May 3, 2009
Honorable Barack Obama
President of the United States
Dear Mr. President:
The College of Physicians and Surgeons of Puerto Rico strongly believes that your presidency constitutes an historical call from the people of
the United States of America for a better World; not only for us, but for all humanity. Your presidency represents a new level of social justice, a
major step in our continuing journey to achieve fundamental Human Rights for all citizens of the United States and, through our leadership,
The Right to the enjoyment of the highest attainable standard of physical and mental health is a supreme Right of all Human Beings. This
Right is the one and only that truly allows a person the empowerment and enjoyment with plenitude of all other Rights and prerogatives, the
one that lets a human being live and die with dignity. Universal Health Care, with identical availability and accessibility to all of the inhabitants
of a state or country, constitutes a courageous and transcendental step toward the achievement of this Right. It embraces profound humanitarian
wisdom, and recognizes the positive obligation to care and to promote the right that all of us live and die with dignity.
For this reason, the College of Physicians and Surgeons of Puerto Rico supports the implementation of a Universal Health Care Plan
with a single payer system that will finally bring social justice to all people. We know that for decades the realization of such an important
objective, undertaken by many presidents, has been impeded by exceptionally strong forces who oppose it. However, we believe in your
courage and leadership. We believe that the foundations and moral underpinnings of such enterprise are in your mind and soul, just as they
are in the minds and souls of millions of Americans who cherish such a plan as one of their most precious hopes and expectations. We are
ready to assist and support such a noble objective.
The College of Physicians and Surgeons of Puerto Rico proposes that a pilot program of a Universal Health Plan with a single payer
system should be implemented on the island of Puerto Rico. Hawaii and Alaska, given their contained environments and other social and
economical characteristics, should also be considered to partake in any projected pilot program. However, as Puerto Rico is the poorest area
in the United States, we feel that it will benefit more than any other area from such a program.
The reasons for choosing Puerto Rico for such a pilot program are many.
• Puerto Rico has a geographical area of only 9,104 km², with a population of nearly 4 million people. The population density of 438 people
per square kilometer is the second highest in the US after New Jersey.
• Puerto Rico has an unemployment rate of 14.7 percent, which is rapidly growing.
• Puerto Ricans had a median household income of $17,741 for 2007, making it the poorest state of the Union. Puerto Rico has an alarming
45.5% of the population living below the poverty line, compared to 12% in mainland USA.
• Puerto Rico’s public debt has grown faster than its economy, reaching approximately $46.7 billion in 2008.
• Approximately 500,000 Puerto Ricans have no health insurance at all.
• By comparison with the 50 states of the nation, Puerto Rico has the highest incidence of Diabetes mellitus (12.8 per 1,000 people versus 9.0
per 1,000 in the mainland USA). Among persons younger than 45 years of age, the prevalence of hypertension in Puerto Rico is twice the
rate observed in the United States (8.1% versus 4.2%).
• AIDS cases per each 100,000 population are 21.5 versus a US National average of 12.4. Notably the Age-Adjusted Death Rate for HIV Disease
in 2005 was 14.4 for 100,000 inhabitants for Puerto Rico versus an average of 4.2 for mainland USA.
• The Influenza vaccination rate for people older than 65 years is 32% in Puerto Rico versus 72% in mainland USA.
On April 17th 2009, the University of Puerto Rico’s Humacao Campus became the home of a Community Conclave. This Community Conclave
is composed of the leadership of a wide variety of local and national organizations representing over 50% of the citizens of Puerto Rico. On
that occasion, a Universal Health Plan was declared a top priority for the people of Puerto Rico. This declaration is now being taken to all local
and national authorities, in order to support its implementation by the year 2010.
Recently WHO Director-General Dr. Margaret Chan stated: “A world that is greatly out of balance in matters of health is neither stable nor
secure…the core strategy for tackling inequalities is to move towards universal coverage in a spirit of equity, social justice, and solidarity.
Fairness and efficiency in service delivery are overarching goals…with the costs of health care rising and systems for financial protection in
disarray, personal expenditures on health now push more than 100 million people below the poverty line each year…” A pilot program of a
Universal Health Insurance Plan with a single payer run in Puerto Rico is an excellent opportunity to demonstrate the benefits of universal
Please let Puerto Rico be the front line of a noble endeavor. Let the fifty states learn through the Puerto Rican experience how a Universal
Health Care Plan with a single payer system can bring social justice to all citizens, regardless of their income, age, gender or health conditions.
Please let Puerto Rico be an important player in the implementation of universal coverage, an accomplishment of your administration that
will become an historical milestone toward the achievement of social justice for all American People.
Eduardo Ibarra MD
Puertorican College of Physicians and Surgeons
This letter to Honorable President Barack Obama was published by El Nuevo Dia on 3 May 2009.