#patientsincluded

The Tear Gas

I traveled to Santiago, Chile recently. My timing was auspicious, since my news-puke bingo card still had an open slot preventing me from screaming BINGO at the top of my lungs. That open square was “get tear gassed” — it got filled at around 11am Atlantic Time on Monday, October 21, as tear gas rolled down Avenida Libertador General Bernardo O’Higgins, called La Alameda by locals. It’s really hard to scream BINGO at the top of your lungs while getting tear gassed, by the way. In case you wondered.

I was in Chile to attend and speak at the annual Cochrane Colloquium, a global meeting for health researchers, science geeks, and health policy nerds from all over ever’where, to share the experience of being part of the first #PatientsIncluded Cochrane Colloquium in Edinburgh last year. The conference was scheduled to start on Tuesday, October 22.

On Thursday, October 17, Chilean citizens — who have had to put up with A LOT over the last sixty or so years — got fed up with ever increasing costs of living and took to the streets to protest a subway fare hike, led by high school students who jumped turnstiles to evade paying the new fare.

EVADE become the mantra of the protest, which kept growing over the next couple of days, with some seriously crunchy stuff happening — a Walmart in Valparaiso got burned down, and a Santiago office tower occupied by an energy company burned, too. All of this was ramping up as I traveled from the US to Chile on Saturday into Sunday, October 19 and October 20, so when I got to Santiago on Sunday morning, there was already a curfew on tap, and a whole lot of military dudes in camo and battle gear wandering around the streets toting assault rifles.

I checked into my hotel downtown, and spent a little time looking around the neighborhood. Everything — restaurants, cafes, stores — was closed, except for a few mini-marts around the corner, which had folks lined up to buy groceries at each one. I joined one of the lines, and bought some stuff for dinner in my hotel room.

Meanwhile, my email inbox was stacking up with traffic about the coming Cochrane conference, and whether or not it was actually going to happen, given the rising tide of rage in the streets across the country. On Sunday mid-day, Cochrane decided to cancel the event, “[d]ue to the worsening situation of civil unrest across the city of Santiago.”

Which brings me to Monday, and my news-puke BINGO! moment. In a fruitless search for an ATM or casa de cambio (currency exchange) downtown, I wandered a widening circle around my hotel, winding up on La Alameda around the time that protests were set to kick off around 11am, and getting my snoutful of tear gas. I had dressed for cool-morning-then-warming weather, so I had a shirt that I’d taken off as the temperature rose on my pasear — I wrapped that around my face, and moved away from the rolling miasma of 2- chlorobenzaldene malononitrile (CS), aka tear gas.

As a former news-puke type human who has also studied history, along with living some of it directly, getting tear gassed in Chile was … kinda perfect. I grew up in a military family — US Navy, to be precise — with a dad who was not just a Top Gun (fo’ realsies) fighter pilot, but also an historian and political economist. I spent my childhood through young adulthood surrounded by history books, foreign policy journals, military briefs (declassified, of course), and at least three metropolitan dailies delivered to our door. And that was just dad — mom was Science Girl, so there was also scientific reading of all sorts available throughout the house. So of course I wound up in the news business.

My dad was always happy to talk to me about global events, and emerging history — also called “the news.” The only rule was whatever was discussed in the house, stayed in the house. His military gig, and rank, meant he had all sorts of information and knowledge. That my coming of age happened in the late 1960s through the 1970s means that he and I had all kinds of deep, crunchy conversations about everything from the Vietnam War (dad was not a fan) to Watergate (he was not a Nixon fan) to economic issues like the oil crunch (did I mention that political economy thing? He wound up with a Masters from University College, Dublin).

I learned a lot, including how to apply critical thinking, from dad. And the Jesuits — I grew up in a Catholic family, so Jesuits were always a risk — got in there, too, since they’re considered the intelligentsia of <snark font> Holy Mother Church Universal and Triumphant </snark font>, and I attended a Jesuit university.

So that’s the tear gas part — and a whole lot of backstory.

The neoliberalism

Neoliberalism is an ideology and policy model that emphasizes the value of free market competition. It first appeared as a word/concept around the turn of the 20th century, when all sorts of intellectual fist fights were going on over “communism or nah?” and “capitalism or nah?” I’m not going to go into a whole history of classical liberalism — short snort definition is “political philosophy and ideology in which primary emphasis is placed on securing the freedom of the individual by limiting the power of the government.”

Confused yet? I swear I’ll stop with the definitions now.

Neoliberalism became the very favorite thing of Milton Friedman, a University of Chicago economics guy who became the father (figuratively) of the Chicago Boys, a group of Chilean economists who wound up influencing Chilean monetary and economic policy under the Pinochet dictatorship, which was in power 1973–1990. Pinochet was a charming little despot, who led a military coup to overthrow the elected president of Chile, Salvador Allende, with the support of the Nixon Administration.

Chile became a proving ground, a laboratory, for neoliberalism as an economic and political theory put into practice. If that whole “free market competition” thing in the definition makes you think of Ronnie Reagan and Maggie Thatcher, you’re not hallucinating. They were neoliberals, dedicated to proving that free markets solve everything. Got a societal or economic problem? Free markets will solve it! Lower taxes, stop making so many rules (aka “regulations” or “laws”), just let a free market fix everything!

Which is great if you already have a little money, or even a job that pays a living wage. If you don’t have either of those — sorry, loser! “Free market” for you will mean you’ll be free to pay the market price for [whatever you need], or just do without. Neoliberalism is all about freeing up capital by lowering taxes on people with high incomes, or with big investment portfolios. If you’ve noticed that many countries, including the US, have been dealing with rising income and economic inequity, you can lay that at the door of neoliberal economic practice.

So the folks in Chile who are burning down Walmart and setting fire to energy company office towers have a point. They’re mad as hell, and they’re not going to take this <neoliberal bullshit> any more.

As an official old, I’ve been around to see the impact of neoliberalism on global politics and global development. “Free market” thinking has mostly wound up putting what both capitalism and communism call “the means of production” — the stuff that makes the stuff that gets sold in/on the markets — in the hands of an ever-shrinking number of people and organizations. Neoliberalism, as a 20th century political philosophy, was brought into being by folks like the all-American Koch family who, after working with Stalin and Hitler in the early days of both Stalinist USSR and Nazi Germany, put their finely tuned libertarian-now-called-neoliberal political POV to work in the US.

They promoted anti-communism by buddying up with the John Birch Society, and started a “Freedom School” in Colorado Springs to promote their Ayn-Randian/rugged individualism/every man (and it’s really always men) for himself philosophy. They birthed the American hard right. If you want the whole story in almost excruciating, but very well written, detail, read “Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right” by Jane Mayer. Buy a bottle of bourbon to drink while you read it — you’ll thank me for suggesting that.

Back to Chile and neoliberalism. The “Chile miracle” — where Chile sported the most vibrant economy in South America — was seeded by democracy under Allende, not by Pinochet, although Pinochet kept getting the credit. Here’s a good explainer on that by Heraldo Muñoz, “Is Augusto Pinochet responsible for Chile’s success?” [spoiler: nope]

So that’s A WHOLE LOT — a mile wide and about a millimeter deep — about neoliberalism.

 

HTF does #PatientsIncluded come in here?

I’m SO glad you asked!

One of the reasons the folks in Chile are in the streets is that the government is trying to fully privatize the Chilean healthcare system. As an American, I can testify to what a totally shitty idea that is.

Rather than just me banging on about this, here’s the summary points from an article on PLOS Medicine, “Chile’s Neoliberal Health Reform: An Assessment and a Critique” (published in 2008):

• The Chilean health system underwent a drastic neoliberal reform in the 1980s, with the creation of a dual system: public and private health insurance and public and private provision of health services.
• This reform served as a model for later World Bank–inspired reforms in countries like Colombia.
• The private part of the Chilean health system, including private insurers and private providers, is highly inefficient and has decreased solidarity between rich and poor, sick and healthy, and young and old.
• In spite of serious underfinancing during the Pinochet years, the public health component remains the backbone of the system and is responsible for the good health status of the Chilean population.
• The Chilean health reform has lessons for other countries in Latin America and elsewhere: privatisation of health insurance services may not have the expected results according to neoliberal doctrine. On the contrary, it may increase unfairness in financing and inequitable access to quality care. [emphasis mine]

That I traveled to Chile to speak about #PatientsIncluded at a global health research and policy conference, as the citizens of that country said AH HELL NAH to being the policy version of a bunch of lab rats in the neoliberalism experiment, is some delicious irony. And why I actually kind of enjoyed being tear gassed on La Alameda — as an American, I know my own country is on the wrong side of “you break it, you bought it” in Chile. We broke this. So we own it. I learned that from my dad, in our long discussions of world politics over decades.

One of the chants I heard on the streets in Santiago was “no son unos 30 pesos, son unos 30 años” — “it’s not about 30 pesos, it’s about 30 years.” The ghost of Augusto Pinochet, who was finally deposed in 1990 after 17 years of torturing, disappearing, and murdering his own citizens, still haunts, perhaps even rules, in Chile in 2019. March 11, 2020 is the 30 year mark since Pinochet got drop kicked from office. Chileans are still recovering from Pinochet Syndrome, along with the rest of the world that got jiggy with neoliberalism, thinking that unrestrained free markets would be just awesome.

Participatory medicine is a core principle in #PatientsIncluded. Participatory democracy — individual participation by citizens in political decisions and policies that affect their lives, often directly rather than through elected representatives — is #CitizensIncluded. Simply putting “the grownups” — doctors, in the case of medicine; elected officials, in the case of democratic government — 100% in charge is a bad idea, since patriarchal or dictatorial bullshit can ensue.

Putting any other “grownups” — folks with lotsa money and/or power, in either medicine or civil government — in charge delivers plutocracy.

We all need to be grownups. Which is why #PatientsIncluded came into being in medicine — let patients help build systems, and policies, that work for everyone — and why participatory democracy, which sometimes comes in the form of people taking to the streets to say …

… is a hallmark of people standing up for their rights as human beings, and as citizens.

So … tear gas, neoliberalism, and #PatientsIncluded — will it blend?

It will, because all humans deserve to be provided with the basics of a dignified life, which include shelter, water, food, education, meaningful work for which they are paid a fair wage, and a voice in the circumstances of their lives, the lives of their families, and of their community.

They’ll face tear gas to tear down neoliberal bullshit, and the inequity it breeds, and demand to be included in building a world where human dignity and human rights are the prime directive.

A Twitter thread as lagniappe …

And here’s the virtual version of our Cochrane Santiago presentation on YouTube.

This piece originally appeared on my Medium page.