Health Care and The Atacama Salitreras

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 The names of far places can magnetize the human  mind, inducing a lifelong attraction.  The  Atacama Desert &  Antofagasta are found at the North  end of Chile, the country with the farthest north-south range of any on   earth,  a   very narrow slip of volcanic land  clinging to  the western edge of south America and the Andes mountain range. It is a land of chaotic climatic and topographic contrast, from the arid North to the glaciated South;  in an East-West direction it   rises from sea level to the Andean heights like Ojos del Salado, a few meters lower than the  highest in the western hemisphere, Aconcagua. It is  of necessity a nation of engineers who  design  earthquake tolerant roads and buildings, and operate many mines, including the largest underground and open pit mines on earth.   The people are defined by the sea, the mountains, and small fertile valleys-In the words of an epic Chiean poet- una loca geografía – a crazy geography.

Sodium nitrate (Calicihe, or saltpeter)  is abundant  in the desert North, once  the world’s best  source of raw material for  both guns and butter-fertilizer and gunpowder. But that changed overnight after WWI when Germany found that nitrogen could be harvested  from the air as ammonia. During the following half century of severe economic and  social decay, the nitrate mines were confiscated and operated at great cost to the government, even though the situation of hard bitten and proud miners remained dismal.

By the 1970s two government saltpeter mines remained, some  distance  inland from Antofogasta, each home to about 10,000  people: miner families. The State, goaded by very strong  and aggressive  left wing Unions,  tried very hard to comply with demands. A  hospital was built to provide OB and basic surgical care.  To  partially repay for free training, medical school graduates without any prior experience were assigned to the hospital- essentially alone – for two year terms- sentences, in the view of some. One can imagine the outcomes.

 Low numbers of patients made  even marginal care very costly.  Conditions for miners remained deadly, as the average miner had to be ‘retired’ before age 35 due to silicosis. The ambient dust was so bad they had to be moved away. Elsewhere in the Atacama  only ghost towns  remained where  empty opera halls and  neglected elegant mansions  told  of a long gone opulence.

During the 1970’s   privatization of most state owned industry  began, including the two Salitreras of the Atacama.    The new owners consisted of  a curious amalgam of  investors and  union organized mine workers. The disparate groups of owners had a designed-in  mutual interest, however:  a concern for costs, survival, and  profit;  they needed to agree on a way forward because they were prohibited from selling their shares  for seven years.  The question of what to do with an inefficient and  prohibitively expensive hospital came up.

A friend of ours  had visited here during his  illness, co incidentally hearing of the Kaiser- Permaente health system. So when he called about assessing the hospital situation at Pedro de Atacama,  I immediately agreed.  My old  mental magnetization for  Antofagasta was operational. What follows is a very abbreviated outline of what we came up with. It is outdated to a degree, and has, I expect, inaccuracies. Yet I offer it for consideration in view of our situation today in the U S.  Perhaps, if the  reader prefers, it can be considered creative non fiction, like the daily news and media mouthing.

In the Chile of those times the social security system was  changed. A person could elect either  to continue the existing national  system,  or to switch to  managed investments among 12 competing brokerages, operating something like restricted IRAs; the contributions to this plan remains the property of contributor and hiers. With that as an example we discussed an option for health care  to be made available to larger employee  groups, like the salitrera miners; they would elect, by majority vote, to retain their government mandated health care contribution themselves, and manage their own health care for their own group care (in this case about 20,000 including the other nearby sister mine.); they would define benefits, elect co-pays if required (at the outset this would be rather easy  because benefits were scant and marginal at best.);  they could  elect to contract with health providers or employ them; at the end of each year they would  review and revise  their plan for the next year; as they gained experience and resources, they could invest  more in health diagnosis or treatment; they could acquire, lease, and  operate clinics or hospitals; they could  contract  to provide defined benefit health care to people who were  ineligible for a large group plan; last, the most significant and important feature of the proposal, I think,  was that if a surplus were available at the end of any year, it could  be either used to  expand services, or to  distribute a dividend to members.

Obviously this proposal was influenced by the Kaiser-Permanente model. It was not fully accepted or implemented, but many aspects of the plan were adopted. The hospital at the Salitrera was abandoned in favor of a clinic, with the loss partly assuaged by free daily bus travel  to Antofagasta and  the proffered group  health care  there.

It would be interesting if something similar could be considered here;  and yet, that seems unlikely. Would it work? Would it be possible given our republicrat/media/industrial complex? I leave those questions to the reader to consider.  ¡Salud!

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