental pillars?
If the Covid-19 pandemic made something evident, it was precisely the lack of protection of the national population against the old, but also against the new social risks. Because although the reconversion of clinics and hospitals to attend to the emergency was achieved, this did not prevent the death of more than 700,000 people and, as a side effect, led to the deepening of the crisis of the deferral of consultations, surgeries and processes rehabilitation of millions of people.
All of this has placed us in an unprecedented crisis, since the result we have is a country that, between 2020 and 2022, has lost just over 3 million people, of whom at least half of that number deaths could be classified as “avoidable deaths” and “preventable excess deaths”.
Never before in the country’s history have we had such a number of deaths in such a short time. And this necessarily forces us to think about the urgent fiscal reform that allows solving three fundamental questions in the construction of a country of human rights and general well-being: a) guarantee universal coverage; b) guarantee decent pensions in old age or associated with disabling processes; and c) redistribute the country’s wealth with greater social equity in order to temper the deep inequalities that divide us and on many occasions also confront us.
It should be considered that the national care system that has been proposed should include social protection mechanisms particularly aimed at children: day care centers and safe and quality care centers; as well as care centers and protection mechanisms for older adults, which should include instruments to guarantee, when possible, active aging.
It should be considered that Mexico is facing one of the fastest aging processes in the world; that in cities like Mexico, the Aging Index already exceeds 100 points, and that by 2030 there will be at least five other entities at that level.
Thinking of a renewed, powerful IMSS with more and new capabilities implies having the ability and audacity to think in long-term horizons. Its construction must be a permanent process that gradually but rapidly leads us towards an inclusive, fair and generous country in the next 100 years.
It should also not be forgotten that the IMSS is also the repository of complementary programs, as was originally the IMSS-COPLAMAR project, which was part of a great regional development strategy, and which, after multiple transformations, to date is what has allowed the Government of the Republic to reconsider the general scheme of affiliation. From this perspective, it is not an exaggeration to say that the IMSS and the UNAM constitute two central institutions of the Mexican State and that, due to their vocation and social sense, they would allow the reconstruction of a national project of great depth.
Having a social security system like the one proposed is feasible. Its financial cost can be faced in the short and medium term; but this requires redefining priorities; carry out large-scale investments to rehabilitate its infrastructure and equipment; expand it where it is most urgent to do so, and have a well-articulated plan to think that, in 10 years, all Mexican men and women can be covered by the social solidarity that is implicit in its institutional logo.
The existence of the IMSS is the difference for millions of people, between life and death; It has been that way for decades. Therefore, the responsibility of the State is to ensure its preservation and work with all possible capacities, so that these are only the first 80 years of life of one of the most important Institutions in the social panorama of Mexico.