In past elections in Colombia, security was always a top concern of voters. But with the security situation in places like Bogota much improved in the past 8 years, polls have shown that social issues such a jobs, education and healthcare have become the primary anxiety people will consider when voting in this election for president on Sunday.

Healthcare is one issue that has been talked about a lot in Colombia lately. The system is dominated by private health insurance companies.

The public healthcare system for the people who cannot afford private insurance - about half of Colombia’s 44 million people - is in debt by some estimates to the tune of $3 billion dollars.

In short, there is simply no more money in government coffers to fund extensive healthcare for those who need it the most and can’t afford private insurance. Even the government has admitted in recent weeks the system is in crisis.

Below is an interview I conducted this week in Bogota with Jose Felix Panti?o where we discussed the healthcare issue in more depth.

Panti?o, 83, is the president of Colombia’s National Academy of Medicine, a Yale medical school graduate, the former president of one of Colombia’s most prestigious universities, and a former minister of health.

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J???ose Felix Panti?o, President of Colombia's National Academy of Medicine. Photo Maria Elena Romero/Al Jazeera ?

Question: What is the main problem with Colombia’s health care system, as you see it?

Jose Felix Panti?o: “The main problem is that Colombia used to have a very strong public health system and this system was based on network of public hospitals, the most important were the university hospitals. Not anymore. At the present time we no longer have a public health system it is mostly private, for profit. And what is left of our public system just doesn’t work in the same way it used to.”

“What has happened is that health care which was a social activity became a commercial activity and the industry of health became really the dominate part in the healthy system here. So we do not have in Colombia an organization that is socially oriented - not for profit. What we have here is a series of private insurance companies that provide health insurance, pre-paid, mostly for profit. We think about half the money that goes to health in Colombia is in the hands of the private insurance companies.”

Question: But there is a public plan in Colombia, explain the differences with public and private.

Jose Felix Panti?o: “It is complicated, but what we have here is an obligatory health plan. There is a private plan for the rich people, which is quite adequate. And then there is a public plan for the people in the next regiments, which is the subsidized plan, but that is a plan that is much smaller. As you descend in the social economic levels the health plans available to Colombians are less and less and less. The people in the lowest economic class, economically speaking, are the ones that get the worst care in Colombia.”

Question: Some important things are covered in the public plans right?

Jose Felix Panti?o: Things like prenatal care are available to almost everyone in the system, and in big cities it is adequate. But health care provided in the small towns is very inadequate. So the people who have suffered the most are the people who have the least economic power. If you have money you can have good healthcare, if you do not have money, then you have care that is diminishing according to the lower income levels.

Question: Who is benefiting the most from the system as it is now? And what is the economic thinking behind the way the system is currently set up?

Jose Felix Panti?o: “The people benefiting are the private insurance companies. I think (President Alvaro) Uribe has really the same economic thinking that Bush had in the United States. They think that if you give the opportunities to the rich people they become richer and eventually richness will flow down to the poor. But that doesn’t happen. The rich people get richer, and richer, and richer, and the poorer people get poorer and poorer. Today at the end of Uribe’s government we have more poor people than we had when he started as president.”

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Guillermo Orosco is at risk of his body rejecting his kidney transplant because he only makes about $150 a month and the critical medicines he needs are $2,000 a year. Photo: Maria Elena Romero/Al Jazeera

Question: How has health become a major issue in the presidential campaign?

Jose Felix Panti?o: “We do hope the next president that will be elected Sunday will change this system. It’s been impossible to chance up to now, because the current president - Alvaro Uribe - was the Senator who presented the bill in the 1990’s (that made the system what it is today). So he considers it his bill, and he doesn’t want to change it. In spite of all the arguments we have provided. So we do have at the current time a very expensive and very unequal health care in Colombia.”

Question: What needs to change? And what is the underlining problem of the current way the system is set up?

Jose Felix Panti?o: "I think what has to be done is change the system. Because at the present time the system is supported by the citizens who buy health insurance. If you have an income you buy in the system and a percent of that goes into the system for poor people’s health insurance. But what has happened is that this has become a business action rather than a social action. Healthcare here in Colombia is a business and does not serve a social purpose. And the problem is that if you are a president of an insurance company selling healthcare, the only way you have bigger profits is by curtailing the healthcare of the people. You can not have as much laboratory tests, you can not have diagnostic imaging, you can not have specific consultations. So we are now in a very bad situation and I am not speaking from a political standpoint. I was minister of health I managed the health system in the old years. I do know very well the public system, and what has happened now is that Colombia is the only country in the world, along with the US, that has health in the hands of the private sector, for profit."