Healthcare in Chile and the USA

In Chile, you have nearly Universal healthcare including a thriving private sector-ISAPRE-and FONASA-the public plan. Chileans pay 7% of their income and then make a choice to enter the FONASA or ISAPRE system-and have further choice to elect greater coverage in private plans.

I'm not saying Chile has the best system in the world but it does seem odd and a bit sad that I am less likely to die here because of a needed operation. A friend of mine recently had an operation, a much needed femoral bypass. It cost about $12,000 usd cash, no insurance-that includes everything and a 5 star room to boot.. The average "list price" in the US is $50,900 according to this website. Apparently it can be done as cheaply as $18,900(huh?). Perhaps that's a good place to check before your next operation in the USA folks.

What I know is that the US is falling in status from a number of lists.

The World Health Organization's ranking
of the world's health systems (Top 50)
In 2000, The US was still barely ahead of...Cuba. Chile beat the US by 4 places(and has improved its system under Bachelet while the US has deteriorated. The US also beat Slovenia by one place. The U.S. spends 16 percent of gross domestic product (GDP) on health care, compared with 8 to 10 percent in most major industrialized nations. According to the World Factbook
(which is suspiciously updated only to 2005) The US was #2 in healthcare spending by GDP so i would guess it's now easily in 1st place(yay!!!)

The saddest statistic must be infant mortality. Nationmasters, I see, no longer lists the US there but there are other sources like here. And now I see, Nationmasters sources from the CIA Factbook-better you don't see that I guess. Anyway,

Since ranking a fairly respectable 12th in 1960, the U.S. fell to an all-time low 29th in the world in infant mortality in 2004, according to the report Recent Trends in Infant Mortality in the United States from the Centers for Disease Control (CDC). The U.S. infant mortality ranking has been falling steadily, from 23rd in 1990, to 27th in 2000. The U.S. infant mortality rate of 6.78 infant deaths per 1,000 live births in 2004, compared unfavorably with the lowest rates of 3.5 per 1,000 reported in Scandinavian and East Asian countries. Overall, 22 countries had infant mortality rates below 5.0 in 2004.

But wait, this is 2009 and those are statistics from 2000-but according to our new link here, the US is now #37!

37.

United States

6.37

deaths/1,000 live births

Uh oh, Cuba is #35 on that list, no wonder the US government no longer reports it. But we're still a place ahead of Croatia, by god. Wait, this is bad-South Korea has less babies die at birth than the USA????

Well, how how about life expectancy-surely a great country like the US places well there.

172.

United States

78.00

years

There are 37 countries with better life expectancies out of the total 208 listed, including Bosnia and Puerto Rico... interesting as well is that many countries are improving while US stats get worse.

160.	Chile	76.96	years
161.	Cuba	77.08	years

The point was never that Cuba-or Chile-has better healthcare but that those countries improve while the US continues to fall.

Continuing on, I looked for other categories but saw this:

Healthy Life Expectancy (UN 1997/1999)
Health Performance Rank By Country(UN 1997/1999)
WHO ranking of the world's health systems (2000)
Total Health Expenditure as % of GDP (2000-2005)
Global Hunger Index by country 1990-2008
HDI - Human Development Index 1975-2005
Refugees, asylees, internally displaced persons, by country - 2007

See the pattern? Old statistics on what I've just discussed but new, bright shiny statistics where the US "shines".

I meant to write more but this is an exhausting subject. The US healthcare "plan" every day seems to need a motto like If you're wealthy and 84, we would rather you live in a coma and have a heart transplant than save the lives of babies. If you're 50 and healthy, you will be charged an unbelievable amount-the price of a current mortgage so although your mortgage payment may be low, that extra money will be replaced by an inadequate insurance policy-which, of course, if you ever actually have to use it-you'll be cancelled.

Although they say 46 million Americans are uninsured(I would guess it's much higher-people don't know their insurance is inadequate until they need it), the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens. Here's a lot of scary facts here.

And here's a story about a 35 year old and his 35 year old wife. The story is a good one but here's an excerpt:

She told me that she had just opened a letter from our health insurance that informed us that our monthly premium was increasing from $534 to $738 next month.

A $204 increase per month? $2448 more per year? A 38% increase in one month?

.....They came back again and explained that it was 38%. 17% was an annual increase. The rest was due to my wife and I both turning 35 this year.

A 21% increase for turning the ripe old age of 35.

A 38% increase in on month. From $534 per month to $738. $204 more per month. $2448 more per year.

That's $8,856 a year for two 35 year olds-how much for two 50 year olds? Here's the problem-the money spent on health insurance or healthcare is not being spent other places. This is a serious problem for the economy and the USA. Forget that new house or new car, buy health insurance. The best way to get healthcare if you're middle class is now to become poor so you can get medicaid. I have never in my life used any type of government assistance. I went to college, got my degree, raised my son, paid my taxes, bought a small house(before I cancelled my insurance, it was more than my mortgage payment so I sold my house), bought cars and generally helped the GDP like all good Americans. So I'm very sad. If I ever return to the US, my choice is to divest myself of all assets(I saved for retirement, silly me) and try to hop on the government 'dole' for the first time in my life or just hope I never get sick(I'm healthy but that seems unlikely) or I have the "freedom" to die-even if diagnosed with an easily curable form of breast cancer.

A few thoughts in answer to what I hear from the opposition to healthcare reform in the US. I know they're scaring you but they're not telling you the truth.

1.I hear this "in Canada, my friend's grandmother died because of the lines"

A. This is not Canada. None of the plans proposed look anything like Canada's. In Canada, they do have healthcare priorities. The 5 year old will be in line ahead of the great-grandmother. A 5 year's life is more important to me than my own at 54 and I would hope 84. In the US, the middle class child is more likely to die than a well to do 84 year old. So I believe Canada is correct. But please stop comparing US healthcare to any portion of any healthcare plan around the world that has nothing to do with the US. The rich and privileged in the USA will always have the best healthcare. Always.

2. But I don't want rationed healthcare, I want to keep my doctor!

A. You can keep your doctor under ALL plans proposed. Younger, healthy people here in Chile are mostly in the ISAPRE private sector. Those that are older or not healthy use the public FONASA option. I want a choice too. The choice not to die because of non-invasive breast cancer.

3. But America is about Freedom!

A. The freedom to live if you have the money and the freedom to die if you don't. The freedom to pay more for healthcare. Health care spending is 4.3 times the amount spent on national defense. Except suicide is illegal. Yet suicide rates are increasing

October 21, 2008

U.S. Suicide Rate Increases

Largest Increase Seen in Middle-Aged White Women

The rate of suicide in the United States is increased for the first time in a decade, according to a new report from the Johns Hopkins Bloomberg School of Public Health’s Center for Injury Research and Policy. The increase in the overall suicide rate between 1999 and 2005 was due primarily to an increase in suicides among whites aged 40-64, with white middle-aged women experiencing the largest annual increase. Whereas the overall suicide rate rose 0.7 percent during this time period, the rate among middle-aged white men rose 2.7 percent annually and 3.9 percent among middle-aged women. By contrast, suicide in blacks decreased significantly over the study’s time period, and remained stable among Asian and Native Americans. The results are published online at the website of the American Journal of Preventive Medicine and will be published in the December print edition of the journal.

Imagine that-I wonder if that has anything to do with increasing medical problems and healthcare costs in middle age.

4. There won't be any doctors!

A. Yes, there will. I know many doctors here in Chile. A personal friend is a cardiologist. And here's a website from US doctors for US healthcare reform. And let me direct you to their list of questions and answers. Granted, they would like a single system which the US is unlikely to get.

And it looks more likely by the day, that there will be any real reform passed. I am sad. sad for me but sadder still for all the young people that have no idea how bad things can get.

5. I don't want socialized medicine!

A. The most unbelievable really. In answer, I saw President Obama read a letter from an older woman which read in part "I don't want socialized health care and hands off my Medicare!" Really?

Medicare is socialized healthcare, by most definitions. So this woman is saying "I want it for me but no one else!" She made it to 65, the hell with the rest of you.

If you are against "socialized" , you must be against Medicare and fireman. Against a police force, against street cleaners and snow plows. Against the post office(it takes 3 weeks here to send a letter from one end of the country to the other-the miracle of privatization), against the dog pound(don't get me started on the stray dog problem here). The list is endless.

Yes, the US is spoiled in many ways but healthcare here is better.

Pinochet went to England for healthcare?

I was reading today a number of different accounts of chronologies of Pinochet and came across this in a Washington Post story:

In October 1998, the 83-year-old Pinochet traveled to England for back surgery. He was arrested on a warrant issued by Spanish prosecutors...

This England?

The National Health Service (NHS) is the publicly funded healthcare system in England. The NHS provides healthcare to anyone normally resident in the UK with most services free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care. The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare, ophthalmology and dentistry. The National Health Service Act 1946 came into effect on 5 July 1948. (Wikipedia)

Mr. Jose Pinera, architect of Chile's healthcare system under Pinochet, please tell me why that would be when Chile has a simply wonderful privatized system that you yourself helped to spawn? Did he believe the "socialized" healthcare was better?

And don't we hear it said that in the USA, maybe the system has problems but without a doubt, they have the top specialists anywhere? If you can afford it, that's where you want to go to get treated...yet, Pinochet(who could afford it ) went to England where you have one of the largest and oldest "socialized" systems. Oh, I see, that "socialized" tag not completely correct. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.

But why England and not the say, the USA? Oh, here it is

Even before the former Chilean dictator offered his country's tacit support to the UK during the 1982 Falklands War, Margaret Thatcher had long been an admirer of his radical free market economic policies.

General Pinochet was detained in London on 17 October following a request for his arrest and extradition by two Spanish judges investigating some of the 4,000-plus political murders believed to have been committed during his 1973-1990 rule.

Well, all those atrocities under Pinochet but the economy-he and Milton Friedman saved it right? Given that we are talking about the price of lives and freedom now by exchanging a "good" economy for a "bad" one(which I find horrifying), I contend those policies didn't give Chile a good economy. Here's one take on it(a portion follows):

Cinderella's Fairy Godmother, Tinker Bell and General Augusto Pinochet had much in common.

All three performed magical good deeds. In the case of Pinochet, he was universally credited with the Miracle of Chile, the wildly successful experiment in free markets, privatization, de-regulation and union-free economic expansion whose laissez-faire seeds spread from Valparaiso to Virginia.

But Cinderella's pumpkin did not really turn into a coach. The Miracle of Chile, too, was just another fairy tale. The claim that General Pinochet begat an economic powerhouse was one of those utterances whose truth rested entirely on its repetition.

Chile could boast some economic success. But that was the work of Salvador Allende - who saved his nation, miraculously, a decade after his death.

For nearly a century, copper has meant Chile and Chile copper. University of Montana metals expert Dr. Janet Finn notes, 'Its absurd to describe a nation as a miracle of free enterprise when the engine of the economy remains in government hands.' Copper has provided 30% to 70% of the nation's export earnings. This is the hard currency which has built today's Chile, the proceeds from the mines seized from Anaconda and Kennecott in 1973 - Allende's posthumous gift to his nation.

So, why is Chile in great shape economically? Copper revenues of course-Allende nationalized and Pinochet didn't privatize(mainly because the military was guaranteed a percentage) and the Concertation rule has meant every President has saved money, lots of it. When the bad times came, they were able to spend quite easily. Save in the good times and spend in the bad times-John Maynard Keynes must be smiling in his grave.

Sebastian Pinera, Chile and the US

I never realized before I moved from the US to Chile that there are many links between the two countries. These days I seem to run across stories that contain the links on a daily basis.

First, a little background. Sebastian Pinera (Miguel Juan Sebastián Piñera Echenique) was a Presidential candidate running against current President Michelle Bachelet but lost in 2005/2006. A new election is coming soon (there is currently a 4-year limit for presidents here). Pinera is the perennial candidate of the right-wing National Renewal Party(part of the "Alliance for Chile" coalition) and Michelle Bachelet of the Concertación-affiliated Socialist Party, has won record high approval ratings (74 percent) for her handling of Chile’s economic crisis. Candidates of the Concertación – formally known as the Agreement of Parties for Democracy – have won every presidential election since 1989, the return of democracy after the Pinochet dictatorship.

There are many parties here but they have become part of "coalitions", the Concertacion specifically to combat the Pinochet years. I hear the screaming all the way from the USA that you need more than a two-part system. And I understand. But the parties here(here's a list )
simply group into coalitions-and parties join and leave at will(not so different than Republicans becoming Democrats and vice-versa).

Back to Pinera. His brother Jose Pinera works at the Cato Institute in the US now and was responsible for promoting a plan of "free market reforms" that he considered could double Chile's annual rate of growth to 7%, he became, first, Secretary of Labor and Social Security (1978–1980), and then, Secretary of Mining (1980–1981), in the cabinet of General Augusto Pinochet. As such, he was responsible for four structural reforms: the creation of a retirement system based on private personal accounts (the AFP system), the opening of the private health insurance system (the ISAPRE system), the redesign of the labor code changing the terms of trade union elections, and the constitutional law on mining. Never mind that the pension system here is a mess(especially after the economic mess), never mind that fees charged for pension account eat most of the returns(link here) with portion below.

There are prohibitively high expenses and fees. Voracious commissions and other administrative costs have swallowed up large shares of personal accounts. It is estimated that roughly 28 to 33 percent one-quarter to one-third of contributions made by employees retiring in 2000 went toward fees.

• The brokerage firm CB Capitales calculated (see English language discussion by Stephen Kay of the Federal Reserve Bank of Atlanta here) that when commission charges are taken into consideration in Chile, the total average return on worker contributions between 1982 and 1999 was 5.1 percent-not 11 percent as calculated by the superintendency of pension funds. That report found that the average worker would have done better simply by placing their pension fund contributions in a passbook savings account.

That was written with 1999 figures-imagine people with pensions here now with the stock market crash. They were still paying those high "fees" even though their pension funds suffered tremendously.

...Are you listening up there in the USA? Look no further than Chile and its "free market reforms" of privatization to see how they don't work. More about those another time...these "reforms" were instituted under a dictatorship(often undisclosed in glowing accounts of Friedman and Pinochet "saved" Chile). Make no mistake, Chile's strong economic position today is the result of Concertacion policies. But, know that Jose(I see he has a Youtube entitled "José Piñera - The Man Who Fought for Prosperity and Democracy"....yeah he improved "prosperity" alright for the insurance companies, the corporations. The people?

Jose was by GW Bush's side, back in the social security privatization discussions in the US. Ans although you'll see recent rants by Jose about how wonderful privatization is, the other side has moved on-but don't think privatization won't continue to rear its' ugly head in the US. And if you don't think the US health plan won't look similar to Chile's ISAPRE, I know some swampland for sale...

So, Sebastian Pinera, perennial candidate, is running again. I saw a poll showing he and Frei (concertacion candidate) were within a few points but another independent and former socialist party candidate has entered the race. He is somewhat left of Frei and appears to be taking votes-Pinera is now far ahead with the other two splitting the rest of the vote. Pinera has carefully distanced himself from the Pinochet legacy.

So today I saw an article that, if true, is pretty shocking.

Santiago - Documents revealed by the US Central Intelligence Agency (CIA), published on Friday in this capital, relate presidential candidate Sebastian Pinera to ex dictator Augusto Pinochet and several actions for illegal enrichment.

El Siglo weekly highlighted today several CIA documents, one of which said Pinera's father had collaborated with that spy agency since 1965, and his brother Jose, Pinochet's Labor and Mining minister, was its direct collaborator and financial analyst.

Pinera told Spanish El Mundo daily in early July that he had always been opposed to Pinochet's government.

The weekly, which entitled its front page headline as Dossier Pinera: secret CIA documents, devoted several pages to demonstrate Pinera's closeness to Pinochet's environment, as well as data about the origin of his fortune.

The reports conclusions emphasized "the inconvenience that a man about whom the intelligence services of the largest power in the world have so much information assumes the Republic's presidency."

Quoting the documents, El Siglo journalist Francisco Herreros revealed a 1982 operation, ordered by the then US ambassador, to take Pinera out of the country because he had been accused of several crimes related to fraudulent placing in administration and liquidation of the Talca Bank.

A list of around 80 false companies were created to receive credit from the Talca Bank and then "to buy its shares," is among the crimes attributed to Pinera and his brother Jose, together with Carlos Massad, El Siglo

The link here:

And I went to the original story which is here and in Spanish at La Nacion, a small Chilean paper. I did a google translate and it is passable. There are several other stories there that link as well and tell a tawdry tale of high finance, corruption and politics. Chilean banks were mainly nationalized before Pinochet, then sold(privatized) under Pinochet-another "miracle", Allende paid money out of the treasury to nationalize and Pinochet sold the banks, thereby receiving money.

The first document is a collection of background and analysis on Juan Miguel Sebastian Piñera Echenique, ordered by the Communications Department of the United States Embassy in Santiago, which is numbered WSA/Was/3215B records the data entry 1975, 1984 and 1990 and relates to the laundering of assets, creation of shell companies, bribery and conspiracy, all acts related to the intervention and liquidation of the Bank of Talca in 1982.

Below is a list of shell companies set up to receive credits from the Bank of Talca and buy shares of the bank. " El documento atribuye la autoría intelectual de esa asociación ilícita a José Piñera Echeñique, Carlos Massad y Sebastián Piñera Echeñique. The paper attributes the intellectual authorship of that conspiracy to Jose Pinera Echenique, Carlos Massad and Sebastian Pinera Echenique.

A link here.

I have to see if I can find the so-called CIA documents...but another day. I have to say it seems suspicious as it's a little unclear how Sebastian Pinera attained his billionaire status, although he is widely know as the "father of credit" in Chile. Hmmm.

Update: The Santiago Times has a story here in English.

August in Chile(It's still winter)

Frosty mornings here but the sun soon warms and melts it. You can actually see the frost melt as the sunlight creeps across the grass.







And the rainy days here in the valley translate to lots of snow on top. Yes, they ski up there.

My Invented Country By Isabelle Allende

My sister sent me a small box of books(I am so grateful!) and this one was included. Knowing Allende was a writer I would like(thanks Vicki!), I immediately started to read.

Isabelle Allende is related to the famous ex-president but not so directly. I believe her father(who left when she was very young-as she says "went to buy a pack of cigarettes and never returned" ) was a cousin. The book is really not very political. She speaks of the horror and it's interesting that she experienced Sept 11th 1973 in Chile and then Sept 11th 2001 in the US. And some reference to the coup as it relates to her state of mind. She left Chile after the coup(not wanting to raise her children under a dictatorship) and didn't return for many years.

But mostly the book is the thoughts of a woman who loves and understands Chile and her people and many of the customs. I laughed many times and agreed "yes, that is Chile". This is a book for anyone that wants to understand Chile or already does...or simply enjoys a nice story. I should have read it long ago and perhaps would have understood Chile better in the beginning.

The title, My Invented Country, comes from the stories she tells her grandchildren about Chile-and the children think perhaps she invented these stories for them. But I wondered later on-she "invented" a new life in a new country. She currently lives in California and perhaps she is speaking about the U.S. as well.

It is a book of nostalgia, as she freely says is the reason she writes the book but also that our memories are always colored by so many things that the book is her truth but maybe not everyone's.

July Weather in Chile

Everything you read might make you think there is perfect weather in Chile. And it's nice but not perfect. First of all it's just WRONG that July is winter. The seasons are nearly exactly opposite. Mid-summer in the US is mid-winter in Chile. There are four distinct seasons here, unlike some tropical areas in South America. It is a Mediterranean climate here in the central area (and the climate in Chile can vary within mere miles) and the summers are very hot and nearly without rain. It's humid so it feels even hotter. After 1 pm in the summer, no more yard work but time to move inside to read or take a nap. As the evening gets cool, outside we go again. Lunch here is the big meal of the day, eaten at around 2 pm. Clever Chileans. It used to be(and still is in smaller towns) that everything closed at lunchtime for hours, perhaps the entire afternoon. or maybe until the next day. But even on the hottest summer days, the evenings are cool. We live in a classically built Chilean house-the structure is of massive brick and cement walls. The reason is clear now-the humidity rots and molds any wood structure. And the house is nice and cool in summer. The walls take in the cool of the nights and keep it cool all day-no air conditioning needed. Unfortunately, this same structure means it's darn cold in the winter.

Fall here is gorgeous. There are maple trees everywhere turning red and the days are warm and sunny. My biggest problem with fall is what it's always been-it is is clear that winter is coming! But fall is the time to plant many things-before the rains. You can't plant much in the heat of summer for the plants will wilt and die even with heavy watering. But plant just before the rains and watch things thrive!

Plants and flowers seed themselves freely here. The snapdragons(perritos) went to seed in mid summer and came back and then repeated the feat again. Many become a brand new variety of different colors-a miracle of cross pollination I suppose. My small Chilena friend's latest English phrase is "look at that!" and that's what I want to say-"Look at that! That flower is yellow and the others are pink!" Ah, the geraniums are still alive on the patio. In the Spring, Summer and Fall, there are many gardening miracles. And many grow in the winter-the palm trees set against the snow topped Andes. The ganzania daisies(at least cousins) continue to bloom on sunny days. And there are sunny days. Sunshine follows rain.

But now it is winter. Winters are damp and cold for the most part. Reading by the wood stove is highly recommended. I don't know anyone with central heating. Perhaps a gas heater in the central part of the house but really...we have a wood stove in the main living area and a portable propane heater in the bedroom. Many don't bother, many places are hardly heated. It is the "norm" to wear three or four layers of clothes. It is common for people to wear coats in the house. Soles on shoes are thick for good reason. People walk a lot and tile floors are cold! I was so cold the first winter-and then I learned. On cold days, I wear long underwear. The more stylish women wear pantyhose but...as a gringa, I'm forgiven for my strange ways. Two pair of socks always. And I'm not cold. Here's the funny thing, many Chilean women dress surprisely sexy(well, that is pretty latin) even in winter. I'm glad to be old enough to prefer comfort over level of sexiness!