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!